On chloroform and other anæsthetics: their action and administration

by John Snow

August 6th, 1858.

CONTENTS.

HISTORICAL INTRODUCTION		[1] to 24
General Remarks on Inhalation		[25]–26
CHLOROFORM		[27]–344
	History and composition of	[27]–8
	Mode of preparation	[28]–9
	Chemical and physical properties	[29]–30
	Adulterations	[30]–32
	Vapour of	[32]–34
Physiological Effects of Chloroform		[34]–48
	Degrees of narcotism	[35]–43
	Effect of chloroform on the pulse	[43]–4
	Action of chloroform on the nervous system	[44]–8
Circumstances which influence or modify the Effects of Chloroform		[48]–58
	Age	[49]–50
	Strength or debility	[50]
	Hysteria	[50]–2
	Epilepsy	[52]–3
	Pregnancy	[53]
	The menstrual period	[53]
	Diseases of lungs	[53]–4
	—— —— heart	[54]–6
	Cerebral disease	[56]–7
	Insanity	[57]
	Hard drinking	[57]–8
Amount of Vapour of Chloroform absorbed to cause the Various Degrees of Narcotism		[58]–74
	Experiments	[60]–73
Preparations for inhaling Chloroform		[74]–78
Mode of administering Chloroform		[78]–97
	Signs of insensibility	[87]–97
	Repetition of chloroform during an operation	[97]
Recovery from the Effects of Chloroform		[97]–100
Occasional Sequelæ of the Inhalation of Chloroform		[100]–107
	Sickness	[100]–3
	Faintness and depression	[103]–4
	Hysteria	[104]–7
Cause and Prevention of Death from Chloroform		[107]–120
Fatal Cases of Inhalation of Chloroform		[120]–200
Alleged fatal Cases of Inhalation of Chloroform		[201]–212
Symptoms in fatal Cases of Inhalation of Chloroform		[212]–217
Mode of Death in the Accidents from Chloroform		[217]–222
The Two Kinds of Syncope		[222]–228
Supposed Causes of Death from Chloroform		[228]–245
	Idiosyncrasy	[231]–2
	Alleged impunity of chloroform	[233]
	Apparatus employed	[233]
	Alleged exclusion of air	[233]–4
	Alleged closure of glottis	[234]–8
	Alleged exhaustion from struggling	[238]–9
	Sitting posture	[239]–40
	Effect of surgeon’s knife	[240]–3
	Sudden death from other causes	[243]–5
	Falling back of the tongue	[245]
State of the chief Organs after Death from Chloroform		[245]–8
Further Remarks on the Prevention of Accidents from Chloroform		[248]–251
Treatment of suspended Animation from Chloroform		[251]–262
Effect of Chloroform on the Results of Operations		[263]–270
Administration of Chloroform in the different Kinds of Operations		[271]–318
	Lithotomy	[271]–4
	Lithotrity	[274]–5
	Perinæal section	[275]–6
	Stricture	[276]
	Amputation of thigh	[276]–7
	—— —— leg	[277]
	—— —— arm	[277]–8
	—— —— ankle	[278]
	Other amputations	[278]
	Operations for necrosis	[278]–9
	Excision of head of femur	[279]
	Excision of elbow	[279]–80
	—— —— knee	[280]
	—— —— wrist	[280]
	Removal of tumours of upper jaw	[280]–5
	—— —— —— of lower jaw	[285]
	Tumours of female breast	[285]–7
	Other tumours	[287]–9
	Nævi	[289]
	Ligature of arteries	[289]–91
	Tumours of bone	[291]
	Hare-lip	[291]–3
	Cancer of the lip	[294]
	Division of nerves	[294]–6
	Operations on the eye	[295]–8
	—— —— —— ear	[298]
	—— —— —— nose	[298]–9
	—— —— —— mouth	[299]–300
	Plastic operations	[300]–1
	Raising depressed skull	[301]–2
	Operations for ununited fracture	[302]
	Reduction of dislocations	[302]–3
	Forcible movement of joints	[303]
	Tenotomy	[303]–4
	Operations for hernia	[304]–5
	—— —— —— hæmorrhoids and prolapsus	[305]–7
	Fissure of anus	[307]–8
	Fistula in ano	[308]
	Operations on ovarian tumours	[308]–10
	Operations for cancer of vagina	[310]
	—— —— —— rupture of perinæum	[310]
	Removal of testicle	[310]–1
	Operations for phymosis	[311]
	Removal of bursa	[311]
	Evulsion of nails	[311]
	Laryngotomy	[312]
	Extraction of teeth	[313]–18
	Secondary hæmorrhage after operations	[318]
Chloroform in Parturition		[318]–329
The Inhalation of Chloroform in Medical Cases		[329]–344
	Neuralgia	[329]–31
	Spasmodic asthma	[331]
	Spasmodic croup	[331]–2
	Hooping-cough	[332]
	Infantile convulsions	[332]–3
	Delirium cum tremore	[333]–4
	Delirium in fever	[334]–5
	Hydrocephalus	[335]
	Tetanus	[335]–6
	Epilepsy	[336]–7
	Puerperal Convulsions	[337]–9
	Hysterical paralysis and contractions	[339]–41
	Mania	[342]
	Spasmodic pain	[342]–3
	Frequent and long continued use of chloroform	[343]–4
SULPHURIC ETHER, OR ETHER		[345]–371
	History and composition	[345]
	Chemical and physical properties	[345]–9
	Physiological effects	[349]–55
	Administration of ether	[356]–61
	Great safety of	[362]–9
	The combination of chloroform and ether	[369]–71
AMYLENE		[372]–410
	Preparation and properties	[372]–7
	Physiological effects	[378]–86
	Use in surgical operations	[386]–94
	Use in parturition	[394]–7
	Its effects	[397]–419
THE MONOCHLORURRETTED CHLORIDE OF ETHYLE		[420]–23
ILLUSTRATIONS.
	Chloroform inhaler	[82]
	Ether inhaler	[349]

THE
LIFE OF JOHN SNOW, M.D.

There is not much credit in the mere acts of living and dying; in being driven by unavoidable fate through the common journey, with shoulders uncovered and the whip over them; in doing nothing save the drudgery of existence; in enjoying, in an approach to the recognition of enjoyment, the brief dreams of childhood; in struggling into manhood; in battling through the after-strife obedient to the castigator behind; and in dying at last, as though life had never been; dead to-day, wept for tomorrow, and forgotten by the morrow’s succeeding sun. There is not much credit in this surely, for credit must be earned by something done beyond that which all must perforce do. But, in the face of all the struggles incidental to the existence, so to have managed as to have stolen out of time hours which other men knew not in their calendar—so to have defied the inexorable taskmaster as to perform more than is included in his demands; so to have willed and acted as to live on when death has done his worst; to assist all coming wayfarers in their conflict wherever they may meet it; to prove that there is something more in life than labour lost, and nothing more in death than an idea—Hoc opus hic labor est—in this there is achieved the grand attainment; the perpetual life.

He whom I, with poor biographer’s pencil, put forward now in brief sketch, is one amongst the few who have thus realized the ideality of death. It were but little matter, therefore, though no biography should appear at all; it is of but little count that such biography, as the recollections of friends and intimates shall call forth, be scanty in its details; it is of but little count that the life of him who is to be shadowed forth is destitute of incident fitted for the taste of wonder-loving, passion-courting, romance-devouring, readers. Biographies for these are common. Good men are scarce.

John Snow, the subject of the present memoir, was born at York, on the fifteenth day of June, 1813. He was the eldest son of his parents. His father was a farmer. His mother, who is living, resides still at York. As a child, he showed his love of industry; and increasing years added only to the intensity with which he applied himself to any work that was before him. He occasionally assisted his father in agricultural pursuits, and often in later life spoke with great naïveté of the recollections of those early winter mornings when his boy’s fingers were too intimately to be pleasantly acquainted with the effects of benumbing cold. He was first sent to a private school at York, where he learned all that he could learn there. He was fond of the study of mathematics, and in arithmetic became very proficient. At the age of fourteen, he went to Newcastle-on-Tyne, as an apprentice to Mr. William Hardcastle, surgeon, of that place. He had also the opportunities of studying at the Newcastle Infirmary. During the third year of his apprenticeship, viz., when he was seventeen years old, he formed an idea that the vegetarian body-feeding faith was the true and the old; and with that consistency which throughout life attended him, tried the system rigidly for more than eight years. He was a noted swimmer at this time, and could make head against the tide longer than any of his omnivorous friends. I have heard him tell that so long as he continued to qualify his vegetables with milk and butter, the vegetarian plan supported him fairly. But on one unfortunate morning, when taking his milk breakfast, some quizzical friend, learned in botany, cross-examined him as to the vegetable on which he was then feeding. The joke went home; and the use of milk, as food for a pure vegetarian, became too absurd for consistency. The milk, therefore, must be put aside, and the butter and the eggs. The experiment did not answer; the health of our pure vegetarian gave way under the ordeal, and although in after life he maintained that an approach to the vegetarian practice was commendable, in that it kept the body in better tone for the exercise of the mind, he admitted that in his own case his health paid the forfeit of his extreme adherence to an hypothesis. Amongst his earlier scientific readings was a book in defence of the vegetable regimen by John Frank Newton. This book is annotated by himself, 1833. It is an useful book, full of curious arguments, facts and suggestions, many of which, as his own after writings indicate, he had carefully studied and applied.

At or about the same time that he adopted his vegetarian views, he also took the extremity of view and of action, in reference to the temperance cause. He not only joined the ranks of the total abstinence reformers, but became a powerful advocate of their principles for many succeeding years. In the latter part of his life, he occasionally and by necessity took a little wine, but his views on the subject remained to the end unchanged; he had strong faith in the temperance cause, and a belief that it must ultimately become an universal system.

In 1831–32, cholera visited Newcastle and its neighbourhood, and proved terribly fatal. In the emergency, Mr. Snow was sent by Mr. Hardcastle to the Killingworth Colliery, to attend the sufferers from the disease there. In this labour he was indefatigable, and his exertions were crowned with great success. He made also on this occasion many observations relating to this disease, which proved to him of immense account in after years.

He left Newcastle in 1833, and engaged himself as assistant to Mr. Watson of Burnop Field, near Newcastle. Here he resided for twelve months, fulfilling the assistant duties; regarding which it can only be said, and that from analogy, that they were neither without their anxiety nor their reward. Leaving Burnop Field in 1834–5, he revisited his native place, York; made a short stay, and thence, to a certain half-inaccessible village called Pately Bridge, in Yorkshire, to assistant it with Mr. Warburton, surgeon there. Some few years ago a friend of mine went to the same village, by the recommendation of Dr. Snow, as assistant to the present Mr. Warburton of that place, a son of Dr. Snow’s “old master”. The circumstance of this recommendation often led Dr. Snow to refer to his life at Pately Bridge in our conversations. He invariably, on such occasions, spoke of Mr. Warburton, his “old master”, in terms of sincere respect, and depicted his own life there with great liveliness. He was a vegetarian then, and his habits puzzled the housewives, shocked the cooks, and astonished the children. His culinary peculiarities were, however, attended to with great kindliness. Eighteen months at Pately Bridge, with many rough rides, a fair share of night work, a good gleaning of experience, and this sojourn was over. Now back again went our student to York, to stay this time a few months, and—not to be idle—to take an active share in the formation of temperance societies. In leisure days during this period it was his grand amusement to make long walking explorations into the country. In these peregrinations he collected all kinds of information, geological, social, sanitary, and architectural.