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 first degree of narcotism recurs when consciousness returns as the
effect of the chloroform is subsiding. At this time, there is generally
a greater amount of anæsthesia than at the commencement of inhalation,
just before consciousness is removed. I have many times known the
introduction of sutures, and such like measures, performed at the
concluding part of an operation, after the patient had recovered his
consciousness, without his feeling what was being done. As a general
rule also, the smarting of the wound does not commence till some time
after consciousness has returned.
In the second degree of narcotism, there is no longer correct
consciousness. The mental functions are impaired, but not necessarily
suspended. When a patient inhales chloroform quietly for a medical or
surgical purpose, he usually appears as if asleep in this degree; but if
his eyelid be raised, he will move his eyes in a voluntary manner. There
are occasionally voluntary movements of the limbs; and although the
patient is generally silent, he may nevertheless laugh, talk, or sing.
Persons sometimes remember what occurs whilst they are in this state,
but generally they do not. Any dreams that the patient has, occur whilst
he is in this degree, or just going into, or emerging from it, as I have
satisfied myself by comparing the expressions of patients with what they
have related afterwards. There is sometimes a little trouble with the
patient in this degree of narcotism. He feels the inconvenience of the
vapour he is breathing, and having become unconscious of the object for
which it is inhaled, he endeavours to push away the inhaler. As a person
in this condition can generally hear and partly understand what is said,
a few kind words will often render him tractable. This is generally true
of all those who have been brought up with care and kindness, more
especially patients of the female sex; but the man who has been roughly
treated from the time of his birth, can often be made insensible only by
means of a little restraint.
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