Series of cases which show that the quantity of urine, after the administra tion of ether, was reduced in amount. This reduction is in the urinary water only. There is little evidence to show that ether exerts directly any deleterious influence on the kidney-parenchyma. This anwsthetic should be given with care, and an undue quantity should not be administered. Dudley Buxton and A. G. Levy (Brit. Med. Jour., Sept. 22, 1900).
Although ether is not destructive to red blood-corpuscles, it nevertheless pro duces diminution of the hmmoglobin and leucocytosis: effects which render rapid ity of the operative measures desirable.
Ether anaesthesia in men has uo de structive influence on the red corpuscles; it causes a very marked leucocytosis, the maximum amount of leucocytosis being first found immediately after the anaes thetic is well drawn; it may produce albuminuria; yet, even where there are diseased kidneys, ether is preferable to chloroform. Lerber (Centralb. f. Gyniik., No. 19, '97).
Ether causes blood-destruction; those who believe otherwise are misled by the concentration of blood due to prelimi nary treatment and sweating during the administration. The color index almost always (forty-nine out of fifty cases) falls and the number of corpuscles in creases, showing marked blood-destruc tion and increased production of cor puscles deficient in hemoglobin. Sections of marrow of the femur of a rabbit etherized to death showed marked eryth roblastie proliferation. The hemoglo bin is absolutely reduced after ether ization, as shown by reduction in individual corpuscular hemoglobin value. The increased luemolysis which occurs is nature's effort quickly to replace the destroyed corpuscles, and the regen erated cells are lacking in hemoglobin.
It is urged that whenever possible one or two blood examinations be made be fore preparation of the patient for etherization. Less than 50 per cent. of hmmoglobin indicates that an anmsthetic is dangerous and only allowable in vital emergencies. J. Chalmers Da Costa and J. L. Kalteyer (Boston Med. and Surg. Jour., June 13, 1901).
Method of Administration. — The stomach should not contain food, lest it be regurgitated during the administra tion of the amnsthetic; hence nothing should be taken by the patient within the four hours preceding the operation, the last meal being liquid; a soft-boiled egg may, however, be included among the aliments allowed. The rectal ad
ministration of milk with a little brandy or caffeine, or warm coffee, is advisable when the operation is to be a prolonged one, or when the patient is weak. False teeth and neckwear should be removed, and everything so disposed as to insure respiratory freedom.
the opening being at least one inch in diameter, the aim being to give a very small quantity of the anwsthetic at first, and to mix that with a sufficient quan tity of air. An imperfect cone is worse than the plain folded towel used by many operators, since the air is easily admitted from all sides beneath the hori zontal surface of the towel.
When a more perfect instrument is to be used, Allis's inhaler (see illustration) can be recommended. Its perpendicular linen partitions allow a free passage of air, and when the patient inhales he re - The method most generally utilized is to form a cone or cornucopia with a towel; but the cone usually obtained in this manner is closed at the upper end; when the ether is poured into it, and when its base or open extremity is applied to the face a quan tity of ether-vapor deprived of air sud denly impinges upon the mucous mem brane of the upper respiratory tract, and suffocation, manifested by struggling and other evidences of fright, results. If a cone is employed, therefore, the apex should be open as well as the base, ceives, if the instrument is properly used, equal quantities of air and ether vapor.
A graduated bottle, such as that de vised by Holtzclaw (see next page), is advantageous. In the ground-glass stop per there are, on opposite sides, two grooves extending about half the length of the stopper. When wanted for use, the stopper is turned so that its grooves come in apposition with the air-bole on one side and with the groove in the neck on the other. This adjustment can be so regulated as to permit a stream to.
flow or only a drop every two or three seconds. When not in use the stopper is turned half-way around.