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
When the forceps have to be applied, it is desirable to make the patient
insensible, as if for a surgical operation just before they are applied;
and to leave off the chloroform as soon as they are introduced, in order
to allow of the uterine action to return, and assist in the delivery. I
have always found the action of the uterus return immediately after the
forceps were introduced; and where the child was not delivered at once,
I have continued the chloroform in sufficient quantity to keep the
patient unconscious, whilst allowing the uterine contractions to
continue.
I have administered chloroform on nine occasions in which the forceps
were applied; in four of the cases, I was sent for in consequence of the
operation being required; and in the other five cases, I was in
attendance from an early part of the labour, and had administered
chloroform more or less for some hours before the forceps were applied.
They were applied in three instances by Dr. Murphy, twice by Dr.
Ramsbotham, and in the other cases by Drs. Farre, Frere, and Thudichum,
and Mr. Peter Marshall.
I have administered chloroform in two cases of craniotomy, both of which
were performed by Dr. Murphy, on account of deformity of the pelvis. The
amount of chloroform scarcely requires to be increased during this
operation beyond what would be given according to the strength of the
pains which may be present at the time.
In the operation of turning the child, the mother requires to be made
quite insensible, in order that the uterine contraction may be entirely
suspended till the legs of the child are brought down, when the
inhalation should be discontinued to allow the contraction of the uterus
to return. I have notes of six cases of turning the child, in which I
have administered chloroform. The first case, which occurred in 1848,
was one of natural presentation, in which turning was performed by Dr.
Murphy, on account of narrowness of the pelvis, and the impossibility of
applying the forceps; the introduction of the hand was difficult on
account of want of space, but the uterus offered no resistance. Dr.
Murphy has related the case. Three of the other instances of turning
were performed by Mr. French, in cases which had been attended by
midwives, and the membranes had been ruptured for several hours. The
shoulder and part of the chest were in each case pressed down into the
pelvis, and the pains were very strong; yet under a full chirurgical
dose of chloroform, the child was turned as easily as if the membranes
had not been ruptured. In the first of these three cases, the child was
dead before the operation commenced. In the other two, it was born
alive. In the last case, the membranes had been ruptured for ten hours
before the operation was performed. After the child was delivered, there
was found to be a second child presenting naturally, but I did not stay
to give any more chloroform. The fifth case of turning was performed in
a case of elbow presentation by Mr.
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