262
A suggestive and very practical fact which came out in our experiments is that some-
- t i m e s d u r i n g a n i n h a l a t i o n o f n i t r o u s o x i d e t h e r i s e o f t h e a r t e r i a l p r e s s u r e i s e x t r a o r d i n a r y
and abrupt. Not long since, in the city of Philadelphia, a gentleman arose from the dentist's
chair after an inhalation of nitrous oxide, staggered, and fell in an apoplexy. Is it not easy
to perceive that when the arterial system is diseased the great strain of a sudden rise of blood-
pressure may produce rupture?
Some year s si nce Dr . Kender di ne, a Phi l adel phi a sur geon of l ocal not e, di ed of
diabetes, which he insisted was produced in him by the inhalation of nitrous oxide. This
is in accord with the researches of the French physician. Dr. Lafont, who reported a case in
whi ch s ugar appear ed i n t he ur i ne t wi ce i n a pat i ent af t er t he i nhal at i on of t he gas , and who
also caused in himself, and in dogs. temporary glycosuria by such inhalations. Further,
D r . L a f o n t n o t i c e d i n a c a s e o f mi t r a l i n s u f f i c i e n c y t e mp o r a r y a l b u mi n u r i a .
I am not aware that suggestive statements of the French physician have
given rise to any research. except five experiments made recently upon healthy men, with
negative results, by two medical students of the University of Pennsylvania. Messrs. George
S. Woodward and Al fred Hand. j unr. I do not, bel i eve that ordi nari l y ti me i nhal ati on of
nitrous oxide is followed by sufficient disturbance of the circulation to register itself in the
urine. but the negative evidence of Messrs. Woodward and Hand is not sufficient to render it
improbable that in exceptional cases the inhalation of nitrous oxide may produce albuminuria
or glycosuria. Such phenomena, if they occur, are in all probability not directly produced by
the nitrous oxide, but are due to the disturbances of capillary circulation caused by it,
However these facts may be, it seems to me that great caution should be used in the
administration of nitrous oxide to persons, the coating of whose arteries is diseased, and it is
probable that when widespread atheroma exists, ether is a safer anæsthetic than nitrous oxide.
When respiration has been suspended in nitrous oxide anæsthesia, the overwhelming
indication is certainly for the employment of artificial respiration.
Not with standing the great safety and the many advantages which attend the anæsthetic
empl oyment of ni t rous oxi de, t he gas can never be used for t he general purposes of t he
surgeon, on account of the excessive fugaciousness of its influence.
The perfect anæsthetic will be a substance which has the power of paralysing the sensory-
nerve trunks without affecting other functions of the body. If such drug exists it yet awaits the
coming of its discoverer. Probably until such a sensory-nerve paralysant is found chloroform
and ether will maintain the complete supremacy which they now have; and in the further
discussion of my subject I shall confine my remarks to them. Lack of time limits this discussion to:
(1) The method in which these two drugs kill, both in man and in the lower animal,
that is, whether they destroy life through the circulation or the respiration.
(2) The comparative fatality attending the use of these two agents, and the reasons
for the difference.