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
Further particulars are not given; but as the patient died suddenly,
when the surgeon had scarcely divided the skin, it must be admitted that
he was, in all probability, correct in attributing the event to the
chloroform. The patient usually yields to the laws of gravity when only
partially under the influence of chloroform, and it seems surprising
that the operation should have been undertaken without placing the
patient in the horizontal posture. The proper position of the patient,
when a large tumour of the back is to be removed, is to be lying almost
flat on the abdomen, the head being a little turned on one side, so that
it rests with one ear on the pillow.
_Case 37._ Jane Morgan, aged fifty-nine, died whilst inhaling chloroform
in the Bristol Infirmary, on January 21st, 1854. She was moderately
stout, pale, but not otherwise of unhealthy appearance. “The
stethoscopic indications were favourable, the beat of the heart was
natural, and the air passed freely throughout both lungs; but the chest
movements on the right side were not quite so free as on the left.”
Chloroform was ordered by Mr. Harrison, the senior surgeon of the
Infirmary, with the intention of attempting to reduce a dislocation of
the humerus of eight weeks standing. “Having taken no food since her
breakfast, she commenced the inhalation of one drachm of chloroform, at
2 P.M., in bed in her ward, under the superintendence of Mr. Hore, the
house-surgeon. Nothing unusual occurring in the patient’s general
condition during inhalation, a second drachm, in about five minutes from
the first, was poured upon the sponge, and the inhalation was continued.
Almost immediately after the addition of the second drachm, the
chloroform was withdrawn, as the patient’s breathing became stertorous;
and immediately afterwards her pulse, which had hitherto continued
pretty firm, was suddenly imperceptible, the respiration ceasing at the
same time. The pupils were not dilated.” Various measures were promptly
resorted to with the hope of restoring the patient; but there were no
further signs of life, unless “some convulsive efforts of the
respiratory muscles,” under the application of galvanism, be so
regarded.
At the examination of the body on the following day, the right pleura
was found to be adherent. The lungs were healthy in structure, but
gorged with dark fluid blood. There was about an ounce of fluid in the
pericardium. There was a small quantity of fluid blood in each of the
cavities of the heart. For the length of an inch from their
commencement, both coronary arteries were much dilated, and studded with
atheromatous and bony deposits. The muscular structure of the heart was
examined under the microscope by Dr. William Budd, and a considerable
proportion of the fibres were found in a state of incipient fatty
degeneration. It was learned, after her death, that she had been subject
to occasional attacks of fainting.[108]
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