At post-mortem intense venous con gestion the only abnormal sign found. H. Hammond Smith (Brit. Med. Jan. 8, '98).
Chronic renal disease or the presence of any of the systematic signs of renal inadequacy, rigid arteries, high-tension pulse, and dilated right heart with bron chitis are contra-indications of the use of ether. In such cases chloroform should be used. Thomson (N. Y. Med. Jour., Dec. 2, '99).
Case of death from ether anaesthesia. The patient had a compound fracture of the forearm, which exposed the wrist- and elbow- joints, accompanied by rather extensive laceration of the muscles of that member. The autopsy showed interstitial myoearditis of mod erate degree, complicating functional cardiac hypertrophy: chronic arterio sclerosis of marked degree in the aorta. but not extending to the smaller vessels. excepting those of the heart; sub menimval of slight extent, Ihn ited to the cerebral vertex: pigmenta tion of the ganplion-cells of the cerebral cortex, and a similar condition of the eells along the floor of the fourth ventricle. 11. Brooks (Sled. Record. Nov. 9. 1901).
Advanced kidney disease is a radical contra-indication to the use of ether, es pecially since ether-pneumonia has been attributed to the renal insufficiency. Al buminuria, if not marked, does not seem to compromise the result.
In ether anaesthesia the kidney be comes congested, and on microscopical examination the cells show cloudy swell ing. The cells of the convoluted tubules are primarily affected, the tufts and collecting tubules only evincing change when the ancesthesia has been prolonged. The local effect of ether is deleterious to an already diseased kidney. In eases of nephritis ether should be given only with the greatest care, continually watching for any signs of failure of the respiration. George B. Wood (Univ. Med. Sept., '94).
Ether and chloroform act as poisons, causing degenerative, inflammatory, or necrotic processes, sufficient, in organs previously weakened, to bring about cessation of their functional activity. Parasporo (11 Polielinieo, Dee., '97).
Many surgeons prefer chloroform to ether when children are to be anaesthe tized, but this preference is not based on good ground, all things being equal. Pneumonia is no more likely to occur than under chloroform, if care be taken to avoid undue exposure of the body during and after the administration of ether.
Ether is to be employed with prefer ence in infants. St. Germain states that
he has chloroformed 6000 infants with out a single death. For the same period of life—i.e., up to 12 years—there is not one death recorded from ether, while from chloroform there are 21 deaths found in literature. R. Weir (N. Y. Med. Jour., Mar. 1, '90).
During ether ancesthesia the tempera ture falls. The variation in tempera ture is much more marked at first than subsequently. The fall continues, though slightly, during deep sleep after anxsthesia. The temperature begins to rise at the moment of waking, and pro ceeds in an inverse ratio to the fall, so that the variation becomes more and more marked in proportion as the pa tient gets more thoroughly awake.
This lowering is due to the fact that ether determines well-marked vasodila tation, loss of heat naturally following. Angeleseo (Medical Week, Dec. 14, '94).
The effect of ether inhalations upon the lungs is a double one (1) the pul monary vessels lose their tone and dilate; (2) their walls become more per vious, and hence cedema results. With out cardiac weakness the (edema cannot become dangerous. W. Lindemann (Centralb. f. Path., 11-12, '98).
Untoward Effects.—During ether an wsthetization the most frequent un toward feature is retching and vomiting, even when proper precautions have been taken to insure an empty stomach. It is often due, according to Buxton, to swal lowing of mucus and saliva impregnated with ether, but the liquid regurgitated is often mixed with bile. The patient's head should be gently tilted to one side so as to cause the fluid to vacate the air passages, the mouth being opened with the gag if necessary; the liquids remain ing in the mouth are swabbed out with a small sponge held with forceps. The vomiting is of no importance in itself; it is of vast importance, however, if the freedom of the air-passages is not borne in mind, since the aspiration of some of the ejected substances may cause as phyxia. When the mouth is opened and cleared, it is well to draw the tongue with the fingers (protected by a napkin) so as to facilitate the passage of air through the larynx by raising the epi glottis. If any asphyxia show itself, La borde's method—rhythmic tractions of the tongue eighteen times a minute—is to be practiced. Vomiting unattended by other untoward symptoms does not preclude continuation of the ether.