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
If it were possible for a medical man to mistake or disregard the
symptoms of approaching danger, and to go on exhibiting vapour of
chloroform, diluted to a proper strength, till the death of the patient,
this event would take place slowly and gradually, as in Experiment 23,
related above, and every other experiment in which the air did not
contain more than five per cent. of vapour. The action of the heart
would survive the respiration; there would be a great tendency to
spontaneous recovery, and the patient would be easily restored by
artificial respiration, if it were performed whilst the heart was still
acting; as I have always found it to be successful in animals under
these circumstances.
In examining the recorded cases of fatal inhalation of chloroform, we
shall find, however, that they have none of them taken place in this
gradual manner; but that in all cases the fatal symptoms, if not the
actual death, have come on very suddenly. Dr. Sibson was, I believe, the
first to point out that, in the fatal cases of inhalation of chloroform,
death was caused by its paralysing the heart; but he was not at that
time aware of the physical conditions under which this agent may act
directly on the heart. In commenting on the first four deaths from
chloroform, he says:[61] “In all the four cases it is manifest that the
immediate cause of the instantaneous death lay in the heart. The heart,
influenced by the poison, ceased to contract, not from the cessation of
respiration, for the heart in asphyxia will beat from one to three
minutes after respiration has ceased, but from immediate death of the
heart. There is no doubt a combination of causes operating to destroy
the heart’s contractile power: the mental influence, the congestion in
the systemic, and that in the pulmonary capillaries, will all have a
material influence.” And further on he says: “We are obliged, then, from
the experience of these cases, to conclude, that in man the death is
usually instantaneous, and due, as every instantaneous death is, to
paralysis of the heart. In animals the death is usually due to paralysis
of the muscles of respiration. It is chiefly owing to the superior
control of the mind over the body in man, that in him the poison acts on
the heart more than in dogs.”
Public-domain text, read in full here on John Shaqi.
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