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Anne Allen, RN

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MY MOM WAS a nurse: Ellen Conklin Tuller,1904-1985. She had a handy Pocket Cyclopediaof Nursing,1 with her name embossed in goldon the burgundy cover.

Just about any information a nurse might needcould be accessed quickly in this handy refer-ence. There is no index, and pages are notnumbered. Order is alphabetical, abortion tozingiber, “an ingredient of many ‘cancercures’.”

Several pages of the cyclopedia are devoted toanesthetics and anesthesia. The discussion ofether anesthesia explains that “the patient hasundergone various preparations for the opera-tion, and has pictured in his mind various ideas

Reprinted with permission from J Post Anesth Nurs 1:2-4,1986.

From St. Francis Hospital, Tulsa, Okla.Address correspondence to Anne Allen, RN, 6537 S 109th

East Ave., Tulsa, OK 74133.© 1986 by the American Society of Post Anesthesia Nurses.1089-9472/05/2001-0003$30.00/0

odoi:10.1016/j.jopan.2004.11.012

4

f pain and suffering. This makes him quiteervous and anxious, and the pulse quite rapid.e therefore regards every act of the doctor orurse with suspicion.”

“choking sensation” and “profuse flow ofaliva” describe induction. “The sense of touchs blunted, objects are seen through a mist, andounds appear to be at a distance. Often ringing,issing or roaring sounds are heard.”

The second stage, or excitement stage, beginsith movement of the arms. Many patients

truggle violently, others shout, sing, groan, orurst into fits of laughter. The skin is flushed,ften blue, the breathing is irregular because ofhe struggling.”

The third stage” is entered when the patientecomes calm, “quiet, and unconscious. Whenhe ether is stopped, the patient may againecome somewhat excited and talkative: heeels nauseated and vomits.” The anesthetist isdvised to constantly keep the mouth “mopped

nne Allen, RN, was Patient Care Supervisor in the Postan-sthesia Care Unit at St. Francis Hospital, Tulsa, Okla. Her0-year nursing career included staff nursing positions inmergency room, intensive care, and postanesthesia nursing,

ncluding two years as a Preoperative Visiting Nurse. She is aormer editor of Vital Signs, Newsletter of the Oklahomassociation of Postanesthesia Nurses; Editor of Breathline,ewsletter of the American Society of Post Anesthesia Nurses;nd a past member of the Advisory Board of Current Reviewsor Recovery Room Nurses. She was a Director of the Amer-can Society of Post Anesthesia Nurses. Anne also served ashe ASPAN president from 1988-1989.

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TRANSITIONS 5

The symptoms of “ether collapse” indicate “toomuch ether is being given.” Breathing is “slow,shallow, and gasping.” The face then “becomesblue and cyanotic and the breathing stops.” Thepulse “soon becomes weak and irregular. Thepupils are widely dilated, and do not react tolight. The pulse grows weaker and death resultsfrom respiratory paralysis.”

Along with stopping anesthesia, giving artificialrespiration, and elevating the foot of the table,the practitioner is instructed to “stretch thesphincter of the rectum to induce breathing bythe reflex action thus produced.” Heart andrespiratory stimulants such as “caffeine, strych-nine and atropine” are recommended. “Themost common condition that may occur withether anesthesia is pneumonia.”

The significance of a child’s cry, diabetes, anddigitalis are discussed in the book. Applicationof an “ice bag or a hot water bag to the regionof the heart” is listed among measures for treat-ment of digitalis poisoning.

Dyspnea is described in detail and with compas-sion for the afflicted. “Every breath is quick andlabored, performed with great difficulty andonly after a hard struggle so that the patient isexhausted with the prolonged effort.”

The section on eclampsia illustrates dramati-cally the pieces of knowledge that were ontarget as well as the erroneous beliefs thatformed the basis for treatments that probablyhastened the patient’s demise:

“While the patient is comatose or anesthetized astomach tube should be passed, and the stom-ach washed out with a weak solution of bicar-bonate of soda. Six ounces of magnesium sul-fate in a saturated solution should then bepoured down the tube and left in the stomach.”If, on the other hand the patient was able toswallow, “she should be given a potent purgesuch as six grains of calomel along with a dramof jalap.” At the same time, a large warm enema

was given. The flushing of the colon with hot w

uid was believed to stimulate the kidneys.Their action may be further increased by hotomentations or poultices applied to the flanks.”t was also recommended that the skin be stim-lated by hot packs of “hot air baths.”

here the arterial pressure remained high andfits” continued after the birth of the child,venasection” was advised, and 10 or 15 ouncesf blood were removed. This was thought toemove “a certain amount of toxin.” The re-ainder of the toxin could be “still more di-

uted” by the administration of saline per rec-um very slowly “one pint in half an hour,epeated every four to six hours as necessary ornto the loose cellular tissue under the breast.”here is a note of caution regarding the “ten-ency of edema of the lungs” lest the patientecome “increasingly waterlogged and die.”ulva pads were made of “Gamgee tissue” andsterilized or scorched brown by the fire.”

eeching as a method of “abstracting blood forhe purpose of relieving local inflammation orcute congestion” is said to be “preferable tohe knife.” Swedish leechs were consideredest because they extracted more blood thanmerican leeches. Leeches were most com-only applied, according to the cyclopedia, to

he temple or nape of the neck in meningitis, orehind the ear to “relieve cerebral congestion.”ne of the disadvantages of leeching listed is

hat “they may have a bad psychic effect on aervous patient.”

ostoperative treatment of the patient with aew tracheotomy suggested that “to assure aough sufficient in strength to expell a mucouslug, a sterilized feather might be introducedhrough the tube and the trachea tickled.”

he transfer of blood from one person to an-ther involved coating the inside of needles toake the “surface smooth and prevent clot-

ing.” A glass graduate received the donor’slood. Sodium citrate solution (50 cc of citrateo 500 cc of blood) was added. A basin of warm

ater kept the blood warm for transfer to the

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ANNE ALLEN6

patient. It is unclear in the text exactly how theblood is then infused into the patient, thoughcomplications such as “overdose” are men-tioned.

Obviously there has been tremendous progresssince the cyclopedia was written. Change anddiversity have always been integral to the nurs-ing profession. The history of nursing is a storyof transition. Laurie Koszuta has reported someof the history of postanesthesia care in herarticle, “On the Road to Recovery,” in this issue.

Sophisticated technological innovation has pro-vided the basis for transition during my 20 yearsin nursing. Advanced diagnostic, monitoring,and support systems improve and extend lifeand intensify concern with moral, ethical, andlegal issues.

We have now entered an era of turbulencebrought about by drastic changes in health careeconomics. The health services environmenttoday forces examination of the appropriate-ness of what we do in terms of cost and benefit.This is a special time of searching for new ideas,for mastering new kinds of knowledge, and forusing valuable old knowledge in new ways. Asuccessful manager contributes to the genera-tion of new ideas by assuring an environment inwhich creativity and innovation can flourish.

The necessity of marketing adds a new dimen-sion to nursing research. Our image in the com-

munity is critical in this new competitive envi- Y

onment. Today we must package and marketur nursing services, in ways considered unac-eptable just a short time ago, while maintain-ng a very professional image. We must be alerto ensure the “packaging” projects nurses asrofessional, educated, informed, and enthusi-stic.

ow our high-tech atmosphere must be bal-nced with high touch, high visibility, and highnteraction with family members. Patients andheir families may not always have the prepara-ion necessary to judge the real quality or com-etency of the care we give or the soundness ofur nursing judgment. They do always notehether they are treated with respect, concern,

nd compassion and whether the system oper-tes efficiently.

n extra bratty kid, I resisted Mom’s attempts toducate me. I sure wasn’t interested in how toake a bed “the way they do at the hospital.”ut somehow she was able to pass on to me aense of the values and professional ethics thatranscend all time and the sense of wonder andompassion evident throughout the instruc-ions found in her handy pocket cyclopedia.hese are things to hold on to, as are the uniquepportunities nurses will always have to wraphe gifts of science and technology in thearmth of dignity and caring.

eferences

1. Scott RJE (ed): Pocket Cyclopedia of Nursing (ed 2). New

ork, Macmillan, 1926