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The constants of t h e oil are as follows:
Although Pirogoff’s enthusiasm prompted him to predict t h e . supplanting of t h e inhalation procedure by Refractive Iodine Saponification Specific gravity index (15.5’ C.) NO. NO. 15.5’ C. t h e rectal method, references t o it disappeared from Sample I... . , . . . 1.4760 122.8 122.3 0.9157 t h e literature until 1884. Then hlolliers’ revived Sample 11.. . , , . . 1.4767 interest in t h e method by using a hand bellows for The analysis was made from t h e oil expressed from forcing t h e ether vapor into t h e intestine. Variathe seeds, after warming. The seeds crushed very tions in t h e technique were introduced during t h e same easily, b u t with t h e press t h a t we were able t o con- year, b u t t h e experiences of Yversen, Harter, Bull,2 struct, only about 20 per cent of oil was extracted. Wancher4 a n d Post6 showed more or less diarComparing this oil with other edible oils, i t has a rhea and melena as after-effects. These after-effects, high iodine number-between t h a t of sesame oil a n d with one case of death directly attributable t o t h e propoppy oil, a n d much higher t h a n ’ordinary oils. I t s cedure: caused t h e method t o again fail in securing specific gravity is similar t o t h a t of olive oil and mus- serious recognition until 1903 when Cunningham6 t a r d oil; its saponification number is high-near t h a t employed air as a vehicle for sweeping the ether of poppy oil. The oil is readily hydrogenated, a n d a vapor into t h e colon. I n 1909 Leuguen, Money and bland product is produced which has a n iodine number, Verliac’ used oxygen as t h e vehicle for the ether 7 2 . 8 . Although experiments are lacking t o prove vapor. Bustons in his splendid book on “Anesthesia” t h a t t h e oil is nonpoisonous, it seems t o have no says t h a t he found t h e procedure most satisfactory injurious effects from tasting small quantities. Feed- for certain operations, for example, those having t o ing experiments are in progress with mice, t o prove, if do with t h e mouth, nose, etc., but he remarks, “Deaths possible, t h e bland quality of t h e oil. It is a well- have occurred.” Sutton’sg introduction of a return known fact t h a t under t h e name of Blartynia t h e flow tube for these gases introduced a n d unabsorbed green pods are often used as food and for making constituted a distinct advance in anesthesia by colonic pickles. absorption. I n a n effort t o avoid certain well-known difficulties’ If t h e plant is abundant enough, or if it can be grown cheaply enough in t h e arid regions, i t may solve t h e in intravenous anesthesia, Gwathmey esperimented question as t o what t o do with the otherwise barren with mixtures of normal saline solution and ether per land. Further experiments are in progress t o test t h e rectum. The concentration of ether in t h e aqueous quality of t h e oil. The press cake will no doubt solution was so small t h a t excessive volumes of liquid were needed, a n d furthermore t h e ether parted from prove t o be valuable stock food. t h e solution so very rapidly t h a t experimentation U N I V E R S I T Y O F KANSAS, LAWRENCE along those lines was abandoned. Gwathmey then applied a solution of ether in olive oil. 4 s oil and ether make perfect solutions in all mixtures, it was his hope ON THE RATE OF EVAPORATION OF ETHER FROM t o reduce the total bulk of the fluid introduced into t h e OILS AND ITS APPLICATION IN OIL-ETHER colon by using a stronger solution of ether in oil t h a n COLONIC ANESTHESIA’ is possible with any known aqueous mixture. A s By CHAS.BASKERVILLE oils are lubricants it was also hoped t o avoid t h e irriReceived June 14, 1915 tation of the mucous membrane previously noted. It is conceded t h a t t h e anesthetic agent must get The ether may always be separated from the oil b y into t h e blood for distribution and for eventual elimi- warming, b u t unless t h e temperature of t h e mixtures nation, whatever theory of general or central anes- is suddenly raised t o a n excessively high point, t h e thesia one may support. The anesthetic agent has ether passes o f f deliberately. It was thought t h a t t h e normally been introduced into t h e blood by inhalation evaporation of the ether would induce some cooling or intravenously. I t is normally eliminated v i a t h e of t h e mixture with a consequent checking of t h e lungs. evaporation and its absorption. These premises The intestinal mucous membrane of vertebrates coupled with slow absorption b y t h e colon in comis well known as a n efficient transmitter of gases to parison with t h e rapid elimination b y t h e lungs would and from t h e blood. Pirogoff2 appears t o have been automatically regulate any anesthesia t h a t might be t h e first t o mention the administration of ether by induced in this manner. As a result, Gwathmey this route. Liquid ether was used until hlagendie presented a paper before the 17th International gave warning as t o t h e danger of its use a n d ether Medical Congress in London in 1913 on t h e work with vapor was substituted. During t h e same year R O U X , ~animals done b y himself and Wallace. 1 L y o n Medical, 1884, p. 45. y’Yhedo,’ a n d ‘Dupreyj employed liquid ether or 2 N. Y . Med. J . , March 3, 1884. aqueous mixtures t o induce complete anesthesia. 8 Med. Rec., 1884.
i:;:]
1 Read before the American Philosophical Society, Philadelphia, April 23, 1915; the New York Section of the American Chemical Society, June 11. 1915; and the American Association of Anesthetists, San Francisco, June 21, 1915. 2 “Recherches pratique et physiologiques sur l’etherization,” St. Petersburg, 1847. 8 J . d. 1’Academie d. Sciences, 1847, p. 18. 4 Gazette med. d. Paris, 1847. 6 Academie royale de medicine, March 16, 1847.
Cong. internat. d . Sciences med., 1884. Boston Med. and Sur& J.. 1884. 6 Cunningham and Leahy, Boston Med. and Surn. J . , April 30, 1905: V i d e also Dumont, Corrcspond. B1. f. Schweitzer Aertne, 1903, 1904, 1908; Krugeline, Wiener klin. Woch., Dec., 1904. 7 Compt. rend. soc. Biol., June, 1909. 4
5
8
“Anesthesia,” London, 1907.
9
For full account of techniqup and literature, see “Anesthesia” b y
Gwathmey and Baskerville. Appleton, New York (1914): pp. 431-457.
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At t h e request of m y co-laborer, Gwathmey, I undertook an insTestigation on t h e r a t e of evaporation of ether from oils t o secure t h e following information t h a t might be of service t o him in his further application of his ideas with h u m a n subjects: I-A comparison of t h e r a t e of evaporation of ether from different mixtures of ether a n d t h e same oil. 2--4 comparison of t h e r a t e of evaporation of ethcr from t h e same per cent mistures of different oils a n d ether. 3-The influence of surface on t h e r a t e of evaporation. As t h e result of much preliminary experimentation, t h e following mode of procedure was settled upon.
FIG.I
I n t h e experiments t o determine t h e influence extent of surface played upon t h e r a t e of evaporation, the same precautions were taken as t o height of walls of t h e containing vessels. I n t h e largest areas worked with, this involved using as much as 600 cc. of t h e mixture. As t h e 7 j per cent mixture h a d been found most satisfactory clinic ally , this was deter mi ne d ’ivi t h t h a t misture only. T h e ether used was t h a t prepared under m y supervision a n d was 9 7 per cent absolute with 3 per cent absolute alcohol, being free from acids, aldehydes, a n d water. The oils used were of three types, vegetable, animal,
FIG.I1
RATESO F
EVAPORATIOS FROM 2 5 ,
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FIG.I11
5 0 A S D 75 P E R C E N T 1xIXTURES OF OILS A S D E T H E R
Large glass tubes were calibrated t o I cc. from 20 cc. t o Ioj cc. Mixtures of Z j , j o a n d 7 j per cent of oil a n d ether were carefully placed in t h e tubes. T h e tubes were weighted with lead a n d placed in a thermos t a t , whose temperature was so regulated as not t o vary more t h a n * 0 . 0 3 ’ C. from 37’ C., t h e same being controlled b y a toluene-m ercury temperature r e P lator. All connections (gas, water, etc.) were made with lead pipes for safe use over night, as occasion arose. T h e water in t h e b a t h was stirred b y a system of paddles a n d shaft operated through belt a n d pulleys b y a small hot air engine. T h e tubes m-ere immersed in t h e b a t h t o within z cm. of t h e tops. During t h e first five minutes t w o readings were made in each case t o get t h e highest point to which t h e volumes expand upon heating u p t o 3 7 O C. After t h a t readings were made every five minutes for t w o or three hours. Since t h e evaporation of a n y liquid depends upon t h e partial pressure of t h a t liquid at its surface, t h e higher t h e glass wall above t h e surface of t h e oil-ether mixture, t h e heavier tile column of ether vapor resting on t h e surface of t h e mixture a n d t h e slower will be t h e evaporation; consequently t h e different oil mixtures with t h e different percentages of ether were experimented with in t h e same t u b e filled t o t h e same height in all experiments.
a n d mineral, being, respectively, olive, cottonseed, corn, peanut a n d soya-bean; cod-liver a n d lanolin (anhydrous); a n d Russian mineral oil. A11 t h e vegetable oils, except olive, were refined by a process devised b y t h e author’ a n d were neutral. T h e other oils were purchased in t h e open market. The experimental work was carried out by N r .
H~~~~ Storch, under my direction,
T h e d a t a obtained for t h e z j , 5 0 a n d 7 5 per c e n t mixtures vegetable a n d animal oils are shown graphically in Figs. 1-111. I n t h e curves t h e abscissae show t h e percentage of ether evaporated (based on volume measurements) a n d t h e ordinates time of t.he evaporation. Fig. I T T (selected a t random f r o m charts made f o r each oil) shows t h e difference in rate of evaporation of 2 5 , jo, a n d i j per cent mixtures with one oil. Fig. v shows t h e effect of increas.ed surface on t h e r a t e of evaporation. One O i l only was selected to show t h e principle, which is t h a t t h e r a t e of evaporation bears a direct ratio to the surface These experiments were made in glass, hence t h e y do not disclose all t h e factors in t h e conduct of s u c h mixtures in contact with t h e walls of t h e colon, f o r 1
“Refining Oils,’’ Oil, Paint and Drug Reporlev, May, 1915.
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there t h e principles of osmosis a n d diffusion are involved. B u t these observations demonstrated several striking facts: I-While ether boils at 34.6' C., i t does not escape violently from an oil-ether mixture, as from a n aqueous
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inhalation anesthesia, unless induced b y t h e most improved modern technique, are virtually absent, including post-anesthetic nausea. Its use for special cases involving t h e head, breathing passages, etc., is superior. Although having h a d t h e privilege of attending clinics, I a m not qualified t o pass j u d g m e n t upon its value, b u t from w h a t I h - v e learned. if necessary, "Give i t t o me t h a t way." COLLEGE OF THE-CITY
O F NEW
YORK
DISCUSSION' T. GWATHKEY
By JAMES
T h e r a t e of evaporation of ether from oil is t h e one all-important factor t o be considered in oil-ether colonic anesthesia. If ether evaporated irregularly, either as t o time or q u a n t i t y , oil-ether colonic anesthesia would be a most dangerous procedure. T h e charts showing t h e percentage of ether evaporated during a period of two a n d one-half hours would convince t h e most skeptical t h a t as far as this factor is concerned anesthesia colonically should be a very even a n d safe procedure. T h e whole medical profession owes a debt .of gratitude t o Dr. Baskerville for t h u s placing this method upon a scientific basis. Other factors t o be considered would be injury t o t h e F I G . IV-COMPARISON OF RATES OF EVAPORATION OF DIFFERENT MIXTURES colon, safety, a n d t h e time required for a patient OF OLIVE OILAND ETHER t o come out. All of these problems have been worked mixture, when t h e mixture is heated higher, namely, o u t satisfactorily a n d we can control a patient under t o t h e body temperature of 37' C. this form of anesthesia just as readily as we can under ina-The rate of separation of ether from t h e oil quickIy halation anesthesia. If i t were possible for t h e ether acquires a definite a n d fairly fixed speed. t o leave t h e oil a t a n y b u t a regular rate, which r a t e T h e significance of this conduct cannot fail t o be of is determined b y t h e per cent used, t h e n this method great importance, for b y this means t h e proper content of anesthesia would be very unsafe. of ether m a y be maintained in t h e blood t o produce T h e fact t h a t we have used i t in over one thousand cases without a n y untoward effects a n d in not a single case have me h a d bloody stools or diarrhea following mould seem to indicate t h a t i t is as safe as a n y other method of anesthesia when used in t h e proper way. By placing a special rectal t u b e in position a n d massaging over t h e colon from right t o left we can bring a patient out of a very deep anesthesia in fifteen t o t h i r t y minutes. The charts show t h a t t h e patient does not get a tremendous a m o u n t of ether at first a n d t h e n gradually recover, which would mean anesthetic shock a n d recovery n-henever this method was a t t e m p t e d b u t t h a t t h e patient goes under very slowly a n d gradually, a n d on account of t h e rapid elimination from t h e lungc t h e depth of anesthesia is constant. T h e charts will have a tendency t o inspire confidence in those who have n o t F I G . V-EFFECT OF INCREASED S U R F A C E ON THE RATEOF EVAPORATION OB ETHER F R O M A 7 5 PERCENTMIXTURE OF CORNOIL A N D ETHER hitherto used this method. It is especially indicated a n y desired physiological effect t h a t has a quanti- in all operations upon t h e head a n d upper t r u n k where tative relation thereto, for example, t h e third or surgical t h e anesthetist is usually in t h e way. For t h e insane, or wherever t h e element of fear is prominent, i t is stage of anesthesia.' T h e last mentioned has been demonstrated clini- indicated in preference t o all other methods. T h e fact t h a t nausea, Iyomiting a n d other sequellae a r e recally b y Wallace, who found respiration a n d blood pressure fully maintained, a n d Gwathmey a n d others duced t o a negligible quantity is also a factor in favor with records t o d a t e of about 1000 h u m a n cases. So of this method. 40 EAST4 1 s " STREET, N E W Y O R K f a r , not a case of post-ether pneumonia has been encountered. T h e after-effects usually associated with I In this connection i t may be stated that about 30 mils of a 75 per cent mixture to 20 Ibs. of body weight is administered as an enema.
1 A t Meeting of the New York Section of the American Chemical Society, June 1 1 . 1915
