The plan of inducing anæsthesia per rectum, which has recently been brought before the profession in this country by Dr. Dudley Buxton, was originally suggested by Pirogoff in 1847, ether being the agent employed; but the introduction of chloroform in 1848 led to the disuse of ether in any way for many years. More recently Pirogoff’s suggestion has been resuscitated, and made use of by Bull, Weir, and others in America, Ollivier and Molière in France, by Iversen and Wancher in Copenhagen, and by Dudley Buxton in this country. The last-named anæsthetist recommends an apparatus (supplied by Mayer and Meltzer) consisting of a receiver for the ether, which is placed in water at about 120° F. The vapour thus given off is conducted by a ¾-inch rubber tube, about four feet long, through a specially constructed intercepter to prevent any liquid ether bubbling into the rectum, and enters it by an anal tube. A special device maintains sufficient pressure upon the perineal pad to prevent the escape of flatus or ether from the bowel. Anæsthesia may be induced from the first in this manner; or, as a preliminary step, chloroform or ether may be given by inhalation in the usual way, and the rectal administration subsequently relied on. The disadvantage of this combined method is the difficulty of judging when the absorption by the rectum is sufficient to be trusted alone; otherwise the patient may regain partial consciousness, and struggle. When the rectal plan only is used, the patient is often twenty or thirty minutes becoming unconscious, although ether may be smelt in the breath within five of its commencement. There is no excitement or struggling, and fewer after-effects. Care must be taken to regulate the amount of ether used, or abdominal distension and rectal catarrh may result; particularly is this the case if the operation be protracted. The method may prove of value, when properly employed, in operations involving the tongue, lips, pharynx, larynx, palate, jaws, &c. There are, however, obvious dangers in connection with its use, and unfortunately these fears have been realised in America by the combustion of the vapour leading to rupture of the bowel and other disastrous consequences.
FOOTNOTES
[1] Trendelenburg, ‘Deutsche Chirurg.,’ Lief. xxxiii, Hälfte 1.
[2] Rouge, ‘L’Uranoplastie et les divisions congénitales du palais.’
[3] Oakley Coles, ‘Deformities of the Mouth’ (Churchill).
[4] Dieffenbach, ‘Die operative Chirurgie’ (1845).
[5] Mason, ‘On Harelip and Cleft Palate’ (Churchill), p. 54.
[6] Op. cit., p. 55.
[7] Warner, ‘Brit. Med. Journ.,’ 1889, July 27th.
[8] ‘Trans. Path. Soc.,’ xxxviii, p. 446.
[9] ‘Bull. de Soc. Anat. de Paris,’ December, 1883.
[10] Ibid., April, 1886.
[12] ‘Medical Times,’ 1862, p. 402.
[13] Trendelenburg, ‘Deutsche Chirurg.’ (Billroth and Luecke), Lief, xxxiii, Hälfte 1.
[14] ‘Trans. Odont. Soc.,’ vol. xx, p. 90.
[15] Similar cases have been recorded by Von Ammon, Hippe, Liebrecht, Beely.
[16] ‘Archiv f. klin. Chir.,’ xvi, p. 684.
[17] Ditto, xx, p. 396.
[18] Pelvet, “Mémoires sur les fissures congénitales des joues,” ‘Gaz. méd. de Paris,’ 3 s., xix, p. 417.
[19] “Über die morph. Bedeut. der Kiefer, Lippen, und Gesichtsspalten,” Langenbeck’s ‘Archiv,’ xxxi, 2.
[20] ‘Dublin Quart. Journ. of Med. Sci.,’ 1862, xxxii, 15.
[21] ‘Odontological Trans.,’ 1887, p. 105.
[22] ‘Bull. de Soc. Anat. de Paris,’ 1886, p. 599.
[23] ‘Bull. de Soc. de Chir.,’ 1860, ii, p. 642.
[24] ‘Bull. Gén. de Thérapeutique,’ 1862, lxii, pp. 13, 66.
[25] Op. cit.
[26] ‘Wien. klin. Wochen.,’ 1889, ii, p. 520.
[27] ‘Dict. de Sci. Méd. de Paris,’ viii, p. 642.
[28] Wölfler, ‘Langenbeck’s Archiv,’ 1890, xl, p. 795.
[29] ‘Gaz. des Hôpit.,’ 1870, liv.
[30] Parisé, ‘Bull. Gén. de Thérapeut. de Paris,’ 1862, lxiii, p. 269.
[31] Demarquay, ‘Bull. de Soc. de Chir.,’ Paris, 1869, 25, ix, p. 111.
[32] ‘Brit. Med. Journ.,’ 1863, i, p. 412.
[33] Manley, ‘New York Med. Journ.,’ June 15th, 1889.
[34] Kölliker, “Über das Os intermax., &c.,” ‘Nova Acta der Leopold Akad.,’ Halle, 1882, p. 343.
[35] ‘Deutsche Zeitsch. für Chirurg.,’ 1885, p. 205.
[36] ‘Congrès Franc. de Chir.,’ 1888, p. 480.
[37] Op. cit., p. 5.
[38] ‘Insanity,’ p. 442.
[39] ‘Brit. Med. Journ.,’ 1889, ii, 1272; 1890, ii, 447.
[40] ‘Trans. Odontological Soc.,’ 1872, vol. iv.
[41] ‘On Oral Deformities.’
[42] For this chapter I am indebted to the pen of my colleague, Mr. Carless.
[43] Sudduth, in ‘American System of Dentistry,’ vol. i, p. 648.
[44] Galen, ‘De Usu Partium,’ lib. ix, cap. 20; and ‘De Ossium Naturâ,’ cap. 3, p. 14.
[45] Nesbitt, ‘Human Osteogeny,’ London, 1736, pp. 90, 91.
[46] Goethe, ‘Sammtliche Werke,’ in 36 vols., Cotta, 1868; vol. xxxii, p. 159.
[47] Vicq d’Azyr, ‘Œuvres,’ iv, p. 159.
[48] ‘Philosophical Trans.,’ 1869, p. 166.
[49] Gilis, ‘Bull. de Soc. Anat. de Paris,’ 1888, p. 372.
[50] The dotted line from e is erroneously prolonged a little beyond the suture.
[51] ‘Virchow’s Archiv,’ Bd. cxi, i, p. 125; ‘Anat. Anzeiger’ (Breslau), 1888, p. 577.
[52] Albrecht: (1) “Die Morph. Bedeutung der seitliche Kieferspalte,” ‘Zool. Anzeig.,’ 1879, p. 207. (2) ‘Sur les 4 Intermaxillaires, &c.,’ Soc. d’Anthropol. de Brux., 1883. (3) “Über die morph. Bedeutung der Kiefer-, Lippen-, und Gesichts-spalten,” ‘Lang. Archiv,’ xxxi, 2; ‘Centr. für Chirurg.,’ 1884, 4. (4) “Zur Zwischenkieferfrage,” ‘Fortschritt d. Med.,’ 1885, iii, 14. (5) “Über sechs-schneidezähnige Gebisse beim normalen Menschen,” ‘Centr. für Chir.,’ 1885, No. 24. (6) “Über den morph. Sitz der Hasenscharten Kieferspalten,” ‘Biolog, Central.,’ 1886, vi, 3, pp. 80 and 122.
[53] Sabourand, ‘Bull. de Soc. Anat. de Paris,’ 1890, No. 13, p. 270.
[54] ‘Bull. de Soc. Anat. de Paris,’ 1886, p. 350.
[55] ‘Journ. of Anat. and Phys.,’ xix, p. 198.
[56] “Über das Os intermax. des Menschen und die Anat. des Hasenscharte und des Wolfsrachen,” ‘Nova Acta der Leopold Carol. Akad. der Naturforscher,’ Halle, 1882, Bd. xliii, No. 5, p. 369.
[57] “Über den morphol. Sitz der Hasenscharten Kieferspalten,” ‘Biolog. Central.,’ Bd. v, 13, pp. 80 and 122.
[58] “Lippen und deren Complicationen,” ‘Virchow’s Archiv,’ cxi, p. 138.
[59] Occasionally the lateral or accessory incisor may be developed or suppressed on one side only, a fact explaining the occasional occurrence of cases with three or five incisors present.
[60] Kölliker, op. cit., p. 369.
[61] Biondi, op. cit.
[62] ‘Langenbeck’s Archiv,’ xl, p. 795.
[63] ‘Trans. Med.-Chir. Soc.,’ 1845.
[64] Churchill, 3rd edition, 1881, chap. vi.
[65] Op. cit., p. 109.
[66] ‘Archiv f. klin. Chirurg.,’ v, p. 52.
[67] Trendelenburg, ‘Deutsche Chirurg.,’ Lief. xxxiii, Hälfte 1.
[68] ‘Deut. Zeitsch. für Chir.,’ xix, p. 15.
[69] Hermann, ‘Beitr. z. Statistik und Behandlung der Hasenscharten,’ Diss. Breslau, 1884.
[70] Gotthelf (Heidelberg), ‘Archiv f. klin. Chir.,’ xxxii.
[71] Op. cit., p. 39.
[72] Trendelenburg objects to the harelip operation being called a life-saving one, on the ground that the inability to gain sufficient nutriment depends rather on the associated cleft palate than on the cleft lip. But if the lip be united efficiently the method of feeding by bottle suggested at p. 66 enables the child to suck and swallow satisfactorily in spite of the palatal defect.
[73] Fergusson, ‘A System of Practical Surgery’ (Churchill), 1865, p. 497.
[74] ‘The Works of the famous Chirurgeon, Ambrose Paré’ (1579), translated in 1678 by Th. Johnson.
[75] In view of the dilatation of the nasal aperture, which often takes place at a later date, it is advisable to make it at first actually smaller than on the opposite side.
[76] The lower lip may also be kept drawn down and everted by the use of collodion applied longitudinally between it and the chin, thus obviating in part the need of the constant application of the nurse’s finger. This ingenious plan has been suggested and practised by one of the sisters in my wards at King’s College Hospital.
[77] ‘Dict. de Médicine,’ p. 703; M. Coste, ‘Lancet,’ 1851, ii, 203.
[78] ‘Dublin Quart. Journal,’ 1868, vol. xlv, p. 269.
[79] It may be interesting to quote Franco’s own words on this subject:—“Pour l’extirpation de telle turpitude, nous y deuous en premier lieu procéder de la manière que dessus (Cure des leures fendues, ch. 119), hormis que quand les dents et mandibules passent dehors, et que ne peuuent estre couuertes de la bouche, il n’y a point de danger de copper le superflu et ce qui ne sert à rien avec tenuailles incisiues ou auec scie ou autre instrument propre à cest essait, en laissant la chair qui est dessus icelles dents s’il y en a, affin qu’elle serue en cousant les deux autres parties en icelles de chaque costé, et s’il y auoit telle distance entre lesdites leures qu’on ne peut les assembler, il faudrait user de semblables dissections en la bouche qu’au cas précédent, et procéder au reste ainsi qu’auons montré” (Franco, Traité des hernies, &c., cure de dents de lieure, chap. cxxii, Lyon, 1561).
[80] Sédillot, ‘Gaz. des Hôp.,’ 1861, Nov. 7th.
[81] ‘Journal de Malgaigne,’ Jan., 1843.
[82] Bardeleben, ‘Lehrbuch der Chirurgerie und Operationslehre,’ 1872, vol. ii, p. 252.
[83] Butcher, ‘Essays on Operative Surgery,’ p. 715; ‘Dublin Quarterly Journal of Medical Science,’ xxix, p. 296.
[84] ‘Archiv,’ vol. ii, p. 230.
[85] The central portion requires catgut stitches in addition to being transfixed by the upper wire.
[86] Ehrmann, “Des operations plastiques sur la palais chez l’infant,” Cong. Franc. de Chir. 1888, p. 462.
[87] Many of the points alluded to under this heading are obtained from an excellent paper furnished me by Mr. G. L. Cheatle, late Surgical Registrar to King’s College Hospital, who has had considerable experience in such work.
[88] ‘Lancet,’ vol. ii, 1852.
[89] Graefe, ‘Hufeland’s Journal,’ 1816.
[90] Roux, ‘Mémoire sur la Stapyloraphie,’ Paris, 1825.
[91] ‘Mémoires sur différents objets de Médicine,’ Paris, 1764.
[92] ‘Dictionnaire de Médicine et de Chirurgie Pratiques,’ 1836, vol. xv, p. 19.
[93] ‘Die Operative Chirurgie,’ von Johann Friedrich Dieffenbach, Erster Band, 1845, p. 856.
[94] Trélat, “Technique des operations plastiques sur le Palais,” Revue de Chirurg., 1886, p. 89.
[95] ‘Brit. Med. Journ.,’ 1890, ii, 950.
[96] Rotter, ‘Munch. Med. Wochensch.’ 1889, xxxvi, p. 535.
[97] Wolff, ‘Berl. Klin. Wochensch.,’ 1889, p. 577.
[98] ‘Amer. Syst. of Dentistry,’ vol. ii, p. 1056.
[99] Baker, ‘Boston Med. and Surg. Journ.,’ 1889, p. 212.
[100] This is more likely to happen if the stitches are removed too soon from loss of their support.
[101] ‘Archiv für klin. Chir.,’ vol. v, 1, p. 3.
[102] Ehrmann, “Des opérations plastiques sur le palais chez l’enfant; leurs résultats éloignés,” ‘Cong. franç. de Chir.,’ 1888, p. 462.