Volume 1

Remarks on the fatal case of inhalation of chloroform; including additional explanations from Dr. Meggison / [John Snow].

  • John Snow
Date:
[1848]
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Licence: Public Domain Mark

Credit: Remarks on the fatal case of inhalation of chloroform; including additional explanations from Dr. Meggison / [John Snow]. Source: Wellcome Collection.

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    escapes except to enter the lungs, I find that a fluid drachm is sufficient to induce narcotism to the fourth degree in a stout man, when the exhibition of it occupies two or three minutes, and about half as much in a young person of the probable size of this patient ; but when the vapour is inhaled rapidly, a given quantity produces a greater effect ; and Dr. Simpson remarks, that he has ‘seen a strong person rendered completely insensible by six or seven in- spirations of thirty drops of the liquid.” Whenever I have had the opportu- nity, for the last two months, I have cautioned the profession against the too rapid action of chloroform when given on a handkerchief or sponge. In objection to what I am saying, the numerous cases in which it has been safely administered in this way may be pleaded, notwithstanding one fatal case. I may mention, however, that I have been privately informed of three or four cases in which the medical man was greatly alarmed for the life of his pa- tient. One case also of this kind oc- curred in Guy’s Hospital, and was related by Dr. Gull in the Mepica. GazeETTE, in the latter part of last year; and I believe that many patients have owed their safety to the rapid loss of the chloroform by evaporation. If it were correct that some indivi- duals require to inhale several drachms before becoming insensible, there would be reason to believe that others would be unusually sensitive to its effects; but with chloroform, as with ether, I | have met with no such exceptions, and I have not heard of any when the vapour has been so administered that | it was inhaled without loss. Under these circumstances, the quantity con- sumed in producing insensibility al- ways appears proportionate to the size and probable weight of the patient, if the inhalation is not interrupted ; and the time required to induce insensibi- lity proportionate to the strength of the vapour and the activity of the respiration. Although many of the inhalers in use are very faulty, I consider that they are safer than the handkerchief. They are liable to the objection that they obstruct the respiration, by causing the air to pass through sponges; but with a limited supply of air the chloroform is necessarily limited also, as its vapour, having no existence in a separate state at common temperatures, can only be inhaled with the air. To give chloro- form in surgical operations, an instru- ment should be used which offers no obstruction to respiration, and by which the proportion of vapour in the air can be regulated; and those who have but a handkerchief or sponge had better use ether, which I consider has not yet been known to cause death, until other narcotic vapours may be introduced. In the case under consideration, the fatal result should be attributed to the action of the chloroform on the ner- vous centres having extended so far as to. put a stop to respiration; and I can- not agree in the opinion of Sir John Fife, that the immediate cause of death was congestion of the lungs, an affec- tion which could only have caused death in a somewhat tedious and not in a sudden manner, and which ought undoubtedly to be looked on merely as a consequence of the mode of dying, and as an indication that the heart continued to inject blood into the lungs after oxygen was no longer admitted to facilitate its passage through the capil- laries. In certain instances this is the case in animals killed by chloroform, whilst in other instances, which I shall endeavour to explain in a future com- munication, the respiration and circu- lation seem to cease together. Unless when the patient coughs or holds his breath, there is no tendency to congestion of the lungs during the inhalation of chloroform judiciously administered; for the free respiration and undiminished volume of the pulse, shew that the blood passes freely through these organs. Dr. Glover, I am aware, detected obstruction to the pulmonary circulation during life, by the hemadynamometer placed in one of the arteries of an animal under chloroform; but in that in- stance the chloroform had been in- jected into the veins; and any sub- stance that will not dissolve in the blood causes mechanical obstruction to its passage through the lungs: atmo- spheric air, the presence of which in the lungsisnecessary totheir circulation, when injected into the veins arrests it. I would observe in conclusion, that I attribute blame to no one; for Dr. Simpson cannot be blamed if, in con- ferring on us the benefit of chloroform, his instructions did not issue, like Mi- nerva from the head of Jupiter, perfect and incapable of improvement. Frith Street, Soho, Feb. 1848.
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