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
“As the patient’s health was good, he was at once, and by his free
consent, placed under the influence of chloroform. As usual, a piece of
fine gauze was employed; it was spread over the face, leaving a free
passage for atmospheric air; the chloroform was dropped from time to
time upon that portion of the gauze which was over the nostrils. It was
administered by two assistants who were accustomed to its use, and who
at the time attended to the pulse. The operator superintended the
assistants. At the end of four or five minutes, the patient still felt
and spoke; and at the end of another minute, he still spoke and was
somewhat restless. Up to this time, from a drachm to a drachm and a half
of chloroform had been employed. The pulse was regular, and of the
normal strength. All at once the patient raised his body, and struggled
so that the limbs escaped from the hold of the assistants, who however
seized them quickly, and replaced the patient in his position. Within a
quarter of a minute, one of the assistants stated that the pulse at the
wrist had ceased to beat. The handkerchief was removed. The countenance
was completely altered. The action of the heart had altogether ceased;
the pulse could not be felt anywhere; and the sounds over the region of
the heart could no longer be heard. Respiration still continued, but it
became irregular, weak, and slow; and at length ceased completely in the
space of about half a minute.
“The extreme danger of the patient was manifest, and immediate and
energetic means were employed to rouse him. Ammonia was held to the
nostrils, and rubbed in large quantity over the surface of the chest and
abdomen. It was also applied to the most delicate parts of the skin, _e.
g._, the lips and the extremity of the penis, with a view to excite
irritation. Mustard was used; the head was inclined over the bed; and,
finally, an attempt was made to restore respiration by means of
alternate pressure on the abdomen and chest. After two or three minutes,
respiration reappeared, and even acquired a certain fulness, but the
pulse nowhere returned. Frictions were continued. Respiration became
again slower, and at length ceased. Artificial inflation was practised,
at first through the mouth, and afterwards through the larynx, by
passing a tube through the glottis, as it was perceived that air had
passed from the mouth into the stomach. The precordial, epigastric, and
laryngeal regions were energetically cauterised with a hot iron. The
pulse did not return. For the space of half an hour every effort was
made to resuscitate the patient; but in vain.
“The autopsy could not be made until seventy-two hours after death. The
temperature being low, the body showed no signs of decomposition; there
was still rigidity of the limbs. The features were not altered. The
examination of all the organs was made with care.
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