Ether as an Anaesthetic in Cases Where There Is Obstructive Disease of the Left Side of the Heart.

Abstract

HOUSE-SURGEON, YORK COUNTY HOSPITAL. UNTIL the following case came under my observation I never thought it necessary to examine the heart before administering ether. In all cases, provided the patient was neither a young child nor an old person, I was in the habit of giving ether without making any further examination than glancing at the chest walls, to see that they were not too rigid, and asking the question, " Have you a cough ?" Both these points being settled in the negative, the anaesthetic was given without further delay. Having given the anæsthetic in several cases of regurgitant valvular affection, and having noticed its great stimulating effect in this form of cardiac derangement-so great that in three cases the murmur has been found to disappear under the ether, reappearing gradually as the effects of the drug wore off,-and also in the almost pulseless heart of collapse; the conclusion was somewhat hastily arrived at that the state of the heart did not matter in ether giving. However, last year a male patient, aged fifty-two, was admitted to the hospital under the care of Mr. Jalland, who decided to perform an operation upon him. Accordingly, the man not being emphysematous and not having a cough, the administration of ether was commenced. The patient took the anaesthetic badly, and there was a good deal of struggling, some minutes elapsing before conjunctival insensibility was arrived at. Just at this stage the patient's breathing began to excite attention; it became somewhat hurried and very shallow. The pulse, however, continued regular and strong; in a very few seconds the face commenced to turn blue, and the respiration became so shallow as to be purely laryngeal, no movement of the abdomen nr chest-wall hp.in!1 percentible.The fthfr was a,t rmcf discontinued, and artificial respiration commenced. After t a few minutes the blueness of the face had disappeared, r and the respiration had become fairly normal. As r it was important that the operation should be at r once performed, the patient was allowed to partially come t round, and then, his heart having been stethoscoped and found to be apparently healthy, chloroform was administered. 1 Up to this time, even when he appeared to be on the verge of death from the first anaesthetic, his pulse had remained good, but now, after a couple of minutes of chloroform mhalation, it rapidly failed, becoming irregular. By means of the cold water towel and brandy the patient was brought round and the operation postponed. In the evening of the same day the man's heart was again examined, this time more carefully; there was now found a slight thrill at the apex and a somewhat presystolic murmur in the same situation, which murmur could only be heard over about half a square inch of chest surface. These symptoms evidently indicated mitral stenosis. A week after the patient was again brought into the operating room and kept under the influence of unmixed chloroform for about fortyfive minutes, without at any time showing any alarming symptom.Remarks.-In t...