On chloroform and other anæsthetics: their action and administrationSnow, John
History
On chloroform and other anæsthetics: their action and administration
Snow, John
Anesthetics; Chloroform; Snow, John, 1813-1858
The length of time which it is most desirable to occupy in the
administration of chloroform, before the commencement of an operation,
is about two minutes in infants, three minutes in children, and four or
five minutes in adults. Circumstances occasionally occur, however, to
lengthen these periods. The time during which the adult patient usually
remains conscious whilst inhaling, is about two and a half minutes, but
this period is sometimes prolonged from the nervousness of the patient,
or his intolerance of the pungency of the vapour. Again, when
unconsciousness is induced, there is, in many cases, an increased flow
of saliva; and although this usually causes no impediment, the patient
sometimes keeps making efforts of deglutition which very much retard the
inhalation; and, at other times, he holds his breath, with his mouth
full of saliva, as if he had some obscure idea of disposing of it in a
suitable manner.[56] The delay which often arises from the struggling
and rigidity has been already mentioned; but notwithstanding all these
circumstances, it hardly ever takes more than seven or eight minutes to
make a patient sufficiently insensible.
I have indeed met with a few cases in which a longer time has been
occupied, but there has always been a physical reason for it. I have
never had occasion to attribute the delay to any idiosyncracy, or great
peculiarity in the patient, but only to the circumstance that the vapour
did not enter the lungs in sufficient quantity within a given time. I
have had under my care several patients who, it was supposed, were not
susceptible of the effects of chloroform, or were, at least, very
difficult to bring under its influence, as previous attempts had failed.
It so happens, however, that I have had no difficulty whatever with any
of these cases.
Two or three female patients who were about to undergo some trifling
operation, preferred to leave off before they were unconscious, on
account of unpleasant sensations in the head or chest, and to have the
operation performed without the full effects of the chloroform; but
there is no doubt the agent would have acted well enough if it had been
continued.
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