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
_Cancer of the Lip._ I have memoranda of nineteen cases of cancer of the
lower lip, and three or four of the upper lip, in which I have
administered chloroform. As there is never an easy chair in the
operating theatre of an hospital, and it is difficult to keep the
patient in a common chair when he is under the influence of chloroform,
it is better to place the hospital patient on the operating table, with
his head and shoulders raised during this operation; but in private
practice the patient may either be placed on a sofa, or in a large easy
chair with a high back. The effect of the chloroform often lasts to the
end of the operation, if it be completed within two or three minutes;
but I always go provided with a hollow sponge, and a mixture of
chloroform and spirit to apply during the operation, if required.
_Division of the Sensory Nerves of the Face._ I have notes of nineteen
cases in which I have administered chloroform during this operation.
They were chiefly performed by Mr. Fergusson, but a few of them by Mr.
Bowman. The operation is of so painful a nature, that I believe it was
seldom performed before the practice of inhaling narcotic vapours was
introduced. It is done subcutaneously, by means of a small sharp-pointed
bistoury, by which the affected nerves are chopped up by twenty or
thirty incisions, at and near the points where they issue from their
respective foramina. In operating on the mental branch of the fifth
nerve, the bistoury is sometimes introduced from the face, and sometimes
from the interior of the mouth. The pain continues for two or three
days, till the inflammation caused by the operation subsides, when there
is usually a complete absence of pain for three or six months, at the
end of which time the operation has often to be repeated. I am not aware
whether the relief has been permanent in any case, but it has often been
very complete for a time. One patient, on whom Mr. Fergusson operated in
King’s College Hospital, looked like an old man at the time of the
operation, but this was the effect of his severe suffering; for a week
or two afterwards he looked his real age, which I think was less than
forty. This operation is not performed for the milder cases of
neuralgia, or for cases that can be cured by quinine or iron; but only
for the more terrible forms of the complaint, which fortunately are
somewhat rare. Rare as they are, however, they occur sometimes in near
relatives.
_Division of other Nerves of Sensation._ I have notes of nine cases in
which nerves in other parts of the body were divided, and a portion cut
out, for neuralgia. On four occasions the nerve was situated in a stump
following amputation; and on two occasions a tumour of the nerve was
removed. The operations were performed by Mr. Fergusson, Mr. Solly, and
Mr. Paget.
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