ON THE USE OF NITROUS OXIDE GAS AS AN ANqSTHETIC IN SURGERY, WITH COXETER'S LIQUID GAS

C FOX
1870 The Lancet  
5 still there is ample need for enlightened improvement. The i ball-room affords at the present time the only opportunity i of active exercise to many; and, in spite of the disadvantages I of late hours and hot rooms, I am convinced that the iiiurlcular exercise of dancing supplies to many a real want. We hear much at the present day about the improved education of women; but it must be remembered that the more we assimilate their sex to our own in this respect, the more requisite will it be
more » ... them also to graduate in manly I sports. Without cricket, or foot-ball, or rowing, it would be most unwise to tax the female brain with higher and harder work. In the treatment of the insane, the value of modern enlightened improvement is nowhere better seen than in the great prominence now given to active employment ; and anyone who pays a visit to Hanwell or our other great asylums must be gratified to see the inmates working eagerly at farm duties or other industrial pursuits. And among idiots the same principle has been most beneficially adopted. Dr. Langdon Down, whose ability and zeal have long made him our leading authority on all concerning this hapless class, has favoured me with an interesting letter on the subject. He writes:" Great difficulty was always found in effecting the combination of idiots in games of play. There was always a want of spontaneity about them, and great efforts were required to induce a spirit of emulation. I took great pains to carry out systematic training in the playground, and with some remarkable results. Those who made exceptional progress in this made coetaneous progress in mental character. There is among idiots a great want of muscular co-ordination, and at the same time a want of endurance of muscular fatigue. They were for the greater part people of low Tn/stM—succumbed readily to illness that others would tide over. Some were agile, but they were the exception, and at a game of French and English' with intelligent boys of far less weight they would be nowhere. They played at this rall1e, at racing, skittles, jumping over horizontal bars, leaping, &c. Some were employed on the farm, but they always avoided physical exertion. I made a strong point of carrying out physical training pari passlt with the mental." Now, as regards the proper dose, so to speak, of exercise, every man, under ordinary circumstances, must be his own physician. Physiologists have calculated for us the amount of work which can, or at least should, be done by a healthy man; and Dr. Parkes states that such ought, if possible, to take a daily amount of exercise which shall be not less than 150 tons lifted one foot, this being equivalent to a walk of about nine miles. But, as he remarks, has there is much exercise taken in the ordinary business of life, this amount maybe in ordinary cases reduced." Of course in diseased conditions we will usually be expected to interfere, and lay down precise rules; but average people might as well weigh their ordinary meals as calculate by the inch or ounce how much their muscles ought to do. I believe a weakened heart may often be braced up by a moderate amount of exercise, for this may act medicinally like digitalis, either paralysing or reinforcing cardiac energy according to its dose and mode of administration. I have seen several instances of boys who had been debarred from active exertion on account of palpitation, speedily lose all their symptoms on being permitted to rejoin their companions' sports ; and a striking case recently recorded in the practice of Dr. Stokes showed how a man suffering from intense dyspnaea, the result of extensive heart disease, only obtained relief by the violent exertion of running after a car. But the unfavourable side of the question also demands some notice; and in devoting a few minutes to its consideration, we must recollect that muscular degeneration is frequently brought about by overas well as by under-work. Dr. Chambers,in his clinical lectures, narrates some curious instances of this : one in which the arms of a blacksmith's apprentice became atrophied from wielding too heavy a hammer; another in which a lady nearly lost the use of her right hand by excessive sewing ; a third where a literary lady over-exerted herself in ijiowing her lawn, and sunered from a, painful loss of power in the right deltoid and biceps. It is not likely that any such dangers as these will result from our present system of athletic games; but there is too much reason to fear that their great increase checks __ __. __ * Practical] Hygiene, p. 344. ' Vidf LPCtIIrP, ^1121JF CJlnIC2J, p. 351. mental progress, not orly by occupying time and energ-y.. but by dulling the sharpness and clearness of the brain, and lessening the aptitude for concentration and real work. within the last few years outdoor sports have taken so deep a root, and have come to be considered by many as the most important features of our public school system, that I there is now real risk of their being carried to excess. It is perhaps natural that boy hero-worship should run in the direction of his strong and active, rather than his intellectual companion; but when this goes so far as to lead to a double strain-when the natural division of the studious lad from the noted cricketer or foot-ball player is confused by an attempt to excel specially in both, then we find evil effects. There is, it is well known, a certain amount of compulsion exercised in our schools with reference to games, the heads of houses being empowered to order so many a week, and no one is exempt, save by an order from home, or the local medical officer. It may thus happen that a weakly lad, who is studious, and anxious about his work, feels that playing takes too much out of him; he finds his working power fail, perhaps he does not get enough sleep, and in the end he breaks down. A well-marked instance of this series of events came under my observation recently. I was asked to see a boy of sixteen, who had suddenly bepn taken ill. I found him in bed, with a flushed face, pulse 120, temperatnre ] 030 ]'ahr., much headache, and confusion of ideas. He was naturally of a studious disposition; and having got into the sixth form at an early age, and being also head of his house, he was obliged to read hard and take a prominent part in football. He had been heard to express his belief that the double strain was too much for him; but though often entreated to relax in either direction, he would never do so. The evening before my visit he had a shivering fit, and passed a restless night, wandering and seeing imaginary objects; in short, his condition at this time somewhat resembled a mild form of delirium tremens. For five days he continued in a somewhat doubtful state: the fever ran high; the intellectual faculties were much obscured, and it seemed probable that more serious cerebral mischief mig-ht supervene; and even } after all risk of this had gone by, giddiness and inability to concentrate his thoughts, and the very unusual excess of phosphates excreted by tlv urine, showed the serious weakening of the brain. Although his general health is now fairly re-established, he is still unable to make any approach to a resumption of head work. This is, of course, an extreme case, but one of a class which we must occasionally expect to meet with when both mind and body are strained almost to the limit of endurance. j (To & u g r a v e ; e c01!cluilÚl.) I ON THE USE OF NITROUS OXIDE GAS AS AN ANÆSTHETIC IN SURGERY, WITH COXETER'S THERE being, then, according to my showing in the former part of this paper, so many reasons in favour of using this gas, the inquiry naturally follows—How is it that, notwithstanding many successful causes of surgical operations under the influence of nitrous oxide in America, and here in England under the care of Messrs. Clover, Braine, Coleman, Rendle, myself, and others, the use of the gas is certainly not generally in favour for surgical cases F Several reasons may be assigned for this, but I shall now deal with one only; and that is, the bulkiness of the gas and the difficulty of conveying it from place to place. When first introduced into this country, those who desired to use it had no alternative but to fit up an elaborate apparatus and gas-reservoir at home, carrying it out in large bags ; subsequently Ir. Barth supplied us with compressed gas in heavy iron bottles, holding only fifteen gallons each: with these it was almost impossible to press its use on the
doi:10.1016/s0140-6736(02)66198-7 fatcat:3dckzyhzw5dchjo53ndndmpvvq