NITROUS OXIDE AS AN ANÆSTHETIC IN SQUINT OPERATIONS
811 breathing. He should let his own breath, as it were, hang on the breathing of his patient, so that he cannot breathe himself till his patient breathes. In this way he will he able to detect the slightest irregularity. With ether there is often some spasm, and respiration stops for a time, but a tap on the chest or rotating the head starts it again, as a rule. If inspiration seems difficult, remove any mucus from the fauces with the finger, draw out the tongue with a pair of artery forceps
... of artery forceps and pull it well forward, so as to open the glottis. If this does not succeed, artificial respiration must be resorted to while the tongue is still drawn forward, but it is satisfactory to say that I have never yet needed to have recourse to it. The colour of the skin of the ears is a good index to the state of the circulation. If these are livid, the administration should be stopped temporarily. After the operation.-It is prudent not to leave the patient, or at least except in the care of a properly qualified medical attendant, until he has shown signs of returning consciousness. This may be hastened by sponging his face with cold water, or slapping it gently with a wet towel, not so roughly as to cause marks. Sometimes holding the nose provokes a long inspiration through the mouth, followed by the sudden return of consciousness. This manoeuvre is of no use when ruder measures fail, but it may precede them, and is often successful. ' Where chloroform, for any of the reasons given above, is to be preferred, I administer it on a towel folded square. The preliminary arrangements and precautions are much the same as in the case of ether; but the patient requires, if possible, more careful watching. The reflex sensibility of the eye must be tested frequently ; when it is abolished the operation may commence, and the chloroform should be administered with caution. Stertorous breathing is a warning to suspend the administration. Should respiration stop, the tongue must be drawn out, and artificial respiration commenced at once. The respiration must be watched continuously. The pulse may be disregarded, as it gives no timely warning of approaching danger. Although chloroform does not require to be administered continuously, it is not less necessary to continue to watch the respiration, even though no chlorofor7n is being given. Accidents often happen from disregard of this precaution. The chloroform may be safely poured freely on the towel, but this should be cautiously approached to the face, until finally the fingers of both hands press its lower edge against the margin of the jaw, while the surface of the towel forms an angle of forty-five degrees with the face. The experience of the Edinburgh school affords the widest basis for affirming the practical value and safety of this method of administering chloroform. I have had two deaths from anesthetics—one from chloroform and one from ether. The former was a case of gummatous disease of the larynx, for which tracheotomy was performed when the patient was nearly moribund from asphyxia. It was in my early days, and at the present time I should decline to administer any anoesthetic in such a case. The other was from acute oedema of the lungs supervening some hours after the administration of the ether, and which I fully reported at the time. Both were hospital cases. In the numerous administrations I have had in private I have never met with a case which has given me any cause for alarm, though many have given me much anxiety. Indeed, I may say I never administer anaesthetics without anxiety; for it appears to me no slight thing to hold a fellow-creature suspended between life and deat.h for an hour or more, during which each respiration is watched for anxiously, and all our attention is strained to notice the first indication of impending danger. In conclusion, I will recapitulate the points which I desire especially to insist upon:-1. Ether is to be generally preferred as an an scathe tic. 2. Inflammatory affections of the lungs and air-passages absolutely contra-indicate its employment. 3. It should be the sole business of one person to administer the anaesthetic during an operation. 4. The breathing must be watched so long as the patient is under the influence of the anaesthetic, whether it is still being administered or not. FooT-AND-MOUTH DISEASE. -After the lapse of nearly two year-!, foot-and-mouth disease has again made its appearance in Lancashire. It is supposed to have been introduced by some Scotch cattle purchased recently in Scotland. The disease has also broken out at Sheffield. NITROUS OXIDE AS AN ANÆSTHETIC IN SQUINT OPERATIONS. CURATOR AND REGISTRAR, ROYAL LONDON OPHTHALMIC HOSPITAL. As nitrous oxide, though of late occasionally used and favourably spoken of in America by Dr. Mathewson and others, has, I think, not been hitherto tried in this country, the following brief recital may be of interest. W. S. W-, aged eighteen, healthy and robust, is the subject of a convergent strabismus of his right eye of four millimetres. It having been decided to use nitrous oxide, he was put fully under its influence by Mr. Spencer in eighty seconds, and was retained so for two minutes and a half, during which time a tenotomy of the right internal rectus was performed. During the last thirty seconds of this time the inhaler was withdrawn. He recovered instantly after the operation, without any unpleasant symptoms, though he declares that he felt some pain during its terminal stages. A tenotomy being now seen to be necessary on the other eye, the gas was again administered. This time. however, he did not come under its full influence till the expiration of four minutes. His conjunctivas became extremely tumid and congested. The tenotomy occupied ten minutes, owing partly to the awkward position of the operator on the left hand of the patient, on account of the inhaler, and partly to a tendency to the return of sensibility on the least shifting of the inhaler. Recovery from the anaesthesia was almost immediate, and no unpleasant after-effects of any sort were experienced. The inhaler employed was that of Clover. Nitrous oxide is preferable to both ether and chloroform, in being more safe, more rapid in its and much more aree:lble to take. It leaves no unpleasant after-effects at all comparable with the others. In this respect it as much excels ether as in the question of safety it is superior to chloroform. The want of full relaxation of the muscles is no impediment to its use in strabismus. Its average cost is rather more than that of the others; but this is of no moment if the advantages above claimed for it are established. Doubtless a face-piece offering less impediment to the operator could easily be arranged. Though squints may be efficiently operated on without the use of an anaesthetic, yet this procedure undoubtedly involves considerable pain to the patient.