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
The blood which escapes when the infant is laid on its back flows back
into the throat, and it usually passes on each side of the epiglottis,
and runs into the stomach without any act of deglutition. In a few cases
of strong children, in whom the bleeding is rather free, the breathing
gets embarrassed, and Mr. Fergusson turns the face of the child
downwards for a moment to let the blood run out of its mouth. When the
quantity of blood flowing into the throat is greater than can run down
into the stomach, in the way I have mentioned above, the glottis closes
and the breathing stops, which gives the indication for turning the face
downwards. I have seen a few operations in the hospital for hare-lip,
without chloroform, whilst the children were on their backs. In these
cases they cried violently from the pain, set the blood in the mouth
into violent commotion, and then drawing a deep inspiration, drew a
little of the blood into the larynx, which caused a violent cough; so
that there was usually much more appearance of choking than in the cases
where chloroform was given. Moreover, in these latter cases, it is
usually towards the end of the operation that the children sometimes
become embarrassed with the blood; not because the quantity of blood is
greater, but because the sensibility is returning. I have seen one case
which shows that the effects of chloroform, when deep or long continued,
will diminish the sensibility of the glottis. After an infant was made
insensible some years ago for an operation for hare-lip, it was found
that an instrument for dividing the projecting intermaxillary bone was
wanting, and I kept the child insensible for several minutes, by
administering chloroform occasionally, until the instrument was found;
the bleeding was rather free, and some of it entered the windpipe and
caused a tracheal râle. The child coughed it up on awaking, and no ill
consequences followed; but the occurrence confirms the opinion
previously expressed, that the insensibility should not be both deep and
long continued at a time when copious hæmorrhage is flowing into the
throat. The effects of chloroform pass off very quickly in infants, and
it is not often that they last till the operation of hare-lip is
finished, short as that operation is. In private practice, indeed, when
the parents of the infant are close by, I usually have an opportunity to
apply a little chloroform, mixed with spirit, on a sponge, in the course
of the operation, when it is required to prevent crying; but in the
hospital, the children sometimes cry a little before the operation is
concluded.
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