A combination of inhaler and gradu ated bottle has been contributed by Rosenberg, the construction of which can readily be understood by the illus tration shown on the opposite page.
Another excellent combination instru ment is that of \Tulpius, shown in the illustration on the opposite page.
The preliminary application of a 5 per-cent. solution of cocaine by means of an atomizer (a few puffs being suffi cient) is of importance, as already stated, to avoid the reflex influence of the nasal nerve-supply, or a little nitrous oxide may be given for the same purpose—an excellent method, according to Dudley Buxton.
Suggestion that patient be allowed to smell at the ether-bottle or inhale from the inhaler, holding it away from the face with his own hands. This prelim inary step produces anaesthesia of the pharyngeal mucous membrane, and over comes the feeling of suffocation and in clination to cough which so often mark the initial stage of etherization. Rush more (Jour. Amer. Med. Assoc., Mar. 19, '92).
When ether is mixed with twice its volume of a bland, light preparation of liquid petrolatum and thoroughly nebu lized with a suitable atomizer, it is ab solutely nnirritating, A few puffs of the mixture from the atomizer directly into the nostrils, before administering ether in the usual way, followed by happy re sults. D. H. Ludlow (Phila. Polyclinic, Feb. S, '90), In 1500 cases of ether administration which had been preceded by, nitrous oxide gas there had been only 1 case of bronchitis, 1 of pneumonia, and 4 of slight bronchial irritation. These 1500 cases included every variety of surgical operation, and were in no way selected; some had albumin in the urine. 4 had small quantities of sugar, and several had cardiac disease. Sidney Rumboll (Lancet, Feb. 10, 1900).
Ether given after preliminary narcosis with nitrous oxide offers the following advantages: Safety, saving of time to the operator, and elimination of the dis agreeable features of ether-inhalation. The patients recover more promptly; nausea and vomiting are of shorter dura tion. The quantity of ether required is often less than half that generally used. Carter (Med. News, Apr. 14, 1900).
Ethyl-bromide used before ether anes thesia to a strong, alcoholic, and vio lently-struggling patient. With the first breath of the ethyl-bromide the strug gling ceased. The patient was then
gently laid recumbent, and in twenty seconds he was completely and deeply anaesthetized, and all reflexes abolished except the pupillary light reflex. Then ether was administered from a second cone. Experience in over one hundred cases shows the following to be the best method: 1 or 2 drachms of the drug are poured on the distributor of a partially closed cone inhaler, which is closely ap plied, and when sufficient anaesthesia has been attained,—i.c., in from thirty to forty-five seconds (rarely a second dose is needed).—ether is given slowly by the drop method in the usual way through a slit in the cone. Fowler (N. Y. Med. Jour., Apr. 2S, 1900).
The administration, previous to the ether, of a subcutaneous injection of grain of morphine and grain of atropine sulphate has also been recom mended_ ether upon the towel, cone, or inhaler used, the latter should be held some dis tance from the face, taking care to avoid gagging the patient. "Air" slightly im pregnated with ether should be the first Administration.—When ether is to be administered, the patient should be well covered, to prevent lowering of tempera ture, and his body should be protected against chilling by the judicious appli rule, and "ether impregnated with air" the second; but the latter is only appli cable when the patient's membranes have become tolerant of the action of the ether. When this stage is reached, how cation of towels over the parts that would otherwise become moistened by the anti septic solutions used in connection with the operation.
After pouring a small quantity of ever, the agent may be pushed until the ether-vapor is inhaled with as small a quantity of air as the instrument used will admit when applied close to the face.
Important in this connection is the fact that ether-vapor is irritating to the eyes; this untoward effect may be pre vented by placing a wet compress over them as soon as the patient is beginning to show signs of antesthesia. If done at first this procedure is apt to cause appre hension and the fumes are sufficiently condensed to cause irritation only when the inhaler is close to the face—though not against it. To protect the skin of the face, a little cosmolin applied over it is very efficient.