The anodyne mixture which I have found to be the most manageable is composed as follows: Alcohol, two ounces; one drachm of aromatic tincture; with sufficient chloroform added, short of the production of a turbid state of the fluid. The object of adding the tincture is to make it pleasanter to inhale; the spice also appears to prevent the sickness which would otherwise sometimes arise from long-continued inhalation. By giving a little colour to the mixture, also, it prevents any accident that might arise by putting in by mistake pure for the modified chloroform. I prepare the aromatic tincture as follows: One drachm of nutmegs; two drachms of cloves; pterocarp chips, a drachm and a half; water, four ounces; alcohol, five ounces: mix.
Mode of administering the anodyne vapour.—The great object to be attained is to so far influence the nerves of sensation as to prevent pain, and yet not carry the anæsthetic agent to the extent of producing unconsciousness. This can be effected in the following manner:—The woman, in the upright or recumbent position, as the case may be, holds the Inhaler in her right hand. She is directed to take a full inspiration, and then to apply the Inhaler to the mouth and nose. She is then to breathe rapidly for six, eight, or more inspirations (the inspirations and expirations being equal) only with the diaphragm and abdominal muscles, the chest being kept a fixture all the time. The Inhaler should then be removed immediately, and one or two full, deep, quick chest-inspirations taken. This will be found sufficient to relieve all pain, and there will be no loss of consciousness. During the entire process it is desirable to have a full light upon the face, to watch the countenance and feel the pulse occasionally, and observe the pupils. These, in some cases, are very quickly affected, and then the inhalation requires to be suspended for a time. During the time the process is going on, I am in the habit of giving a teaspoonful of brandy in a cup of weak tea with plenty of milk, and something to eat; or, instead, a glass of wine and a little cake or bread-and-butter, from time to time, to keep up the strength and prevent that sudden pallor of the face which sometimes occurs. I may add, as only a portion of the alcohol is taken up in vapour, it accumulates in the sponge, so that it is necessary occasionally to squeeze it out before adding a fresh quantity.
I can hardly attempt to explain clearly the modus operandi of the agent. Practically, however, it answers the purpose intended. The great point is, of course, to arrest its action before it produces unconsciousness. This is effected by using it as I have described. It is requisite that the patient be carefully watched, so that the moment for administering the agent may be seized. From the experience I have now had of its use, I can estimate pretty accurately the exact time the inhalation should be resumed or discontinued. After a little practice this knowledge can be obtained by any competent observer. I have now given my anodyne mixture in 216 cases, and without in any one instance seeing a bad result quoad the administration of the mixture. Of these cases many have come to me in consequence of the severity of their former labours, their extreme nervousness, and other causes.
I select a few instances from my notebook in which the anodyne was employed with complete and satisfactory effects:
1. The patient was in her twenty-ninth year, by no means robust, of a nervous temperament, and looking forward to her first labour with great apprehension.
2. Was in her thirty-third year, and looked forward to her first labour with great dread.
3. Her sixth labour; all her previous labours had been very severe.
4. Her tenth labour; her previous labours very severe, and each time followed by a great deal of after-pain.
5. Her eighth labour; had suffered intensely in every previous labour, in some of which she had been delivered with instruments; had had a protracted recovery after each labour.
6. Her seventh labour; inflammation had followed each of her former labours.