Fig. 39
Barton’s head bandage as employed for suspension in applying plaster-of-Paris bandage.
Crinoline impregnated with starch is also in general use and makes a serviceable bandage for head injuries. When prepared with plaster of Paris it is capable of affording absolute support and even rigidity.
CHAPTER XX.
ANESTHESIA AND ANESTHETICS, GENERAL AND LOCAL.
To Oliver Wendell Holmes we owe the term anesthesia, as generally employed and made to mean insensibility to pain, no matter how produced. A more strict definition would limit the term to conditions comprising not only insensibility to pain but loss of consciousness. For mere loss of sensation we should, strictly speaking, use the word analgesia. This is a distinction with a difference. Thus I have on rare occasions seen a patient under chloroform absolutely oblivious to pain but perfectly conscious, and chatting intelligently throughout the operation. This is a rare phenomenon, but has been noted by various observers. So after intraspinal cocaine injections we secure complete analgesia of the lower portion of the body, but not complete anesthesia, the former being what we are most anxious to produce.
The discovery of anesthesia is essentially to America’s credit. Long, of Georgia, had produced anesthesia by ether as early as 1842; Jackson, of Boston, also claims credit for the discovery; but to Morton, a dentist of Boston, is undoubtedly due the honor of having introduced it for surgical purposes. The first public demonstration of its properties was made by Morton and Warren, October 16, 1846, in the Massachusetts General Hospital. Chloroform seems to have been exploited independently by Guthrie, of Sackett’s Harbor, N. Y., and Simpson, of Edinburgh, in 1847. It is a curious historical fact that the patient to whom Simpson meant first to administer chloroform in his clinic did not receive it because of some failure to have it on hand; she took ether instead and died, presumably of the anesthetic. Had she died under the influence of chloroform it would have been a serious setback to any general appreciation of its merits. Nitrous oxide is also an anesthetic for which America may take the credit. These are the three drugs in common use today, although there are others which are coming into general favor.
It can be stated as an axiom that when a surgeon tries to abolish human sensibility, or pass an instrument through the human skin, he introduces elements of danger which can never be certainly and completely controlled—that is to say, the administration of an anesthetic is never to be undertaken as a trifling matter, but should be entered upon as carefully for a minor procedure as for a dangerous and prolonged operation.
Anesthetics are sources of danger, not only for the moment while they are in use, but because of the disturbances which may follow in their train. These drugs should never be administered carelessly nor thoughtlessly, nor by inexperienced individuals, but entrusted to the wisest and the most discreet. More is expected of the anesthetizer than that he shall barely keep the patient alive; he should be so expert as to keep the patient safely on the side of complete anesthesia and muscle relaxation. Nor should he be willing to yield to the importunities of an impatient operator who may be continually appealing to him to crowd the anesthetic. When thus given, and by an expert, such postanesthetic distress as nausea, vomiting, coughing, etc., may be avoided. So generally are these facts now realized and appreciated, that in many of the large hospitals a regular anesthetizer is employed, whose sole duty it is to administer the anesthetic for the attending surgeons. The management of an anesthetic has much to do with the allied subjects of the preparation of the patient, the management of shock or reduced blood pressure, and the status lymphaticus, which have already been considered.
Fatal accidents from anesthetics are the appalling ones which have generally occurred in cases where it has been assumed that the patient is in good condition, and where neither preliminary examination nor preparation has been made. In the presence of unmistakable cardiac disease, or of great arterial tension, the surgeon may, by foreseeing the possibility of trouble, do much to prevent it; but when an apparently healthy individual is placed upon the operating table without attention to these matters it may happen that his heart will stop as suddenly and unexpectedly as though it had been transfixed. In other words, the accidents of anesthesia usually occur when least expected; on the other hand, accidents will be few and far between when all cases are handled as though promising to be severe ones.