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
With regard to the third of the above conclusions, it is not a little
remarkable that most even of those speakers who opposed the conclusions
of the commission, agreed that death was caused by a sudden development
of air in the veins; and differed from them only in this, that they
considered the chloroform as the cause of the evolution of air or gas,
and that it proved fatal in this way. That the air was not caused by
putrefaction, and that it did not enter by the wound in the thigh, may
be readily admitted, but there remains the artificial respiration, which
was performed with such force as to produce permanent dilatation of the
air-cells. It was argued in the Academy that, as the air was in the
systemic, as well as in the pulmonary veins, it could not have been
introduced by the artificial respiration, since the left ventricle had
previously ceased to act; but the action of the left ventricle is not
necessary for the passage of the contents of the arteries through the
capillaries into the veins, since this commonly goes on after death, the
arteries being usually found entirely empty of the blood they must have
contained at the moment of death. With regard to the passage of the air
out of the heart into the arteries, supposing that the pulmonary veins
were ruptured during the inflation of the lungs, there is an observation
of Dr. Sibson’s which will explain both this circumstance and the fact
of the heart itself being found empty of blood. He found that the heart
was often emptied of blood by distending the lungs with air after death
in preparing the body for his diagrams of the position of the
viscera.[74]
With the conclusions above quoted, some additional ones were adopted
from the second part of the report of the commissioners; in these it was
admitted that chloroform is capable of causing death, if administered
too long, or in too large doses. One of these additional conclusions,
however, is as erroneous as the previous ones. It is, “there is risk of
asphyxia when the anæsthetic vapour is not sufficiently diluted with
air.” When the vapour is not sufficiently diluted with air, the risk is
one of sudden death, by paralysis of the heart. Chloroform does not
yield enough vapour, at the natural temperature and pressure of the
atmosphere, to exclude the air to the extent which would cause asphyxia.
When chloroform vapour largely diluted with air is long continued, it
may cause, not real asphyxia, but a mode of death resembling it, owing
to the medulla oblongata and nerves of respiration becoming over
narcotised.
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