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
This operation had been rarely performed till within the last seven
years, and there is every reason to believe that it never would have
been frequently performed, if the practice of producing anæsthesia had
not been introduced. I shall speak of this operation again in treating
of amylene.
_Excision of Wrist._ There have been two cases of this operation
performed by Mr. Fergusson in King’s College Hospital.
_The Removal of Tumours of the Upper Jaw._ Mr. Syme, Mr. Lizars, and
some other surgeons, expressed an opinion at one time that chloroform
could not be safely used in this operation, as the blood would be liable
to flow into the lungs. This is not the case, however, as the glottis
retains its sensibility apparently unimpaired, if the influence of the
chloroform is not too deep or long continued. It is only necessary to
hold the head forward now and then, when the throat is very full of
blood, in order to allow the patient the same opportunity of breathing
that he would require if he were awake. A good deal of blood passes into
the stomach in great operations about the mouth under the influence of
chloroform; and if a few drops pass into the windpipe, they are coughed
up again, as they would be in the waking state; there is, however, less
appearance of suffocation in operations where the blood flows back into
the throat, when the patient is insensible, than when he is awake. The
glottis appears to retain some sensibility as long as a creature is
capable of breathing, for I have placed the head of more than one cat
under water after making them thoroughly insensible with chloroform, and
the action of the respiratory muscles lasted more than two minutes, but
no water entered the lungs.
I have always made the patient insensible in the usual way, with the
inhaler, before the operation of removing tumours of the jaw, and have
kept up the insensibility during the operation by means of a mixture of
chloroform and spirit on a hollow sponge; or in cases in which I have
not been provided with this mixture, I have put not more than fifteen or
twenty minims of chloroform on the sponge at one time. Owing to the
hands of the surgeon and his assistants being very much in the way, I
have not always been able to keep the patient quite insensible
throughout the operation. He has sometimes struggled or cried out, but
there has been hardly any case in which the patient afterwards
remembered any considerable part of the operation.
I have notes of twelve cases of removal of the upper jaw in which I have
administered chloroform, in addition to four cases to which I alluded in
the _Medical Gazette_, in the early part of 1849. In some of the cases,
the malar bone was removed, as well as the superior maxillary. Eleven of
these operations were performed by Mr. Fergusson, and the others were
performed by Mr. Partridge, Mr. Henry Charles Johnson, Mr. Hewett, Mr.
Henry Smith, and Mr. Haynes Walton.
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