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
_Tumours of the Female Breast._ I have memoranda of 222 cases in which I
have given chloroform during the removal of tumours of the breast, or
tumours which returned after the breast had been removed. I do not
include with these a considerable number of small tumours, situated
upon, and near the gland, but not involving it. By far the greater
number of the tumours of the breast were looked upon as malignant, but I
am not able to state the numbers which were believed to be malignant,
and which were thought not to be so. I may state that there is no
surgeon whom I am in the habit of assisting who does not occasionally
remove malignant, as well as non-malignant, tumours of the breast. By
far the greatest proportion of the above mentioned operations on tumours
of the breast were performed in private practice. In a number of cases
diseased glands were removed from the axilla, in addition to the mammary
gland. It is desirable in the removal of large tumours of the breast
that the surgeon should be well seconded, by assistants who are in the
constant habit of assisting him, in order that the bleeding may be
restrained and arrested as quickly as possible. I have not seen any case
in which the patient did not go through the operation, and live, as far
as I can remember, for two or three days. But a few of the patients have
been very faint from bleeding during the operation, and faintness from
hæmorrhage seldom takes place during the influence of chloroform unless
the loss of blood is very great. The greater portion of the patients who
have been faint during the operation have done well afterwards, but a
few of them have not. In cases where there is a great loss of blood, and
a very large wound remains, the patients are apt to sink and die in from
three to five days. Most patients may recover from a considerable
hæmorrhage, and most patients may be able to bear up during the healing
of a large wound, but the combination of a great hæmorrhage and a great
wound is apt to be fatal; especially to patients who are already reduced
by illness. The largest tumour of the breast I have seen removed, was
one on which Mr. Fergusson operated, in King’s College Hospital, on Feb.
26th, 1853; it weighed eighteen pounds and a half. On the 4th of June,
following, the same patient had a small tumour removed from the same
situation. It probably resulted from a portion of the large one which
had been left behind.
There are a few surgeons who prefer to have the patient seated in an
easy chair whilst removing a tumour of the breast; but it is more
convenient, under the influence of chloroform, that the patient should
lie on a table, or sofa, or in bed. I usually keep the patient
unconscious till the wound is stitched up, and the plaster and bandage
applied.
I have administered chloroform in four cases of tumour of the male
breast. These tumours were all of them malignant, I believe.
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