On chloroform and other anæsthetics: their action and administrationSnow, John
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On chloroform and other anæsthetics: their action and administration
Snow, John
Anesthetics; Chloroform; Snow, John, 1813-1858
Such measures as dashing cold water on the patient, and applying ammonia
to the nostrils, can hardly be expected to have any effect on a patient
who is suffering from an overdose of chloroform; for they would have no
effect whatever on one who has inhaled it in the usual manner, and is
merely ready for a surgical operation, but in no danger. I have applied
the strongest ammonia to the nostrils of animals that were narcotized by
chloroform to the third or fourth degree, and it did not affect the
breathing in the least. They recovered just as if nothing had been done.
It is difficult to suppose a case in which the breathing should be
arrested by the effects of chloroform whilst the skin remained sensible,
yet it is only in such a case that the dashing of cold water on the
patient could be of use. There is, however, no harm in the application
of this and such like means, provided they do not usurp the time which
ought to be occupied in artificial respiration; for this measure should
be resorted to the moment the natural breathing has entirely ceased.
I have only seen two cases in which the patients seemed in imminent
danger from the direct effects of chloroform. One of these occurred in
1853. It was the case of a child, aged six years, but small and
ricketty, which had the greater part of the eyeball removed on account
of melanotic disease. The usual inhaler was employed, and when the child
seemed sufficiently insensible, it was withdrawn. The operation was
commenced by introducing a large curved needle, armed with a thick
ligature, through the globe of the eye, in order to draw it forward. As
the needle was introduced, the child cried out a very little, and
thinking the parents, who were in the adjoining room, would be alarmed,
I poured some undiluted chloroform hastily on a rather large sponge, and
placed it over the nostrils and mouth. The sponge became pressed by the
surgeon’s hand closer on the nose than I intended, but it was removed
after the child had taken a few inspirations. The operation was quickly
concluded without any further sign of sensation than that mentioned
above. At the end of the operation, the breathing was natural, but the
face was pale, and the lips blue, and the limbs were also relaxed. I
tried to feel the pulse at the wrist, but did not discover any. The
chloroform had at this time been left off half a minute at least. The
pallor and blueness continued, and in a little time the breathing became
slow and embarrassed, and appeared about to cease altogether, the pulse
being still absent. The windows were opened, and cold water dashed
freely on the face. The child made gasping inspirations now and then,
but they did not follow immediately, or seem connected with each
application of the water. The gasps became more frequent, till the
breathing was thoroughly reestablished, when the colour returned to the
lips, and the pulse was again felt at the wrist. In a minute afterwards,
Public-domain text, read in full here on John Shaqi.
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