A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    50/878 (page 26)
    impression on my mind is, that a patient is better off with chloroform both under and after an operation than if he were without it. When an operation is contemplated under chloroform, almost the only precau- tion worthy of being taken is, that food should be avoided for several hours before, as chloroform on a full stomach is almost certain to induce sickness. So much has been written on the subject of chloro- form since its introduction that I deem it unnecessary to say much more regarding it at present, and I trust from what has been stated, that it will be understood that, with the few exceptions above made, and such others as might incidentally arise, the use of this agent is recommended as an invariable accompaniment of all surgical operations involving pain. . . The quantity of chloroform required for different patients is very variable. A few drops may suffice for some, while drachms may be needful for others, and generally the amount will be in proportion to the duration of the operation. Some persons take it kindly, even greedily, others make great objection and resistance to its use, both while conscious and unconscious, but all can be at last so thoroughly overpowered by its influence that, compatible with respiration and cir- culation, the greatest imaginable quietness can be obtained, there> is very little effect on the pulse in such cases; sometimes it is slightly excited at first, and if the dose be very potent, it may become slow and weak. There is greater effect on respiration. In some, in the early stages, the movements are rapid, and there seems an eager- ness to fill the lungs with the vapour. In others a tickling cough is excited. In many, the full effect is induced with as slight a percepti- ble change as if sleep had suddenly come on, but in many others great irregularity in the respiratory movements ensues, and much cerebral excitement is induced. Rapid breathing may happen, as a rea y mentioned, but the reverse may be the case, and the power of inspira- tion may suddenly seem to have ceased. For many seconds there may be no seeming attempt at respiration, but at last a deep breath1S usu^ ^ taken which makes amends for the previous cessation. I he cerebral excitement is evinced by crying, bawling, singing, laughing, inco eren talking, and with many there seems some prevailing idea-avhich calls forth unusual and often great muscular action. Some strike forcib y with the fists, and with no seeming want of skill; others use their lower extremities, and others again make such violent general strugg es as necessitate the greatest muscular exertion in those around to keep them steady. Often these violent struggles, and the temporary cessa- tion of respiration fall together, and to those not accustomed to such scenes, it appears as if immediate dissolution were impending; but m all such cases a little more of the vapour induces all that quietude which is characteristic of its full effect for the surgeon s Purposes. There are various ways in which it may be decided that this period has arrived. Muscular relaxation is one of the best, but perhaps there is no test equal to that of touching the sur ace o eyeball with the point of the finger. If there be any indication of