249
LETTER FROM DR. WM . HORROCKS, F.R.C.S.
To THE EDITORS OF "THE LANCET."
Sirs,—The subjects of anæsthetice is of such importance to surgeons that every detail
in its administration must be criticised and discussed as thoroughly as possible. In your last
issue Mr. Nance in a very practical letter writes, among other things, of the use of Clovers'
inhaler. My own experience, after five years of surgical hospital residence, leads me to
think unfavourably of that form of inhaler. In producing anæthesia with it, the patient
b r e a t h e s a n d r e b r e a t h e s h i s o w n e x h a l e d a i r .E
v e n
i f t h e a i r i n t h e b a g i s c o n s t a n t l y
c h a n g e d o n e f r e q u e n t l y n o t i c e s t h e m ar
k e d
c y a n o s i s o f t h e p a t i e n t , d e n o t i n g c a r b o n i c a c i d
asphyxia as well as etherisation. This has been very forcibly impressed on me lately by a case
of operation for intestinal obstruction, where the other was given in a Clover's inhaler, with
a f r e e a d m i x t u r e o f a i r . T o w a r d s t h e e n d o f t h e o p e r a t i o n t h e r e w a s m a r k e d c y a n o s i s , a n d
after partially recovering the patient died. It is but fair to state that the patient was sixty-
three years of age, that the anæsthesia lasted rather over an hour, and that the pulsed, before
the operation, although fair, was somewhat irregular. Allowing for all these factors, the
opinion of the anæsthetist that the constructive fault of the inhaler contributed in no slight
degree in causing death was concurred in by those present at the operation.
I am, Sirs, faithfully yours,
B r a d f o r d , J u l y 7 t h , 1 8 9 0 .
L E T T E R F R O M D R . C . R U A T A
T O T H E E D I T O R S O F " T H E L A N C E T . "
SIRS, —I have read with great interest the Report of the second Hyderabad Chloro-
form Commission, published in The Lancet ofJ u n e 2 1 s t l a s t , t h e m o r e s o a s t h e i r r e s u l t s a g r e e
with those which I obtained after a long series of experiments which I performed during the
years 1885-86, with the object of ascerta
ining the " influence of anæstheticso n t h e r e s p i r a t i o n . "
The manner of experimenting which I adopted was mainly as follows. A canula is connected
by elastic tubes at one end with a bottle containing pieces of sponge saturated with the
anæsthetics, at the bottom of which is inserted a tube for pumping the air from without; the
other end of the canula is attached to a second, canula, inserted into the trachea, and fastened
to it. The main canula has two tubes springing from it, one communicating with the air
and the other with a style which writes on arevolving drum. The mouth of the tube com-
- m u n i c a t i n g w i t h t h e a n æ s t h e t i c h a s a v a l v e w h i c h o p e n s d u r i n g i n s p i r a t i o n a n d i s s h u t d u r i n g
expiration; the tube communicating with the air has a valve which opens during expiration
and remains shut during inspiration. This arrangement allows the air passing through the
sponge charged with the anæsthetic to enter the lungs, and does not permit the air expired
t o e n t e r t h e b o t t l e c o n t a i n i n g t h e a n æ s t h e t i c .
I enclose two pamphlets, which I published in 18 8 6 ,
in which you may see some selec--
tions from the different tracings I obtained. The conclusions I arrived at by this mode of
3 2