On chloroform and other anæsthetics: their action and administration

by John Snow

On December 11th, I administered the amylene again in five more cases of tooth-drawing, with very similar results to those obtained in the previous cases; and on December 13th, I exhibited it in some more important cases.

Mr. Fergusson performed an operation for fungus of the testicle; Mr. Bowman removed some diseased glands from the groin; and there were two cases of tenotomy, in one of which forcible extension of the knee was made.

From November 1856 to July 1857, I exhibited amylene in 238 cases. There were seven cases of lithotomy; six of the patients were children, and the seventh a young man of seventeen. They all recovered. Five of the operations were performed by Mr. Fergusson, in King’s College Hospital; and two were performed in St. George’s Hospital, by Mr. H. C. Johnson and Mr. George Pollock.

There were five cases of resection of the knee; three of the patients got well, and two died. These operations were performed in King’s College Hospital, one of them by Mr. Partridge, and the other four by Mr. Fergusson. Of the seventeen cases of resection of the knee, mentioned at page 280, in which chloroform was administered, I know the result only in thirteen of the cases. Of these, eight recovered, one of them after undergoing subsequent amputation at the thigh; and five died.

Some statistics of this operation have been gathered by collecting the cases which happen to be reported in the medical journals, but such statistics are likely to be extremely erroneous. The cases that are reported are probably far more favourable than those that are not reported. A surgeon undertakes an operation of this kind with no other view than the benefit of his patient, and without thinking of the medical journals; and, if his first or second case is unsuccessful, he is probably not inclined to repeat the operation. If the cases should be successful, however, he is inclined to repeat the operation when opportunity occurs, and may ultimately give the result of his experience to the profession.

Mr. Bowman removed the head of the femur in two little boys to whom I administered amylene; they both recovered, as did a girl who inhaled amylene whilst Mr. Fergusson performed resection of the elbow. I administered amylene in four cases of amputation of the thigh: one of these operations was performed by Mr. Henry Lee, on January 7th, 1857, on a girl aged twelve or thirteen, who underwent resection of the knee on the 1st of November previously. That operation was performed by Mr. Bowman, and the girl inhaled chloroform. At the time of the amputation, she was suffering from pyæmia, was extremely weak, and had a pulse of 150 in the minute. The vapour was exhibited to the patient in bed, before her removal to the operating table. There was an examination of the knee before the operation; and the anæsthesia was kept up till the dressings were applied, which was twenty-five minutes from its commencement, and nearly three fluid ounces of amylene were used. She went through the operation extremely well. There was no sign of pain, and the pulse remained the same throughout the operation, and there was no depression. The patient recovered.

There was one operation of amputation below the knee by Mr. Fergusson, in which I administered amylene. The patient was a woman of twenty. The operation was performed on account of paralysis of the muscles of the leg and foot. She recovered. There was an amputation of the forearm; two amputations of the great toe, with its metatarsal bone; and two or three of toes and fingers: four cases of operation for stricture of the urethra by perinæal section—three of them by Mr. Fergusson, and one by Mr. Curling. There were three operations of lithotrity, two for hæmorrhoids and prolapsus ani, and four for fistula in ano. There were nine operations for the removal of tumours of the female breast; there were seventeen operations for necrosis of the tibia, femur, lower jaw, and other bones.

I administered amylene in several operations on the eye. There were two operations for cataract by extraction, and one by drilling, performed by Mr. Bowman; eight cases of excision of the eye by that surgeon, as well as some operations for artificial pupil, for the removal of foreign bodies from the eye, for staphyloma, and one for the separation of the eyelids from the globe. There were also twelve operations for strabismus, eleven of them by Mr. Bowman, and one by Mr. Fergusson.

I exhibited amylene in forty-eight operations of tenotomy. Several of them were performed by Mr. Fergusson, but the greater number were performed by Mr. W. Adams and the late Mr. Lonsdale, in the Orthopædic Hospital. The narcotism was scarcely carried beyond the second degree in any of these cases. The eyes were open, and the features generally had an expression as if the mind was active on some subject or other. The muscles were nearly always in a state of tension, at least they were not relaxed in any case. Many of the patients were children, and a number of them only inhaled between one and two minutes. There were five operations for the forcible extension of stiff joints, and two for dislocation of the humerus: the latter were treated in the St. James’s Parochial Infirmary. The first case was a dislocation downwards in a woman aged sixty-eight. She inhaled for three minutes, when, extension being made, the bone slipped into its place with the utmost ease, although Mr. French had found a good deal of resistance in an attempt he made just before sending to me—not any serious resistance or pain, but so much of both as led him to think it would be a good opportunity for trying the amylene. In two minutes after the reduction of the dislocation, and five minutes after beginning to inhale, the patient was quite awake again, and said that she had felt nothing. The other case was a dislocation forwards in a man aged seventy-two. No attempt to reduce it was made till the amylene was administered. The case was under the care of Mr. Buzzard. After inhaling two or three minutes, the old man got into a state of muscular rigidity, and did not get beyond this state, although I continued the inhalation nearly ten minutes, until about two ounces of amylene were used. He was quite insensible, but the rigidity prevented the reduction of the dislocation. So I discontinued it, and sent for some chloroform, which I administered a few minutes afterwards. It produced muscular rigidity rather stronger than that which the amylene had caused; but, by continuing the inhalation steadily for about two minutes, the limbs became relaxed, and the humerus slipped easily into its place. This is the only case in which the amylene has not effected the purpose for which I have exhibited it; and I have no doubt that I could have produced relaxation of the voluntary muscles by increasing the strength of the vapour the patient was breathing; for I have always been able to produce relaxation of the muscular system of animals with it; but there were one or two circumstances which at the moment stood in the way of this. The patient’s face was so hollow from his loss of teeth that the face-piece fitted badly; and, as it was early in a frosty morning, the water-bath of the inhaler was colder than usual. These defects could have been remedied if necessary, but I thought it as well to use chloroform; and I am inclined to think that chloroform and ether are better agents to employ in those instances where relaxation of the voluntary muscular system is required.

Sixteen tumours of different kinds were removed from different parts of the body, in addition to the tumours of the breast previously mentioned, in cases in which I administered amylene; and there was also a number of miscellaneous operations which I have not mentioned.