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 1855, two years after M. Devergie had given the above opinion, Dr.
Black, of St. Bartholomew’s Hospital, who has had great experience in
the administration of chloroform, advanced a similar theory in the
pamphlet previously alluded to. He did not, however, confine the effects
of the supposed closure of the glottis to possibly causing a death here
and there, as M. Devergie had done, but he attributed all the accidents
which had happened to this cause, and not to the effects of chloroform
in the system. He says that “the chloroform has not been even inhaled:
its pungency was felt at the glottis, and its inspiration was
immediately arrested. The patient would have removed the apparatus, but
in this he was restrained. The struggle forthwith commenced, but up to
the moment of his death, not a single inspiration took place.” These
remarks were not applied to a single case, but generally to the
accidents from chloroform. Dr. Black says: “Any concentration of the
vapour of chloroform which can be breathed is safe; any condition of
dilution which forces the patient to cough or hold his breath is
dangerous, and if persevered in for even half a minute, may be fatal....
We have only to attend to the breathing; we may disregard all
considerations affecting the relative proportion of the chloroform in
the air which is breathed;... if the patient breathes easily he is in
safety, whatever be the amount of chloroform which is passing into the
lungs.”
In Experiment 28, previously related, where the respiration was kept up
by a tube in the trachea, there could be no error in respect to the
vapour of chloroform entering the lungs, when a bladder of air charged
with ten per cent. of that vapour was substituted for the bladder of
simple air; and the immediate paralysis of the heart was evident. An
examination of the fatal cases, of which the particulars have been
recorded, shows that death did not occur in the manner Dr. Black
suggests. In the majority of the cases, the patients were rendered quite
insensible by the chloroform, and the operation had either been
commenced, or was on the point of commencing; when the fatal symptoms
set in. In several other cases, the patients were partially under the
influence of the vapour before the symptoms of danger commenced; and in
the six cases where death occurred at the beginning of the inhalation,
without loss of consciousness having been induced, the patients were not
restrained in any way, and it was observed that they did breathe the
chloroform; three of them were speaking up to the moment when the pulse
stopped, and one took a full inspiration the moment before the fatal
symptoms set in. It is only in eighteen of the fatal cases that there is
any reason to suppose that the patient required to be held, and then
only from mental excitement or muscular spasm, arising from the
physiological effects of the absorbed chloroform. It is hardly possible
that the struggles of a conscious patient from inability to breathe,
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