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
The partial recovery of the patient is a remarkable feature in this
case, and it is difficult to explain why he did not recover completely.
The number of the pulsations during this partial recovery is mentioned,
but not their quality, and I cannot help supposing that the pulse must
have been extremely weak, as well as slow, at this period. The ten
minutes during which the pulse and breathing returned is mentioned with
the qualifying term of “perhaps”, which leads to the supposition that it
was not noted by the watch or clock, and under such circumstances of
anxiety and suspense, the time might be very much over-rated. The slight
fatty degeneration of the heart might probably interfere with the
complete recovery of the patient, after this organ had once been
paralysed by the chloroform.
_Case 41_ took place on July 13th, 1854, in the Middlesex Hospital. The
patient was a stout, muscular, and florid man, 65 years of age, on whom
Mr. De Morgan was about to perform amputation at the upper part of the
thigh, on account of a large malignant tumour growing from the inner
side of the femur.
“Chloroform was administered by Mr. Sibley, the registrar to the
hospital. Snow’s inhaler was employed. The quantity at first placed in
the inhaler was rather less than two drachms, and another drachm was
added eight minutes afterwards. The patient inhaled the chloroform
without difficulty, and went through the usual stages; at the end of
about ten minutes violent spasm was induced; this continued about three
minutes, and then somewhat abated. The pulse, which had risen to about
120, descended to 70, having a full, steady, and deliberate beat. The
pupils, which had been much dilated, became less so. The respiration
continued free and deep, but not stertorous. The colour of the face
remained good.
“At this moment, which was between thirteen and fourteen minutes from
the commencement of the inhalation of the chloroform, the pulse gave a
few rapid and irregular beats, and then ceased. Respiration, which, as
has been stated, had been going on freely, ceased simultaneously. The
face became suddenly pallid and deathlike. The inhaler was removed
instantaneously, and cold water dashed on the face. Mr. Sibley
immediately commenced to carry on artificial respiration, by applying
his mouth to that of the patient, and inflating the lungs. The period
that elapsed between the sudden cessation of the pulse and the inflation
of the lungs was only a few seconds. After a few inflations, there
appeared to be a slight effort at inspiration, but this was the only
sign of life discovered after the syncopal attack. Galvanism was in
operation within two minutes after the cessation of the pulse.”
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