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 AN IMPROVED METHOD OF GENERAL ANES- 
 THESIA IN HEAD-SURGERY BY MEANS 
 
 OF GLASS NASAL TUBES * 
 
 JOSEPH E. LUMBARD, M.D. 
 
 Anesthetist to the Harlem Hospital, the General Memorial Hospital 
 
 and the Lying-in Hospital ; Fellow New York 
 
 Academy of Medicine, etc. 
 
 NEW YORK 
 
 Anesthesia for head-surgery certainly presents diffi- 
 culties for the anesthetist. In order to insure greater 
 safety to the patient and less interference of the anes- 
 thetist with the surgeon during an operation on the 
 head, many inhalers have been produced. Nasal tubes 
 for such purposes of anesthesia were introduced in 190b 
 by Dr. Edwin Pynchon of Chicago and Dr. Stuart B. 
 Blakely of New York independently. Since one of 
 these instruments allows the entrance of too much air 
 and the other does not provide sufficient air, I have 
 devised an instrument which experience has proved to 
 be more practical than any other on the market. 
 
 My apparatus consists of two glass tubes (Fig. 1, A 
 and B) so bent that each will properly fit a nostril. 
 These tips are connected with the mechanism which sup- 
 plies the anesthetic vapor by means of two soft rubber 
 tubes (Fig. 1, C), joined together at the supply end by ;i 
 glass Y, which also connects them with the supply tube 
 (C) itself. They are furnished in three different 
 sizes in order to make the apparatus adapted to nostrils 
 of different shapes. 
 
 Furthermore, the apparatus which I use for continu- 
 ing the anesthesia is different from that employed hy 
 either Dr. Pynchon or Dr. Blakely. I induce anes- 
 thesia in the usual way and then introduce the glass 
 
 * Demonstrated before the Harlem Medical Association, May 14 
 1910, and the Valentine Mott Medical Society, May 24, 1910. 
 
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 nasal tips into the nose. For convenience these may be 
 held in position by means of a small piece of adhesive 
 plaster placed across them transversely on the forehead 
 (Fig. 2). The anesthesia is then continued by supply- 
 ing the vapor in one of four ways: first, by the Crile 
 method, that is, by the use of a funnel and tube (Fig. 
 1, C), on the stretched gauze of which ether is dropped; 
 second, by the one-bottle Junker apparatus, as used so 
 
 Fig. 1. — Glass nasal tubes for general anesthesia in head-surgery 
 (A and B) ; connected with supply tube (C). 
 
 commonly in England for head-surgery; third, by the 
 two-bottle modification of the Junker apparatus, as used 
 by Dr. T. W. Brophy of Chicago for work on cleft pal- 
 ates; fourth, by the Gwathmey three-bottle modification 
 of the Junker apparatus. By each of the Junker meth- 
 ods anesthesia vapor is pumped into the nostrils by 
 means of suitable bulbs. 
 
I much prefer the Gwathmey apparatus, as it allows 
 the use of both ether and chloroform, either singly or 
 combined in any proportion, with the greatest safety 
 and ease. 
 
 The following are some of the advantages of the glass 
 nasal tips over the long rubber tubes which have been 
 in common use : 
 
 Fig. 
 
 -Glass nasal tubes for anesthesia in use. 
 
 1. They are more safely and easily introduced into 
 the nose. 
 
 2. They allow the anesthetic vapor on its way to the 
 lungs to become warmed by the nose. 
 
 3. Successful use. of the instrument is in no way 
 interfered with by a deformed nasal septum or exostosis. 
 
4. They do not cause nasal hemorrhage. 
 
 5. They cannot become obstructed with blood and 
 mucus. 
 
 6. They remain in position much better than rubber 
 tubes. 
 
 7. They are easier to clean and sterilize. 
 
 A method very similar to mine has been successfully 
 employed at Boosevelt Hospital in New York City, 
 where it is now entirely used for head-surgery in place 
 of rectal anesthesia. 
 
 The glass nasal tips, as above illustrated, are certainly 
 a most excellent means of producing a safe and contin- 
 uous anesthesia in head-surgery, not interfering with the 
 surgeon. 
 
 1925 Seventh Avenue. 
 
 Reprinted from the Journal of the American Medical Association 
 Oct. 8. 1910, Vol. LV,pp. 1258 and 1259 
 
 Copyright, 1910 
 American Medical Association, 535 Dearborn Ave., Chicago 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/improvedmethodofOOIumb 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
 This book is due on the date indicated below, or at the 
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 provided by the rules of the Library or by special arrange- 
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RD81 
 Lombard 
 
 L973 
 
 COLUMBIA UNIVERSITY LIBRARIES (hsl.stx) 
 
 RD 81 L973 C.1 
 
 An improved method of general anesthesia 
 
 2002283654