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THE DANGER OF ALL ATTEMPTS AT ARTIFICIAL RESPIRATION, EXCEPT IN THE PRONE POSITION.
would
seem that we can only obtain from them excitement collapse, and that the medium state, which constitutes essentially "tolerance," cannot be produced. They commence, as do nearly all subjects, by excitement, and arrive at collapse; but as soon as this is about to finish, it gives place to new excitement. It is only in children, in certain women, or in adults very debilitated, that we pass from the period of excitement to that of "tolerance" without observing the state of
or
dressing, I haemorrhage application
collapse. The employment
of chloroform would leave nothing to deif one could succeed in freeing it from the states of excitement and collapse, and in establishing at the outset that of " tolerance." This certainly is observed sometimes, but in an exceptional manner; and the means which have appeared to us the most proper to produce this advantageous result, are the slowness and the well-managed graduation of the inhalation. We see, after what has been said, that the surgeon gives himself much more trouble when he wishes to obtain in his patient the state of tolerance; but if he succeeds in obtaining it, he is amply recompensed by the assistance which it contributes towards the success of the operation. The action of chloroform, then, presents itself to us as being able to produce three different effects-excitement, collapse, and tolerance Some present tolerance from the outset. Others arriveat tolerance immediately after the period of agitation. The greater number do not arrive at tolerance except after having passed through the other two states. Lastly, certain subjects seem ″Refractaires’’ to the anaesthetic tolerance.
sire,
CHAPTER II. THE ANTI-HÆMORRHAGIC ACTION OF OPERATIONS.
CHLOROFORM DURING
and it is worth remembering that there happened a which did not show itself until a certain time after the of the dressing, and several hours after the patient had been taken back to her bed. It is not only with regard to arterial haemorrhages that chloroform can be considered as diminishing loss of blood; it is with respect also to those of a venous character. We know, in fact, that the badly restrained struggles of a patient dispose him in a particular manner to venous hemorrhage; for he is under the influence of two causes which play a considerable part in these sorts of haemorrhages-first, an imperfect respiration; and secondly, energetic muscular contraction. Chloroform removes these two causes, but only by producing collapse or anaesthetic tolerance. If we wish to render a rational account of the means by which happen the phenomena which occupy us, it will be sufficient to compare briefly the state of a patient operated upon under the ordinary conditions with that of one who has arrived at the period of tolerance. With the first, the fear of the operation about to be performed hurries the pulsations, increases the force of the impulse of the walls of the heart, and retards the free arrival of venous blood, not only in consequence of the impediment brought to respiration, but also by the efforts which the patient makes. Thus, increase in the number of pulsations, augmentation in their intensity, stagnation of the venous blood, such are the circulatory conditions of the patient who submits to an operation without the employment of anassthetics. If these have been administered, what do we see? The pulse is less frequent and less strong, and there is a normal state of the respiration and venous circulation. In comparing situations thus opposed, it is not difficult to understand the difference of the results with regard to the
It is impossible for surgeons, who have performed a great number of operations with the assistance of chloroform, not to have been struck by the small quantity of blood lost during severe operations by certain subjects submitted to the action of this anesthetic. It is for my part a remark that I have made Without otherwise attaching importance a long time back. to this particularity, I have not been able to prevent myself comparing the smallness of these losses of blood with the extent of those which have taken place during great operations performed without the assistance of chloroform. Reflecting on the mechanism, in virtue of which could be produced such a result, I understood very quickly that a subject in whom the physical and moral excitement caused by an operation accelerated the pulse to 120, ought by an open artery to lose more blood than the one who had only 60 pulsations a minute. I believed that I had found in this fact something very advantageous, and of direct application to practice, with respect to haemorrhages that take place during operations. But to draw conclusions, and, above all, conclusions applicable to practice, something else besides impressions and reasonings, however plausible they might be, was necessary. I resolved, then, to submit to special observation a certain number of patients operated upon at the Hopital St. Antoine. It is the results of these operations which I desire to submit to the attention of surgeons.
Eleven subjects, of whom three underwent amputations of the thigh, four of the breast, one of the leg, one an entire resection of the first metatarsal and of the first cuneiform bone, one a resection of the humerus, and one of the inferior maxillary bone, have furnished me the occasion to state that, whether in the period of collapse or in the period of anaesthetic tolerance, the losses of blood which constantly attend similar operations were enormously lessened, and that particularly in two cases (an amputation of the breast in a woman, and of the thigh in a man) the operation was performed, so to speak, without any loss of blood. In the latter case it is true that the compression of the femoral was made with great exactitude ; but that which proved to us that the chloroform had a considerable share in these results was, that when I ordered my assistants to suspend compression, all the surface of the wound, with the exception of the principal artery, which furnished a very moderate jet, gave but a very inconsiderable quantity of blood, and that we were obliged to wait for the cessation of the anaesthetic state to render possible the ligature of the secondary arteries. As to the patient with the amputation of the breast, who was a little more than twenty years of age, and had come to be operated upon for an adenoid tumour of the right breast, there did not literally flow a teaspoonful of blood during the operation. I was wrong here in not waiting for the awakening of the patient before proceeding to the
134
hasmorrhagic tendency.
Let us examine now what conclusions we can draw for practice from what has just been laid down. In this respect, and as the result of our observations, we might note1st. That the sedative action of chloroform during the period called tolerance diminishes in the patientsA. The number of pulsations. B. The force of the impulse of the beats of the heart. C. The stasis of the blood, the cause of venous hasmor.
rhages.
2nd. That the diminution of haamorrhage during the period of tolerance can render real service in the cases of operations which suppose the possible opening of a great number of vessels. 3rd. That if it is sometimes useful, as has been recommended by some surgeons, not to make the dressing until a certain time after the operation, this advice becomes, so to say, obligatory after the employment of chloroform, the chances of an ulterior hsemorrhage being so much the greater as less blood has been lost during the operation. (To be continuecl.)
THE DANGER OF ALL ATTEMPTS AT ARTIFICIAL RESPIRATION, EXCEPT IN THE PRONE POSITION. BY
MARSHALL
HALL, M.D., F.R.S.;
OF THE INSTITUTE OF
FRANCE; ETC.,
ETC.
I HAVE shown, in a previous paper, not the inutility only, but the daiige)- of the iva2-ii?, Lceth in the treatment of apncea or asphyxia. I now proceed to demonstrate the danger of all attempts at the induction of artificial respiration-the special remedy against asphyxia,-except in the PREONE position. If the asphyxiated patient be moved and placed in the supine position, in which no attempts at artificial respiration can be effectually made, what is the condition of the rima glottidis, or entrance into the windpipe ? Is it fRee, so that air may be pressed or drawn into it ? And if apparently free, does it reo main so at the moment when an effort to force or draw air into it is made ? 1. Is the tongue so securely siiuated, all muscular energy having ceased, as neither to fall backwards nor to be drawn backwards, and so close or obstruct the orifice and entrance into the windpipe ? 2. Is there no accumulation of mucus, or other animal fluid., or of fluids from regurgitation from the stomach, which may also
more, which may be forced or drawn into the windpipe, inducing a second and fatal suffocation? No one can say, à priori, that one, or even both, of these events may not occur. These are not only possible, but probable,-not only probable, but inevitable under certain circumstances. There is one fact of the utmost importance. When, from any circumstances, the nervous and muscular powers are in abeyance, nothing is so common as regurgitation from the Under stomach, from change of position, compression, &c. such circumstances, compression of the sides of the thorax would certainly be apt to produce this effect. Now, in the supine position, the matters so regurgitated would remain in the fauces, obstruct the glottis, or, when the pressure was removed, be drawn into the windpipe. Leroy’s mode of attempting to effect artificial respiration, of which a sketch is given by the Royal Humane Society in its Reports, is utterly with danger. ineffectual; but if effectual, would be The only certain safeguard against such a fatal accident isthe PRONE position. In this position, the tongue tends to fall forwards, and all fluids flow from the fauces and the mouth, or are expelled by the first induced expiration. All this is reasonable, à priori. But we must not rest here. Our appeal must be to facts, not to mere notions. The facts must be ascertained by careful examination of the dead sub-
obstruct the glottis ? nay
replete
ject.
the lateral way between ’’
position and the table, when it ceased. These are the original experiments. They are extracted from a little pamphlet entitled " Abstract of an Investigation into Asphyxia," &c., and now out of print. Those who may wish to pursue this investigation will read with great interest and advantage the experiments and observations made, at my request, at St. George’s, by Mr. R. L. Bowles and Mr. Charles Hunter, and communicated to me by the former gentleman, and by me to THE LANCET.* I conclude by observing that the principle of prone respiration is of such importance as to demand a new designation to impress it on the attention and the memory: I propose to term it PRF-PRENOPNŒA.. _____
The number of cases of apnoea and asphyxia, the effects of which have been rescued 1 the " Ready Method," and of which I have received authentic details, now amounts to THREE. The last of these was communicated to me by an eye-witness of the operation, which consisted in tenotomy in a little boy, aged about four, under the influence of the anoesthetic ; suddenly the child turned pale and ceased to breathe, and looked as if it were dead. Cold water was dashed on the and other ordinary measures were adopted utterly in face, vain. The Ready Method was now instantly adopted and efficiently applied: after the first inspiration produced by rotation after pronation with pressure, the mouth was observed to open and air to be inspired; the movements were repeated, physiological respiration commenced, the little boy cried, and all was safe. I conclude the momentous subject by several aphorism8 in regard to the treatment of asphyxia :1. The effects of suspended respiration can only be removed by the renewal of respiration. 2. Artificial respiration can only be certainly, effectually, and safely performed in the PRONE position; for, 3. In the supine position the larynx is apt to be obstructed by the falling back of the tongue and epiglottis, or by the accumulation of fluids already in the mouth or regurgitated from the stomach. 4. These fluids may be fatally inhaled into the windpipe when inspiration is mechanically effected. 5. All other measures are subsidiary, even the rubbing the limbs with pressure Upwards; and all which exclude respiration are, ipso facto, destructive; the warm bath is of doubly fatal tendency,-first, by excluding pronation and rotation, and secondly, by promoting the formation and the circulation of the blood-poison-carbonic acid.
chlorofornan,
1. What is the position of the tongue when the body has been roughly moved about and laid in the supine position, all cadaveric rigidity of the parts being overcome by previous movement of this organ backwards and forwards ? 2. What is the further position of the tongue in the supine position, at the moment of attempted inspiration, first, by means of the bellows, or, secondly, by the removal of the pressure on the ribs or sternum, and the consequent dilatation of the thorax ? These facts may be ascertained by removing the tissues on one side of the neck, so as to give a lateral view of the tongue, glottis, epiglottis, and pharynx, and by replacing them by a portion of transparent glass of the proper size and form, properly placed and carefully maintained in its position. The first part of this examination has been already made : The subject being placed in the supine position, and the lateral parts of the neck being removed, so as to admit of observing the relative position of the internal organs-the tongue, the epiglottis, the glottis, the pharynx,-it was seen that obstruction to the entrance of air actually did take place. I now propose to place a piece of transparent glass so as accurately to close the cavity and allow of the observation, first, of the effect of position, the supine and the prone comparatively, and then of any attempt to induce inspiraction. A similar examination of this internal in reference to fluids ON THE present in it (and we never can know when such fluids are fluids will is to the lowest unnecessary: gravitate present) MENTAL, NERVOUS, AND CONVULSIVE parts of a cavity, and will be drawn into an open orifice, such DISORDERS as the glottis, under the influence of air forced or inhaled into TRACEABLE TO PHYSIOLOGICAL OR PATHOLOGICAL CONit. And such an event not only renders all attempts at inDITIONS OF THE SEXUAL ORGANS IN WOMAN, spiration nugatory, but induces a permanent because material AND MORE ESPECIALLY TO THE OVARIA. obstruction of the entrance in the windpipe. In confirmation of these views I again appeal to experimental BY THOMAS LIGHTFOOT, M.D. facts*-"The following experiment has been repeated many times, and has been witnessed by George Webster, jun., Esq., of SECTION II. Dulwich; Mr. Williams, superintendent of the Royal Humane WHEN the ovaria cease their functions, the uterus also brings Society, Hyde-park; and other gentlemen: The dead subject being placed in the supine position, and its labours to a close. At this period the constitution is tried pressure made on the sternum and ribs, a little gurgling was to the utmost : organic disease of the lungs appears ; cancers heard in the throat; but, the pressure being removed, there in various organs ; diseases of the heart ; dropsies. Of these I was no evidence of inspiration. do not mean to speak here, but shall confine myself exclusively Now let us contrast with these abortive attempts to induce to the complaints announced in the heading of this memoir. If artificial inspiration in the supine position, the beautiful and the organs have been called on or permitted rightly to perform life-giving results-inspiration and expiration-of alternate rotation from the FEOXE position and repronation. I continue their functions during the matronly period, disease is not the quotation: greatly to be apprehended. Nevertheless, we have seen a case ’’ The subject being then turned into the PRONE position, and where the cerebro-spinal axis or nervous centres suffered pressure being made on the spine and the ribs, and removed as severely in a married person who had borne children, and had before, there were free expiration and inspiration." to that period the best of health. These centres enjoyed up is the effect of and more marked rotation: Far pronation " The subject was turned into the prone position: consider- sympathize deeply with the sympathetic or ganglionic system able expiration took place, which was much augmented by of nerves, which supply mainly the vital organs. The sensapressure of the hands on the back. On removing this pressure tions, it is true, are indirect, and the reaction, as in the heart, The body being then rotated a little inspiration took place. intestines, womb, &c., that is, the motor power, is not placed on the right side, considerable inspiration again took place, whilst moving through one fourth of a circle; on continuing at the command of the will ; nevertheless, there cannot be a the rotation, inspiration continued until the shoulder was half . See Taz LANCET for October, 1866.
I
.
135
seem that we can only obtain from them excitement collapse, and that the medium state, which constitutes essentially "tolerance," cannot be produced. They commence, as do nearly all subjects, by excitement, and arrive at collapse; but as soon as this is about to finish, it gives place to new excitement. It is only in children, in certain women, or in adults very debilitated, that we pass from the period of excitement to that of "tolerance" without observing the state of
or
dressing, I haemorrhage application
collapse. The employment
of chloroform would leave nothing to deif one could succeed in freeing it from the states of excitement and collapse, and in establishing at the outset that of " tolerance." This certainly is observed sometimes, but in an exceptional manner; and the means which have appeared to us the most proper to produce this advantageous result, are the slowness and the well-managed graduation of the inhalation. We see, after what has been said, that the surgeon gives himself much more trouble when he wishes to obtain in his patient the state of tolerance; but if he succeeds in obtaining it, he is amply recompensed by the assistance which it contributes towards the success of the operation. The action of chloroform, then, presents itself to us as being able to produce three different effects-excitement, collapse, and tolerance Some present tolerance from the outset. Others arriveat tolerance immediately after the period of agitation. The greater number do not arrive at tolerance except after having passed through the other two states. Lastly, certain subjects seem ″Refractaires’’ to the anaesthetic tolerance.
sire,
CHAPTER II. THE ANTI-HÆMORRHAGIC ACTION OF OPERATIONS.
CHLOROFORM DURING
and it is worth remembering that there happened a which did not show itself until a certain time after the of the dressing, and several hours after the patient had been taken back to her bed. It is not only with regard to arterial haemorrhages that chloroform can be considered as diminishing loss of blood; it is with respect also to those of a venous character. We know, in fact, that the badly restrained struggles of a patient dispose him in a particular manner to venous hemorrhage; for he is under the influence of two causes which play a considerable part in these sorts of haemorrhages-first, an imperfect respiration; and secondly, energetic muscular contraction. Chloroform removes these two causes, but only by producing collapse or anaesthetic tolerance. If we wish to render a rational account of the means by which happen the phenomena which occupy us, it will be sufficient to compare briefly the state of a patient operated upon under the ordinary conditions with that of one who has arrived at the period of tolerance. With the first, the fear of the operation about to be performed hurries the pulsations, increases the force of the impulse of the walls of the heart, and retards the free arrival of venous blood, not only in consequence of the impediment brought to respiration, but also by the efforts which the patient makes. Thus, increase in the number of pulsations, augmentation in their intensity, stagnation of the venous blood, such are the circulatory conditions of the patient who submits to an operation without the employment of anassthetics. If these have been administered, what do we see? The pulse is less frequent and less strong, and there is a normal state of the respiration and venous circulation. In comparing situations thus opposed, it is not difficult to understand the difference of the results with regard to the
It is impossible for surgeons, who have performed a great number of operations with the assistance of chloroform, not to have been struck by the small quantity of blood lost during severe operations by certain subjects submitted to the action of this anesthetic. It is for my part a remark that I have made Without otherwise attaching importance a long time back. to this particularity, I have not been able to prevent myself comparing the smallness of these losses of blood with the extent of those which have taken place during great operations performed without the assistance of chloroform. Reflecting on the mechanism, in virtue of which could be produced such a result, I understood very quickly that a subject in whom the physical and moral excitement caused by an operation accelerated the pulse to 120, ought by an open artery to lose more blood than the one who had only 60 pulsations a minute. I believed that I had found in this fact something very advantageous, and of direct application to practice, with respect to haemorrhages that take place during operations. But to draw conclusions, and, above all, conclusions applicable to practice, something else besides impressions and reasonings, however plausible they might be, was necessary. I resolved, then, to submit to special observation a certain number of patients operated upon at the Hopital St. Antoine. It is the results of these operations which I desire to submit to the attention of surgeons.
Eleven subjects, of whom three underwent amputations of the thigh, four of the breast, one of the leg, one an entire resection of the first metatarsal and of the first cuneiform bone, one a resection of the humerus, and one of the inferior maxillary bone, have furnished me the occasion to state that, whether in the period of collapse or in the period of anaesthetic tolerance, the losses of blood which constantly attend similar operations were enormously lessened, and that particularly in two cases (an amputation of the breast in a woman, and of the thigh in a man) the operation was performed, so to speak, without any loss of blood. In the latter case it is true that the compression of the femoral was made with great exactitude ; but that which proved to us that the chloroform had a considerable share in these results was, that when I ordered my assistants to suspend compression, all the surface of the wound, with the exception of the principal artery, which furnished a very moderate jet, gave but a very inconsiderable quantity of blood, and that we were obliged to wait for the cessation of the anaesthetic state to render possible the ligature of the secondary arteries. As to the patient with the amputation of the breast, who was a little more than twenty years of age, and had come to be operated upon for an adenoid tumour of the right breast, there did not literally flow a teaspoonful of blood during the operation. I was wrong here in not waiting for the awakening of the patient before proceeding to the
134
hasmorrhagic tendency.
Let us examine now what conclusions we can draw for practice from what has just been laid down. In this respect, and as the result of our observations, we might note1st. That the sedative action of chloroform during the period called tolerance diminishes in the patientsA. The number of pulsations. B. The force of the impulse of the beats of the heart. C. The stasis of the blood, the cause of venous hasmor.
rhages.
2nd. That the diminution of haamorrhage during the period of tolerance can render real service in the cases of operations which suppose the possible opening of a great number of vessels. 3rd. That if it is sometimes useful, as has been recommended by some surgeons, not to make the dressing until a certain time after the operation, this advice becomes, so to say, obligatory after the employment of chloroform, the chances of an ulterior hsemorrhage being so much the greater as less blood has been lost during the operation. (To be continuecl.)
THE DANGER OF ALL ATTEMPTS AT ARTIFICIAL RESPIRATION, EXCEPT IN THE PRONE POSITION. BY
MARSHALL
HALL, M.D., F.R.S.;
OF THE INSTITUTE OF
FRANCE; ETC.,
ETC.
I HAVE shown, in a previous paper, not the inutility only, but the daiige)- of the iva2-ii?, Lceth in the treatment of apncea or asphyxia. I now proceed to demonstrate the danger of all attempts at the induction of artificial respiration-the special remedy against asphyxia,-except in the PREONE position. If the asphyxiated patient be moved and placed in the supine position, in which no attempts at artificial respiration can be effectually made, what is the condition of the rima glottidis, or entrance into the windpipe ? Is it fRee, so that air may be pressed or drawn into it ? And if apparently free, does it reo main so at the moment when an effort to force or draw air into it is made ? 1. Is the tongue so securely siiuated, all muscular energy having ceased, as neither to fall backwards nor to be drawn backwards, and so close or obstruct the orifice and entrance into the windpipe ? 2. Is there no accumulation of mucus, or other animal fluid., or of fluids from regurgitation from the stomach, which may also
more, which may be forced or drawn into the windpipe, inducing a second and fatal suffocation? No one can say, à priori, that one, or even both, of these events may not occur. These are not only possible, but probable,-not only probable, but inevitable under certain circumstances. There is one fact of the utmost importance. When, from any circumstances, the nervous and muscular powers are in abeyance, nothing is so common as regurgitation from the Under stomach, from change of position, compression, &c. such circumstances, compression of the sides of the thorax would certainly be apt to produce this effect. Now, in the supine position, the matters so regurgitated would remain in the fauces, obstruct the glottis, or, when the pressure was removed, be drawn into the windpipe. Leroy’s mode of attempting to effect artificial respiration, of which a sketch is given by the Royal Humane Society in its Reports, is utterly with danger. ineffectual; but if effectual, would be The only certain safeguard against such a fatal accident isthe PRONE position. In this position, the tongue tends to fall forwards, and all fluids flow from the fauces and the mouth, or are expelled by the first induced expiration. All this is reasonable, à priori. But we must not rest here. Our appeal must be to facts, not to mere notions. The facts must be ascertained by careful examination of the dead sub-
obstruct the glottis ? nay
replete
ject.
the lateral way between ’’
position and the table, when it ceased. These are the original experiments. They are extracted from a little pamphlet entitled " Abstract of an Investigation into Asphyxia," &c., and now out of print. Those who may wish to pursue this investigation will read with great interest and advantage the experiments and observations made, at my request, at St. George’s, by Mr. R. L. Bowles and Mr. Charles Hunter, and communicated to me by the former gentleman, and by me to THE LANCET.* I conclude by observing that the principle of prone respiration is of such importance as to demand a new designation to impress it on the attention and the memory: I propose to term it PRF-PRENOPNŒA.. _____
The number of cases of apnoea and asphyxia, the effects of which have been rescued 1 the " Ready Method," and of which I have received authentic details, now amounts to THREE. The last of these was communicated to me by an eye-witness of the operation, which consisted in tenotomy in a little boy, aged about four, under the influence of the anoesthetic ; suddenly the child turned pale and ceased to breathe, and looked as if it were dead. Cold water was dashed on the and other ordinary measures were adopted utterly in face, vain. The Ready Method was now instantly adopted and efficiently applied: after the first inspiration produced by rotation after pronation with pressure, the mouth was observed to open and air to be inspired; the movements were repeated, physiological respiration commenced, the little boy cried, and all was safe. I conclude the momentous subject by several aphorism8 in regard to the treatment of asphyxia :1. The effects of suspended respiration can only be removed by the renewal of respiration. 2. Artificial respiration can only be certainly, effectually, and safely performed in the PRONE position; for, 3. In the supine position the larynx is apt to be obstructed by the falling back of the tongue and epiglottis, or by the accumulation of fluids already in the mouth or regurgitated from the stomach. 4. These fluids may be fatally inhaled into the windpipe when inspiration is mechanically effected. 5. All other measures are subsidiary, even the rubbing the limbs with pressure Upwards; and all which exclude respiration are, ipso facto, destructive; the warm bath is of doubly fatal tendency,-first, by excluding pronation and rotation, and secondly, by promoting the formation and the circulation of the blood-poison-carbonic acid.
chlorofornan,
1. What is the position of the tongue when the body has been roughly moved about and laid in the supine position, all cadaveric rigidity of the parts being overcome by previous movement of this organ backwards and forwards ? 2. What is the further position of the tongue in the supine position, at the moment of attempted inspiration, first, by means of the bellows, or, secondly, by the removal of the pressure on the ribs or sternum, and the consequent dilatation of the thorax ? These facts may be ascertained by removing the tissues on one side of the neck, so as to give a lateral view of the tongue, glottis, epiglottis, and pharynx, and by replacing them by a portion of transparent glass of the proper size and form, properly placed and carefully maintained in its position. The first part of this examination has been already made : The subject being placed in the supine position, and the lateral parts of the neck being removed, so as to admit of observing the relative position of the internal organs-the tongue, the epiglottis, the glottis, the pharynx,-it was seen that obstruction to the entrance of air actually did take place. I now propose to place a piece of transparent glass so as accurately to close the cavity and allow of the observation, first, of the effect of position, the supine and the prone comparatively, and then of any attempt to induce inspiraction. A similar examination of this internal in reference to fluids ON THE present in it (and we never can know when such fluids are fluids will is to the lowest unnecessary: gravitate present) MENTAL, NERVOUS, AND CONVULSIVE parts of a cavity, and will be drawn into an open orifice, such DISORDERS as the glottis, under the influence of air forced or inhaled into TRACEABLE TO PHYSIOLOGICAL OR PATHOLOGICAL CONit. And such an event not only renders all attempts at inDITIONS OF THE SEXUAL ORGANS IN WOMAN, spiration nugatory, but induces a permanent because material AND MORE ESPECIALLY TO THE OVARIA. obstruction of the entrance in the windpipe. In confirmation of these views I again appeal to experimental BY THOMAS LIGHTFOOT, M.D. facts*-"The following experiment has been repeated many times, and has been witnessed by George Webster, jun., Esq., of SECTION II. Dulwich; Mr. Williams, superintendent of the Royal Humane WHEN the ovaria cease their functions, the uterus also brings Society, Hyde-park; and other gentlemen: The dead subject being placed in the supine position, and its labours to a close. At this period the constitution is tried pressure made on the sternum and ribs, a little gurgling was to the utmost : organic disease of the lungs appears ; cancers heard in the throat; but, the pressure being removed, there in various organs ; diseases of the heart ; dropsies. Of these I was no evidence of inspiration. do not mean to speak here, but shall confine myself exclusively Now let us contrast with these abortive attempts to induce to the complaints announced in the heading of this memoir. If artificial inspiration in the supine position, the beautiful and the organs have been called on or permitted rightly to perform life-giving results-inspiration and expiration-of alternate rotation from the FEOXE position and repronation. I continue their functions during the matronly period, disease is not the quotation: greatly to be apprehended. Nevertheless, we have seen a case ’’ The subject being then turned into the PRONE position, and where the cerebro-spinal axis or nervous centres suffered pressure being made on the spine and the ribs, and removed as severely in a married person who had borne children, and had before, there were free expiration and inspiration." to that period the best of health. These centres enjoyed up is the effect of and more marked rotation: Far pronation " The subject was turned into the prone position: consider- sympathize deeply with the sympathetic or ganglionic system able expiration took place, which was much augmented by of nerves, which supply mainly the vital organs. The sensapressure of the hands on the back. On removing this pressure tions, it is true, are indirect, and the reaction, as in the heart, The body being then rotated a little inspiration took place. intestines, womb, &c., that is, the motor power, is not placed on the right side, considerable inspiration again took place, whilst moving through one fourth of a circle; on continuing at the command of the will ; nevertheless, there cannot be a the rotation, inspiration continued until the shoulder was half . See Taz LANCET for October, 1866.
I
.
135