IMAGE EVALUATION TEST TARGET (MT-3) % A 1.0 1.1 1^128 mm 125 Its ■4.0 Ml 2.0 11.25 U 11.6 Photographic Sciences Corporation 23 WIST MAIN STRUT WIBSTIR.N.Y. 14SS0 (7I6)1I72-4S03 / CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Institute for Historical Micioreproductions / Institut Canadian de microreproductions historiques Technical and Bibliographic Notas/Notas tachniquaa at bibliographiquaa Tha Instituta haa anamptad to obtain tha baat original copy available for filming. 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L'axamplaira fiim* fut raproduit grica i ia gAniroaitA da: MMiieal Library McGill UniMrtity Laa imagaa suhrantaa ont 4t* raproduitaa avao ia piua grand aoin. compta tanu da ia condition at da la nattatA da l'axamplaira fiimA, at an conformit* avac laa eonditiona du contrat da fiimaga. Original copiaa in printad papar covara ara filmad baginnlng with tlia front covar and anding on tha iaat paga with a printad or liiiiatratad Impraa- •ion, or tha bacic covar whan appropriata. Ail othar original copiaa ara filmad baginnlng on tha f in«t paga with a printad or illuatratad impraa- •ion. and anding on tiM iaat paga with a printad or illuatratad impraaaion. Laa axamplairaa originaux dont la couvartura an papiar aat ImprimAa sont filmte an commandant par la pramlar plat at an tarminam aolt par la damlAra paga qui comporta una omprainta d'impraaaion ou dllluatratlon, soit par la sacond plat, salon la caa. Tous iss autraa axamplairaa originaux aont fiimte an commandant par la pramlAra paga qui comporta una amprainta dimprassion ou d'iliustration at an tarminant par la damlAra paga qui comporta una talla amprainta. Tha Iaat racordad frama on aach microficha shall contain tlw symbol — ^ (moaning "CON- TINUED"), or tha symbol V (moaning "END"), v;hichavar appliaa. Un daa aymbolaa suhrsnts apparattra aur ia damlAra Imaga da chaqua microficha. salon la caa: la aymboia — ^ signlfia "A 8UIVRE". la aymboia ▼ aignifia "FIN". Mapa. piatas, charta. ate., may ba filmad at diffarant raduction ratioa. Thoaa too larga to ba antiraly inclu Jad In ona axpoaura ara filmad baginnlng in tha uppar iaft hand comar. laft to right and top to bottom, aa many framaa aa raquirad. Tha following diagrama iliuatrata tha mathod: Laa cartaa, pi, ;;■>-■(' :'&^M3 ANESTHESIA IN A CASE WITH DIMINISHED BREATHING AREA.* By G. Gordon Campbell, B.Sc., M.D., Assistant Demonstrator in Mouioine, MoOill University. Assistant Pliysioian. Montreal General Hospital. The patient, Mrs. S., was a middle-aged, slightly built woman, of medium height, much emaciated, and suffering from an enormous abdominal tumour. As I liad not seen the case until just before I began to aniesthetise her, I had prepared to administer ether by means of a Clover's inhaler. While making the usual explanations about the effect of the ether, I noticed that her respirations were extremely shallow and quicker than normal ; and on re(|Uesting her to take several long breaths, in order to fill the bag before turning on the ether, I saw that this was an impossibility. No effort on her part increased the air capacity of the lungs as it was ah ady taxed to the utmost limit. I then turned on tlie ether and gave it very cautiously at first, with plenty of fresh air, not thinking it advisable in this case to hasten the anaesthesia by shutting off the air. All went well until there was about 20 per cent, of ether vapour in the respired air, and then the breathing, which had been gradually getting quicker, became rapid and laboured, and reminded me \'ery strongly of the condition present during a bad attack of asthma ; violent efforts at respiration and little or no air entering the chest. There was no spasm in the air passages, and the patient was only partially anassthetised, so, in order to remove any possible degree of asphyxia which might be added to the effect of the ether, I gave it without using the bag No improvement followed, and chloroform given on a piece of stockinette stretched over a wire frame was sul)stituted. The dyspn(Tea gradually passed off and the breathing, although con- tinuing quick and shallow, was not laboured, the pulse, however, was rapid and of small volume. Full anaesthesia was established in a few minutes, and after the usual pi-eparation the abdomen was opened and the growth removed. While the adhesions between it and the intra- abdominal ctrgans were being separated, the usu 1 respiratory reflexes were excited, and a condition of dyspna^a, similar but less pronounced than that seen at the outset under ether, occurred. I had to request the operator once or twice to cease his manipulations for a few moments and allow the quickened respirations to subside. I feared * Read! before the Montreal Medioo-Chirurgioal Society, April 19i 1896. m' Ml'^^l^''^-:^^ :*;• '■■-Y T'V -W -,H. .*/;/*--. .,r^^>;^^w^ .,^"."V'^' 'v:' to continue giving the chloroform while they were presen lest I should give an overdose, and withdrawing it altogether for any length of time would have allowed of partial recovery of the patient ; an equally dangerous condition. The pulse had become much slower (80) and was of very poor volume indeed when the tumour was removed, eighty minutes after I began the anresthesia I then replaced the chloroform with ether and continued the anaesthesia for an hour longer with the Clover's inhaler. In order to compare as far as possible the two agents, without having a possible third factor, asphyxia, in the case, I gave six breaths of pure air to every one from the bag. An almost immediate improvement was noted in the patient's condition, the pulse became quicker, increasing to 105, but was very much fuller, and more forcible, although in sudden relief of abdominal tensions like this the opposite usually occurs, the patient bleeding into her own abdo- minal vessels. The respirations increased from 24 to 30 per minute, and intra-abdominal reflexes of about equal intensity to those observed Under chloroform were set up by further manipulations in the abdo- minal cavity. Now, however, there was no interference with the breathing, showing that the cause of the former dyspnoea had been mechanical altogether. The immense size of the solid tumour had completely filled up the abdominal cavity and pushed up the diaphragm encroaching upon the area of the thorax. The dyspnoea here was plainly due to the physiological effect of the ether absorbed upon the respiratory centre, causing quickened breathing ; once the mechanical cause of obstruction was removed, the increased respiratory rate and increased depth of breathing caused no distress. The patient made an exceptionally good recovery and had no after vomiting. The chief interest in the case, apart from the comparison of the two agents, lies in tlie fact that it shows a condition in which chloroform should be selected in preference to ether as an anajsthetic. It must, however, be borne in mind that in cases such as these, where there is some interference with free breathing, the danger of accidents from chloroform is very considerably increased. 0"^ *1 '^m