ETHYL-CHLORIDE. — Chloride of ethyl (mono-chlor-ethane) is a gas at ordinary temperatures, but when com pressed it becomes a colorless, very in flammable liquid, boiling at 54° F. When ignited it burns with a green flame. It has an aromatic, sweet taste and an ethereal odor. It is exceedingly volatile, which latter property renders it unfit for genuine anaesthesia.
Dose and Physiological Action.—For internal use it has been given in closes of 10 to 30 drops dissolved in an equal quantity of alcohol. When thus taken it. has a stimulating action. When ethyl chloride is inhaled its chief effect ap pears upon the circulation and respira tion, there being a marked lowering of the pulse-rate and the blood-pressure; the respirations are at first increased in depth and frequency. Tonic doses cause cessation of cardiac and respiratory movements. Sprayed on skin or mucous membrane, it causes them to become white, cold, and insensitive.
Poisoning by Ethyl-chloride.—Ethyl chloride inhaled in tonic doses produces poisonous effects similar to those of chloroform, but is less of a cardiac de pressant. Death results from paralysis of the respiratory centres and the heart.
Treatment of Poisoning by Ethyl chloride.—When poisoning has been in duced by inhalation, the tongue should be drawn forward, and caffeine, strych nine, or atropine given by hypodermic injection. Artificial respiration should be used faithfully, the head being low ered as in chloroform syncope. Amyl nitrite, ammonia, and warmth are also useful.
Therapeutics. — While ethyl-chloride has been given continually as a stimu lant, its use is not advised, as other equally-efficient stimulants are available which are free from danger. We would also warn against its use for the purpose of inducing general anaesthesia, as the dangers incurred therefrom are too great. The legitimate field of usefulness of ethyl-chloride lies in the production of local anesthesia for the relief of pain and for the purpose of performing minor surgical operations in dental surgery.
Ethyl-chloride used in 1263 operations and to the skin alone in 503 eases. The local ancesthetic was combined with moderate chloroform narcosis in 393 cases. Study of the sensibility of the various tissues showed that practically all sensation of pain was confined to the skin, where incisions are made with a sharp knife. Most of the deeper struct ures are easily incised without pain with a sharp knife, pain being only caused by stretching or pulling apart of the tissues. lfinch (St. Paul Med. Jour.. Jan., 1900).
Ethyl-chloride used as a general anes thetic in 400 cases in von hacker's clinic at Innsbruck. Complete aniesthesia is induced in from a half to two minutes. according to the age of the patient and the amount of alcohol he is used to drink; a stage of excitement is observed only in alcoholic subjects: symptoms; of heart-failure or of disturbed respiration are never seen, and the tongue has no tendency to fall backward; consciousness returns directly the mask is removed from the face, and unpleasant sequelx, such as headache or vomiting, are ex tremely rare. Though most suitable for
short operations, ethyl-chloride has been employed of late successfully in opera tions lasting as long as fifty minutes. It is especially valuable in cases with seri ous circulatory troubles, fatty degenera tion of the heart, and respiratory dis eases, where it is inadvisable to give chloroform or ether, and in shock or after copious haemorrhage. When anws thesia is complete the pupil and corneal reflexes usually persist. Wiesner (Wiener med. Woch., July S. '99).
Series of experiments upon eleven dogs and the use of ethyl-chloride as a genera] anaesthetic in seven hundred eases, patients ranging from two months to sixty years of age, showed that the use of this drug is simple, rapid, and not dangerous. It is given upon a few layers of gauze. Narcosis follows in from ten to fifteen seconds. If the operation is to last some time, chloro form can then be used. Muscular relax ation, regular respiration. and decreased arterial tension are noted. The pulse rate rapidly decreases with the tension, during the narcosis, and increases when the patient comes to. The liver and kidneys seem affected in spite of the short anaesthesia, albumin and bile-pig ment appearing in the urine after anms thesia. Mentally this narcosis resembles the coma of the last stages of alcoholic intoxication. It is especially indicated for short operations. It is also an ex cellent method with which to begin ehloroformization. A. Malherbe and J. Roubinovitch (Le Bull. MiA., June 11, 1902).
–Ethyl-chloride is usually dispensed in large tubes, one end of which is drawn out to a fine point, or in tubes closed by an automatic cap. When the former are used, the point is broken off, and the tube held in the hand, at a distance of from six to ten inches from the part to be anaesthetized. The heat of the hand causes the lique fied gas to issue in spray-form. By its rapid vaporization the part soon becomes frozen and ready for operation. As the skin hardens under the ethyl-chloride the exact limits of the operation must be determined beforehand. The highly inflammable nature of this agent must be remembered, and operations must be done at a good distance from gas and other flames or by electric light. The absence of unpleasant after-effects and of any influence on the sensory centres of the brain are its advantages over some other agents used for local anaesthesia. It is used in the treatment of ingrowing toe-nail, the opening of abscesses, re moval of ganglia, or for any painful skin incision. If the liquid is ignited as it issues from the broken tip, the flame thus produced may be used to cauterize septic or aseptic wounds or for cutane ous cauterization.
NE URALGIA.—Ethyl-chloride in spray has been used with success in supra orbital and facial neuralgia, sciatica, neuralgia of the breast, upon the pain ful joints of incipient gout, scrotal pru ritus (diabetic), and in migraine. From 2 to 5 drachms may be used in spray at one sitting, the lesser quantity usually being sufficient.