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
_Amputation of the Thigh._ This operation is often performed for disease
of the knee, when the joint is in such a state of tenderness that the
least motion causes great pain. In such cases, I have administered the
chloroform to the patient in bed, before his removal to the operating
table, and given a little more chloroform just before the operation was
commenced. In King’s College Hospital, I have several times given the
chloroform in the ward in such cases, before the patient was removed to
the operating theatre; but in St. George’s Hospital, the passages and
doors being wide, the patient has been carried on his bed into the
theatre, where the chloroform was administered just before his being
lifted on the table. In those cases in which the tourniquet is applied,
in preference to pressure with the fingers, it should be adjusted as the
patient is getting under the influence of the chloroform, and tightened
just before the operation begins. It is desirable to keep the patient
quite insensible till the limb is removed, and the femoral artery is
tied; after which a little chloroform may be given whenever the patient
shows by a slight flinch, or contraction of his features, that sensation
is returning. A few patients have recovered their consciousness during
the tying of the smaller arteries, and have entered into a conversation
without feeling the pain, but this condition is quite the exception. I
have notes of 49 cases of amputation of the thigh in which I have
administered chloroform. Some of the patients, who were almost grown up
to the adult age, did not know that the limb was removed till three or
four days had elapsed.
_Amputation of the Leg._ I have notes of 31 cases in which I have
administered chloroform during this amputation. The remarks made above
with regard to amputation of the thigh are applicable to this operation.
_Amputation of the Arm._ I have only administered chloroform five times
in this operation, and only in one case during the last seven years.
This case was that of a boy, aged sixteen; Mr. Hancock was the operator,
and the patient recovered. I have no note of the disease for which the
operation was performed, but in two or three of the remaining cases, the
arm was amputated on account of malignant disease of the forearm. In one
of the operations, the patient was seated in an easy chair, but in the
others, the patients were lying on a sofa, or operating table, with the
head and shoulders a little raised.
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