The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].
- Duncum, Barbara M.
- Date:
- 1947
Licence: In copyright
Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.
416/664 page 396
![as a preventive. . . . My attention has for some time past been directed to the probable value of a prior dose of atropin, as an antidote to the cardio-inhibitory effects of chloroform ; and I have made a number of experiments, as yet unpublished, on the subject. . . . The precaution would only be of value in those cases in which, with the greatest care in administration, death is liable to ensue from the sudden arrest of the heart's action ; but, since the idiosyncracy cannot be detected beforehand, the atropin should never be omitted.' 1 After the appearance of Schafer's letter a correspondent wrote to the Journal drawing attention to certain points. These points were incorporated by the editor in an annotation : ' Professor T. R. Fraser, of Edinburgh, . . . has shown atropia to be a cardiac stimulant, advisable when chloroform is to be given. It stimulates the heart, not only indirectly, by lowering the conductivity of the cardiac terminations of the vagi, and thus, of course, diminishing their inhibitory power [2], but also directly by stimulating the intramural motor ganglia of the heart ; and possibly, also, by raising the excitability of the accelerator nerve to the heart from the cervical sympathetic ganglia ; and perhaps it may even stimulate the cardio-motor centres in the medulla oblongata.' Fraser, it was stated, ' considers it advisable to combine with the atropia a little morphia, say i/120th to 1/60th of a grain of sulphate of atropia . . . and one-twelfth to one-eighth of a grain of acetate or hydrochlorate of morphia. These are injected about fifteen or twenty minutes before the administra- tion of chloroform is begun ; and by this means, (1) not only is the patient in a less nervous state when the inhalation is com- menced, but (2) less chloroform is required, and, (3) moreover, a very objectionable evil is got rid of, or, at all events, ameliorated, viz., the emesis which is apt to occur with chloroform. In the cases in which our correspondent has seen this method followed, there has been no vomiting whatever, although in some the inhalation was considerably prolonged '.3 Although, as this annotation implies, combined atropine and morphine injection before chloroform anaesthesia had, at Fraser's 1 Brit. med. J., 1880, ii, 620. 2 The discovery that stimulation of the peripheral ends of the vagus nerves will inhibit the heart's action was made by the brothers Ernst and Eduard Weber in 1846. (Bayliss, W. M. 1918. Principles of general physiology. London. 683.) 3 Brit. med. J., 1880, ii, 715.](https://iiif.wellcomecollection.org/image/b20457200_0420.jp2/full/800%2C/0/default.jpg)
