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portation. Three drops, .20 c.c., to 4 oz., 120. c.c., of urine
is sufficient. Allow the chloroform to evaporate before testing
the urine.]

Internal. Mouth. If concentrated, it produces irritation
and a burning sensation. If diluted, it has a sweetish taste,
which renders Aqua Chloroformi a valuable vehicle for the ad-
ministration of nauseous drugs. It reflexly gives rise to an in-
creased secretion of saliva, and is a local anaesthetic.

Stomach. The action of chloroform is very like that of
alcohol. Large doses cause marked gastro-intestinal irritation.
Small doses produce a feeling of warmth, dilatation of the gastric
vessels, and increased secretion of gastric juice, and more regular
and more powerful gastric movements. It is perphaps slightly
astringent to the intestines.

Absorption. It is absorbed into the blood from the stomach
and intestines, and, if given as vapor, from the lungs ; but it is
very uncertain what changes it subsequently undergoes. Pro-
bably most of it is decomposed, but some is certainly eliminated
in the breath and some in the urine, and it may be found in the
blood of those who have been poisoned by it.

Temperature. The internal temperature falls about i F.
[0.5 C.] after the prolonged administration of chloroform.

Nervous system. Chloroform is an excellent instance of the
law of dissolution (see p. 104), and also of the well known fact
that drugs which, in small doses, stimulate any part, in large
doses often depress it. The phenomena resulting from the in-
halation of chloroform are commonly divided into three stages.

First stage. This is, at first, one of general stimulation, the
highest functions being the most stimulated, usually unevenly, so
that the patient is somewhat incoherent. The imagination is
momentarily excited, and he experiences a general feeling of
warmth and comfort spreading over the entire body. The mind,
from the irregular excitation, is confused. Sight and hearing are
stimulated, he experiences sensations of ligh't and hears noises.
The stimulation of all these higher functions is very transitory,
and he quickly begins to lose consciousness ; he may be aware



CARBON AND ITS COMPOUNDS. 293

that people around him are talking without knowing what they
are saying, but soon he hears and sees nothing. Sometimes dur-
ing the early part of this stage he may laugh or cry. The inabil-
ity to see and hear is quickly followed by considerable blunting
of general sensation. At the same time that these higher func-
tions are being depressed the lower motor functions are excited ;
he will kick and fight, throwing his arms and legs about, so that
much strength may be required to hold him down, and he will
shout and talk incoherent nonsense very louldly. Almost coinci-
dently the stimulation of the lower centres sets in ; the pulse is
increased in frequency, and there is throbbing of the heart and
great vessels. The first inhalation or two may produce a choking
sensation and a stoppage of breathing, which is often voluntary ;
but soon the respirations are increased in frequency. The blood-
pressure at first rises a little, and the face may be flushed. The
pupils usually dilate.

Second stage. This is best called that of depression. Some
authors call it the stage of excitement, because the excitation of
the motor centres may be continued into it. It is important to
remember that there is no sharp boundary-line between the various
stages, they pass insensibly into one another. In this stage the
depression of the highest functions continues, so that the patient
becomes completely unconscious, and he appears to be in a deep
sleep. He sees, hears and feels nothing, hence chloroform is
called a general anaesthetic. The excitement of the motor
functions passes into depression, and he ceases to shout and strug-
gle. Some of the reflex centres are depressed, so that when the
cornea is touched the eye does not shut. The pupil is contracted.
The stimulation of the cardiac and respiratory apparatus gives way
to depression, the pulse and respiration become less frequent and
less strong. The vaso-motor centre is depressed, blood-pressure
falls. As he cannot feel pain, and the reflex activity is so lowered
that the heart will not be reflexly inhibited by the shock of an
operation, this is the period at which to operate safely.

Third stage. In this there is a total abolition of reflex excit-
ability. Even the lowest reflex centres of the cord are depressed,
so that the patient may pass his urine and faeces [involuntarily] ;



294 INORGANIC MATERIA MEDICA.

all muscular tone is abolished, and consequently the muscles are
quite flaccid. Some of them, as those of the arm, were probably
in this condition towards the end of the second stage. The
pupil is widely dilated, probably because of the commencing
asphyxia. This is the period to which the administration is
pushed to facilitate the reduction of dislocations, or to enable
the abdominal viscera to be felt through the abdominal wall. If
still more chloroform is given the depression of the cardiac, respi-
ratory and vaso-motor centres continues, the pulse becomes feeble
and irregular, and the heart finally stops in diastole. At last not
only its central nervous apparatus, but its muscular tissue is
depressed, so that it will not respond to mechanical stimulation.
The respiratory movements become slight and irregular, with
very long pauses between them, and as a result the patient is more
or less asphyxiated. The blood -pressure gradually falls to zero.
There has been much dispute as to whether chloroform kills by
the heart or the respiration. The Commission appointed by the
Nizam of Hyderabad reported that it killed by depression of the
respiratory centre, that respiration always failed before the heart,
and that the fall of blood-pressure was not due to any effect
on the heart. But their results have been disputed, and it has
been shown that the fall of blood -pressure is mainly due to a
weakening effect on the heart. [In the United States it has
been generally believed that death is from depression of the
heart.]

The recovery from chloroform also illustrates the law of dis-
solution. The lowest functions, such as muscular tone, are the
first to reappear ; but the patient does not usually regain his
mental equilibrium for hours.

With the exception of its local action on the skin and ali-
mentary canal, and its last effect on the cardiac muscle, chloro-
form acts entirely on the central nervous system, and this action
is not the result of any effects on the blood. The peripheral
nerves are not affected, unless it be just before death. Chloro-
form narcotizes infusoria.

Vomiting is very liable to occur during the administration of
chloroform, and its advent is often made known by pallor and '



CARBON AND ITS COMPOUNDS. 295

wide dilatation of the previously contracted pupil. Immediately
before death the pupil may be either dilated or contracted.

THERAPEUTICS OF CHLOROFORM.

External. Chloroform is employed in the form of the lini-
ment to produce rubefacient and irritant effects in cases of chronic
rheumatism, myalgia and chronic inflammations.

Internal. It may be used as a local anaesthetic for tooth-
ache, the tooth being plugged with a piece of cotton soaked in
chloroform. It disguises the taste of nauseous medicines, and
therefore Aqua Chloroformi is a very common vehicle and Spiritus
Chloroformi is much used as a flavoring agent. In the stomach
it acts like alcohol, and is given in the same varieties of dyspepsia
as are benefited by that drug. Small doses may be used as a
cardiac stimulant.

Inhalation. It is inhaled to abolish sensations of pain,
whether from surgical operations, biliary, renal and intestinal
colic, or parturition. In the last case [but little] need be given.
It is also inhaled to relax muscular spasm, as in the reduction of
dislocations or hernias, or for the relaxation of muscles for diag-
nostic purposes, as, for example, when we wish to feel the abdom-
inal viscera thoroughly, or to [ascertain] whether a swelling is a
phantom tumor ; or, lastly, it is inhaled to relax spasm in cases
of tetanus, hydrophobia, or other varieties of convulsions. The
A. C. E. mixture, which consists of alcohol, i, chloroform, 2,
and pure ether, 3 vols., is very commonly employed for all these
purposes. It is said to be safer than chloroform. All of its
three constituents volatilize from it at an equal rate.

The following points should be attended to in the administra-
tion of chloroform :

[i. The anaesthetizer must be skilled, and give his attention
exclusively to the production and maintenance of narcosis.]

2. The respiration and pulse should be carefully watched for
any signs of failure.

3. The operation should never be begun till reflex action is
profoundly depressed that is to say till the stage of muscular
relaxation has commenced. Many patients have been lost from



296 INORGANIC MATERIA MEDICA.

neglect of this precaution, for the stimulus of the knife has
reflexly stopped the heart. It is a common and dangerous error
to think that, because the operation is trivial, it may be begun
early ; most of the deaths from chloroform have taken place when
the operation has been slight.

4. Great care must be exercised if the heart is fatty or feeble
from any cause, or if the patient suffer from disease of the lungs,
or if he may be very old.

5. In operations about the mouth care must be taken to see
that no blood gets down the trachea.

6. It is desirable to have the stomach empty, therefore no
solid food should be given for some hours before the administra-
tion. The patient's head must be so directed during vomiting
that no vomited matter can get into the larynx.

7. False teeth should be taken out of the mouth.

8. The chloroform must be pure.

9. It should not be too concentrated. About 5 per cent, of
chloroform to 95 per cent, of air is a good mixture.

10. The head should be a little raised, and the lower jaw held
up so that the tongue shall not fall back over the larynx.

it. Special care must be taken when the operation necessi-
tates awkward positions, especially if respiration is interfere/! with,
as in the lateral position used in obstetrical, [gynaecological] and
renal cases.

12. Because the temperature falls the patient should be kept
warm.

[13. Chloroform should never be administered without an hy-
podermatic syringe, in good order, being at hand. Amyl nitrite,
ether and ammonia should be in readiness.]

If the breathing becomes very weak, or stops altogether, arti-
ficial respiration should at once be commenced, the tongue being
pulled forward by forceps to allow free entry of air to the lungs.
The face and abdomen should be flicked with wet towels, a cap-
sule of amyl nitrite may be inhaled, and ether injected subcu-
taneously. [Brandy should not be administered hypodermati-
cally. The heart may be stimulated by large rectal injections
of hot normal saline solution, or of hot decoctions of coffee, if



CARBON AND ITS COMPOUNDS.

at hand.] It is [extremely questionable] whether galvanization
over the cardiac area is of any use ; it [doubtless] does harm. [If
symptoms of improvement do not appear at once, the patient
should be inverted.] Artificial respiration should be maintained
at least an hour or so, even if there is no sign of returning life ;
and if there is the slightest evidence of a cardiac beat, or a single
automatic respiratory movement, artificial respiration must be
persevered in even for many hours. If the face be pale, the head
should be lowered, and amyl nitrite is especially likely to be
useful. [In spite of all care in administration and the observance
of all precautions, one death takes place in about three thousand
administrations. Hare and Thornton, after a painstaking series
of experiments, believe chloroform to be safe for the majority of
cases, provided it be given by one skilled in its use, and who not
only knows how to give it, but to detect signs of danger. The
respiration should be watched, because so soon as enough chloro-
form is used to endanger the circulation, the respiration will show
some abnormality. Death in the healthy animal is always due to
respiratory failure, accompanied by circulatory depression which
may be severe enough to cause death, even if artificial respiration
be skillfully used. Chloroform may be chosen in hot climates ;
when a large number of persons are to be anaesthetized; in
Bright's disease; in aneurism ; or in great atheroma of blood-
vessels ; in children or adults who already have bronchitis ; and
in persons who struggle violently.]

IV. AETHER.

ETHER. [(C,H 5 ),O=73.84. Synonyms. Sulphuric Ether. Ethylic
Ether. Ethyl Oxide. A liquid composed of about 96 per cent., by weight,
of absolute Ether, and about 4 per cent, of Alcohol containing a little water.

SOURCE. Alcohol is distilled with Sulphuric Acid. Ethyl Sulphuric
(Sulphovinic) Acid and water are first formed. C 2 H 5 OH-f-H 2 SO 4 =C 2 H 5 HSO 4
-|-C 2 H 5 OH (C 2 H 5 ) 2 O-f-H 2 SO 4 . This process is theoretically continuous, the
Sulphuric Acid last formed again acting on fresh Alcohol as it is supplied.
The Ether is freed from water by re-distillation with Calcium Chloride and
Lirne.

CHARACTERS. A transparent, colorless, mobile liquid, having a charac-
teristic odor, and a burning and sweetish taste. It is very inflammable, boils at



298 INORGANIC MATERIA MEDICA.

about 98.6 F. ; 37 C, and burns with a white flame. Sp. gr., 0.725 to 0.728.
Solubility. In about 10 volumes of water.]

IMPURITIES. Water, alcohol and fixed impurities.

Dose, 5 to 60 m. ; [.30 to 4.00 c.c.]

Preparations.

1. Spiritus Athens. [Spirit of Ether. Ether, 325 ; Alcohol, 675.
Dose, ' 4 to i fl. dr. ; i. to 4. c.c.

2. Oleum ^Bthereum. Ethereal Oil. A volatile liquid com-
posed of equal volumes of heavy Oil of Wine and Ether. Alcohol,
1000 ; Sulphuric Acid, 1000 ; distilled water, 25 ; Ether, a sufficient
quantity ; by distillation.

CHARACTERS. A transparent, nearly colorless, volatile liquid, of
a peculiar, aromatic, ethereal odor, a pungent, refreshing, bitterish taste,
and a neutral reaction. Sp. gr., 0.910.
Ethereal Oil is used to prepare Spiritus yEtheris Compositus. ]

3. Spiritus ^theris Compositus. [Compound Spirit of Ether.]
Synonym. Hoffman's Anodyne. [Ether, 325 ; Alcohol, 650 ; Ethe-
real Oil, 25.

Dose, 5 to 60 m. ; .30 to 4.00 c.c.]

ACTION OF ETHER.

External. Ether evaporates very quickly, producing great
cold, and consequently the part to which it has been applied
becomes white from the contraction of the vessels. The cold is
sufficient to cause such marked local anaesthesia that the pain
of slight operations, performed upon the part anaesthetized, can-
not be felt. To produce this result ether is best applied as a fine
spray. If it be rubbed in, or evaporation be prevented, it, like
alcohol or chloroform, is an irritant.

Internal. In the mouth and stomach also it acts like chlo-
roform or alcohol. Thus ether causes a burning taste in the
mouth, an increase of the saliva, of the gastric secretion and gas-
tric movements, and dilatation of the vessels of the stomach.
Consequently it is carminative and aids digestion. Directly
[after] it reaches the stomach it reflexly excites the heart, in-
creasing the force and frequency of the pulse, and causing a rise
of blood-pressure ; it is one of the best cardiac stimulants



CARBON AND ITS COMPOUNDS. 299

we have. In the same way it excites respiration. It is quickly
absorbed, and its stimulating influence on the heart and respira-
tion is continued. It is thus a good instance of a rapidly dif-
fusible stimulant. It is also anti-spasmodic.

Nervous system. Ether is a powerful general anaesthetic.
The phenomena and stages of ether anaesthesia are so like those
of chloroform anaesthesia that the description already given (see
p. 292) will suffice. The following differences, however, should
be noticed :

(1) The heart is paralyzed with much greater difficulty by
ether than by chloroform.

(2) The same is true of the vaso -motor centre.

(3) And also of the respiratory centre.

(4) Ether is much more irritant to the respiratory mucous
membrane, and hence is more liable to increase bronchitis in
those already suffering from it.

(5) [Ether is much more likely to irritate the kidneys, and
those suffering from the various forms of acute or chronic renal
disease, or even from renal insufficiency, should be subjected to
ether anaesthesia only when it is administered with the greatest
caution.]

(6) With ether the stage of stimulation is more protracted,
therefore there is more struggling.

(7) For the same reason the anaesthetic stage is not reached
so soon.

(8) The reduction of temperature is greater with ether.

(9) Ether must be given nearly pure, about 30 per cent, of
air to 70 of ethereal vapor ; hence it is more difficult to ad-
minister.

(10) The smell of ether is more disagreeable, and patients
dislike it more.

(n) Ether is eliminated more slowly, and hence the [odor
lingers] about the patient some time.

(12) Ether being very inflammable cannot be used in the
close neighborhood of a naked light.

[Ether, on account of its greater safety, is more generally used
as an anaesthetic in the United States.]



3OO INORGANIC MATERIA MEDICA.

THERAPEUTICS OF ETHER.

External. Ether, allowed to evaporate, may be used to
cause local anaesthesia in cases of neuralgia. An ether spray is
occasionally employed to produce local anaesthesia for small
operations, but as the ether makes the skin hard and brawny the
operation must be quite superficial, and even then there is much
subsequent tingling and pain.

Internal. Stomach. It may be used for the same classes
of dyspepsia as chloroform or alcohol, and is often employed as
a carminative to expel gas in flatulent dyspepsia.

Heart. Administered subcutaneously (dose, xoto 15 minims)
[.60 to i. oo c.c.] or by the mouth, ether is an excellent cardiac
stimulant of great value in fainting, cardiac failure, or palpita-
tion ; its advantage over chloroform and alcohol being that it is
more rapid in its action. It is, very useful as an and spasmodic
during an attack of asthma.

Inhalation, Ether is inhaled for the same purpose as chloro-
form. There is great divergence of opinion as to which is the
safer anaesthetic. All the published statistics in which the two
are contrasted appear to show that ether is much safer, and this
is what might have been expected from the contrast between the
two already given. Chloroform is administered carelessly more
often than ether, as it is easier to give ; but even allowing for
this, ether is probably, on the whole, safer. The nausea and
vomiting which sometimes follow the administration of ether
may, it is said, be checked by giving 15 grains [i.oo gm.] of
sodium bromide. Very often anaesthesia is commenced with a
few inhalations of nitrous oxide gas, and then completed with
ether. This is much pleasanter for the patient than to use
ether from the first.

V. AETHER ACETICUS.

ACETIC ETHER. C 2 H 5 C 2 H 3 O 2 [=87.8. Synonym. Ethyl Ace-
tate. A liquid composed of about 98. 5 per cent., by weight, of Ethyl Acetate
and about 1.5 per cent, of Alcohol, containing a little water.

SOURCE. A mixture of Sodium Acetate, Sulphuric Acid and Alcohol is
distilled. C



CARBON AND ITS COMPOUNDS. 301

The distillate is purified from acid and water by digestion with Potassium
Carbonate.

CHARACTERS. A transparent, colorless liquid, of a fragrant and refreshing
slightly acetous odor, and a peculiar, acetous, and burning taste. Sp. gr.,
0.893 to -895. Solubility. In 8 parts of water; freely in Alcohol or
Ether.]

Dose, 20 to 60 m. ; [1.20 to 4.00 c.c.]

ACTION AND THERAPEUTICS OF ACETIC ETHER.

It acts like ether, as a stimulant, antispasmodic, and carmina-
tive, but it has a pleasanter taste.

VI. [.ETHYL BROMIDUM.

ETHYL BROMIDE (not official). C 2 H 5 Br=io8.7O. Synonyms.
Either Bromatus. Hydrobromic Ether. This must be carefully distinguished
from Ethylene Bromide.

SOURCE. From a well cooled mixture of Sulphuric Acid, 12 ; and Alco-
hol (sp. gr. , 0.816), 7 ; to which powdered Potassium Bromide, 12, is added;
this mixture is distilled. The distillate is washed by agitation, first with a 5
per cent, solution of Potassium Carbonate, then with an equal volume of water ;
finally it is dehydrated with Calcium Chloride and re-distilled.

CHARACTERS. A colorless, highly refractive, very volatile liquid having a
strong ethereal odor and a sweetish, warm taste. Sp. gr., 1.445 to l-45- I*
is easily decomposed by light and air.

ACTION AND USES OF ETHYL BROMIDE.

Ethyl Bromide was introduced to the profession in 1880 as
the most agreeable and rapid anaesthetic. Several fatal cases
having been reported, its use was abandoned. Recently, how-
ever, Cumston has recommended its inhalation, when pure, in
doses of from 3 fl. dr.; 12. c.c. (child of two years), to 6 fl. dr.;
24. c.c. (adult), for surgical anaesthesia. The following pre-
cautions should be observed : Food, even a glass of milk, is ab-
solutely forbidden on the day of operation. The mask should
perfectly cover the mouth and nose, so that no air is allowed to
enter. The entire dose should be given at once. When nar-
cosis is complete, the mask should be removed, and under no
consideration be re-applied. Do not prolong the administration
over one minute. Sleep is obtained in from twenty to thirty
seconds, and lasts from two to three minutes, sometimes longer.



3O2 INORGANIC MATERIA MEDICA.

The centra-indications to its use are dangerous lesions of heart,
lungs, or kidneys.

VII. BROMOFORMUM.

BROMOFORM (not official). CHBr 3 =252.25. Synonym. Tri-
bromomethane.

SOURCE. By the action of Sodium Hypobromite (which is obtained when
Bromine is added to a solution of Sodium Hydroxide) on Acetone.

CHARACTERS. A clear, colorless liquid, of a peculiar odor, and a sweetish
taste. Sp. gr., 2.90. Solubility. Slightly in water, but readily in Alcohol.
It must be kept protected from light.

Dose, i to 5 m. ; .06 to .30 c.c.

ACTION AND USES OF BROMOFORM.

Bromoform, an analogue of chloroform, is an anaesthetic.
Inhaled, it produces anaesthesia in animals, but of shorter dura-
tion than that of ether or chloroform. It is a remedy of value
for whooping-cough, for which its pleasant taste and convenience
of administration gives it great advantage. It can be given
bromoform, i ; in a mixture of alcohol, 8 ; glycerin, 48 ; and
compound tincture of cardamom, 8. Each fluid drachm ; 4 c.c.,
contains about 3 minims ; .20 c.c. of the drug. Cases of poison-
ing have been reported, so that it must be used with care.

VIII. PENTALUM.

PENTAL (not official). C 5 H 10 =69. 85. Synonym. Trimethylethylene.

SOURCE. It is obtained from Amylic Alcohol by digestion with Zinc
Chloride for twenty-four hours, and fractional distillation.

CHARACTERS. A colorless liquid, very volatile, insoluble in water, but
miscible in all proportions with Alcohol, Ether, and Chloroform ; highly in-
flammable. Sp. gr., 0.620.

ACTION AND USES OF PENTAL.

Pental is an anaesthetic, the equal of nitrous oxide in rapidity
of action and perhaps safety, but superior to it in its more pro-
longed action and in having no unpleasant after-effects. Even
when insensibility to pain is reached, consciousness is retained
sufficiently to respond to commands. The stage of exhilaration
is seldom present ; it does not lose its effect by repeated inhala-
tions. It differs from chloroform in that it acts more promptly,



CARBON AND ITS COMPOUNDS. 303

and has no evil after-effects ; from ethyl bromide, in that it is
somewhat slower in its action, but is more lasting in its effects,
and can be prolonged as may be necessary ; from nitrous oxide,
in its freedom from unpleasant effects.

Two substances used to produce local anaesthesia should be
considered. These are ethyl chloride {synonym, hydrochloric
ether) and methyl chloride (neither official).]

Ethyl chloride is an inflammable liquid of a low boiling-
point and produces intense cold by its evaporation. It is sold
in glass capsules terminating in a fine tube with a screw -capped
point. When the capsule is held in the hand about eight inches
from the part to be anaesthetized, the warmth of the hand vola-
tilizes the ethyl chloride, and the vapor falling on the skin of
the patient, by its evaporation produces enough local anaesthesia
for the performance of small operations, such as the removal of
warts, etc. All fat must be removed from the skin by soap and



Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 26 of 67)