Biomed. WF 102 n.c AOv tm •>.,./ At=c.>Bi1 SOUTH ERN REGIONAL LIBF to o (ARY FACILITY OC\JO "i 4 - THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES RAPID BREATHING AS A PAIN OBTUNDE^ MINOR SURGERY, OBSTETRICS, THE General' Practice of Medicine AND OF DENTISTRY. W. G. A BONWILL, D.D.S. VV f RAPID BREATHING AS A PAIN OBTUNDER MINOR SURGERY, OBSTETRICS, THE GENE RAL PRACTICE OF MEDICINE AND OF DENTISTRY.* By W. G. A. Bonwii/l, D.D.S. Through the kind invitation of your directors, I am present to give you the history of " rapid breathing" as an analgesic agent, as well as my experience therein since I first discovered it. It is with no little feeling of modesty that I appear before such a learned and honorable body of physi- cians and surgeons, and I accept the privilege as a high com- pliment. I trust the same liberal spirit which prompted you to call this subject to the light of investigation will not for- sake you when you have heard all I have to say and you sit in judgment thereon. Sufficient time lias now elapsed since the first promulgation of the subject for the shafts of ridi cade to be well nigh spent (which is the common logic used to crush out all new ideas), and it is to be expected thai gen- tlemen will look upon it with all the charily of a learned body, and not be too hasty to condemn what they have had but little chance to investigate; and. of course, have not practiced with that success which can only come from an intelligent understanding of its application and mod lis ope- randi. Knowing the history of past discoveries, I was well pre- pared for the crucible. I could not hope to be an exception. But, so far, the medical profession have extended me more favor than I have received at the hands of the dental profes- sion. My first conception of the analgesic property of a pain ob hinder in contradistinction to it< anaesthetic effect, which finally led to the discovery of the inhalation of common air by "rapid breathing," was in 1855, while performing upon my own teeth certain operations which gave mi' intense pain, and I could not afford to hurl myself, without a resort to ether and chloroform. These agents had been known so short a time that no one was specially familiar with their action. Without knowing whether I could take chloroform administered by myself, and at the same time perform with skill the excavation of extremely sensitive dentine or tooth bone, as if no anaesthetic had been taken, and not he con- scious of pain, was more than the experience of medical men at that time could assure mc But, having a love for investigation of the unknown, I prepared myself for the ordeal. By degrees I took the chloroform until I began to feel very plainly its primary effects, and knowing that I must soon be unconscious. I applied the excavator to the carious tooth, and. to my surprise, found no pain whatever, but the sense of touch and hearing were marvelously intensi- fied. The small cavity seemed as large as a half bushel; the excavator more the size of an ax; and the sound was equally * Kead before the Philadelphia County Medical Society, May 12. fSSO. by W. G. A. Bon\viil,D.D.S.. Philadelphia. Published in the Scientific American Supplement, Xo. 27~>, April !). 1881. magnified. That I might not he mistaken. I repeated t lie operation until 1 was confident that amestbetics possessed a power not hitherto known — that of analgesia. To be doubly certain, I gave it in my practice, in many cases with the same happy results, which saved me from the risks incident to the secondary effects of an;e>thetics. and which answered for all the purposes of extracting from one to four teeth. Not satisfied with any advance longer than I could find a better plan, 1 experimented with the galvanic current (to and fro) by mi applying the polo that I substituted a stronger impression by electricity from the nerve centers or ganglia to the periphery than wa- made from the periphery to the brain. This wa- so much of a success that 1 threw aside chloroform and el her. and removed the living nerve < if a tooth with instruments instead of using ar-enic, and for excavat- ing sensitive caries in teeth, preparatory to filling, as well as many teeth extracted by it. But this was short-lived, for it led to another step. Sonietirn.es I would inflict severe pain in case- of congested pulp- or from it- hasty application, or pu.-hing it to do loo much, when my patient invariably would draw or inhale the breath very forcibly mid r anticipated, found my steps growing shorter and shorter, until [ cone to a stand, showing to my mind clearly that my argument in advance was right, so far as locomotion was concerned; and, upon referring to my pulse, I found but little acceleration. T < > wli.it ni her conclusion could 1 arrive from this argu- ment, with tlir foundation laid nineteen years before, when 1 established on my own person by experiment the fad of analgesia a> induced from chloroform, \\ ilh tlie many experi- inenK in rapid respiration on tooth bone? From ihis moment until it- first application to the extrac- ii >n of a loitli you can well imagine m\ suspense. Thai 1 might not fail in the very firsl attempt. 1 compelled myself and others in my household to breathe rapidly to investigate l lie phenomenon. This uavc me some idea as to the propel method of proceeding in its administration. The lirst ease soon appeared, and was a perfect success. Lroing far beyond my anlieipations, for the cfTect was such as in produce a partial paralysis of the ham is a ml arms to the elbow. Again and again I tried it in every ease of extrac- tion and many other experiments, doubting my own senses for a long time at a result so anomalous ;ind paradoxical. I was reminded jus* here f a phenomenon which uavc me addi- tional pr ii if— Mi.- 1 1 of blowing a dull tire to revive it. For a minute or so one blows and blows in rapid succession, until. rising from the effort, a sense of giddiness for a few mo incuts so overcomes that the upriirhi position is with ditli c id t y maintained. In this condition you are lit ted for ha vim; a tooth extracted or an abscess lanced. Believing that 1 had something new to offer which might In of use to suffering humanity. I read the first article upon ii Nov. 17. IS?."), before the Franklin Institute. Shortly after 1 was invited before I he Northern Medical Society of this city to address them thereon. A mini her of medical gentle- men have been using ii in their practice, while the bulk of them have spurned ii as " negative " and preposterous, with- out an effort at Irving i\ which I can ii<»r very well under- stand. I nless one j^ aware of the fact that in the u-i- of any agent which ha- 1 1 1 ■ - powei lo suspend the volition, it can be taken in I hat point where he is still conscious of fm/r/i • imi Inuring, and at the same time not cognizant of pain in- tlieieii. i lie action of rapid breathing can not be under- stood. And I I'euTet to say thai of threi fourths of the medical im n I have lalked with on the subji et they had not licet) aware ut si, eh a possibility from ether ami chloroform. I Tit il 'hi- analgesic siate could lie esiablished in their minds i ! was impossible to convince the in that the excess of oxygen. lined by rapid breathing, could In made to produce a simil ,r etl'ect / should liave lieen ;i~ reluctant as any one to ■"Ii veil, had 1 not personally experienced the etl'ect while performing an operation which would otherwise have been \ a r \ painful. Such a result could not well be reached by an.\ course oi n asoniim alone. Has ji pr.'iveii in in\ practice what ha- been claimed \"f it asubsiituie for the powerful ana'>ihctics in minor ope ra- I '■ n- ill - i ' _a ! ". V NIosi einphat ieally. \ > - ' So eompleti has ii fulfilled it- humble mission in my office, that I can -■lib assert then ha- no! been nmii than rivt per cent. 1 ha vc given it under all cireiimstanees eif eli- eased organs, and have -een no either thar tin happi*-> results ii, its after effects. [' may wall b .;-keel jn-T hen Why has ii not been ni"r< LTeiierally and widely u-e.i by tin dental pr fe--ion a- well as the nvdical. if it i- ieally what is claimeo for it? The meisi satisfactory and charitable it -'.vi r to In driven i-. the failure upon their part to compre . the fnrt a- existing in chloroform and ether that there is such a state as analgesia; or, in other words, that the animal economy is so organized, while the sense of touch is not destroyed, hut rather increased, the mind of the subject fails to perceive a sense of pain when anaesthetics are given, and the effects are manifested in the primary stage. As I before intimated, such is the knowledge possessed by most of those who administer ether and chloroform. This was enough to cause nearly every one to look upon it as a bubble or air castle. Many gentlemen told me they tried it upon them selves, and, while it affected them very seriously by giddi- ness, they stil! retained consciousness ; and. such being the case, no effect could be produced for obtunding pain. Others l old me they were afraid to continue the breathing, alarmed at the vertigo induced. And the practitioner who has adopted it more effectively than any other laughed at me when I first, told him of the discovery ; but his intimate asso- ciation Avith me changed his views after much explanation and argument between us. It was hardly to be expected that without this knowledge of analgesia, and without any explanation from me as to the Hindus operandi of rapid breathing, other than a few sug- gestions or directions as to how the effect was induced, even the most liberal of medical men should be able to make it effective, or have the least disposition to give il a preliminary trial upon themselves, and, of course, would not attempt it upon a patient. Notwithstanding, il found a few adherents, but only among my personal medical friends, with whom 1 had an opportunity to explain what 1 believed its physiologi- cal action, and the cases of success in my own practice. To this 1 have submitted as among t lie inevitable in the calendar of discoveries of all grades. My own profession have attempted to ridicule it out of its birthright and possible existence, which style of argument is not resorted lo by true logicians. To all this 1 can truly say 1 have not for one moment fal- tered. 1 could afford lo wait. The liberality of this society alone fully compensates for the seeming indisposition of the past, believing thai il is proper thai every advance should be confronted, and, if in time found worthy, give it God speed. From its first conception I have diligently labored to solve its modus operandi, and the doubt in my own mind as to whether I could be mistaken in my observations. 1 asked the opinion of our best chemical teachers if air could have such effect. One attributed it to oxygen stimulation, and the other to nitrogen. Another gentleman told me the medi- cal profession had come to I he conclusion that it was possible for me to thus extract teeth, but il was due solely to my strong personal mar/neHsm, i which power 1 was noi before aware 1 possessed). Now, from what I have related of the successive and natural steps which finally culminated in this process or plan of analgesia induced by an excess of ordinary air taken forcibly into the lungs above what is necessary for life, and from what I shall state a- to the apparently anomalous or paradoxical effects, with its physiological action, and the simple tests made upon each of my patients, I shall trust to so convince you of its plausibility and possibility that il will be made use of in hundreds of minor operations where ether and chloroform are now used. Aside from my assertion and thai of its friends, that (he effects can be produced by air alone, you must have some light shed upon the causes of its physiological action, which will appeal to your mediral reason. To assign an action to any drug is difficult, and in the cases of ether and the other anaesthetics a quarter of a century still finds many conflicting opinions. This being true, you will deal leniently with ine for the opinion I hold as to their analgesic action. Of course it will be objected to. for the unseen is, to a great extent, unknowable. Enough for my argument, however; it seems to suit the case very well with- out looking for another; and while it was based on the phenomenon resulting from many trials, and not the trials upon it as a previous theory, 1 shall be content with it until a better one can be found. What i- it 1 claim a- a new discovery, and the facts and its philosophy? 1 have asserted thai I can produce, from rapidly breathing common air at the rate of a hundred respirations a minute, a similar effect to that from ether, chloroform, and nitrous oxide gas, in their primary stages; and I can in this way render patients sufficiently insensible to acute pain from any operation where; the time consumed is not over twenty to 1 hi rty seconds. While the special senses are in partial ac- tion, the sense of pain is obtunded, and in many cases com- pletely annulled, consciousness and general sensibility being preserved. To accomplish tin-, each patient must be instructed how to act and what to expect. As simple a- it may seem, there i- a proper and consistent plan to enable you to reach full success. Before the patient commences to inhale he is in formed of the fact that, while he will be unconscious of pain, he will know full or partially well every touch upon the person; that the inhalation must be vigorously kept up during the whole operation without for an instant stopping; that the more energetically and steadily he breathes, the more perfect the effect, and that if he cease breathing dur- ing the operation, pain will he felt. Fully impress them with this idea, for the very good reason that they may stop when in the midst of an operation, and the fullest effects be .ost. It is obligatory to do so on account of its evanescenl effects, which demand that the patient be pushed by the operator'- own energetic appeals to "go on." It is very dif ficuit for any person to respire more than one hundred times to the minute, as lie will become by that time so exhausted as not to be able to breathe al all. as is evidenced by all who have thus followed my directions. For the next minute fol lowing the completion of the operation the stibject will not breathe more than once or twice. Very few have force enough left to raise hand or foot. The voluntary muscles have nearly all been subjugated and overcome by the undue ell'ort at forced inhalation of one hundred over seventeen, i he normal standard. It will be more fully understood further on in my argument why 1 force patients, and am constantly -peaking to them to go on. 1 further claim that for the past four years, so satisfactory ha- been the result of this system in 'he extracting of teeth and deadening extremely sensitive dentine, there was no longer any necessity for chloroform, ether, or nitrous oxide in the denial office. That such teeth as cannot be extracted by its aid can well be preserved and made useful, except in a very few erases, who will not be forced to breathe. The anse-theties, when used in major operations, where time is needed for the operation, can be made more effective I iy a lesser quantity when given in conjunction with " rapid breathing." Drs. Garrettson and Hewson, who have thus tried it, tell me it takes one-half to three-fourths less, and the after effects are far less nauseating and unpleasant. As an agent in labor, where an aiucsthetic is indicated, it is claimed by one who has employed it (Dr. Hewson) in nearly every case for three years, lie has used " rapid breathing " solely, and to the exclusion of chloroform and ether. For this 1 have his assertion, and have no doubt of it whatever, for if any agent could break down the action of the volun- tary muscles of the parts involved, which prevent the invol- untary muscles of the uterus from having their tidiest effect, il is (his. The very act of rapid breathing so affects the muscles of the abdomen as to force the contents of the uterus downward or outward, while the specific effect of the air at I lie end of a minute's breathing leaves the subject in a semi- prostrate condition, giving the uterus full chance to act in the interim, because free of the will to make any attempt at withholding the involuntary muscles of the uterus from doing their natural work. It is self evident; and inthisagenl we claim here a boon of inestimable value. And not least in such cases is. there i.~ no danger of hemorrhage, since the cause of the effect is soon removed. In attestation of many cases where it has been tried, 1 have asked the mother, and. in some cases, the attendants. whether anything else had been given, and whether the time was very materially lessened; there has been bid one response, and that in its favor. Gentlemen, if we are not mistaken in this, you will agree with me in saying that it is no mean thing, and should be investigated by intelligent men and reported upon. From my own knowledge of its effects in my practice, I am bound 'o believe this gentleman's record 1 further claim for it a special application in dislocations. It has certainly peculiar merits here, as the will is so nearly subjugated by it as to render the patient quite powerless to resist your effort at replacing, and at the same time the pain is subdued. It is not necessary 1 should further continue special appli- cations; when its modus opiraraU is understood, its adapta- tion to many contingencies will of a sequence follow. It is well just here, before passing to the next point of con- sideration, to answer a query which may arise at Ibis junc- ture: What are the successive stages of effects upon the economy from its commencement until the full effect is observed, and what proof have 1 that it was due to the amount of air inhaled? The heart's action is not increased more than from seventy (the average) to eighty and sometimes ninety, but. is much enfeebled, or throwing a lesser quantity of blood. The face becomes suffused, as in blowing a tire or in stooping, which continues until the breathing is suspended, when' the face becomes paler. (Have not noticed any purple as from as- phyxia by a deprivation of oxygen.) The vision becomes darkened, and a giddiness soon appears. The voluntary muscles furthest from the heart seem first to be affected, and the feet and hands, particularly the latter, have a numbness at their extremities, which increases, until in many casesjhere i- partial paralysis as far as the elbow, while the limbs be come fixed. The hands are so ihoroughly affected that, when open, the patient is powerless to close them and Her versa. There is a vacant gaze from the eyes and looking into space without blinking of the eyelids for a minute or mure. The head seems incapable of being held erect, and there is no movement of the arms or legs as is usual when in great pain. There is no disposition on the part of the pa tient to take hold of the operator's hand or interfere with the operation. .Many go on breathing mechanically after the tooth is re- moved, as if nothing had occurred. Some are aware that the tooth has been extracted, and say they felt it; other- could not tell what had been accomplished. The majority of cases have an idea of what i- being done, but are power less to resist. With the very intelligent, or those who stop to reason. 1 have to leach them 1 he peculiarities of being sensible of touch and not of pain. One very interesting case I will state. In extracting seven teeth for a lady who was very uittriUing to believe my state- ment as to touch and no pain, 1 h'rsl removed three teeth after having inhaled for one minute, and when fully herself, she stated that she could not understand why there wa- no pain while -lie was conscious of each one ex traeted; it was preposterous to believe such an effect could he possible. a> her reason told her that there is connected with tooth extracting pain in the part, and of severe charac- ter, admitting, though, she felt no pain. She allowed one' to be remove i without anything, and -lie could easily dis- tinguish the change, and exclaimed. " It is all the difference imaginable:" When the other three were extracted, there was perfect succc-s again as with the first three. One of the most marked proofs of the effects of rapid breathing was that of a boy of eleven years of age for whom I had to extract the upper and lowei first permanent molars on each side. lie breathed for nearly a minute, when 1 re- moved in about twenty seconds all four of the teeth. without a moment's intermission or the stopping the vigor- ous breathing: and not a murmur, sigh, or tear afterward. He declared there was no pain, and we needul no such assertion, for there wa- not the first manifestation from him that he was undergoing such a severe operation. Another case, the same day, when I had to extract the -u perior wisdom teeth on both sides for an intelligent young lady of eighteen years, where I had to use two pairs of for- ceps on each tooth (equivalent to extraction of four teeth i. -he was so profoundly affected afterward that she could not tell me what had been done other than that 1 had touched her four times. Sin- was overcome from its effect- for at lea~t a minute afterward. She was delighted. With such severe tests 1 fear very little the result in any case where 1 can have them do as 1 bid. There can be no mistake that there is a specific actio n from something. It cannot he personal magnetism or mesmeric influence exerted by me. for such case- are rare, averaging about 10 percent, only of all classes. Besides, in mesmeric influence the t ime ha~ much to do with it: whereas, in my case-, it cannot last over a half minute or minute at most. It cannot be fear, a- such eases are generally more apt to gel hurl the wor-c. It b not diversion of mind alone, as we have an effect above it. There is no better way of testing whether pain has been fell than by taking the lacerated or contused gums of the pa- tient bet ween the index finger and thumb and making a gentle pressure to collapse the alveolar borders; invariably, they will cry out lustily, that is pain ! This gives undoubted proof of a specific agent. There is no attempt upon my own part to exert any influence over my patients in any way other than that they shall believe what I say in regard to giring ihem in/ in/in and in the following of my orders. Any one who knows how persons become mesmetized can attest thai it is not the operator trho forces them under it against their trill, but it is a peculiar state into which any who have within themselves this temperament can place themselves where any one who knows how can have control. It is not the will of the operator. I therefore dismiss this as unworthy of con sideration in connection with rapid breathing. Then you may now ask, To what do I attribute thi- very singular phenomenon ? Any one who followed, in the earlier part of this paper, the course of the argument in my soliloquy, after twenty years had elapsed from my observation upon myself of the analgesic effects of chloroform, can almost give something of an answer. That you may the more easily grasp what I shall say, 1 will ask you, If it be possible for any human being to make one hundred inhalations in a minute and the heart's action is not increased more than ten or twenty pulsations over the normal, what should be the effect upon the brain and nerve centers? If the function of oxygen in common air is to set free in the blood, either in the capillaries alone, or throughout the whole of the arterial circulation, carbonic acid gas; and that it cannot escape from the system unless it do so in the lungs as it passes in the general current — except a trace that is removed by the skin and kidneys — and that the quantity of carbonic acid gas set free is in exact relation to the amount of oxygen taken into the blood, what effect muxt be manifested where one hundred respirations in one min- ute are made — five or six times the normal number — while the heart is only propelling the blood a very little faster through the lungs, and more feebly — say !)() pulsations at most, when to be in proportion it should be 400 to 100 respirations to sustain life any length of time? You cannot deny the fact that a definite amount of oxy- gen can be absorbed and is absorbed as fast as it is carried into the lungs, even if there be one hundred respirations to the minute, while the pulsations of the heart are only ninety! Nature has made it possible to breathe so rapidly to meet any emergency; and we can well see its beautiful ap- plication in the normal action of both the heart and lungs while one is violently running. What would result, and that very speedily, were the act of respiration to remain at the standard — say IS or '20 — when the heart is in violent action from this running? Asphyxia would surely end the matter! And why? The excessive exercise of the "whole body is setting free from the tissues such an amount of excretive matter, and carbon more largely than all I he others, that, without a relative action of the lungs to admit the air that oxygen may be absorbed, car- bonic acid gas cannot be liberated through the lungs as fast as the waste carbon of the overworked tissues is being made by disassimiiation from this excess of respiration. You are already aware how small a quantity of carbonic acid in excess in the air will seriously affect life. Even 2 to '4 per cent, in a short_ time will prove fatal. In ordinary 10 respiration of 2(1 to the minute the average of carbonic acid < xhaled is 4 '35. From experiments long ago made by Vierordt — see Car- penter, p. 524 — you will see the relative per cent, of car bonic acid exhaled from a given number of respirations. When he was breathing six times per minute, 5 5 per cent, of the exhaled air was carbonic acid: twelve limes. 4'2: twenty-four times, 8 3; forty-eight times. 3; ninety-six times, 2 0. Remember this is based upon the whole number of respi- rations in the minute and not each exhalation — which latter could not be measured by the most minute method. Let us deduct the minimum amount, 20 per cent, of car bonic acid when breathing ninety-six times pe. minute, from the average, at twenty per minute, or the normal standard, which is recorded in Carpenter, p. 524. as 4 - 85 per minute, and we have retained in the circulation nearly 2 per cent, of car bonic acid; that, at the average, would have passed off through the lungs without any ob-ti uction, and life equal- ized; but, not having been thrown off as fast as it should have been, it must, of necessity, be left to prey upon the brain and nerve centers; and as 2 to 3 per cent., we are told. will so poison the blood, life is imperiled and that speedily. It is not necessary we should argue the point as to whether oxygen displaces carbonic acid in the tissues proper or the capillaries. The theory of Lavoisier on this point has been accepted. We know furthermore, as more positive, that tissues placed in an atmosphere of oxygen will set free carbonic acid, and that carbonic acid has a paralyzing effect upon the human hand held in it for a short time. The direct and speedy effects of this acid upon the delicate nervous element of the brain is so well known that it must be accepted as law. One of the most marked effects is the suspension of locomotion of the legs and arms, and the direct loss of will power which, must supervene before voluntary muscular inactivity, which amounts to partial paralysis in the hands or feet, or periphe- ral extremities of the same. Now that we have sufficient evidence from the authorities that carbonic acid can be retained in the blood by excessive breathing, and enough to seriously affect the brain, and what its elfeets are when taken directly into the lungs in ex- cess, we can enter upon what 1 have held as the most rea- sonable theory of the phenomenon produced by rapid breath ing for analgesic purposes; which ilitonj was not fust con- ceived and the process made to yield to it, but the phenom- enon waslong observed, and from the repetition of the effects and their close relationship to that of carbonic acid on the economy, with the many experiments performed upon my- self, 1 am convinced that what 1 shall now state will be found to substantiate my discovery. Should it not be found to coincide with what some may say is physiological truth, it will not invalidate (he discovery itself; for of that I am far more positive than Harvey was of the di eovery of the circulation of the blood; or of Galileo of the spherical shape of the earth. And 1 ask that it shall not be judged by my theory, but from the practice. It should have as much chance for investigation as the theory of Julius Robert Mayer, upon which he founded, or which gave rise to the establishment of one of tin 1 most im- portant scientific truths — " the- conservation of energy," and finallv the "correlation of forces." which theory I am not 11 quite sure was correct, although it was accepted, and as yet 1 have not seen it questioned. In all due respect to him I quote.it from the sketch of that remarkable man, as given in the Popular Science Monthly, as specially hearing on my discovery: "Mayer observed while living in Java, that the cenovs blood of some of his patients had a singularly bright red color. The observation riveted his attention; he reasoned upon it, and came to the conclusion that the brightness of the color \\as due to the fact that a less amount of oxidation was suf- ficient to keep up the temperature of the body in a hot cli mate than a cold one. The darkness of the venous blood he regarded as the visible sign of the energy of the oxidation." My observation leads me to the contrary, that the higher the temperature the more rapid the breathing to get clear of theexcess of carbon, and hence more oxygenation of the blood which will arterialize the venous blood, unless there is a large amount of carbonized matter from the tissues to be taken up. Nor must it be denied because of the reasoning as pre sented to my mind by some outside influence in my so liloquy when 1 first exclaimed, "Nature's anaesthetic," where the argument as to the effects of nitrous oxide gas being due to an excess of oxygen was urged, and that com- mon air breathed in excess would do the same thing. 1 am not sure that it was correct, for the effect of nitrous oxide is, perhaps, due to a deprivation of mechanically mixed air. Knowing what 1 do of theory and practice, 1 can say with assurance that there is not a medical practitioner who would long ponder in any urgent case as to the thousand and one theories of the action of remedies, but would resort to the practical experience of others and his own, finally. (What surgeon ever stops to ask how narcotics effect their influ- ence?) Alter nearly thirty years of association will) ether and chloroform, who can positively answer as to their modus operandi: It is thus with nearly the whole domain of medi- cine. It is not yet, by far, among the sciences, with immu- table laws, such as we have in chemistry. Experimentation is giving us more specific knowledge, and "practice alone has tended lo make perfect." Then, gentlemen will not set at naughl my assertion and practical results. When 1 have stated my case in full it is for you to disprove both the theory and practice annunciated. So far as I am concerned I am responsible for both. You will please bear with me for a few minutes in my attempt at theory. The annulling of pain, and, in some cases, its complete anni- hilation, can be accomplished in many ways. Narcotics, an- aesthetics — local and internal — direct action of cold, and mes- meric or psychological influence, have all their advocates, and each ir ill surely do its work. There is one thing about which, 1 think, we can all agree, as to these agencies: unless the will is partially and in some cases completely subjugated there can be no primary or secondary effect. The voluntary muscles must become wholly or partially paralyzed for the time. Telegraphic communication must he cut off from the brain, that there be no reflex action. It is not necessary there should be separate nerves to convey pleasure and pain any- more than there should be two telegraphic wires to convey two messages. If, then, we are certain of this, it matters little as to 12 whether it was done by corpuscular poisoning and anaemia as from chloroform or hyperemia from ether. 1 think we are now prepared to show clearly the causes which effecl I he phenomena in " rapid breathing." The first thing enlisted is the dicerxion off/it will force in the act of forced respiration at a moment when the heart and lungs have been in normal reciprocal action ("20 respi- rations to 80 pulsations), which act could not be made and carried up lo 100 respirations per minute without such con- centrated effort that ordinary pain c< uld make no impression upon the brain while this abstraction is kept up. Second. There is a specific effecl resulting from enforced respiration of 100 lo the minute, due lo the ores* of en rboiiic iir'il t/iix xr{ free jrtini -.tin Hx.oiex. generated by ibis enforced normal act of throwing into the lungs fire time* the normal amount of oxygen demanded in one minute, when the heart has not been aroused to exalted action, which conies from violent exercise in running or where one i- suddenly startled, which excess of carbonic acid cannot escape in the same ratio from the lungs, since the heart does not respond to the proportionate overaction of the lungs. Third. Ilyperaemia is the last in this chain of effects, which is due to the excessive amount of air passing into the hums preventing but little more than the normal quantity of blood from passing from the heart into the arterial circula- tion, but damming it up in the lira in with its ex cos of carbonic- acid gas to act also directly upon the brain as well as through- out I be capillary and venous system, and as well upon the heart, the same as if ii were suspended in that gas outside the body. The-e are evident to the senses of any liberal observer who can witness a subject rapidly breathing. Some ask why is not this same thing produced when one has been running rapidly for a few minutes? For a very good reason: in this case the rapid inhalations are preceded by the violent throes of (he heart to propel the carbonized blood from the overworked tissues and have them set free at the lungs where the air is rushing in at the normal ratio of four to one. Thi> is not an abnormal action, but is of necessity, or asphyxia would instantly result and the runner drop. Such sometimes occurs where the runner exerts himself too violently at the very outset; and to do so he is compelled to hold his breath for this undue effort, and the heart cannot carry the blood fast enough. In this instance there is an approach to analgesia as from rapid breathing. Let me take up the first factor — dii'rrxinn ofirill — and show that nature invariably resorts to a sudden inhalation to pre- sent sevi re infliction of pain being felt. It is the panacea to childhood's frequent bruises and cuts, -nid every one will remember how when a tinner has be< n hurt it is thrust into the mouth and a violent number of efforts al rapid inhalation is effected until ease comes. By others it is subdued by a lit of crying, which if you will but imitate the sobs, will find how frequently the respirations are made. One is startled, and the heart would seem to jump out of the ehesl ; in quick obedience to nature the person is found making a number of quick inhalations, which subdue the heart and pacify the will by diversion from the cause. The same thing is observed in the lower animals. 1 will relate a case : An elephant had been operated upon for a diseased eye which gave him great pain, for which he was unprepared. 13 and he was wrathy at the keeper and surgeon. It soon passed off, and t lie result of the application was so beneficial to the animal that when brought out in a few days after, to have another touch of caustic to the part, he was prepared for them; and. just before the touch, he inflated the lungs to their fullest extent, which occupied more time than the effect of (he caustic, when he made no effort at resistance and showed no manifestation of having been pained. In many cases of extraction of the temporary teeth of chil dren. 1 make them at the instant 1 grasp the tooth take one very violent inhalation, which is sufficient. Mesmeric anaes- thesia can well be classified under diversion or subjugation of the will, but can he effected in but a small percentage of the cases. To rely upon this first or primary effect, except in instantaneous cases, would be failure. The second factor is the one upon which I can rely in such of the cases as come into my care, save when 1 cannot in- duce them to make such a number of respirations as is abso- lutely necessary. The \rhole mcret of soccexs lien in the ^great- est number of respiration- that can be effected in from 00 to III) seconds, and that without any intermission. If the heart, by the xloio method of respiration, is pulsating in ratio of four to one respiration, no effect run lie induced. When the respirations are. say, 100 to the minute, and made with all the energy the patient can muster, and are kept up while the operation is going on. there can hardly be a failure in the minor operations. It is upon this point many of you may question the fact-. Before I tried it for the first lime upon my own person. 1 arrived at the same conclusion from a course of argument, that rapid breathing would control the heart's action and pacify it. and even reduce it below the normal standard un- der my urgent respirations. In view of the many applications made 1 feel quite sure in my belief that, inasmuch as the heart's action i- bul slightly accelerated, thoimh with less force from rapid breath- ins: at the rate of 100 to the minute, (here is such an excess of carbonic acid gas set free and crowding upon the heart and capillaries of the brain, without a chance to escape by the lungs, that it is the same to ail intents as were carbonic acid breathed through the lung- in common air. Look at the result after this has been kepi up for a minute or more. During the next minute the respirations are not more than one or two. and the heart ha- fallen really lie- low, in some cases, the standard bent, showing most con- clusively that once oxygenation has taken place and that tin- free carbonic acid gas has been so completely consumed, there is no involuntary call through the pneumogastric nerve for a supply of oxygen. If any physiological facts can be proven at all. then 1 feel quite sure of your verdict upon my side. There is no one thing that goes so far to prove the theory of Lavoisier regarding the action of oxygen in the tissues and capillaries for converting carbon into carbonic acid gas instead of the lungs, as held prior to that time, and still held by many who are not posted in late experiments. At the time I commenced this practice I must confess I knew noth- ing of it. The study of my cases soon led me to the same theory of Lavoisier, as 1 could not make the phenomena agree with the old theory of carbonic acid generated only in the lungs. When Vierordt was performing his experiments upon 14 himself in rapid breathing from six times per minute to ninety-six, I cannot understand why lie failed to observe and record what did certainly result — an extreme giddiness with muscular prostration and numbness it* the peripheries of the hands and feet, with suffusion of the face, and such a loss of locomotion as to prevent standing erect without desiring support. Besides, the very great difference he found in the amount of carbonic acid retained in the circu- culation, the very cause of the phenomena just spoken of. One thing conies in just here to account for the lack of respiration the minute after the violent effort. The residual air, which in a normal state; is largely charged with car- bonic acid, has been so completely exhausted that some moments are consumed before there is sufficient again to call upon the will for its discharge. As to hypcncinia, you will also assent, now that my second factor is explained; but it is so nearly allied to the direct effect of excessive respiration that we can well per- mit it to pass without argument. If hypencmia in present, we have a more certain and rather more lasting effect. In conclusion, I will attempt lo prognosticate the applica- tion of this principle to the cure of many diseases of chronic nature, and especially tuberculosis; where from a diminished amount off air going into the lungs for want of capacity, and particularly for want of energy and inclination to breathe in full or excess, the tissues cannot get clear of their excre mentitious material, and particularly the carbon, which must go to the lungs, this voluntary effort can be made' fre quently during the day to free tin; tissues and enable them to take nutritious material for their restoration to their stand- ard of health. Air will be found of far more value than ever before as one of the greatest of factors in nutrition, and which is as neces- sary as proper food, and without which every organization must become diseased, and no true assimilation can take place without a due amount of oxygen is hourly and daily supplied by thi< extra aid of volition which has been so long overlooked. The pure oxygen treatment has certainly performed many cures; yet. when compared lo the mechanical mixture and under tin- direct control of the will, at all times and seasons, there is n<> danger from excessive oxygenation as where pure oxygen is given. When every patient can be taught to rely upon this great safety valve. of nature, there will be less need for medication, and the longevity of mil' race be increased with bin little dread by mankind of that terrible monster con sumption, which seems to have now unbounded control. When this theory I have here given you to-night is fully comprehended by the medical world and taught the public. together with the kind of foods necessary for every one in their respective occupation, location, and climate, we may expect a vast change in their physical condition and a hope for the future which will brighten as lime .advances. I herewith attach the sphygmographic tracings made upon myself by another, showing the state of the pulse as compared ■with the progress of the respiration. ADDENDA. Sphygmographic tracings of the pulse of the essayist. Normal pulse HO to the minute. Six seconds necessary for the slip to pass under the instrument. 15 A. Jl -A_Jl_JY_Jl_JV_ 3 C 7) ^F '•-* rf \„. G A, A 1 , normal pulse. B. pulse taken after breathing rapidly for 15 seconds when 20 respirations had been taken 0, rapid breathing for :{(') second-. 4:! respirations. r>. " •■ 4.-» rii •■ K., " " (50 ■' 96 F, pulse taken after rapid breathing for one minute, as in E, where no respiration had as yet been taken after the it; essayist had kept it up for that one minute. This was after 10 seconds had intervened. G, the same taken 50 seconds after, and still no respi- ration had been taken, the subject having no disposition to inhale, the blood having been over oxygenated. The pulse in E shows after 96 respirations but 14. or S4 per minute, and the force nearly as in the normal at A. A 1 . The record in 1> shows the force more markedly, hut still normal in number. F and G show very marked diminution in the force, but the number of pulsations not over 72 per minute; G particularly so, tin; heart needing the stimulus of the oxy- gen for full power. The following incident which has but very recently been made known, gives most conclusive evidence of the truth of the theory and practice of rapid breathing. A Mexican went into the office of a dentist in one of I he Mexican cities to have a tooth extracted by nitrous oxide gas. The dentist was not in, and the assistant was about to permit the patient to leave without removing the tooth, when the wife of the proprietor exclaimed that she had ofti n assisted her husband in giving the Lias, and that she would do so in this instance if the assistant would extract the tooth. It was agreed. All being in readiness, the lady turned on, as she supposed, the iras. and the Mexican patient was ordered to breathe as fast as possible to make sure of the full effect and no doubt of the final success. The assistant was about to extract, but the wife insisted on his breathing more rapidly, whereupon the patient was observed to become very dark or purple in the face, which satisfied the lady that the full effect was manifested, and the tooth was extracted, to the great satisfaction of all concerned. While the gas was being taken by the Mexican the gasome- ter was noticed to rise higher and higher as the patient breathed faster, and not to sink as was usual when the gas had been previously administered. This led to an invest] gation of the reason of such an anomalous result, when to their utter surprise they found the valve was so turned by the wife that the Mexican had been breathing nothing but common air, and instead of exhaling into the surrounding air he violently forced it into the gasometer with the nitrous oxide gas. causing it to rise and not sink, which it should have done had the valve been properly turned for the pas- age of gas into the lungs of the patient. No more beautiful and positive trial could happen, and might not again by accident or inadvi rtence happen again in a lifetime. A similar case was related to me, by the dentist in charge. which happened in Arlington, Del., but he could not, as in the case of the Mexican, understand why it was so. UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. 3iomed, JLib. MAR .1 1963 MM * \m - '* MAR 2? Form L0- ll6m-8,'62(T)1237s8)444 UC SOUTHERN REGIOMAL LIBRARY FACIL A A 000 152 020