Artificial anæsthesia and anæsthetics / by Henry M. Lyman.

  • Lyman, Henry M. (Henry Munson), 1835-1904.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Artificial anæsthesia and anæsthetics / by Henry M. Lyman. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    thesia. Women pass more readily tlian men into tlio stage of insensibility, nnd the antesthetic sleep is more profound. As a consequence of this fact, syncope is less frequently obsei-ved among them than among men. They resemble children in this particular. The mortality of the male sex is ac- cordingly greater than that of the female. This may be partly owing to the gi-eater fi-equency of sui-gical operations among males ; but, as an offset to this fact, the female sex enjoys an absolute monopoly of obstetrical an- testhesia. The menstrual period would seem to exj)ose the female to greater risks of nei-vous distui'bance, and to the unfavorable consequences of a suppression of the monthly flow ; so that, unless absolutely necessaiy, the employment of anaesthesia should be deferred till the montlily interval is estabhshed. Still, it must be confessed that there is very little experience of actual harm from etherization during the period. The same remarks apply to the condition of pregnancy. Aside from the risk of injury through violent effoi-ts dui-ing the stage of excitement, there seems to be no reason why an- aesthesia should not be tolei-ated during tho time of gestation. Lactation constitutes no contraindication to the use of amtsthetics. Peculiarities of temperament and constitution api^ear to exercise no ap- preciable effect upon the course of an;x3sthesia. Unless there exists an in- dividual predisposition to syncope, ib is a matter of very little consequence whether the patient is gifted with a bUious temperament rather than a san- guine. Such predisposition may be pennanent or it may be temi^orary. It may be the result of disease or of exhaustion. Numerous causes may operate singly, or may combine to produce this element of weakness. If it is known to exist, it should contraindicate the use of anything more pow- erful than sulphiuic ether, and even that benign compound should be ad- ministered with caution. The various diseases of the brain and spinal cor J should cause hesita- tion in the use of anaastheticss. All diseases which encroach upon the re- gions adjacent to the medulla oblongata increase the danger of accidents dming ansesthesia. Epileptic patients are extremely liable to experience an epileptic convulsion dui'ing the stage of excitement, but the speedy re- solution which so quickly supervenes is highly favox'able, and is sufficiently advantageous to warrant the inhalation, if the occasion requires. The same thing is true in cases of hystero-epilepsy—the most violent contortions need not intimidate the attendants. Alcoholic intoxication, and a condi- tion characterized by delirium tremens, should, on the contrary'-, prohibit the use of anaesthetics. The employment of chloroform for the purpose of inducing sleep has too often caused a sudden termination of life in cases of asthenia epotu. In aU such cases there is extreme cardiac debUity, and death is liable to occur as a result of profound s;)Ticope induced by the toxic effects of the agent operating upon vital centres which have already lost the greater part of their energy. For the same reason anaesthesia should be avoided dming the period of shock after severe injmies. The respiratory centres in the medulla oblongata may have been damaged by the violence of con- cussion, so that they are no longer in a condition to tolei'ate the additional effects of artificial toxaemia. Hence the wisdom of the surgical rule to de- fer operation until the establishment of reaction. Gunshot wounds upon the field of battle, however, seem to form an exception to this rule. The exception is, nevertheless, more apparent than real, for a gunshot wound which does not directly involve the brain or the spinal cord seldom dis- turbs the integrity of tissue in those organs in any way that can be com- pared with the actual solutions of continuity which are caused by ordinary concussions of the brain or spinal cord. The experience of military sux-