On chloroform and other anæsthetics: their action and administrationSnow, John
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On chloroform and other anæsthetics: their action and administration
Snow, John
Anesthetics; Chloroform; Snow, John, 1813-1858
The person who is about to inhale chloroform is occasionally in a state
of alarm, either about that agent itself or the operation which calls
for its use. It is desirable to allay the patient’s fears, if possible,
before he begins to inhale, as he will then be able to breathe in a more
regular and tranquil manner. In a few cases, however, the apprehensions
of the patient cannot be removed, and they subside only as he becomes
unconscious from the inhalation. It has been said that chloroform ought
not to be administered if the patient is very much afraid, on the
supposition that fear makes the chloroform dangerous. This is, however,
a mistake; the danger, if any, lies in the fear itself. Two cases will
be related hereafter in which the patients died suddenly from fear,
whilst they were beginning to inhale chloroform, and before they were
affected by it; but the probability is that, if they had lived till the
chloroform took effect, they would have been as safe as other patients
who inhaled it. If chloroform were denied to the patients who are much
afraid, the nervous and feeble, who most require it, would often be
deprived of its benefits. Moreover, the patients would either be
prevented altogether from having the advantage of surgery, or they would
be subjected to the still greater fear of the pain, as well as the pain
itself; for whatever undefined and unreasoning fears a patient may have
when the moment comes for inhaling chloroform, he has only chosen to
inhale it on account of a still greater fear of pain.
Fear and chloroform are each of them capable of causing death, just as
infancy and old age both predispose to bronchitis, but it seems
impossible that fear should combine with the effects of chloroform to
cause danger, when that agent is administered with the usual
precautions. Fear is an affection of the mind, and can no longer exist
when the patient is unconscious; but the action of that amount of
chloroform which is consistent even with disordered consciousness is
stimulating, and increases the force and frequency of the pulse, in the
same way as alcohol. I believe that no one would assert that a person
would die the sooner of fright for having taken a few glasses of wine,
or a small amount of distilled spirits, whatever might be the state of
his health. When chloroform has been absorbed in sufficient quantity to
cause unconsciousness, fear subsides, and with the fear its effects on
the circulation. It is a subject of almost daily observation with me
that the pulse, which is extremely rapid from some ill defined
apprehension, when certain patients begin to inhale chloroform, settles
down to its natural frequency after they become unconscious.
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