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Anaesthesia

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ANAESTHESIA and ANAESTHETICS, terms used in medicine to describe a state of local or general insensibility to external impressions, and the substances used for inducing this state. In diseases of the brain or spinal cord anaesthesia is an occasional symptom, but in such cases it is usually limited in extent, involving a limb or a definite area of the body's surface and depends upon interference with nerve tracts or centres. Complete anaesthesia occurs in a state of catalepsy or trance.

On April 9, 1799, Sir Humphry Davy, while experimenting on nitrous oxide (the so-called "laughing gas"), discovered its anaesthetic properties, and described the effects it had on himself when inhaled with the view of relieving local pain. In 1818 Faraday showed that the inhalation of the vapour of ether pro duced similar anaesthetic effects, as was also shown by the Ameri can, John D. Godman (1822), James Jackson (1833), Wood and Bache (1834) . These observations, in spite of the work of Henry Hickman in his famous pamphlet "A Letter on Suspended Animation" in 1824, remained scientific curiosities until March 3o, 1842, when Dr. Crawford D. Long performed at Jefferson, Ga., an operation under ether. His statue now stands in the statu ary hall in the Capitol, Washington, D.C. In December 1844 Dr. Horace Wells, a dentist of Hartford (Conn.), underwent in his own person the operation of tooth-extraction while rendered in sensible by nitrous oxide. On Sept. 3o, 1846, Dr. W. T. G. Morton, a dentist of Boston, following the suggestion of Dr. C. T. Jackson, employed the vapour of ether in private to procure general anaesthesia in a case of tooth-extraction, and thereafter admin istered it in cases requiring surgical operation with complete suc cess. The first operation in public under ether was performed by Dr. J. C. Warren at the Massachusetts General Hospital on Oct. 16, 1846. On Dec. 19 of the same year Robinson, a dentist in London, and on the 21 st Robert Liston, the eminent surgeon, oper ated on patients anaesthetized by ether; and the practice soon became general both in Great Britain and on the continent.

Sir James Simpson, in 1847, was the first to apply anaesthesia by ether to midwifery practice. On March 8, 1847, M. J. P. Flourens read a paper before the Academie des Sciences on the effect of chloroform on lower animals, and in November of the same year Simpson announced his discovery of the anaesthetic properties of chloroform. During the intervening period other drugs were found to possess anaesthetic properties. Of these ethyl chloride has come into prominence at the present time ; nitrous oxide, too, which had been lost sight of, was reintroduced, to become the most popular anaesthetic in dental practice. Frequently, either alone or with oxygen, nitrous oxide is used in the preliminary stages of inducing ether anaesthesia.

The administration of the above-named drugs is by inhalation, and has to be continued throughout the operation, the reason being that all the drugs are as rapidly excreted as they are absorbed, especially by the lungs, and therefore no other method would be of any avail. On the other hand there are drugs which are suffi ciently slowly eliminated to allow of an operation being performed between the moment of induction and that of recovery. The use of scopolamine and morphine in the production of "twilight sleep" for childbirth is an example. These drugs are injected with a hypo dermic needle. Similarly, urethane produces a profound general anaesthesia but has only been used on the lower animals, as its depressing effect on the respiratory centre contra-indicates its use in human beings.

Local Anaesthesia.

Much attention has been devoted to the discovery of methods by which the insensibility may be con fined to the area of operation and the loss of consciousness avoided. But they have only lately been successfully applied to the severer operations. The earliest local anaesthetic was cold, produced by a mixture of ice and salt. The skin is now frozen by a fine spray of ether or ethyl chloride. The recovery, like that from any other frostbite, is very painful, and the time during which an op eration can be done is very short ; consequently this method has been very largely superseded by the use of drugs, particularly co caine and its derivatives. Cocaine has by far the highest anaes thetic properties; it is, however, in certain individuals a most powerful cardiac depressant and has caused numerous fatalities. Eucaine has now largely taken its place, though its anaesthetic properties are less ; it is, however, less toxic, and can be sterilized by heat.

Spinal Analgesia.

The method of inducing analgesia by in jecting solutions into the sheath surrounding the spinal cord was devised by Bier in 1898, but was not adopted to any great ex tent, until Fourneau discovered stovaine in 1904. The substances injected, by virtue of their specific action on nervous tissues, cause loss of painful sensations in the lower limbs and for a variable dis tance up the trunk. The injection is followed, generally within three to five minutes, by the production of analgesia, which lasts for a period varying from half an hour to two hours. Various sub stances have been used for the purpose of which the following are the chief : tropacocaine, stovaine, novocaine, cocaine, eucaine and alypin. The chief points in favour of this method of pro ducing analgesia are as follow : (a) The patient is not rendered unconscious, and is often able to assist at his own operation, such as by coughing or moving his limbs in any way as may be desired; (b) there are no troublesome after effects, such as nausea, vomit ing and thirst ; (c) surgical shock is considerably lessened, especial ly in such operations as amputations and severe abdominal emer gencies; (d) the risk attending a general anaesthetic is avoided. The chief disadvantages are : (a) A severe form of headache may sometimes follow ; (b) the paralysis of muscles. In a very few cases this has been permanent. The temporary paralysis of the muscles of respiration is apt to be a serious matter; (c) the uncertainty of the method, so that the analgesia is not always as complete as is desirable ; (d) the analgesia for safety must be limited to a line below the level of the second rib in front. Finally, operations have been performed under a local anaesthesia produced by hypnotism (q.v:) but this is a method that can only be used on selected cases.

BIBLIOGRAPHY.-J.

Blomfield, Anaesthetics in Practice and Theory Bibliography.-J. Blomfield, Anaesthetics in Practice and Theory (1922) (bibl.) ; R. E. Farr, Practical Local Anaesthesia and its Surg. Technic (1923) (bibl.) ; C. Hirsch, Lehrbuch des Localandsthesie, etc. (Stuttgart, 1925) (bibl.) ; J. T. Gwathney, Anaesthesia, 2nd ed. (1925) (bibl.) ; S. Johnston and others, "Discussion on the Future of Anaes thesia," Brit. Med. Jn. 1926, ii. 775 and I,Io6 (bibl.) ; J. R. Mackenzie, "Anaesthetics," Lancet, 1927, i. 163 ; G. P. Muller, "The Changing Status of Anaesthetics," Ann. Surg. 1927, lxxxvi. 244 (bibl.) .

anaesthetic, operation, ether, bibl and drugs