ETIIER PNEUAIONIA.—In recent years, however, the view has been advanced that the mortality of ether was as great as that of chloroform when the after effects of the former were taken into consideration. Cases in which pneu monia followed the administration have been repeatedly reported, some of which developed a few hours after anmsthesia.
Case of edema of the lungs one hour after anmsthesia; death one hour later. Reference to 7 cases of the same kind, and S cases of bronchopneumonia also due to ether. If the deaths occurring subsequently were added to Gurlt's fig ures, the proportion would stand about 1 to 2 in favor of chloroform. Poppert (Deutsche med. VVoch., Sept. 13, '94).
Two cases of infectious pneumonia which developed a few hours after ether anmsthesia; marked post-mortem evi dences demonstrate possibility of in fection subsequent to toxic irritation. Possible autoinfection of buccal origin. Nauwerck (Deutsche med. Woch., Feb. 21, '95).
In criticising the above cases Dudley Buxton states that, on carefully investi gating the history of so-called cases of bronchitis and pneumonia following ether, but few are found to be really due to that agent. Removal of the patient to a cold ward after he has been in a hot operating-theatre and subjected to severe shock is the more probable cause of hing trouble, while the flow of saliva into the air-passages suggests the possibility of infection. These are independent factors which due care during and after the administration of the anesthetic can counteract. It is important to bear in mind, however, that the untoward effects of ether are mainly exercised upon the respiratory system.
The term "ether pneumonia" is mis leading. There is no evidence that lobar or croupous pneumonia occurs after ether with greater frequency than might be expected from the normal rate of in cidence of the disease. Pneumonia after ether inhalation does not differ from the ordinary type. On the other hand, ca tarrhal pulmonary affections are prone to follow ether inhalations. J. F. W. Silk (Practitioner, Mar., 1900).
Physiological Action,—An tant element in the physiological action of ether is its irritative influence upon the mucous membrane of the respira tory tract. Great irritation of the naso
pharyngeal and laryngo-tracheal mem brane thus ensues from the start, and arrest of respiration may be induced re flexly through the pneumogastric. Upon this fact is based the prophylactic meas ure proposed by Laborde, of Paris, and subsequently by Rosenberg in 1395, to apply a weak solution of cocaine to the nasal cavities prior to anesthetization. The reflex influence is thus counteracted through the benumbing action of the cocaine. The struggling and choking usually witnessed when the ether is ad ministered too hastily is the result of the local irritation produced. The action of ether is principally exercised upon the respiratory centres.
[A tardy "cardiac syncope" under ether does not occur. If ether kill the healthy subject at all, it kills by as phyxiation, while chloroform may kill suddenly at any period of its use. DUD LEY BUXTON, Assoc. Ed., Annual, '95.] Advantages of the cocainization of the nasal mucous membrane preceding and during the anaesthesia are: 1. As the patient's perception of the odor of the anesthetic is much dimin ished, the feeling of suffocation is en tirely absent.
2. The stage of excitement is either short or entirely absent.
3. Vomiting during narcosis is rarer than usual.
4. Sickness following anmsthesia does not occur.
The patient is directed to blow his nose in order to free it from mucus, then 2 centigrammes of a 10-per-cent. solution of cocaine are sprayed into each nostril. After a pause of two minutes 1 centigramme of the solution is applied again to each side, and then the anes thesia may begin. Every half-hour the application of cocaine is to be renewed. Before removing the patient, the nose should receive a final spraying. At each application about 1 grain of the salt is used. It is important to maintain full anaesthesia uninterruptedly, as the dan gerous fluctuations in the character of respiration and pulse always coincide with the necessity for crowding the an aesthetic. Rosenberg (Annals of Surg., Jan., '96).