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sufficiently numerous to serve as the basis of some general deductions, and as their generally favorable character indicates that it is important that further observations shall be conducted, the following suggestions may be briefly stated :
Cases of single, superficial, and circumscribed cavity with comparatively little surrounding disease, and without implication of the other lung, are best adapted for local treatment by injections.
Cases of cavity, with extensive disease of the surrounding lung or of the other lung, hold out no prospect of permanent benefit from local treatment; but, nevertheless, much relief may be afforded to certain symptoms, as frequent paroxysmal cough connected with efforts to empty the cavity, or fetid expectoration.
In cases of extensive consolidation of lung tissue, there is no good to be expected from injections into the diseased area.
In cases where there is circumscribed partial consolidationas in the first stage of catarrhal phthisis—which persists obstinately and tends to spread despite the use of other measures (hygienic care, change of climate, suitable internal medication, etc.), or, where the most important of these favorable influences cannot be secured, injections of medicated liquids into the diseased tissue may be tried with propriety.
It will thus be seen that more extended experience has amply confirmed the conclusions reached in 1874.1
| Loc. cit., p. 341.
ÆTHER HYDROBROMICUS-BROMIDE OF ETHYL.
Formula C, H, Br.
Molecular Weight, 109.
BY LAURENCE TURNBULL, M.D.,
Diseases of the Eye and Ear, Howard Hospital.
HISTORY OF THE PREPARATION.
HYDROBROMIC ETHER has now acquired considerable reputation as an anæsthetic. It was discovered by Serullas, in 1827, but attracted no special attention until Dr. Vunnelly, of Leeds, made some experiments with it on animals, and published them in 1849 (Transact. Provincial Association). Dr. Nunnelly brought this and another agent again before the profession, and read a paper before the British Medical Association in 1865, a report of which was published in the journal of that association, in which it was stated that he had used either hydrobromic ether or chloride of olefiant gas, in all the principal operations at the Leeds General Eye and Ear Infirmary, but his experiments were not corroborated by any one else. “This was, as well observed by a recent experimenter,' at a time when chloroform held such complete sway in England, that no importance was attached to Nunnelly's experiments, and he had no followers.” In 1876, some experiments were made with it in France, by Rabuteau, on the lower animals, but evidently without a knowledge of the fact that this had been done previously in England. I was the first again to make known the anesthetic properties of hydrobromic ether to the profession.
Without the knowledge that Dr. Nunnelly had performed any experiments on animals or man, I had the ether made by Mr. Joseph R. Remington, a chemist of Philadelphia, in July, 1877, and first placed dogs, cats, frogs, and pigeons under its anæsthetic influence, and found them to recover promptly. I then
Dr. Marion Sims, Medical Record, New York, April 3, 1880, p. 361.
subjected myself to its anæsthetic properties, and discovered at times an increase of the pulse and respirations, but not any disagreeable symptoms, except those reported by me.'
After fully satisfying myself of its efficiency and safety as an anästhetic, I laid the following statement before the Medical Society of the State of Pennsylvania, at its annual meeting held at Pittsburgh, May, 1878, having arrived at the following conclusions, which were published in the Transactions of that year.
“ In ten cases, the shortest time required to place a patient under hydrobromic ether was thirty seconds; longest tinie, four minutes; average time, one minute and a half. Vomiting occurred in three cases out of the ten, when food had been taken prior to the use of the agent. Excitement (hysterical) in two cases; prostration in one case; no asphyxia or fainting. The advantages of this agent over other anæsthetics is the rapidity of its elimination from the system by respiration, with increase of pulse and respiration.
Action on the Lower Animals.-IIydrobromic ether produces absolute anesthesia with dogs, rabbits, and frogs, in a shorter period than even chloroform or ether. There is a pricking feeling of the skin at the elbow, and in the hands, with a rapid loss of power to move. The brain is comparatively free, the pupils are not much affected; the skin, in some few instances, is cold and moist, but in the majority of cases, natural.
It differs from ordinary ether in the stage of excitement being shorter, the sedation and the subsequent elimination more rapid."
My next contribution, comprising twentyfive cases, was published in the second edition of my Manual of Anesthetics, 1879, p. 295. I first noticed symptoms of great rigidity; avd it required 3j of hydrobromic ether to bring the patient under anæsthetic influence. This condition I have noticed as a peculiarity in certain cases, the effects resembling those of uitrous oxide gas. The number of cases in which it was used began to increase rapidly, and in September, 1879, I reported one hundred cases at Amsterdam, at the meeting of the Medical Congress of all Nations. On my return, the number, after a few months, had rapidly increased by other operators all over the country. I found that this agent was being made by two or three chemists, but some of the specimens were not pure, and contained a
| A Manual of Anesthetic Agents, 1st edition. Lindsay & Blakiston, March, 1878.
heavy distillate, which caused the ether to have a disagreeable odor and taste. In January, 1880, the writer read a paper before the Philadelphia County Medical Society on the new anesthetic, which was published in the Phila. Med. Times.
The following were my statements in regard to the anæsthetic as compared with certain others now in use by the profession.
“IIydrobronic ether possesses the following properties:
1. It is an anesthetic, which, with care, may be safely administered to man and animals.
2. It is more rapid in producing anesthesia than even chloroform, and is eliminated by respiration and the kidneys, more rapidly than any other of this class of agents.
3. The heart and respiration are but very slightly affected, unless employed in excessive quantities.
4. Vomiting is more rare than with ether or chloroform.
5. Owing to its odor being more rapidly removed, it can be used with comfort in a private office, or the patient's chamber; and, as a rule, the odor is more agreeable than that of ordinary ether.
6. Hydrobromic ether not being inflammable, and producing its anesthetic influence on the muscles of the throat, any operation can be performed on the mouth and throat with satisfaction to the surgeon, and comfort to the patient.
7. In vivisection, it acts more promptly than ether upon animals, requiring, as a rule, only two minutes to bring a dog under its influence, and it is not fatal like chloroform."
How often was there nausea and vomiting during the administration of hydrobromic ether? In one hundred cases, there were twelre cuses of slight nausea after the operation, and eight cases of vomiting during the operation; but always where the patient had partaken freely of food of a solid character, just prior to the use of the anæsthetic.
Asphyxia.— This disagreeable and painful symptom was not noticed in any of the cases.
Fainting.-In no instance was there any evidence of fainting.
Hysterical Excitement, or rigid Muscular Spasm.—This was noticed in some six cases, but soon passed away, leaving no bad symptoms.
Prostration.-In four cases there was some prostration evinced by cold moisture on the hands and face, but of very short duration.
| Anæsthetic Manual, 2d edit., p. 294.