On the inhalation of chloroform : ita anæsthetic effects and practical uses / by Robert Dunn.

  • Robert Dunn
Date:
[1851?]
Catalogue details

Licence: Public Domain Mark

Credit: On the inhalation of chloroform : ita anæsthetic effects and practical uses / by Robert Dunn. Source: Wellcome Collection.

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    “ If an animal is made to breathe air strongly charged with chloroform, so that at the moment when the breathing ceases there is a good deal of the vapour in the lungs, the vapour becoming absorbed in addition to that already circulating in the blood, the heart’s action is ar¬ rested by the direct effect of the vapour; and this may be called narcotism to the seventh degree.” Dr. Snow justly observes, “that these degrees pass insensibly one into ano¬ ther, so that it is sometimes difficult to say in which of the two contiguous degrees the patient is at the time, and that when the inhalation is dis¬ continued, the effect of the vapours sub¬ sides in the inverse order to that in which they had been induced,—for instance, if the narcotism had been carried to the fourth degree, it diminishes to the third, then to the second, afterwards to the first, and finally subsides altogether. On this account the term degree is more appropriate than stage, as the first degree reappears in the last stage of recovery from the influence of chloro¬ form and other narcotics.” Now, from the records of personal experience, and from a careful considera¬ tion of the phenomena observed in others, we may trace the following order and sequence in the effects of the inhalation of the vapour of chloroform, properly diluted, upon different nervous centres. Thus, the first few inhalations are attended with feelings which indicate disturbance in the action of the sensory ganglia, as“ singing in the ears, a sense of numbness, and tingling of the sur¬ face of the body,” &c., but which are soon succeeded by a transient stage of more general excitement; of delirium in the hemispherical gauglia, for in¬ stance,—as singing and incoherent talk¬ ing, and of excited emotional impulses, and consensual movements in the sen¬ sory ganglia,—as laughter and uncon¬ trollable motorial actions; this is speedily followed by suspension of the function of sensation,* the consciousness of fee l- * The inhaled chloroform entering the circula¬ tion is conveyed to every part of the system, and not only produces anaesthesia of the sensory and cephalic ganglia, but also of the cells or cell nuclei, at the peripheral extremities of the af¬ ferent nerves. In the words of Dr. Sibson, “ being applied everywhere to the peripheries of the nerves, it everywhere, so to speak, pro- ing, while as yet some degree of intel¬ lectual activity remains. Sensorial impressions from without are no longer transmitted from the sensory ganglia to the cerebrum; but this “ suspension of ordinary sensational impressions, as in sleep, with persistent intellectual ac¬ tivity, is the typical characteristic of dreaming;” and dreams often occur. The commissural fibres, between the cerebrum and these ganglia, Reil's nerves of the internal senses being still in action, they transmit downwards the residual intellectual activity from the cerebrum to the sensory ganglia, and frequently give rise to manifestations, which impress the mind of common ob¬ servers with the belief of pain and suffer¬ ing being felt under the knife of the surgeon, while in reality there, are none. The function of the cerebrum as the centre of intellectual action is next suspended; a state of coma is induced, a complete abolition of consciousness, re¬ ducing life to a series of automatic movements. After this the medulla oblongata and true spinal centres be¬ come involved, reflex action is stopped, and breathing by the ribs suspended. The ganglionic system is the last to be implicated; but, with the arrest of the peristaltic action of the heart, life ceases. Dr. Snow as the result of experience finds that about twelve minims of chloroform on the average are sufficient to produce the first degree of narcotism in the adult, twenty-four minims the second, and thirty-six the third, provided these quantities be inhaled within two or three minutes, and from a suitable inhaler, and not from a sponge or hand¬ kerchief. Although less than one fluid drachm of chloroform has proved fatal from be¬ ing improperly administered, Dr. Snow considers that an indefinite quantity, for instance an ounce or two, may with safety be inhaled, provided this be done slowly and gradually, and the chloro¬ form be largely diluted with atmospheric duces directly local anaesthesia of the nervous peripheries, and not only loss of sensation, but of the power of reflex excitability also.” The local application of chloroform, like that of hydrocyanic acid, induces local anaesthesia, by paralysing locally the peripheries of the nerves. Dr. Sibson, in his admirable address “ On the Causes which Excite Respiration,” published in the recent volume of the Provincial Transactions, has ably traced the direct centric effects of the inhalation of chloroform upon the spinal mar¬ row.