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
Owing to the unequal effects of a given quantity of chloroform on
different parts of the nervous centres, and owing to its acting also on
the nerves, a variety of states may be met with during a surgical
operation, some of which have often been thought curious, or anomalous.
The most usual state of the patient during an operation, when chloroform
is successfully administered, is one of perfect quietude, without any
sign of consciousness or sensation. The patient under chloroform may,
however, moan, or cry, or flinch, or show other symptoms which are
usually thought indicative of pain, but without using any articulate
language, or remembering anything of the operation afterwards. If his
flinching or crying out has neither interfered with the surgeon, nor
distressed the friends who may be present, a case of this kind may be
considered satisfactory. A third condition of the patient under the
influence of chloroform is that in which he talks, or laughs, or sings
during the operation, his words having no reference to what is being
done. If he is sufficiently quiet for the proceedings of the surgeon,
the application of the chloroform must be considered successful, and
this condition proves the absence of pain even more completely than that
in which there is neither sign nor sound, except the breathing and
pulsation of the heart and blood vessels. A fourth condition of the
patient is that in which he is conscious, and can look on whilst the
surgeon is performing some small operation, or the minor part of a large
one, without feeling it, or whilst feeling it in a manner which is not
painful. This condition, when it occurs, is the most satisfactory proof
of the power of chloroform to prevent pain. It happens but rarely,
however, and cannot be induced at will, and it is usually at the
concluding part of an operation, during which the patient has been
unconscious, that this condition is met with. He wakes whilst there is
still a vessel to tie, or a suture to be introduced, and does not feel
it, owing, as was stated before, to some of the chloroform being
detained in the extra vascular liquor sanguinis, whilst the brain has
become almost free from the medicine. When the knife, or the needle, is
felt without being painful, it is because the common sensibility,
without being entirely abolished, is so much reduced, that what would
otherwise cause acute pain only occasions an ordinary sensation.
Public-domain text, read in full here on John Shaqi.
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