Note 7 — Chapter XX · ANESTHESIA AND ANESTHETICS, GENERAL AND LOCAL.

Ether Narcosis by the Rectum.—Cunningham and Lahey have revived the almost abandoned method of rectal ether narcosis, after improving the technique. The rectal tube is introduced for ten to fifteen inches and ether vapor is then forced in until considerable gas is pressed around the rectal tube, keeping the forefinger in the rectum opposite the tube until it causes pain and hastens the expulsion of the rectal gases. It is essential that the rectum be distended to the point of keeping closed around the tube, since unless the gas normally in the bowel be first removed the patient absorbs the ether much more slowly, presumably because of its dilution. At the first introduction of the ether vapor the patient may feel a natural discomfort and desire to defecate, but in a short time this sensation disappears; the breath becomes ether-ladened in from one to five minutes, he becomes drowsy, the breathing stertorous, and he passes into complete surgical narcosis without any excitement.

The apparatus used consists of a bottle seven inches in height, of which five inches are used for ether space and the balance for vapor. The afferent tube which leads to the bottom of the ether ends in a bulb, with small perforations, so that the air escapes in several bubbles. This bottle is placed in a water-bath at a temperature between 80° and 90°. By keeping the ether warm, without boiling, the air forced through it is more easily saturated.

The same care must be given to see that the tongue does not fall over the larynx as when ether is given by the mouth. Should narcosis be too pronounced the tube should be disconnected and ether gas forced out of the bowel by abdominal massage. Oxygen may be given through the same tube if desired, while artificial respiration and stimulation are practised as usual when needed. After completion of the operation the ether vapor should be completely expelled by pressure.

The advantages of the method are that but a small amount of ether is used, there is no stage of excitement, vomiting is rare, bronchial secretion is prevented, and recovery is rapid. It has been shown that six volumes per cent. of ether are required in the blood for the production of complete anesthesia. The rapidity with which the latter can be produced depends upon the rapid production of this percentage. This result is attained more readily by the rectum than by the lungs. For the production of narcosis by this method the rectum should be previously and thoroughly emptied.