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
Mr. Bickersteth’s reason for attributing the stoppage of the pulse to
the effect of the knife, rather than the chloroform, was that he had
arrived at the conclusion from some experiments which he performed on
animals, that the action of the heart cannot be arrested by chloroform,
until the breathing has been first suspended. One of Mr. Bickersteth’s
experiments (No. 5, on a half-grown cat) exactly resembles the
experiment (No. 28 in this work) on a rabbit, which I had published
upwards of a year before Mr. Bickersteth’s paper appeared, with the
exception that in my experiment the artificial respiration was performed
with air containing ten per cent. of vapour, and in Mr. Bickersteth’s
the vapour was an unknown quantity. In both experiments, the heart of
the animal was exposed. In that which I performed, three or four
inflations of the lungs almost paralyzed the heart; and nine or ten
inflations, which did not occupy half a minute, had the effect of
paralyzing that organ irrecoverably. In Mr. Bickersteth’s experiment,
the effect of the artificial respiration was as follows:—“After
continuing it for seven minutes, the diaphragm, hitherto unaffected,
began to move very irregularly and imperfectly; then its movements
became slow and hardly perceptible; and, at the expiration of eleven
minutes, they had ceased altogether. During all this time the heart’s
action remained strong and regular, but now it got weaker and more
rapid, and, in four minutes from the time the diaphragm had ceased
acting, had become so feeble (still quite regular) that I feared every
moment it would stop.” Mr. Bickersteth says he performed artificial
respiration with air saturated with chloroform; but saturated or not,
the vapour certainly did not exceed six per cent., and most likely was
only between four and five, if the artificial resembled the natural
respiration in quantity and frequency. The vapour which can be breathed
for seven minutes without causing serious symptoms, and for eleven
minutes without arresting the breathing, is of course incapable of
stopping the action of the heart by its direct effect. It is scarcely so
strong as that which one administers every day to patients with
impunity. The vapour which is so diluted as to require to be added by
small increments during one hundred and fifty inspirations, before the
brain is even narcotized, cannot act directly on the heart, an organ
which can bear a much larger amount of chloroform. Mr. Bickersteth fell
into the error into which the Committee of the Society of Emulation of
Paris afterwards fell, and argued from the rule to the exception. What
he witnessed was the mode of death which would occur, if vapour of
chloroform of the strength which can be safely inhaled, were
deliberately continued till the death of the patient. But an accident
from chloroform is an exception, and the mode of dying is as much an
exception as the death itself, if the inquiry is extended to what this
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