Surgical experience of chloroform / By James Miller.

  • James Miller
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Surgical experience of chloroform / By James Miller. Source: Wellcome Collection.

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    XXV. IN OPERATIONS ON THE MOUTH AND NOSE, ANESTHESIA MUST BE USED WARILY, IF AT ALL. The obvious and urgent cause of prudence here, is the risk of asphyxia by blood escaping into the air-passages. Blood trickles down into the fauces. There, in ordinary circum¬ stances, its presence excites, by reflex action, the function of swallowing; and on it passes to the stomach. Or if some do find its way into the glottis, it is quickly ejected again, by the violent and uncontrollable efforts of cou^hinii, which the presence of all foreign matter there never fails to produce. But, in the deep stupor of Surgical Anaesthesia, the patient is too far gone” for either the receiving or the rejecting func¬ tion ; he is alike dull to sw^allow or to cough; the fluid blood gravitating downwards, as if in a dead body, is as likely to make its way into the air-passages as into the gullet; and accumulating in the former site, because not rejected, it chokes the patient as effectually as if a rope had been drawn tight round his neck, or his lungs injected with plaster of Paris. “ Fatal cases ” may be satisfactorily accounted for in this way, now and then; more especially if dissection show the bronchial tubes tolerably well filled with coagulated blood.” Operating once for cancer of the nose, and having to remove a large amount of vascular texture, incisions in which I knew must be accompanied with extreme pain, I began wdth anaesthesia. From the track of the scalpel blood burst forth in large quantity; and, although I had placed the patient in a sitting posture, I soon found that my sleeping victim was placed in imminent jeopardy of his life. The blood actually boiled and gurgled in his throat; and I was glad to find that consciousness speedily returned, so far as to admit of strenuous ejecting efforts on the part of the thorax. I had to wait until the anassthesia had passed wholly off, or at least until consciousness had been thoroughly restored ; and then completed a bloody and painful, but safe operation. In operating for polypus of the nose, I have employed chloroform ; but alw-ays took care to have the patient seated very erect, and ever and anon to have the head stooped forwards