Vol. 60, 1909 - University of North Carolina at Chapel Hill

XXVIII THE CHARLOTTE MEDICAL JOURNAL.
from innc-cuous, and if used too freely is diminish the first pain of the wound, and
liable to cause serious or even fatal results, the intestines are usually active soon after
Its action appears to be twofold, both the the operation. On the other hand, many
bismuth and the nitrate radical causing patients complain much of thirst, and condefinite
symptoms of poisoning. These in- siderable mental confusion is often evident,
toxications are serious, for even when nor For spinal analgesia, the author uses novofatal
they are chronic in nature, and may caine with the addition of a small amount
cause decided discomfort over periods of of suprarenin. Anesthesia usually sets in
many months. In this connection it is of in fifteen minutes and lasts from one to two
interest to find in the Miincheiter mcdisin- hours.
isck: Wochenschrift for June 8, 1909, a brief The only cocaine substitutes which are at
note by Karl Taege of Freiburg describing present employed are tropacocaine, novoa
method by which iron can be substituted caine, and stovaine. The first and second
for bismuth in x-ray diagnosis. The ob- are only slightly toxic, while the last is supjection
to a watery suspension of iron is posed to stimulate the heart. The disadthat
the metal sinks rapidly, and is not vantages are stated to be: of tropacocaine,
evenly distributed, while an oil emulsion is the short duration of anesthesia; of stovaine,
disagreeable to physician and patient alike, the occasional symptoms of intoxication;
Taege, therefore, suggests as a substitute and of novocaine, the lowering of bloodau
emulsiiou in tragacanth. He grinds pressure. The anesthesia is indicated in
iron oxide in a mortar with tragacanth
powder and then shakes the mixture thoroperations
in which chloroform is not safe
—on the lower part of the body, or in old
oughly with water in a flask. Enough patients when it is desirable to have them
tragacanth must be used to make the final get up soon. Spinal analgesia is contrainwatery
solution contain about one per cent, dicated in nervousness, anemia, cachexia,
of the substance. This gives a syrupy fluid and tendency to headaches, as well as in
in which the iron oxide remains in suspen- marked obesity. The chief after-effects folsion
for hours. If this iron preparation lowing the use of novocaine are vomiting
acts as well in obstructing the x rays and
is less toxic than bismuth subnitrate, it
and occasionally secondary hemorrhage,
while later there may be meningismus or
should prove a valuable substitute for the
latter more dangerous drug.— Berliner klinpareses
of cerebral or
Therap. d. Gegenwart.
spinal nerves.
ische Wochenschrift.
The Final Results ol Tracheotomy.
Recent Methods of Inducing Anesthesia. W. Wolf instituted an inquiry as to the
fate of those children who had been trach-
Special masks for anesthetizing have eotomised for laryngeal diphtheria between
been recommended by Geppert. Roth-Drae- 1395 and 1906 in Trendelenburg's Clinique
ger, and others, but the ordmary mask is at Leipzig. During this period 404 patients
still the most popular, both for ether and ^vere tracheotomised, of whom 264 were
chloroform. W. Busse states that it is not discharged cured. The high mortality was
generally known that many small opera- due to the fuct that many of the patients
tions can be performed in the first stage of ^ere moribund on admission. Wolf was
ether narcosis: It IS only necessary to in- able to trace 173 of these patients: 145, or
struct the patient to breathe deeply seven to 85.5 per cent, were free from any sympeight
times, and then to press a mask satur- toms; 18, or 10.7 per cent, were singers or
ated with 10 Cc. of ether firmly upon the athletes; 24, or 14.2 per cent., since the
face. The anesthesia lasts from five to ten operation had sufi^ered from hoarseness,
minutes, and is not usually followed by nau- shortness of breath, and colds; 7 cases, or
sea or ottiei aiter-etiects. ^ \ percent., presented more serious sequlse;
Scopolamine and morphine have been em- 4 showed signs of tuberculosis, but in 3
ployed subcutaneously, but generally a there was a family predisposition. One
small amount of chloroform is required also, had a permanent fistula, and the other two
This method of anesthesia is used by prefer- had had repeated attacks of pneumonia,
ence in cystoscopy and in obstetrics, yet No case of cicatricial stenosis was observmay
diminish the intensity of the labor ed. This was probably due to the fact that
pains and injure the child. Morphine- the lower operation had been perfomed in
scopolamine may also be used in conjunc- every case. Wolf concludes that serious
tion with spinal analgesia, especially in sequelte after tracheotomy are not frequent,
gynecological work (3 injections, each of 5 that the mortality from tracheotomy and
decimilligrams scopolamine and 0.5 centi- intubation are exactly the same, and that
gram of morphine are used, 2>2, 1>2, and Landouzy's statement that tracheotomy
]2 hours before the operation). The anes- predisposes to tuberculosis is not justified.
"thesia is usually of suflacieut duration to —British Journal of Children's Diseases.
—