On chloroform and other anæsthetics: their action and administrationSnow, John
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On chloroform and other anæsthetics: their action and administration
Snow, John
Anesthetics; Chloroform; Snow, John, 1813-1858
In the human being and all other creatures of warm blood, any vapour
which is inhaled and absorbed in the lungs passes at once to the left
side of the heart, and as the coronary arteries are the first branches
given off from the aorta, the heart must, during the process of
inhalation, be always a very little in advance of the rest of the body,
as regards the amount of vapour to which it is subjected. This, however,
is no source of danger, as regards chloroform, if the inhalation takes
place in a gradual and uniform manner; for the heart being able, as
shown by the above experiments on frogs, to bear a greater amount of
this narcotic than the brain, its action continues even after
respiration has ceased, if the vapour is added only by a little at once
to the blood, as it passes through the lungs. But if the air which the
patient breathes be too highly charged with vapour, it is easy to
understand how the sensibility of the nerves of the heart may be
paralysed, notwithstanding their power to bear somewhat more of this
agent than the brain and nerves of respiration. I calculated (p. 74) the
quantity of chloroform which would suffice to arrest respiration in the
adult of average size to be thirty-six minims, provided it were equally
diffused through the circulation; but supposing a patient breathes, at
any time, air containing ten per cent. of vapour of chloroform, a
considerable part of this might enter the lungs at a very few
inspirations, for thirty-six minims of chloroform occupy only 37·5 cubic
inches, and would be contained in 375 cubic inches of air, and might be
breathed in less than a minute; but for the whole of the blood to pass
through the lungs occupies a considerable time—I believe about four
minutes in the adult—and therefore the portion of blood which is passing
through the lungs, at the time when vapour of the above strength is
inhaled, must become much overcharged with chloroform, making every
allowance for the portion of vapour which is expired again, without
being absorbed.
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