Selected writings of A. Jackson Howe.
Dr. Howe was an advocate of the use of chloroform as an anaesthetic, and it is perhaps to his teachings and experience most largely that Eclectic surgeons and physicians prefer it to ether or to combination anaesthetics. The profession is still divided—the majority regarding ether as the safer but less pleasant agent. Personally, we believe that as much depends upon the skill and care with which the anaesthetic is given as upon the choice of anaesthetic The very danger of chloroform makes one watchful and careful so that it may have less fatalities in competent hands. Dr Howe's views are expressed in the following paper—Ed. Gleaner.
ANESTHETICS—The introduction of the A C E mixture, alcohol, chloroform, and ether, in the ratio of one, two, three, as an anaesthetic has been somewhat favorably received by the medical profession—the idea being that the combination is safer than chloroform has proven itself to be. Now, if a pleasant and efficient anaesthetic be safer than chloroform it is our bounden duty to adopt it in lieu of the more deadly lethal agent. But let us canvass the merits and demerits of the several anaesthetics in common use. Sulphuric ether is offensive to inhale, and quite inefficient—so much so that some patients can not be subdued by the agent; and in the majority of instances the time required to bring about anaesthesia is a serious objection in most surgical procedures After an operator has fixed an hour for executing laparotomy, exsection, or for removing a cervical tumor, he does not feel like wasting forty or fifty minute? in getting the patient ready for his manipulations The same objection can be raised against the triple combination already mentioned, only the latter is more potent and efficient than ether by itself. After waiting twenty minutes for A. C. E. to get a patient into a state of garrulous inebriation, I have pressed into service a drachm or two of chloroform, and thereby produced profound anaesthesia in a very few minutes, demonstrating the superiority of the latter over the former.
I have "aid on other occasions that when ether or any of its associates is employed as frequently as chloroform, nearly or quite as many fatal issues will follow the employment of the so-called "safe" agent. Then, an argument unto myself is that I have administered chloroform several thousand times and have never had a fatal result. If I had given ether with the assurance that no harm could come from it, I might have lost a case. While administering chloroform I know there is danger, and watch my patient with the expectation that something unfortunate may happen. As soon as the patient ceases to breathe in pronounced respirations I slap the posterior aspect of the thorax, the blow with the open hand being no trifling hit. It springs the ribs inward, so that the lebound air is sucked into the lungs, the heart is jostled into motion, and the vital machine, which has come almost to a stand-still, is made to move rhythmically. I have taken so many patients safely through the Scylla and Charybdis of anaesthesia that I think none—or almost none—need be lost. To hunt for a galvanic battery, to rely on dashes of cold water, and to try inefficient means is to court death. A heavy blow administered on the side of the chest with the open hand is the ready and sure way to resuscitate the over-anaesthetized patient.
Chloroform is the pleasantest and the most efficient anaesthetic; but its effects need watching—the respiration is to be observed, and little attention is to be paid to the pulse. In efforts at resuscitation a word, a grunt, or a groan is all the assurance needed. The operator may then go on with his surgical procedure without losing more time; there is no longer a feature of danger.
The head should be lowered and the face turned over a basin if signs of vomiting intervene. The contents of the stomach must not be left in the pharynx: to clog the larynx. A sweep of the finger through the throat will determine whether the respiratory passages be free or not.
I have reiterated the foregoing rules and precautions so many times that I feel some like apologizing for introducing them again. My only excuse is that the rules and precautions are vitally important, and that well enforced repetitions awaken interests and carry convictions.— HOWE, Eclectic Medical Journal, 1887.