RECOVERY FROM THE EFFECTS OF CHLOROFORM.
As soon as a patient has ceased to inhale, the chloroform begins to exhale in the form of vapour from the blood as it passes through the lungs. It cannot be detected by the sense of smell, after the lungs have been emptied, by two or three expirations, of the vapour they contained at the moment when the inhalation was discontinued; but I have detected it by chemical means, after consciousness had returned. The chloroform exhales in greatest quantity at first, and the patient usually recovers his sensibility and consciousness in the time which it ought to take for the chief part of the chloroform to be exhaled, according to mechanical principles; as will be explained in treating of the modus operandi of this agent. The last traces of the chloroform of course exhale more slowly, and a very minute and insignificant quantity may remain for a considerable period in the system, not only of the patient, but of anyone who was standing by whilst he inhaled.
It is probable that a small portion of chloroform passes out by other channels than that of the expired air: the latter, however, offers such a ready and expeditious outlet, that the quantity excreted in any other way is, most likely, very minute. I have on four occasions examined urine passed after the inhalation of chloroform, by boiling it in a flask, and passing the vapour, first through a red-hot tube, and afterwards through a tube moistened inside with solution of nitrate of silver, and I only on one occasion obtained a very slight precipitate of chloride of silver.
The patient usually becomes conscious within five minutes after the inhalation has been discontinued. After a short inhalation, for a very brief operation, consciousness sometimes returns immediately, and after a prolonged inhalation the recovery of consciousness is sometimes retarded till ten minutes have elapsed. Old people are often longer than others in awaking from the effects of chloroform, owing, no doubt, to their slower breathing and circulation. Children, on the other hand, usually recover very quickly from its direct effects; but they often lapse into a natural sleep which lasts a considerable time—even for hours if they are not disturbed, and if the operation has left no painful wound or other cause of uneasiness.
It is desirable not to talk to the patient as he is recovering from the effects of chloroform, but to leave him to collect his ideas, and not speak to him till he is quite conscious, or makes some remark or inquiry himself. If not prevented by the medical attendant, the friends of the patient often address him the moment he opens his eyes; and the words they generally use are of a very equivocal meaning to one who cannot understand their application. They usually say “It’s all over”, which very often has the effect of raising an indefinite feeling of alarm in the patient; for, until he has had time to recover his memory, the operation he was to undergo is generally the farthest thing from his mind. When left to himself the patient usually recovers from the insensibility in a very tranquil manner. If he has not been moved whilst insensible, and awakes in the position in which he fell asleep, he supposes, very commonly, that he has not been asleep at all; and in a great number of instances will contend this point very stoutly, even after a protracted operation, and assert that the chloroform has not taken effect. It is as well to let him remain in this conceit for a while, or even till he finds out the mistake himself; for, if reminded of the pain they have been spared, just on waking after an operation, persons are liable to be excited by emotions of pleasure and gratitude; but a few minutes later, when the effects of the chloroform have more completely subsided, they are better able to control their emotions. A few persons wake with a full recollection of the preceding circumstances, and inquire if the operation is done; whilst others, on first awaking, are still entirely occupied with the subject of their dreams.
The greater number of patients who inhale chloroform have to remain in bed on account of the operation which has been performed, but after minor operations, the patient is sometimes able to walk away within five minutes; although more frequently there is a little languor or feeling of fatigue for half an hour or so; and it is desirable in all cases for the patient to sit or lie quietly for this space of time, if not longer, before he makes any mental or bodily exertion, even if he feels quite well.