gards their danger. He called attention upon the addition of more chloroform. to two cases. One was a case of hare-lip. Both ether and chloroform depress the He gave chloroform and the child died heart, as sphygmographic tracings have on the fourth day with capillary bron- shown. He has not given alcohol for chitis. The other case was a man with ten years, but uses morphia and atropia Bright's disease, to whom he gave ether before the anaesthetic. It reduces the and he made a good recovery. Atropia reflex irritability of the larynx to the stimulates the respiratory centers, ether vapor.

amyl nitrate is also a good stimulant. Dr. W. P. Chunn said he had given Dr. J. T. Smith said the subject both anæsthetics and never saw a life under discussion is an old one, but it is lost. Five or six years ago chloroform constantly recurring. The tide fluctuates was in more common use than ether. in both directions; when men of great Chloroform is more powerful in its efexperience give such diverse opinions, fects and likewise more rapid, conseboth agents must be good. Ether is quently more dangerous. Even if the now more used than formerly, so more chloroform is stopped before the mus deaths have been reported. The safety of anæsthetics in ophthalmic practice is due to the fact that the operator is at the face of the patient and can observe more clearly any changes that might take place. He was glad that the subject was brought forward for discussion.

Dr. W. B. Platt said ether had won its way into England where at one time prejudice was greatly against it. Chloroform is used more in Germany. Morphia was advocated by Prof. Tieste, of Leipsic. It was thought by its use less anesthesia would be required. There will always be some cranks against the use of one or the other of the anæsthetics, just as similar individuals oppose vaccination, for example. He thinks that we will soon settle down to the use of ether again.

cles are relaxed anæsthesia will increase for a time. Chloroform in certain cases is fairly safe. A great deal depends on how it is given. In regard to ether he had never seen an accident.

Dr. W. H. Norris thought that a great deal of the trouble which comes on from anæsthetics is due to the quality of the drug. He had given chloroform many times and he had only seen one case where it acted badly. Chloroform was used during the late war by all army surgeons and they agreed that it was the best anæsthetic. He had had little experience with the use of ether. He related a case of puerperal convulsions where he gave four ounces without effect. He asked the opinion of the members as to the use of the combination of chloroform and ether.

Dr. W. Winsey said as to which is the safer of the two drugs, those who use them will be guided by the effects of either. He prefers ether. A patient under the influence of an anesthetic is never free from danger, the administration of which should only be entrusted to competent hands.

Dr. G. H. Rohé said that he had had a good deal of experience with ether and never had failed to anesthetize his patient. He had one patient to die on the third day after operation for vesico-vaginal fistula from pneumonia. What the cause of the pneumonia was he could not say. He now always has the patient well protected by covering during ether ad- Dr. C. W. Michell said he had given ministration. He never believed in Dr. both agents for the past seven years, Emmet's statement about the danger of though chloroform has been in more ether in Bright's disease. He believes general use. He began its use at the it is not good to give it in bronchitis. Presbyterian Eye and Ear Hospital. He Ether increases the bronchial secretions finds now that ether is more generally and the accumulations may be so great given than chloroform. Anæsthetics in the lungs as not to be thrown off. He should be given as other drugs are; ether believes that Dr. Sayer's method of giv- is not comparatively safer nor comparaing saturated chloroform vapor is a dan- tively dangerous. Care should be gerous one. Death usually takes place ticed in the selection of cases. He had

prac

chloroform and the patient did well. He always precedes the anaesthetic with morphia and atropia.

seen two deaths from the effects of each change the anesthetic even while operadrug. The fact of concentration should ting. Chloroform is better in such conbe considered in ether as well as in chlo-ditions. He related a case where he reform. The bronchial secretions increased moved a tumor from a patient's neck. by the influence of ether, should be al- He began anesthesia with ether, the lowed to escape by turning the head to secretions from the bronchial tubes beone side and pulling the lips apart by gan to pour out so fast that the ether placing the fingers in the patient's mouth. was discontinued and chloroform used The snoring of ether is the result of the instead. The patient did well after the accumulation of mucus in the pharynx. change. In the aged, say 70 years, he Of the two deaths from chloroform, in always gives chloroform, and alɛo in the the first the drug was given by an in-young. In all other cases, other things haling apparatus and only 3 of one tea- being equal, he gives ether. He then spoonful was used; in the second case a related a case where the patient had both towel was used for the administration bronchitis and heart trouble. He He gave and the chloroform was only poured on once; both patients died suddenly. The first case of death from ether the patient died on the ninth day from pneumonia. Dr. J. E. Michael said it is fortunate He thinks that chloroform would have that this subject does recur for discussion. been better. The second case was a pa- The tide is very apt to turn with expertient with cavities in both lungs, upon ience. He is not given to ether alone whom laparotomy was performed. The nor to chloroform, for experience shows fifth day afterwards acute pulmonary that both are dangerous and must be trouble came on, producing severe pul- carefully watched. In both cases of monary hemorrhage and finally death. death from chloroform reported by Dr. Kidney trouble renders both drugs dan- Mitchell there was found disease of the gerous. kidneys. If other thing are equal in a Dr. L. E. Neale was glad to observe patient with kidney disease he does not the practical turn which Dr. Mitchell know which he would choose of the two had given to the discussion in trying to anaesthetics; where there is much bronselect special anesthetics for special chial secretion ether is contra-indicated. cases and special conditions. Just here Chloroform is best in tracheotomy. Select he thought it interesting and important the anaesthetic according to the indicato note that chloroform had thus far tions. The death from ether in the case held the lead as an anesthetic during related by Dr. Mitchell was caused by parturition, and out of many hundred hemorrhage which it excited. These thousands times it been has given not a discussions will compel us to look at the single well authenticated case of death is matter from a clinical standpoint. Tenon record. This was possibly explained dency seems decidedly towards reviewby the physiological hypertrophy of the ing the ground and to determine which heart preventing cerebral anæmia. is the better agent to use under certain circumstances.

Dr. L. McLane Tiffany said the question is not between chloroform and ether, but when we have to produce anæsthesia, how can be best bring it about? It is wrong to think we have only two drugs to select from. The recognition of the disease, the choice of the remedy and its application are the essential points to be considered. There is no such thing as best anesthetic. Then it comes to the indications; contraindications to the use of ether rest largely in the lungs. It has occurred to him to

Dr. R. Winslow said that he was struck while abroad at the faulty methods employed in Billroth's clinic in administering the A. C. E. Mixture. It was frequently given in the upright position. One patient died from this method of administration.

Dr. Hiram Woods, in conclusion, said: What has been said by the gentlemen who have spoken recalled a remark he heard Dr. Tiffany make in this Society about four years ago, when this same

subject was under discussion. He said patient. Dr. Platt says the use of mor"No matter what anesthetic you give phia is not as common abroad as it foryou put patient in a position greatly re- merly was. It has been found that sembling death, and it always needs care large doses depress the heart and add to avoiding stepping over the line." The to the danger. This is just what one mainstay in the use of any anesthetic is would expect from large doses. The the recognition of danger. Drs. Pres- larger the dose the more transient is the ton and Smith have alluded to the palor stage of stimulation and more profound of the face as being more apt to be the stage of depression. The dose noticed when the operation is about that should be small, not overgr. to gr. part of the body, and this, to an extent, at most. Drs. Mitchell and Rohé each explains why the oculist does not have report fatal cases of pneumonia after the many accidents. Another reason use of ether. Dr. Mitchell says the is that it is impossible for the operator pneumonia is always catarrhal. One of to be at work on the eye while the anæs- the cases reported by Dr. Gerster was thectic is being given. Dr Chisolm was lobar pneumonia in the stage of enthe first he heard give this reason. When gorgement. Neither of these gentlethe operation begins, giving of the anæs- men think ether is contraindicated in thetic stops. If the patient awakens nephritis. He knows nothing of ether the anæsthetic has to be renewed, the experimentally, but a reference to Dr. operator stops and as he wants to get Gerster's paper in the Medical Record back to his work as soon as possible will show that many cases have occurred there is not much danger of the patient which shows that ether is very dangegetting an overdose. Dr. Smith has rous in Bright's disease. He could not also alluded to operations about the see how Dr. Rohé can find in Dr. peritoneum as being specially dangerous. Sayre's remarks teaching which advises In the remarks made by Dr. Weir at the administration of a saturated the New York Academy deaths during chloroform atmosphere. Dr. Sayre gives operations on the peritoneum are ex- a summary of the principles he advanced cluded by the speaker from deaths due in 1876, which are substantially the to anaesthetics, because, I suppose, any same as those which he holds now. injury to the peritoneum is so apt to be is not acquainted with the article which followed by shock. He thought Dr. Dr. Robé says was published by Dr. Wiltshire must have misunderstood him Sayre some years ago in which he reor he must have used the wrong work. commends the administration of a satuVulpian's experiments showed that an- rated vapor. His present paper and the æsthetics increase not decrease the inhi- extract he gives from his teachings in bition of the vagus, hence atropia an- 1876 are directly against such practice. tagonized them. As the doctor says, He agreed with Drs. Rohé and Chunn part of the good effects of atropia un- that many of the chloroform accidents doubtedly comes from the direct stimu- occur just after more chloroform is lation of the cardiac ganglia. Dr. poured on the towel. He believed this Johnson's case of capillary bronchitis so because the anesthetizer often puts following the use of chloroform in an the towel with the fresh chloroform just operation for hare-lip and cleft-palate is where he had it before. Dr. Sayre's open to the objection that the operation method of using an inhaler prevents involved the respiratory track. Dr. Ger- this accident from occurring. As rester thinks that all such operations gards Dr. Pancoast's case he did not should be excluded when we are speak- wish to acquit chloroform of its share ing of the effects of anaesthetic agents of the work. All that he claimed_was on the lungs. The reason for the occur- that it is clearly shown that Dr. Panrence of lung troubles after operations coast gives chloroform for slight operawas thought by Dr. Weir to be due to tion's in a manner which many recogfree use of antiseptics in surgical prac-nized authorities consider wrong. If the tice and the prolonged exposure of the interview from the dialy papers which

He

he quoted is correct, the man died ap- seemed to have no vitality to resist parently from shock due to the perform- shock of operation. She was put under ance of a slight but painful operation treatment for three weeks, but so little during partial anesthesia. There was improvement took place in her general of course more danger under the chloro- condition that she was again discharged form than there would have been with- as unfit for operation. She was sent to out any anæsthetic. There was also Baltimore and to Atlantic City and more danger than there would have been came back improved. She went to had the chloroform been pushed to full Wilmington in March and took a course narcosis. of steam-baths and electricity, and returned in April much improved in gen

OBSTETRICAL SOCIETY OF PHIL-eral condition, but with the tumor de

ADELPHIA.

STATED MEETING HELD JUNE 2ND, 1887.

The President THOMAS M. DRYSDALE, M.D., in the chair.

cidedly increased in size. She soon commenced to break down again, and although I did not advise operation, I was willing to do it if her family physician and friends insisted on it. The patient decided on operation, as nothing could be worse than the condition she

Dr. John C. Da Costa read a paper was in. April 20th, 1887. I operated

entitled

on the patient in Jefferson College Hospital in the presence of Dr. Bush, of

CLINICAL NOTES ON OVARIOTOMY FOLLOW- Wilmington, her family physician, and

ED BY HERNIOTOMY IN FOUR DAYS.

RECOVERY.

assisted by Prof. Parvin and Drs. Horwitz, Ashton and Graydon. I removed a 25 pound multilocular cyst of the left M. R. S., age 51, single. Came June ovary, the right ovary was normal, ad29th, 1886, to consult me in regard to hesions were easily torn away. The tis an abdominal tumor, which she had sues were friable and easily broken and first noticed in August, 1885. The the blood vessels were in a degenerated patient was weak, anæmic, full of ma- condition. The pedicle was tied and laria, and broken down by years of hard cut off and the abdomen washed out work and waiting on sick and enfeebled with distilled water. When just ready relatives. She has had, according to to sew up the wound a profuse hæmorher family physician, a history of acute rhage took place, so great that it was dementia; she inherited a tendency to necessary to compress the aorta and enphthisis. She has now weak lungs; large the abdominal wound to find the weak heart with intermittent pulse; bleeding vessel, which was a large dechronic albuminuria; degenerated con- generated artery, which, unable to redition of the blood vessels; double her- sist the vis-a-tergo of the heart had nia, femeral; and an abdominal tumor. broken short and split down about one Examination shows a round mass about inch below the ligatures. A second and the size of a head in the bottom of the third ligature were applied, the last oneabdomen, nearly central in position and quarter of an inch from the uterus. tied down, apparently, by adhesions. This stopped the bleeding and the The tumor was first noticed over ten pedicle was cut off above it with the months ago and has grown slowly but Paquelin thermo-cautery. steadily since. It is very painful when touched and is, at times, subject to sudden increase of pain attended by raise of temperature. She was put under treatment for her general condition for two weeks and was then tapped and about one pint of fluid was removed. I declined to operate on her as she

The wound, eight inches long, was closed with seventeen stitches and dressed with bichloride gauze. The patient was so nearly dead that atropia and whiskey had to be used hypodermically. Vomiting continued for three days when it ceased under the use of calomel and brandy. The menses came

on. The old hernias came down several observations had demonstrated the fact times and were replaced, but on the that ether was a dangerous anæsthetic evening of the 23rd vomiting recurred under such circumstances as described and the hernias coming down the left by Dr. DaCosta, and in such cases could not be returned. Dr. O. H. Allis chloroform is considered by some was called in consultation and we authorities as being much safer. Dr. agreed to wait until morning as the Fordyce Barker considers chloroform patient was unfit for operation. The much safer than ether during parturinext afternoon the patient was ap- tion or if there be heart disease. parently dying, the heart had almost given out, vomiting was constant and the left hernia was strangulated. Whiskey and morphia were used hypodermically. At 4 P. M. Dr. Allis operated for me using cocaine, without ether or chloroform. The vomiting stopped at once, and the patient took and retained three ounces of brandy and twenty-one of milk in the next twentyfour hours. The patient passed a fair night, the bowels were opened and five glasses of milk-punch were taken. The quantity of food was gradually increased. The hernial wound discharged sanious pus and a drainage tube was inserted and the wound was washed with bichloride 1 to 1000. The temperature fell from 102° to 100°. May 3rd the abdominal stitches were taken out and a perfect union was found without pus. The hernial wound improved from day to day. Two points are worthy of notice.

1st. The value of the bichloride solution. The abdominal wound was looked at in nine days and the stitches taken out in thirteen days without pus showing, and the temperature was reduced two degrees by washing out the hernial wound. 2nd. The value of cocaine in albuminuria. The patient was put on cocaine immediately after the ovariotomy, and the urine, which on the second day had fallen to 17 ounces, went up the next day to 37 ounces, and after the herniotomy to 49 ounces. 3rd. The ability to do such a grave operation with cocaine when either ether or chloroform would have killed the patient. May 18th. The patient is well. There has not been 1° variation in temperature nor 10 beats in the pulse-rate for two weeks past.

DISCUSSION.

Dr. M. Price asserted that there was no danger in ether. Accidents happen because the administration is entrusted to any one who may be present, or even by the nurse. It should in all cases be given by one who understands its effects and who will give it his entire attention. Nor should it ever be given to saturation; even a prolonged operation will require but a few ounces, and there is never occasion for the use of a pound or more as is sometimes seen. He has no tear of ether in heart disease or any other condition, even of extreme weakness; he considers the danger of the shock of operation much greater than the danger from the ether; he has used it freely at the Philadelphia Dispensary in the extraction of teeth and has never seen the slightest occasion for fear in its use.

Dr. T. M. Drysdale has employed ether from the time of its introduction and has never seen any bad effect from it even in cases of puerperal convulsions where the kidneys had been affected. If ether is properly administered a few ounces only are required to produce an anesthetic effect.

Dr. Baldy has given ether in patients suffering from weak heart and kidney troubles and has never seen any bad effects. He does not use any antiseptic in abdominal surgery and it is a rare exception, with him, to find pus in the line of union. The diurectic effect of cocaine was announced by Dr. Chas. Penrose.

Dr. Chas. Penrose stated that experiments upon the effect of cocaine used internally, made by him under the directions of Dr. DaCosta at the Pennsylvania Hospital, were published in the Medical News eighteen months ago.

Dr. Parish remarked that ether is not certainly safe under any circumstances, and it is decidedly unsafe in Dr. Longaker remarked that recent patients suffering from diseased kidneys