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
_Operations for Phymosis._ I have memoranda of 76 operations for
phymosis, in which I have exhibited chloroform. The operations were
generally in the adult, although the complaint was, in most cases,
congenital. I have known two cases in which cancer of the penis was
produced by the patient’s suffering a congenital phymosis to remain to
about the age of fifty. The cancer commenced in the glans from the
irritation of the retained urine. One of the patients died of the
disease.
_Removal of enlarged Bursa._ I have notes of six cases in which the
bursa of the patella was dissected out by the surgeons of King’s College
Hospital for housemaid’s knee. The patients were charwomen and domestic
servants. In two cases a bursa was removed from the forefinger.
_Evulsion of the Nails._ I have notes of twenty-five cases in which I
have given chloroform for cutting down the nail of the great toe, and
tearing away the whole, or the two edges of it; and also of three cases
in which one or more finger nails were removed by a similar process.
This operation is one of the most painful of the minor operations of
surgery. It is better that the patient should be lying when it is done
under chloroform.
_Laryngotomy._ I administered chloroform to one or two infants in which
Mr. Henry Smith performed laryngotomy for croup. I also administered it,
on four occasions, to a patient of Mr. Partridge, a boy four years old,
who was believed to have a button in some part of the air-passages. The
larynx had been opened a few days previously to the first occasion in
which I gave chloroform, and I administered it on a sponge, held near to
the tube in the larynx. It was necessary to give the vapour gently at
first, just as if it was entering in the usual way. When it was given at
all strong, whilst the patient was still conscious, he showed exactly
the distress that a patient experiences when he says that the vapour
produces a choking feeling; which confirms my opinion that the feeling
referred to the throat, from the action of pungent vapours and gases, is
caused by their presence in the lungs. The chloroform was given to keep
the child quiet whilst Mr. Partridge searched for the supposed button in
the larynx and bronchi. When the child recovered from the chloroform,
before the operation was concluded, the explorations in its air-passages
embarrassed the breathing much more, and caused more apparent
threatening of suffocation, than they did when he was under the
influence of the vapour. This little boy remained for months in King’s
College Hospital; and at last the embarrassment in his breathing
subsided, the tube was removed from the larynx, and the wound allowed to
heal; and he left quite well, although the button, which was supposed to
have gone down his windpipe at the moment when his symptoms first
suddenly came on, was never found.
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