IMAGE EVALUATION
TEST TARGET (MT-3)

1.0

1.1

1^128

125

Its

■4.0

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. Faaturas of thia
copy which may ba bibilographically uniqua.
which may altar any of tha imagaa Sn tha
raproduction. or which may aignificantly changa
tha uauai mathod of filming, ara chackad balow.

□ Colourad covara/
Couvartura da coulaur

I — I Covara damagad/

Couvartura andomm^gte

Covara rastorad and/or laminatad/
Couvartura rMtaurAa at/ou palliculAa

r~~1 Covar titia miaaing/

La titra da couvartura manqua

□ Colourad mapa/
Ctrtaa gtegraphiquaa wi coulaur

Colourad ink (i.a. othar than blua or black)/
Encra da coulaur (i.a. autra qua blaua ou noira)

I — I Colourad plataa and/or illuatrationa/

D
D

Plar:;iiaa at/ou illuatrationa an coulaur

Bound with othar material/
Rail* avac d'autraa documanta

Tight binding may cauaa shadowa or diatortion
along interior margin/

La r0 liura serrie peut cauaar da i'onbre ou de la
diatoraion la long da la marge intAriaura

Blank leaves added during restoration may
appear within the text. Whenever possible, these
hcve been omitted from filming/
II se peut qua certainas pagea blanches ajouties
lone d'une restauration apparaiaaant dana la taxte.
mais. lorsque cela Atait possible, ces pagea n'ont
pas itA fiimAat.

Additional comments:/
Commentaires supplimantairas:

L'Instltut a microfiimi la meilleur exempiaira
qu'll lui a At* possible de se procurer. Lee dttalis
da tt«t exempiaira qui sont paut-Atre uniques du
point de vua bibliographique. qui peuvent modifier
une imago reproduite. ou qui peuvent exiger une
modification dans la mithoda normaia de fiimage
sont indiquis ci-dessous.

r~1 Coloured pagea/

This item is filmed at tha reduction ratio checked below/

Ce document est film* au taux de reduction indiquA ci-dessous.

Pagaa da coulaur

Pagea damaged/
Pagaa andommagAas

Pagaa restored and/oi

Pagaa restaurias at/ou pelliculAes

Pagaa discoloured, stained or foxei
Pages dAcoiorAes. tachetAes ou piquAes

Pagaa detached/
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Showthroughy
Tranaparence

Quality of prir

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Includes supplementary matarii
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Only edition available/
Seula Mition disponible

|~~] Pagaa damaged/

p~1 Pagaa restored and/or laminated/

r~^ Pagaa discoloured, stained or foxed/

r~~| Pagaa detached/

nn Showthrough/

r~~1 Quality of print varies/

|~~1 Includes supplementary material/

I — I Only edition available/

Pagea wholly or partially obscured by errata
slips, tissues, etc., have been refilmed to
ensure the best possible image/
Lea pages totaiement ou partiellement
obscurcies par un feuiilet d'errata. una pelure,
etc., ont M fiimAes k nouveau de fapon A
obtanir la mailleure image possible.

10X

14X

18X

22X

2SX

aox

12X

•

16X

20X

24X

28X

32X

Th« copy film«d hw hat b«fn raproduetd thanks
to th« ganarotity of:

MMlical Library
McQill Univaraity
Montraal

Tha imagaa appaaring hara ara tha boat quality
poaaibia considaring tha condition and iagibility
of tha original copy and in ica«ping with ttia
fiiming contract spaeif icationa.

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, <cliaa, tablaaux, ate, pauvant Atra
fiimAa A daa taux da rMuetion diff^anta.
Loraqua la documant ast trop grand pour Atra
raproduit an un aaul ciichA, 11 aat film* i partir
da I'angia aupMaur gaucha, da gaucha A droita,
at da haut an baa, an pranant la nombra
d'Imagaa nAcaaaaira. Las diagrammaa suivanta
illuatrant ia mAthoda.

r^.' ■ • *■

,. ;'!■»' •^''TT^T'i

ANAESTHESIA IN A CASE WITH DIMINISHED
BREATHING AREA.

G. GOEDON CAMPBELL, B.So., M.D.,

'itant Demonstrator in Mediofne, HoQill University, Assistant Physieiani Hontrsal

General Hospital.

Reprinted from the Montreal Medical Journal, July, 189b.

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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.

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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.

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