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 quantity of chloroform administered during any one pain, never
exceeds a very few minims; but the quantity used in the course of a
protracted labour is often considerable. I have several times used from
four to six ounces; and in one case, at which I was present the greater
part of the time, seventeen fluid ounces of chloroform were used with
the inhaler, which would produce as much effect as three or four pounds
used on a handkerchief. The inhalation was continued with intermissions
over a period of thirty-one hours. The patient was unconscious during
the greater part of the last five or six hours, but previously to this,
her constant complaint was that she had not enough chloroform. She was
the wife of a physician, was thirty-seven years of age, and in her first
confinement. The membranes ruptured early. The labour was natural, but
there was excessive sensibility. The first twenty-six hours of
intermitted inhalation were during the first stage of labour.
Chloroform can be best applied when there is an additional medical man,
who has not to attend to the ordinary duties of the accoucheur; but it
can be given very well by the accoucheur himself, so as to save the
greater part of the suffering of labour; although he perhaps cannot
always administer it in the perfect way in which he could, if he had no
other duties to divide his attention.
It is probable that the use of chloroform has no particular influence
over the duration of labour, in the whole number of cases in which it is
employed; but individual labours are occasionally either retarded or
quickened by it, according to circumstances. In some cases, the
chloroform, even when very moderately employed, diminishes both the
strength and the duration of the uterine contractions, and prolongs the
interval between them, thereby making the labour somewhat longer—a
matter of no consequence, however, as the patient is not suffering in
any way. In other cases, the inhalation causes the uterine action to
become stronger and more regular, by removing the excess of sensibility
by which it has been interfered with. This occurs more particularly in
the first stage of labour. In some cases, also, the chloroform seems to
act as a direct stimulant to the uterine contractions, increasing their
force and frequency—a circumstance at which we need not be surprised,
when we remember that both opium and brandy, in moderate quantity, often
act in the same manner. Chloroform has also the effect of promoting the
dilatation of the os uteri in many cases, even when no rigidity exists;
and when there is rigidity of the os uteri, the inhalation is of the
utmost service, and shortens labour very much. This is the case, also,
when there is rigidity of the perineum.
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