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
relied on as the chief or sole sign whether the operation may be
commenced, but it is of itself very insufficient, and even fallacious.
The patient may allow his limbs to lie relaxed when he is scarcely
unconscious, and not at all insensible, merely because he is not
exerting his will upon them; if the arm is lifted, it may fall
listlessly down again, at a time when the knife of the surgeon would
rouse the patient to active resistance. Indeed, the limbs, which have
been lying relaxed, may become tense as the effect of the chloroform
increases, and may remain so during a short operation, in which there is
no sign of pain.
Although the pulse of itself gives no indication as to how far a patient
is under the influence of chloroform, it is proper to pay attention to
it, not only during the first administration of the chloroform, but also
throughout the operation, especially if it be attended with much
bleeding. The pulse sometimes becomes intermittent or irregular during
the administration of chloroform, more especially in elderly persons.
This more commonly happens in the first exhibition of it, than when it
is repeated during the course of an operation. I have not seen any harm
from either of these conditions, but it is well to intermit the
chloroform for ten or fifteen seconds, and let the patient have a few
inspirations without it, if the pulse is not in a satisfactory
condition. If the precaution be taken to ensure that the air the patient
breathes shall never contain more than five per cent. of vapour, the
pulse can never be seriously affected by the direct action of the
chloroform, and the state of the breathing affords the best warning
against continuing the inhalation too long at a time.
The breathing is fortunately also a sign that cannot be overlooked. It
is by the breath that the chloroform enters, and it is extremely
improbable that any one would go on giving the vapour after the
breathing became stertorous and laboured.
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