On the cause and prevention of death from chloroform / by John Snow.

  • John Snow
Date:
1852?]
Catalogue details

Licence: Public Domain Mark

Credit: On the cause and prevention of death from chloroform / by John Snow. Source: Wellcome Collection.

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    dose, of the same quantity, was then administered in the same way. Ten minims more were put on the handkerchief, and finally other twenty minims. When the patient was insensible, the operation was commenced; but it had proceeded only a very little way, when the flow of blood and the pulse ceased at the same moment. The breath- ing also stopped at the same time, but the man afterwards took one or two deep sighing inspirations.1 It is evident that the last quantity of chloroform was inhaled in a too concentrated state, and that the heart was paralysed by the absorption of vapour which was present in the lungs at the instant when the inhalation was discontinued. We have no account of the manner in which the breathing and cir- culation ceased in the last case of the list, for no one was observing the patient at the time. The chloroform was administered for the re- moval of impacted fseces from the rectum, a proceeding which would otherwise have been attended with great pain on account of cancerous disease in the neighbourhood. The medical attendant administered the chloroform on a handkerchief, and used altogether eight or ten drachms. He says: When I found the arm fall after being raised (a very uncertain sign to rely on), I proceeded to and accomplished the operation. At this time she was not inhaling. On turning his attention again to the state of his patient he found that she was dead.3 Since the former part of this paper was sent to the press a fatal accident has unfortunately happened, in St. Bartholomew's Hospital, to a young man, aged 23, affected with aneurism by anastomosis of the right ear and surrounding soft parts. Mr. Lloyd, having tied the tem- poral artery the week before, under the influence of chloroform, with advantage, was proceeding to tie an artery between the mastoid pro- cess and ramus of the jaw, when the patient suddenly expired from the effect of the chloroform, which was administered by one of the dressers with an apparatus which had been used on the former occa- sion. In from five to ten minutes the usual effect was produced, the patient having previously struggled much. The operation was then commenced; but no sooner had Mr. Lloyd cut through the skin than it was stated that the pulse had suddenly ceased. The chloroform was at once removed, but in a few seconds the patient had ceased to breathe, and no pulsation could be felt in any of the arteries, or at the heart.3 Under the use of compression, percussion, and other means, the act of respiration was several times performed again, on two occasions, and it is stated that the circulation was observed to be returning.4 I understand that the red colour returned to the face, but have not learnt whether the pulse or action of the heart was distinctly felt or heard. The respiration might cause the colour to return to the face without a true circulation, as I have seen whilst in- flating the lungs of still-born children; for if a portion of red blood be mechanically displaced from the lungs by the motion of the chest, it will be sent on by the contractility of the arteries, which continues for some time after death. If the heart had recommenced to beat, complete recovery would most likely have taken place, for such has i Med. Times, 1851, vol. ii, p. 98. 3 Med. Times and Gaz., p. 203. 2 Ibid., 1851, vol. ii, p. 020. 4 Loc. cit.
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