Imagens das páginas

After in diminution of been continupain was produced

minims of tincture of aconite and five of chloroform. The Smee battery of eight cells was again used, the negative pole being applied to the tooth, the positive to the under surface of the jaw, externally. The tooth was very sensitive, and the pain caused by the current was too painful to be borne. The wires were therefore removed and extraction performed.

Resull.—The ordinary amount of pain was produced ; the application not having been continued sufficiently long to cause any diminution of sensibility.

After this operation it was arranged that further observations on this subject should be entrusted to sub-committees. REPORTS OF SUB-COMMITTEES.

ON VOLTAIC NARCOTISM. Report of a sub-committee, consisting of Dr Richardson, Mr Hockley, and Mr Kempton.

“The sub-committee met on Monday, April the 4th. One patient, a man twenty-four years old, presented himself to have the second right upper molar tooth extracted. An attempt had previously been made on the Friday preceding to remove the tooth, and the crown had been broken off. Since then the tooth and its surrounding structures had been excessively sensitive, so that the parts could scarcely be touched. Four minims of tincture of aconite and ten of chloroform on lint were tried to be inserted into the tooth, but could not be got into any cavity, the broken surface being smooth and flat. The pledget was then laid over the surface simply, and the point of the negative pole from the twelve cell Smee battery was pressed into it. The positive pole of the battery tipped with lint, saturated with eighteen minims of Battley's solution of opium, was applied to the gum interiorly to the tooth. The circuit being thus closed the contact was sustained for seven minutes and a half. The positive pole was changed to the surface of the gum, anteriorly to the tooth. Contact was again sustained for seven minutes and a half, and the poles being removed, extraction was performed. The operation was unusually severe, three attempts having to be made before removal, with considerable force.

" Result. The signs of pain expressed were very severe..

“The sub-committee observes that in this case no alleviation of suffering was obtained in the dislocation, and on examination it was found that the narcotic solution had not entered the tooth at all. The external parts which had before been so sensitive were rendered quite insensible.”

Report of a sub-committee consisting of Dr Richardson and Mr Kempton. The sub-committee state " that four operations have been performed.

“ The first patient was a man; the tooth to be extracted was the upper wisdom tooth of the left side. Into the cavity of the tooth a pledget of lint was introduced, moistened with three minims of tincture of aconite and ten of chloroform. The extreme point of the negative pole of a Pulvermacher battery of 200 elements was bound in the wool ; the conductor of the positive pole tipped with moistened sponge was applied behind the ramus of the jaw, externally. The current was sustained ten minutes, when the poles were removed and extraction made.

" Result.—There was no indication of pain, and after the extraction the patient affirmed that he had felt nothing whatever. He heard a noise on the dislocation being made, but was conscious of no hurt. He complained that at first the passage of the current gave pain, but this passed away, and a feeling of complete numbness supervened.

“ The second case was in a female; the tooth to be removed the second lower molar. There was a deep central cavity in the tooth. The cavity was plugged with lint, saturated with five minims of tincture of aconite and ten of chloroform. The Pulvermacher battery was used exactly as in the preceding case. The current was sustained for seven minutes, then the negative pole was removed from the tooth, and a fresh piece of lint, with the same amount of solution, was inserted. The pole re-applied, the current was kept up for five minutes longer. After this the poles were removed, and extraction performed.

- Result.There was a slight start at the moment of dislocation; but the patient afterwards stated that she felt a shake, not pain. As in the preceding case, there was during the latter part of the application of the anæsthetic a complete numbness of the tooth, which extended along the jaw and into the cheek.

" The third case was in a female ; the tooth to be extracted the upper wisdom tooth of the left side. It was but little decayed, but was inflamed and intensely sensitive. The application of the narcotic solution and electrical current were made as in the two preceding instances, but the lint had to be applied over a slightly broken surface of the tooth. Three applications were made, each time for nine minutes. At the end of this period the external parts being insensible, and the tooth feeling to the patient very benumbed, the extraction was made.

Result.-Some pain was felt, but it was slight and indefinable.

“ The fourth case was in a female; the tooth to be extracted a lower molar, with a large shallow cavity in the centre. The cavity was filled with a pledget of lint, saturated with the narcotic solution as before, one minim of creosote being added. The same battery was used, and the poles were applied as in previous cases. At the end of ten minutes, the external parts being insensible, and the tooth feeling benumbed, the poles were removed and extraction was attempted ; the tooth unfortunately broke in the middle of the fangs.

" Result.The pain of operation was very severe. The patient also complained of the pain produced in the first instance by the passage of the current.

“ The sub-committee in presenting this report would prefer to leave the inferences to be drawn from it with the full committee.”

SUMMARY ON VOLTAIC NARCOTISM. The conclusions arrived at by the committee in relation to the eight observations described above are1. That the application of a narcotic solution to a tooth,

in connection with a continuous current of electricity of considerable intensity, leads unquestionably to the production of local anesthesia, so that in some instances the pain of extraction is entirely broken

by it. 2. The anæsthesia thus produced is true anæsthesia, ex

tending from the tooth to surrounding parts. 3. The process is limited in its application. As at pre

sent understood, it can be only used successfully in

cases where the cavity of the tooth is exposed. 4. The time required in the application of the process

in each case is a serious obstacle to its practical use

fulness. 5. The pain produced in the first stages of the process,

particularly when the tooth is irritable, is always complained of. The pain dies away, certainly, as the process goes on, but to be successful, there should be no pain at all during any stage.

6. The above objections are too decided in character to

enable the committee to recommend this process as a practice. The members are, nevertheless, of opinion that improvements of an important kind admit of being made in the process; and with the hope that the history thus put forward may serve as the basis of such improvements, they lay the results of their united labours before the profession.

The CHAIRMAN, in rising to move " That the Report be received," thought it right that he should make one or two observations before putting the resolution. At the October meeting the Council of the College of Dentists having been requested to appoint a Committee to investigate the subject of Anæsthesia in dental operations, and the effect of Electricity as an Anæsthetic, the Council immediately met ; and they considered that in order to carry out all their observations fully they should invite the assistance of eminent members of the profession who had studied electricity in all its bearings. They accordingly invited Dr Richardson, who had used it greatly; Dr Lawrence ; Mr Harry Lobb, and several others. Those gentlemen had been of very great assistance to the committee, and at every meeting had been punctual in their attendance. [Applause.] The committee had drawn up their report honourably and faithfully, and it was now in the hands of the profession to test. So particular had the committee been that they would not take the report of a single individual; no report was given of an isolated case, and all the operations had been carried on collectively. [Hear, hear.]

The motion for the reception of the Report was then carried.

The CHAIRMAN now said,-The Report having been received, he would invite a discussion upon it by the members present, and be happy to answer any questions that might be thought desirable to put upon it. He would beg to state one fact in addition to what he had before observed :-viz., that the committee had not confined themselves to any particular instruments, but had employed all the electrical apparatus which they could get, whether one patent or another ; they had not chosen any one particular or intermediate current, but all the machines that they could command had been tried in every case, and they had all amounted to the very same thing. There could be but one opinion as to the continuous current, and nothing could be better than Smee's Battery upon that application.

Dr KIDD said that the medical profession were particularly indebted to the committee for their labours, and if they had not "commanded success," they had at all events “ deserved it.” [Hear, hear.] He thought it would be a pity that it should go abroad that the absorption of chloroform acted locally. He was satisfied that after 9 minims had gone into the lungs it acted in the ordinary way. He had known several instances in which 10 and 15 drops clearly produced Anästhesia. He was satisfied that Dr Richardson's application was a valuable one, particularly about the lips, and that it operated in the way of producing an immense deal of good. He did not think it should go abroad amongst the dental profession that a combination of aconite and chloroform applied to a tooth, and then the electrical battery applied, produced Anästhesia : it was the chloroform that was absorbed into the lungs which produced it. Dr Richardson's combination, he thought, was the whole gist of the Report. In cases of irritations arising from carious teeth a very small amount of chloroform and aconite would produce Anästhesia. All the complex batteries that were used were evidently absurd and useless. The Committee de. served great credit for having gone through the matter so steadily and carefully, and the medical profession were, he repeated, much indebted to the College of Dentists for such a valuable Report as that which they had presented.

Dr RICHARDSON remarked that in the cases alluded to he was particular in observing whether there was any general anæsthesia from the effect of the application of chloroform and aconite : but there never was in any degree: the Anæsthesia was entirely confined to the teeth and the gums. Even the gum on the opposite side was sensitive; the fingers and hands were perfectly sensitive ; and the Anæsthesia in each case of the application was entirely local.

Dr Kids observed that the fifth and seventh nerves were of immense sensitiveness, and required a great deal of chloroform. He still thought this, that the patient's mind was so much fixed in the tooth-drawing, it being a sort of new thing, that there was a mental process joined to the local effect of chloroform, that between the two and a very small dose of chloroform, there was what might be called local anæsthesia. He would carefully examine the lower limbs, which were first to come under the effect of chloroform.

Dr CAMPS said he did not pretend to have had much experience in the administration of chloroform, but it was his opinion that its application did produce local anæsthesia, and that Dr Kidd was not justified in affirming that local anesthesia was not produced by the local application of chloroform. He did not present himself as claiming any large experience, but he still thought that he ought not to resist the evidence submitted by the report which had been read that evening

that chloroform locally applied did produce local anæsthesia, quite apart from its inhalation by the lungs. Though he was not one of the members of the College, yet, as a member of the medical profession, he had much pleasure in moving,—That the thanks of the meeting be accorded to the various committees for their labours on this most important subject; because, though they had not arrived at the success they had anticipated, yet, as Dr Kidd had said, they had deserved it, and it was a merit almost as much to deserve success as to obtain it. [Cheers.] Before sitting down perhaps he might be permitted to say that, in his judgment, the successful application of electricity should be looked for rather in its relief to disordered motion than to disordered sensation; and that would remove it almost out of the pale of applica. tion with regard to dental surgery. But he was very much inclined to the opinion that the medical profession had an immense deal to learn with regard to electricity and galvanism (using those terms in their general sense) in their application to impaired or perverted motion, rather than in cases of impaired or perverted sensation. Therefore he was not surprised that the committee had arrived at results in a great degree negative-that was to say, that whether the intermittent or continuous currents of electricity were employed, still the production of anæsthesia was not so certain as they had hoped.

Dr KIDD had very great pleasure in seconding the motion. He was sorry that an impression appeared to have been produced that he had found fault with the report; he had said the report was a most valuable one. [Hear, hear.]

« AnteriorContinuar »