credit of inventing the hypodermic syringe, the use of such an instrument by him as early as in 1824 having been witnessed by Dr. C. S. Abell, aged eighty-four years, still living; or of Dr. Joseph Taylor Bradford, of Augusta, who was the most successful ovariotomist of his day, 90 per cent of his cases during that early period (1840-70) recovering. Still other surgeons have acquired distinction, and I will merely give you the following names of a few of the many, but it would be impossible to do it in the order in which they deserve mention. Most of them are products of Kentucky soil, while others spent a great portion of their lives with us: Samuel D. Gross, Joshua Barker Flint, George Wood Bayless, James Miles Bush, T. G. Richardson, Ethelbert Dudley, John Daviess Jackson, David Wendell Yandell.

As a matter of historic interest, I will say that Dr. William Loftus Sutton, of Georgetown, was the first President of this Society, in 1851. Dr. John Lawson McCullough, of Lexington, was the first to receive the M. D. degree from a school west of the Alleghanies, that being from Transylvania in 1809. Dr. Hart was the first doctor known to have come to and settled in Kentucky, he from Maryland in 1775, to Harrod's Station, and later to Bardstown.

These great intellects were held in high esteem in their respective communities, and there could not have been found then, as now, men in any calling who were truer, bolder, yet conservative, more noble, more self-sacrificing, more progressive, more devoted to their country, more earnest in their desire to benefit mankind. They shall ever continue to live in history, because by their deeds they did something for the welfare of their fellow-men. All these add luster to Kentucky's fame, and from the light of their genius we should find inspiration to emulate them in their labors and accomplishments. Let us, with well-directed and untiring zeal, with an earnest purpose born of a desire to be of service to those now living and to come after us, labor to become worthy successors of these great men who bore the burden and heat of the day.

Though so much has been accomplished during the century just closed, we stand at the early morning of possibly the greatest epoch in the history of our calling, and to the men young in the profession at the beginning of this century I would suggest that if you will wear well the mantle-as did Elisha that of Elijah-of these great men gone before, you must "spurn delight and live laborious days. To you an inspiration comes from the graves of the dead and from the deeds of

the living, kindling hope and ambition to emulate their fame and to do their works, or even greater work."

If you do not want to go down in the battle of life with the army of unnumbered names, then work, work, and write your name high in the temple of fame. Live for others, remembering that "nothing in nature, much less conscious being, was ere created solely for itself," and let the world be better for your having lived.

BIBLIOGRAPHY.

American Medical Biography, Gross.

Transactions International Medical Congress.

History of Kentucky, Collins.

Sketch of Dr. Walter Brashear, Coomes.

HENDERSON, KY.

SOME OBSERVATIONS ON ADMINISTRATION OF ANESTHETICS.*

BY B. C. FRAZIER, M. D.

In introducing such an important though time-worn topic, I do not feel it needful to offer any apology, for such a vital subject should be discussed often and freely.

I will speak more particularly on chloroform anesthesia, and try to give some good reasons for preferring it to ether, though not trying by any means to decry the use of ether. In certain cases, and in the hands of men who have not had chloroform anesthesia training, I deem it wise that they should confine themselves to the one with which they are most familiar and in which they have most confidence.

The preparation is very important where the operation will be of sufficient magnitude to necessitate the patient's keeping in bed for some time, and where there will have to be a restricted diet. The best possible condition of the stomach and bowels is imperative, and to obtain this condition the subject should not be prepared too hastily. Where there is no immediate hurry, three days should be given up to the preparation of the patient for surgical operation and general anesthesia; a mercurial purge should be given on the first day, followed by a saline. Liquid diet should be observed from the first, and a colon douche or a high enema given on the night previous to the operation, with a low enema on the morning of the operation to relieve the rectum

* Read before the Louisville Medico-Chirurgical Society, May 31, 1901. For discussion see page 21.

of any possible retained feces that might be expelled under the relaxation of the anesthetic. Very often the patient is only partially prepared, and nausea is dependent on the general condition of the patient as much or more than on the anesthetic. All of you have had disagreeable experiences from the patient's involuntary movement of the bowels. This can be avoided by the more careful preparation, as just outlined. The anesthetist should have clean hands.

In beginning the anesthesia care should be exercised to have every thing in the way of foreign bodies removed from the patient's mouth; the neck- and waist-bands should be loose, and the patient be made as comfortable as possible; usually a small pillow should be allowed for the head. In arranging the patient and asking as to the comfort and other questions that naturally arise, you get the subject's attention and become somewhat acquainted, if you have not had opportunity to do so before. The Esmarch inhaler is the most satisfactory instrument in administering the chloroform, for you can hold the inhaler some distance from the face and begin by a single drop, and the patient can be brought under the chloroform in this manner usually without either the stage of excitement or primary nausea.

It is well to constantly assure patients you will be careful, and will not cause them any discomfort, and that he or she will not realize that they are going under, because it will be so gradual. If your patients are very restless and nervous, have them converse with you, or count with you. You then keep, to some extent, their fears calmed, and they breathe more evenly. By all means never begin by telling patients to take long or deep breaths, for if there is considerable vapor to come in contact with the fauces they are very apt to cough or strangle, thus making them more fearful, and they will not breathe freely any more during the primary stage. Ask them to breathe just as though they were lying down for a nap. By beginning the chloroform very slowly, that is, a single drop at a time, with the inhaler some distance from the face, you do not allow enough vapor to be given off to irritate the fauces, and thus do not cause an excessive flow of saliva and consequent cough.

Time is not worth more than the comfort and safety of your patient, and by slowly inducing anesthesia you are very much less likely to have any alarming symptoms arise. I usually take from ten minutes to a quarter of an hour to get surgical anesthesia.

It is my custom to have a wet cloth put over the eyes in the begin

ning to prevent the irritating effect of the vapor. In hot weather have a cold, wet cloth; in cold weather have a hot one; you thus make it comforting to the patient and keep the eyes closed, thus keeping them more quiet. The room should be quiet, with as few present as possible -of course the nurse or some other attendant should always be present. It is dangerous to give an anesthetic without assistance. The patient should not be moved any further, while under the anesthetic, than can be avoided. The anesthesia-room should be adjoining the operatingroom but not connecting, for the talking and general noise during the preparation are often the cause of alarm and great nervousness on the part of the patient.

The patient should be fully under the effects of the chloroform before the surgeon is allowed to begin, for the attending shock is much greater than if you have your patient fully anesthetized. With the corneal reflex abolished or blunted, with the pupils smartly contracted and not dilating to light, with the easy sighing respiration, is considered evidence of complete anesthesia. I think it rather bad practice to put your finger on the cornea, as you may thus do some injury to the eye.

I make it a rule to wash up thoroughly before beginning the anesthetic, to avoid any possible chance of infecting the eye from my finger. I consider the eyelashes more sensitive than the cornea, and there is less likelihood of doing the eye any injury.

When the operation involves tissue that is the seat of inflammation, anesthesia has to be more profound than where normal tissue is gone through. Tubercular patients do well under chloroform, and in tubercular empyema necessitating extensive operation the patient is not a bad subject for anesthesia unless there is leakage upward into the upper air-passages, which may cause coughing and strangling. I have noticed that patients operated upon in the Sims position all do well, and even those who have to lie directly on the chest and belly. I have always attributed this to the fact that the position rather hindered deep respiration, believing when chloroform is inhaled slowly that the stage of anesthesia is more tranquil and less liable to be carried to a dangerous point. The Trendelenburg position is favorable in some cases and very unfavorable indeed in others. Where there is feeble circulation, and the patient is small and thin, without very abundant abdominal contents, the Trendelenburg position is not contra-indicated; but when there is a large abdominal cyst, or where there is a large amount

of fluid free in the cavity, the lowering of the head may mean a serious affair. The whole weight gravitates against the diphragm, the lungs and heart are both impinged upon, and the circulation and respiration are both very much interfered with.

I have given chloroform several times in the reclining posture when the patient could not assume the recumbent posture, and while I have not met any interference, I would not by any means recommend it; on the other hand, would advise against it if there be any possible way to avoid it.

There is less danger in anesthesia given in disease than given for repair of injury. The injury has already produced shock which the slow or very rapid onset of disease has not produced, and consequently the anesthetic is not so well borne. Chloroform is the ideal anesthetic in head injuries or brain operations; also in labor. I may have my faith more closely pinned to chloroform than I should have, but in more than six hundred cases of chloroform anesthesia I have had but two cases that caused me serious alarm.

The first case was in a boy, aged eleven years, from the mountains of Kentucky, at the Children's Hospital. He had a clubfoot of traumatic origin. The morning of the operation Dr. Vance asked me if I had examined the heart thoroughly, and if not, he insisted that I do so. I remarked that the boy had been climbing about the mountains on a crutch, and there could hardly be any thing the matter with his heart. However, I made a careful examination, and nothing abnormal was discovered. The boy was put under the influence of chloroform, and, as usual, Dr. Vance asked me if he was ready. I said that he was, and the operation had been scarcely commenced when I asked him to desist, as the boy had gotten pale, respiration had ceased, and his jaw dropped. He looked like one dead. I drew his head back over the edge of the table, and, if I remember correctly, Dr. Vance raised him up by the heels; we practiced artificial respiration for a few minutes, injected nitro-glycerine, etc., and the boy in a short time had recovered. No further operative steps were undertaken that day.

About ten days later chloroform was again administered, and the boy took it as quietly and evenly as any patient I ever saw. The operation was quickly and successfully completed. It developed afterward that this boy was the subject of periodic "fits," and that the nurse had seen him in one or two attacks while in the hospital. I believe now that he had one of these attacks (probably epilepsy) while the anesthetic was being given for the first operation.