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 syncope occasioned by some kinds of mental emotion is of the
ordinary or anæmic kind, and consequently the condition of the brain
must act first on the bloodvessels, and not directly on the heart.
Certain persons are liable to faint on witnessing a surgical operation.
Now if the mental emotion of these persons acted directly on the heart,
whilst the rest of the vascular system was unaffected, the distribution
of the blood would be nearly the same as in asphyxia, where the
circulation is first impeded in the lungs, and is ultimately arrested by
loss of power in the heart. If the action of the heart were weakened, or
stopped, in the first instance, by the kind of emotion under
consideration, the arteries would be emptied by their contractility and
elasticity, and the blood would accumulate in the right cavities of the
heart and the great veins leading to them. In a medical student fresh
from the country, who is by no means deficient in blood, the jugulars
would become distended and the face livid, and the recumbent posture
would probably do but little towards removing the symptoms. The
phenomena which are witnessed, however, indicate a very different
condition of the vascular system. The person about to faint from the
cause indicated, frequently becomes pale before he feels anything wrong;
and when requested to retire and sit down, often says that there is
nothing the matter with him. In a short time he faints, and falls, if no
one catches hold of him; but the moment he is in the recumbent posture
he recovers. In such a case as this, the effect of the mental emotion
must be first exerted on the veins, or the veins and capillaries,
through the nerves which supply these vessels; they allow themselves to
become distended, and the heart ceases to act for want of its supply of
blood, as in syncope from blood-letting, and anæmic syncope from any
cause.
Several authors have attributed the empty state of the heart met with
after death, in certain cases of fatal syncope, to want of power in the
left ventricle to supply the right cavities of the heart; but this is to
argue as if the blood passed out of the body after leaving the right
ventricle, and the left ventricle had to supply a newly formed fluid.
The effects of want of power in the left ventricle are the same as those
of an obstruction at the origin of the aorta; the lungs become
congested, and the right cavities of the heart more or less distended,
from the blood not being able to pass readily through the lungs.
Patients who die of heart disease die with the cavities of that organ
full. Some patients, indeed, with fatty disease of the heart, die
suddenly of anæmic syncope, and the heart is found empty; but in these
cases it is evident that death is not occasioned by the disease of the
heart, but by some condition of the bloodvessels which accompanies it.
Public-domain text, read in full here on John Shaqi.
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