Attention has been called to the im portance of examining the urine, espe cially for albumin, before subjecting a patient to a general anxstlietic, and par ticularly in subjects of middle or vanced age, whose appearance suggests the presence of renal disease. Whether the presence of albumin in the urine should prohibit any surgical operation is a mooted point. Snow laid it down as an axiom that, if an operation must be per formed, however serious it might be, the administration of an amesthetic was justifiable, on the whole, and that rule has been pretty generally adopted with out any manifest bad results. Benjamin 1Vard Richardson, referring to the above, stated that he had administered ether, chloroform, and methylene to great num bers of persons suffering from albuminu ria, without any untoward results.
The marked increase of albumin noted in albuminuric cases and the presence of it in cases which had not shown any be fore the administration of the anaas thetic shown in the following abstracts, nuertheless counsel prudence.
It seems obvious that renal lesions can but cause increased blood-pressure, and thus tend to enhance the likelihood of cardiac syncope, and that, when kidney lesions are known to exist, chloroform should be administered with unusual pre caution.
The urine of one hundred male pa tients studied before and after chloro form narco.sis. The alteration of the kid ney is a tis.sue-lesion which removes the power of inhibiting the loss of serum albumin, the canses of which lie in the poverty of oxygen in the blood, the de struction of blood-corpuseles by the chlo roform, the injury to the tis.sues by the liberated chlorine. and, lastly. the lower ing of blood-pressure. As evidence for the occurrence of a tissue-lesion, the fact was adduced that in 44 out of 56 eases investigated upon this point. after nar cosis, the urine contained nueleo-albn min. V. Friedliinder (Viertel. f. ger.
Dritte Folge, B. S. Supplement, H., 94)• After prolonged chloroform narcosis in healthy persons there is prolonged dis turbance in metabolism of albuminous substances. Kast and Mester (Zeit. f. klin. Med., vol. xviii, '95).
llesult of a study of two hundred and fourteen eases of chloroform amesthesia in which the urine lVfliti carefully exam ined. Albuminuria occurred in 80 per (-(111. of the cases, lasting from two to six days. Sii!)-ar and neetone were never found. In 60 per cent. casts were pres ent, mostly hyaline, but also a few epithelial and granular. All degrees of cliang(s Nv(re found in the kidneys, from single hyp(1-(einia and capillary licemor rliages to extensive coagulation necrosis of the renal epithelium. K. Ajello (-Mon
ograph, Milan, '96).
Examination of the urine in 130 cases of anoesthesia,-60 from ether and 70 from eldoroform. In 8 eases out of 13 in which there was albumin in the urine before the amestliesia there was an in erease of the albuminuria: 4 times after ether and 4 times after chloroform. Eisendrath (Deut. Zeit. f. Chir.; B. 40, '96).
Effects of ether and chloroform nar cosis on the kidneys. In 29 per cent. of the cases after etherization a Ibmnin was found in the tit.ine, and in 18.89 per cent. after chloroform narcosis. In each ease the urine before the operation was free from any trace of albumin. The ether ize(' animals showed renal alteratiotA consisting of diffuse hremorrhagie nephri tis, w-ith preponderating glomerulitis and multiple renal Inumorrhages. The su periority of ether over chloroform from the point of view of safety is shown. Dabacci and Debi (11 Polielin., May 1, '96).
Examination of the urine of 54 people after chloroform amesthesia, and of 41 cases after ether aristhetization. _Nar cosis in chloroform eases lasted, on an average, 57 minutes, and in the ether cases one and a half hours. There were 10 cases of albuininuria and eylindruria after chloroform; 15 cases after ether. In 3 of this last series there Wf1S pre existing kidney disease. Autopsy in 2 ether eases showed lnemorrhagic nephri tis alrec.ting especially the glomeruli. Al bumin i.s more frequently observed in the urine after ether than after chloro form, but the nephritis cause(' by ether is transitory, while that due to chloro form is likely to become chronic. Le grain (Ann. des Aral. des Org. Genito ITEM.. No. 2.. p. 191, '97).
Permeability of the kidneys after chloroform narcosis tested with solution of rose aniline. As a rule, it took twenty-four hours to g,et rid of all traces of the pigment, the patient hav ing, as far -was known, healthy kid neys. In every ease elimination NI'a S de layed by chloroform amesthesia: while it took thirty-five hours to eliminate the pigment before chloroform, in one case it required forty-one hours after ward. No constant relation between the quantity of chloroform and dura tion of the amestliesia and the altera tion in renal function could be detected, as the personal equation of the kidney varies so much. The quantity of urine after chloroform narcosis was, for the most part, redueed. Benassi (Gazz. degli Osped., 3Iar. 3, 1901).