University of the Pacific School of Dentistry - Chips Yearbook (San Francisco, CA)

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NITROUS OXID .l'1'ROL'S OXUJ was discovered by l'riestly. Its pain reliev- ing qualities were first recognized by Sir Humphrey Davy, and Horace lVells discovered its anesthetic properties in the year 1884. Un that day modern anesthesia was given to the world, and nitrous oxid has proved to be a blessing to suffering humanity, and a forerunner to all other anestheticsf' CThorpej lt has become very popular with the dental practictioner in the past few years, and not without reason, as it is non-irritating, pos- sesses a pleasant odor and will not cause nausea if administered under proper conditions. fn producing anesthesia the gas. in a vapor form, is inhaled into the alveoli of the lungs, where, by the process of dialysis, it enters into loose chemical combination with the hemoglobin of the erythrocytes, and by the circulation of the blood is distributed over the whole system. When the charged erythrocytes reach the cere- brum, the action of the gas upon the body becomes apparent. The centers of perception are first acted upon, followed by the paralyza- tion of the sensory part of the chorda spinalis. The gas next effects the motor centers of the spinal cord, the medulla oblongata, and the respiratory and circulatory centers. Of course paralyzation of either of these centers will mean death. An over dose of nitrous oxid produces death in nearly all cases from asphyxiation, the heart in some cases, continuing to beat for a period of several minutes after breathing has ceased. Success in administrating anesthetics does not depend entirely on the particular anesthetic employed, as the manner in which it is administered is an important factor. The necessary forceps or other instruments should be ready, but must be kept out of the sight of the patient. Avoid at all times a second or third examination, as this habit tends to unnerye the patient to' such an extent that a longer time and a greater quantity of the anesthetic is required to produce anesthesia. lVhile anesthesia is being induced, perfect quiet must be main- tained in the room, No talking or whispering should be tolerated, and no words spoken except those of suggestion to the patient. Sounds are exaggerated under the influence of anesthesia and an ordinary tone of voice may sound very loud and be disquieting in the extreme. For this reason all suggestions to one undergoing anesthesia should be made in a quiet, firm, subdued tone. '- 30

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W'OLFF'S LAW Julius Wolff taught: l orm is the outcome of function and that a continuous or sufficiently frequent performance of function in a given position is followed by or associated with a corresponding structural change and adaptation. This law explains the rearrangement of bone structure seen after an injury, operation or change of form due to softening of bone. Many of the operations, much of modern nomenclature of Orthopedic Surgery have been handed down to us from and before the time of Galen. The individual who would claim to be the discoverer of something distinctly new would be greatly undeceived by a reference to the literature of the subject. lt would be impossible without injustice to many men of merit to attempt to give a list of many surgeons of Europe and America who have added to the efficiency of our work in deform- ities. However a just tribute to one of the greatest of them all cannot be harmful. To the late Lewis A. Sayre the writer wishes to record his gratitude and heartfelt thanks for his skill- ful teaching and hearty encouragement in the beginning of that which was to become a lifework. As a memento to the students of the little college, who have faithfully worked with the writer many days in the past few years, two illustrations will be included in this sketch. They represent the adaptation of a common and homely device to a useful purpose in our work, This device can be adapted to use in many ways and enables us to secure quick and safe results without pain to our patients. Many students have desired some- thing by which to remember the l'. X. S. orthopedic clinic, VVe have all worked hard in our clinic for the betterment of the poor and unfortunate. VVe have striven to learn and to help each other. The writer hopes to see the day when some of his former students may far outstrip our present work. The greatest ap- preciation possible for any student to express can be accompl- ished by adding something to the work on Orthopedic Surgery. VVishing all of the students of the College of Physicians and Surgeons Godspeed, the writer bids you adieu for the year. l2'rn.xN H. SMITII, M. D. 29

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Stenosis, and obstructions of any kind whatever in the mouth, nose, pharynx, larynx, trachea, bronchi or the lungs, interfere more or less with inducing comfortable and successful anesthesia. Hyper- trophied turbinated bones, devided septum, nasal polyp or polypi, enchondioma, or osteoma in the nares, or any other pathological condition of the respiratory passages or organs, tend to prevent the patient from succumbing to the influence of the anesthetic. The anesthetic itself is not always to blame for imperfect anesthetization and should not be condemned before all conditions are understood. During administration the face, and especially the lips, should be watched for symptoms of cyanosis. This condition indicates that the system is over saturated with nitrous oxid, and should be relieved by the prompt addition of oxygen. The corneal reflexes are also indicative of. the condition of the patient, and the anesthetist should quite frequently test the sensitivity of the conjunctiva. The College of Physicians and Surgeons has recently added to its equipment one of the latest models of apparatus for administering nitrous oxid and oxygen, mixed in any desired proportions. Ricusnp I. Nixsslsn, 'l3. ,Q I '70 I 31