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
I was present at the examination of the body on the following day. The
mouth was sore and swollen from the effects of the inunction of mercury.
There were a few drachms of clear serum in the pericardium. The heart
was large for the size of the patient. There was a patch of organised
lymph on the pericardium, covering the left ventricle. The right
cavities of the heart were full of dark fluid blood, and the left
cavities contained a little. The mitral valve was much thickened, but
the other valves were healthy. The lungs were healthy, and not much
congested. The brain was healthy. The patient had suffered from acute
rheumatism before entering the hospital.
It will be observed that the pulse is not mentioned in the above case,
until its absence is alluded to, when the patient was already cold, and
the breathing is not alluded to throughout the account; indeed, it is
not known when the patient died. She was alive after the application of
the nitric acid, as she was observed to move her legs, but further than
this there is no clear evidence.
It is perhaps an open question whether this patient died at once from
the direct effects of the chloroform, or whether she died after
partially recovering and going on favourably for a time. The account
would, at first view, seem to favour the latter opinion, but it is not
corroborated by any other case. Patients have been partially recovered
from the effects of an overdose, without being entirely restored, and
others have sunk after great operations, attended with hæmorrhage, when
the effects of the chloroform had more or less subsided, but there is no
instance of a patient going on favourably, and partially recovering from
the influence of the vapour, and then dying suddenly without any other
known cause. Patients have occasionally become faint whilst recovering
from chloroform, more especially if they remain in the sitting posture,
but in those cases the right side of the heart is probably
insufficiently supplied with blood; whilst, in the case under
consideration, the patient was lying, and the right cavities of the
heart were found full after death, the serum in the pericardium showing
that they had probably been distended when death took place. If Mr.
Heath had made any observation which enabled him to say that the patient
was really alive, when he went up to the foot of the bed, before leaving
the ward, it would decide the question, and show that death did not take
place at once from the direct effects of the chloroform, but he only
makes the negative remark that he did not notice anything unusual about
the patient.
I had an opportunity of examining the particular inhaler employed, and
found that it was so arranged that the vapour might be breathed from it
in much greater proportion than would be safe, if precautions were not
taken to leave the expiratory valve a considerable way open, especially
when the high temperature of the weather at the time is taken into
account.
Public-domain text, read in full here on John Shaqi.
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