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
In thirteen cases the inhalation was discontinued on account of the
sudden appearance of dangerous symptoms, after consciousness had been
apparently suspended. These cases are numbered 9, 15, 17, 20, 27, 30,
33, 35, 37, 40, 41, 44, and 47. In the greater number of these cases the
over-action of the chloroform appeared to be exerted simply on the
heart, the only dangerous symptoms being referrible to the paralysis of
that organ; whilst in some of these cases symptoms of over-narcotism of
the brain were conjoined with those connected with the heart. In the
case of J. Verrier, No. 9, and in the case at Stockholm, No. 15, the
sudden and entire cessation of the pulse was the symptom which first
called attention to the danger of the patients, whilst the breathing was
still going on. In Case 30 the woman became suddenly insensible and
pulseless, after a short period of excitement. In Cases 35 and 40,
although the pulse did not absolutely and entirely cease at once, its
sudden failure was the first alarming symptom. In Case 20, at the Cavan
Infirmary, the breathing and action of the heart ceased at the same
moment. In Case 41, at the Middlesex Hospital, at a time when the pulse
was full and steady, seventy in the minute, it gave a few rapid and
irregular beats, and then ceased, and the breathing, which was free and
deep, but not stertorous, ceased at the same time. In Case 15, which
occurred at Jamaica, the patient, after a period of excitement, made one
stertorous inspiration, when the breathing ceased. There were afterwards
a few distant inspirations. The pulse is not mentioned; but it is pretty
certain that it must have ceased about the time of the stertorous
inspiration, or the additional inspirations which took place after the
chloroform was withdrawn, would probably have restored the patient; to
say nothing of the measures that were resorted to with a view to his
resuscitation. Of Case 27, which happened at Melbourne, it is merely
related that the patient spluttered at the mouth, and suddenly expired,
just after a fresh portion of chloroform had been applied on the
handkerchief. The symptom of spluttering at the mouth is recorded as
occurring in other cases, just at the moment when the pulse had suddenly
ceased.
In Case 44, at the Royal Ophthalmic Hospital, the narcotism of the brain
and nervous system proceeded as far as the third degree, which was
attended with strong muscular spasms, as not infrequently happens; and
an overdose of chloroform appears at this moment to have acted on the
heart, for the pulse could not afterwards be felt. In Cases 33, 37, and
47, the narcotism of the brain proceeded as far as the fourth degree,
producing stertorous breathing, when the chloroform caused paralysis of
the heart, by its direct action on that organ.
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