CLINICAL SURGICAL CASES
OBSTETRIC SURGEON TO THE CHELSEA, BROMPTON, AND BELGRAVE DISPENSARY. I HAVE stated in previous communications to THE LANCET* that one of my chief purposes in introducing my method of " anesthesia by mixed vapours" was to obtain the best form of administering anaesthetics in labour. It is, in actual practice, extremely difficult to avoid an overdose of chloroform by any method hitherto devised. And it is very common to find that the result is-what might easily be anticipatedthat the anesthetic
... ally protracts the parturient effort by its interference with the pains. In my system of anesthesia by mixed vapours this is scarcely possible, and the accoucheur possesses in it an easy means of giving complete relief to his patient without retarding her labour. In fact, it is my experience that by the gentle stimulus these vapours communicate, while they quite remove the consciousness of suffering, the expulsive efforts are really assisted, and that labour is shortened thereby. I need not enlarge on the value of such aid to the accoucheur, nor on the excellent effects upon the patient in the avoidance of prostration, depression, sickness, and all the other unpleasant consequences of ordinary chloroformization. My present purpose is to introduce a new and most simple form of my mixed-anesthetic inhaler, which will be found, I trust, of value in the lying-in room. This I call the " Obstetric Inhaler." It comtahes all the excellences of my former instru--ment, but is much cheaper, less complicated, and has the great advantage of being quite self-acting and self-supplying. It may be used either for pure chloroform, or for the mixed vapours, as may be required. The instrument is represented in the cut. It consists (the face-piece, &c.,being all as usual) of two parts-an upper, which holds the chloroform or other anaesthetics, and a lower for the alcohol and general evaporation of the fluids. The upper part is an entirely new little apparatus which I have designed and perfected for dropping chloroform in an equal ratio per minute: : * February 10th, and uay izth, 180S. this I call the "chloroform-dropper." " It consists of a glass bottle of a peculiar construction (a), perforated at both ends.* Up its centre runs a double metallic tube (d), the inner one of which contains a few strands of wool, and the outer serves as a cap to prevent spilling and irregular action of the apparatus. This is held in its place by a cork fitted into the lower end of the bottle. The upper end has a flat stopper, removable to allow of pouring in fresh supplies of fluids. Now, when a definite quantity of chloroform is poured into this bottle, the wick immediately causes it to rise up the tube, and, descending within it, the fluid appears below in regular drops. The rate at which the fluid comes over is easily learnt by calculation, and there is an engraved scale (c) on the side of the bottle which accurately informs the operator how much fluid per minute is escaping from the bottle, and the consequent per-centage of chloroform vapour which his patient is inhaling. Nothing more is necessary in order to give chloroform at a rate of from one to three per cent. than simply to pour the fluid, at intervals of five or ten minutes, into this little reservoir, up to the indicated mark for the per-centage requisite. The beautiful regularity with which this most simple instrument performs its required office must be seen to be fully appreciated. At its highest power it can only give off three per cent. of chloroform. Absolute security is thus obtained, while-a much lower per-centage being, in my opinion, quite sufficient-this can be perfectly secured by keeping the fluid at a certain point by occasional replenishment. Its tendencies, also, are all in the direction of safety, for its rate diminishes, with great equability, from three per cent., until, if left unsupplied, it finishes with about a half per cent. of the chloroform. Thus the patient, once anaesthetised, may be kept in that state with the greatest safety, since at every few minutes she derives a smaller and a smaller quantity of fluid from the apparatus. The lower part consists of a simple metal cylinder (b), the interior of which is occupied by my arrangement of leaf-like processes for the evaporation of alcohol. Upon this fimbriated structure the chloroform drops, and passes with the alcohol and ether vapour into the respirations of the breather. To this part of the apparatus is attached the elastic tube and facepiece. These have been well made by Messrs. Savigny, the makers of my other apparatus. In actual practice the instrument is thus used. A certain portion of pure alcohol is poured upon the evaporating surface in the cylinder; this lasts for about ten minutes. The chloroform-dropper is supplied up to the required mark on the scale with the fluid, and immediately delivers its contents drop by drop over the evaporator, on to which a few minims of ether are occasionally poured; or ether and chloroform in equal parts may be poured into the dropper, and coming over in single drops are dissipated into vapour with wonderful regularity. But the alcohol cannot be thus mixed; it is always to be poured on to its own proper surface. The instrument is thus entirely self-acting, and to a great degree self-supplying. It is incapable of derangement by agitation or otherwise; it affords a perfect security to the patient, who cannot draw from it more than a known (and visible) per-centage of chloroform ; and it is almost as simple as the commonest kind of inhaler. So soon as these facts shall become known and mixed anesthetics more generally used in our profession, I believe the napkin and tumbler system of giving chloroform, especially in midwifery, will drop out of knowledge and practice.