RENAL AND BILIARY COLIC.—Ill renal and biliary colic inhalations of chloro form offer the best source of relief when the suffering is beyond the influence of safe doses of morphine. It is superior to ether in that a much smaller dose is required to relieve the pain, while the after-effects are comparatively nil.
A. C. E. Mixture.
A. C. E. mixture is an amesthetic proposed by Harley (as modified by Martindale), and composed of alcohol, as a menstruum, 1 part; chloroform, 2 parts; and ether, 3 parts; by bulk. It is termed the "A. C. E. mixtnre" from the initial letters of the names of its ingre dients. It is thought to present many advantages over ether or chloroform, being less dangerous than chloroform alone and more speedy in its action than ether.
Administration.—The A. C. E. mixt ure does not seem to possess the advan tages claimed for it in text-books. While entailing the dangers of chloroform an resthesia, it tends to cause confusion in the recognition of the danger-signals.
The fact, recently recognized, that chloroform is not as safe an anmsthetic for children as was generally thought to be the case, has caused the A. C. E. mixt ure to be tried as a substitute, but only for the first stage, ether being then sub stituted.
Even in very small children it is far safer to commence the induction with the A. C. E. mixture and substitute pure ether as soon as that drug can be borne. Commencing with A. C. E. on an open or Skinner inhaler, the A. C. E. is then given in a celluloid mask of Rendle's pattern, gradually adding- more and more ether; when a fair quantity of the latter is borne, without hesitation the sponge exchanged for 011C containing, ether alone.
The following advantages claimed: (1) the time required to produce g,00d antes thesia is rarely more than four minutes, (.2) the guides to the anacsthetist are clear, (3) flaccidity and freedom front movement during the operation 'are com plete, (4) the after-effects bear compar ison with those after any other method, and (5) the method is safe. Even should an inexperienced administrator encoun ter stoppage of respiration from an over dose,—the only accident to be reckoned with,—all that is needed is a little com pression of the chest, the circulation not being prejudicially affected as in the case of such an event under chloroform. The method is recommended especially for children under five or six years, and for any child with obstruction in the upper air-channels. In children above that age the combination of gas and ether is so well borne that nothing need replace it. G. Rowell (Brit. Med. Jour., May S, '97).
Physiological Action.—Truman has shown that the depressing action of the chloroforra upon the heart by the stimu lating action of the ether is not based upon chemical facts, the latter vaporiz ing out of all proportion to the chloro form. In administering the mixed
aimsthetics, therefore, a vapor of vary ing and uncertain composition is em ployed.
The disproportion indicated by Tru man is desirable: the most dangerous period is the beginning, and this cor responds with that of excess of ether. :Marshall (London Lancet, Feb. 16, '95).
Untoward Effects.—The deaths occur ring after the administration of the A. C. E. mixture seem to be associated with pathological conditions similar to those met with in fatal cases following the use of chloroform.
Death from A. C. E. mixture in an alcoholic subject in whom three previous administrations of the amesthetic bad produced no unpleasant symptoms ex cepting slight prolongation of the strug gling stage. The physical examination showed no lesion of the heart; the urine contained no casts, albmnin, or sugar. After a few whiffs and before conscious ness was entirely lost, the patient strug gled violently and ceased breathing. The pulse continued to beat, for nearly a minute after respiration had ceased. No post-mortem permitted. 11. S. Jewett (N. Y. Med. Reeord, Nov. 13, '97).
Oxygen and chloroform combined with a view of avoiding asphyxia. The strik ing effect of this chloroform-oxygen nar cosis is manifested in the following symptoms: After several inspirations the skin and visible nmeous membranes become light red. Extremely amemie and weak patients exhibit a healthy color. The pulse becomes slower and fuller, similar to a digitalis pulse, and its rate is nearly always about 60. Nar cosis has reached the surgical stage in little children in one-fourth of a minute; in larger children and women, in three to seven minntes: in men, five to twelve minutes. An insufficiency in the chloro form-supply, with a eonsequent lighten ing of the aluesthesia, increases the pulse-rate. Eespiration is absolutely uniform, slow, and quiet. A gage of excitement is but, rarely observed, and then, as in alcoholics, it is short and moderate in degree. Voiniting during and after aniesthesia is comparatively rare. There is never an increase of se cretion of mucus and saliva. The sen sations observed when the patient is awakening are agreeable in character.
Personal experience with this form of narcosis eomprises more tban three hun dred eases. One hundred and sixty-six patients were fully eonscious imme diately after operation; 13 required be tween S and 30 minutes; one woman, after the use of 55 grammes of chloro form, slept 3 hours; 21 dispensary pa tients got off the table and walked home. E.vidney irritation was never ob served. Heinz Wohlgeinuth (Interstate A.led. Jour., Oet., 1901).