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
_Case 32_ occurred in the Royal Infirmary of Edinburgh to a man aged
forty-three, on whom Dr. Dunsmure was about to operate for stricture of
the urethra by perineal section. The chloroform was administered by Dr.
Struthers. About an ounce of chloroform was used, and the patient had
been put under the influence of this agent on two former occasions, when
a similar quantity was employed without ill effect. The following is Dr.
Dunsmure’s account of the case:—
“While the patient was inhaling the drug, he struggled considerably, and
became a good deal congested in the face and head. He seemed to take a
slight convulsion, like an epileptic fit, and such as I have seen on
several occasions in people who have led an intemperate life. During the
convulsion, the handkerchief containing the chloroform was removed to
some distance from the face. In a short time the inhalation took effect,
and he began to snore, and although still violent, the chloroform was
removed from the face entirely, and the handkerchief placed under the
pillow. As soon as the patient became more quiet, he was pulled down on
the table, and placed in the proper position for the operation. I then
shaved the perineum, and was just going to make my first incision, when
one of the assistants said that his pulse was becoming weak. The
posterior tibial, Mr. Spence then remarked, was good, but in a second or
two after, both gentlemen exclaimed that the pulse was gone. I rushed
from my seat to the patient’s head, and found that his breathing had
ceased. Those present who had an opportunity of observing the
respiration, which I had not, owing to the stool on which I sat being
low, positively assert that the breathing did not cease before the
pulse. The face was much congested, the jaws were firmly closed, and the
pupils were dilated. I immediately forced open the lower jaw by means of
the handle of a staff, and with catch forceps pulled out the tongue.
Artificial respiration was had recourse to, and in a few minutes he made
a long inspiration. This was soon followed by a second, by a third at a
longer interval, by a fourth at a still longer period, and then by a
fifth, when all attempts at natural breathing ceased. No pulsation could
be felt in the radial arteries. The chest was noticed to be much
contracted, to have apparently lost its elasticity, and not to expand
when the ribs were forcibly compressed during the artificial
respiration. I had previously sent for a galvanic apparatus, which was
in the flat below, and it arrived almost immediately after the patient
had made the fifth inspiration. When the tongue was pulled out, and
before the first breath was taken, I was on the point of opening the
trachea, but this proceeding was then abandoned; it was now, however,
had recourse to, in order to carry on artificial respiration more
certainly: the external jugular was also opened, and about a couple of
ounces of blood flowed. By the time the tracheotomy tube was inserted,
Public-domain text, read in full here on John Shaqi.
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