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 commenting on the fatal case No. 12, which occurred in St. Thomas’s
Hospital, I have suggested that the accident might have happened from
liquid chloroform being dropped into the throat; but liquid chloroform
is very different from the vapour; it causes a lasting irritation if
applied to a mucous membrane; when used for toothache, it often blisters
the gums. The irritation caused by the vapour, on the contrary, is only
momentary, and its local action ceases directly it ceases to be inhaled;
for what is left in the air-passages is immediately absorbed or expelled
with the expired air. The glottis is not a vital organ of itself. Its
closure only causes death by preventing the access of air to the lungs.
The glottis does not remain permanently closed, I believe, from the
contact of any elastic fluid, however irritating;[135] but it does from
the contact of a liquid, and persons who die by drowning, die with the
glottis closed, for they do not fill their lungs with water. Therefore,
if the vapour of chloroform did cause persistent closure of the glottis,
and if a person were to hold it by force to the patient, the death it
would occasion would be precisely like that in drowning. Death by
asphyxia is a comparatively slow one. I find that when the access of air
to the lungs is entirely cut off, death does not take place in less than
three minutes and a half in guinea pigs, and four minutes in cats. In
dogs, the process of asphyxia is still slower. Mr. Erichsen states, that
on taking the average of nearly twenty experiments, the contractions of
the ventricles continued for nine minutes and a quarter after the
trachea had been closed, and that the pulsations of the femoral artery
also were perceptible for an average period of seven minutes and a half.
The process of drowning in the human subject is well known to occupy
some minutes; and even if the pungency of the vapour of chloroform
should entirely prevent the patient from breathing, and the medical man
could overlook the fact that breathing was not going on, it cannot be
supposed that he would use the force, and have the perseverance to cause
his patient to die slowly by asphyxia. If any patient, therefore, has
died from closure of the glottis, it must have been one in whom there
was a great tendency to sudden death from any slight interruption to
respiration. I do not know the particulars of the case respecting which
M. Devergie was giving his evidence, but in those fatal cases previously
related, in which the symptoms are sufficiently described, it is not
probable that death took place in any instance from closure of the
glottis. In the sudden death at St. George’s Hospital (page 209), it is
possible that the slight pungency of the vapour might assist the fear
under which the patient was labouring in impeding the breathing, and
thus add to the distension of the right cavities of the heart, under
which the patient apparently died.
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