Removal of the Testicle; Amputation of the Penis, etc. I have memoranda of twenty-seven cases in which I have administered chloroform during the removal of a testicle, generally for malignant disease; and six cases in which I have administered it for amputation of the penis, always for malignant disease. There were six operations, also, in which a part of the penis was removed for malignant disease; and eleven cases in which warts were removed from the glans penis, generally with the knife. In two cases in August 1854, Mr. Acton destroyed a number of venereal warts on the glans penis and prepuce by a caustic composed of potassa and lime. In all the operations on the testicle and penis, under chloroform, the patients have been lying on the back.
Operations for Phymosis. I have memoranda of 76 operations for phymosis, in which I have exhibited chloroform. The operations were generally in the adult, although the complaint was, in most cases, congenital. I have known two cases in which cancer of the penis was produced by the patient’s suffering a congenital phymosis to remain to about the age of fifty. The cancer commenced in the glans from the irritation of the retained urine. One of the patients died of the disease.
Removal of enlarged Bursa. I have notes of six cases in which the bursa of the patella was dissected out by the surgeons of King’s College Hospital for housemaid’s knee. The patients were charwomen and domestic servants. In two cases a bursa was removed from the forefinger.
Evulsion of the Nails. I have notes of twenty-five cases in which I have given chloroform for cutting down the nail of the great toe, and tearing away the whole, or the two edges of it; and also of three cases in which one or more finger nails were removed by a similar process. This operation is one of the most painful of the minor operations of surgery. It is better that the patient should be lying when it is done under chloroform.
Laryngotomy. I administered chloroform to one or two infants in which Mr. Henry Smith performed laryngotomy for croup. I also administered it, on four occasions, to a patient of Mr. Partridge, a boy four years old, who was believed to have a button in some part of the air-passages. The larynx had been opened a few days previously to the first occasion in which I gave chloroform, and I administered it on a sponge, held near to the tube in the larynx. It was necessary to give the vapour gently at first, just as if it was entering in the usual way. When it was given at all strong, whilst the patient was still conscious, he showed exactly the distress that a patient experiences when he says that the vapour produces a choking feeling; which confirms my opinion that the feeling referred to the throat, from the action of pungent vapours and gases, is caused by their presence in the lungs. The chloroform was given to keep the child quiet whilst Mr. Partridge searched for the supposed button in the larynx and bronchi. When the child recovered from the chloroform, before the operation was concluded, the explorations in its air-passages embarrassed the breathing much more, and caused more apparent threatening of suffocation, than they did when he was under the influence of the vapour. This little boy remained for months in King’s College Hospital; and at last the embarrassment in his breathing subsided, the tube was removed from the larynx, and the wound allowed to heal; and he left quite well, although the button, which was supposed to have gone down his windpipe at the moment when his symptoms first suddenly came on, was never found.
I have administered chloroform in a great variety of surgical operations, in addition to those mentioned above, but as they required only the usual management in the application of the vapour, I need not allude to them, but shall, however, make a few remarks regarding dental operations.
Extraction of Teeth. It is the custom in the medical journals and medical societies, to object occasionally to the use of chloroform in tooth-drawing, as if the operation were not sufficiently severe to require it. I will say nothing of the wives and daughters of medical men in connexion with this subject, but will only allude to the case of an elderly lady, who had for thirty years been the private friend, as well as the patient, of one of the Council of the College of Surgeons. After she had had ten necrosed teeth extracted, and had awakened from the effects of the chloroform, her friend and surgeon, who had been looking on, discoursed eloquently on her case, explaining how the state of her mouth was ruining her health; how impossible it would have been for her to go through the operation without chloroform, and what a great advantage it was.
Dr. Watson says in his Lectures:[[148]] “I am not at all sure that the increased longevity of modern generations is not, in some degree, attributable to the capability of chewing their food which the skill of the dentist prolongs to persons far advanced in life.” I have seen at least fifty cases in which the dentist has been able to exert his skill in enabling his patient to masticate only by the aid of chloroform; cases of feeble, aged, or debilitated persons, whose mouths contained between twenty and thirty stumps of teeth or necrosed teeth; and who were able to get rid of them all at two or three operations a few days apart; but without the opportunity of being made insensible, would undoubtedly have continued with the mouth in a tender and painful state.
It was in consequence of the relief afforded by nitrous oxide gas, in pain caused by a tooth, that Sir Humphrey Davy suggested its application in surgical operations; it was for the extraction of a tooth that Mr. Horace Wells first carried out the suggestion of Davy; and it was in the extraction of teeth that Dr. Morton first employed sulphuric ether as a substitute for nitrous oxide gas. These circumstances seem to point to a demand for anæsthetics in operations on the teeth; and when the great frequency of these operations is considered, it is probable that more pain may be prevented during their performance than in any other class of operations.
I have notes of 867 cases in which I have administered chloroform during the extraction of teeth, chiefly by dentists living in this neighbourhood: amongst whom are Mr. Saunders, Mr. Cartwright, Mr. Samuel Cartwright, Mr. Arnold Rogers, Mr. Thomas A. Rogers, Mr. Tomes, Mr. Bigg, Mr. Crampten, Mr. F. W. Rogers, Mr. Alfred Canton, Mr. Woodhouse, Mr. Lintott, Mr. Rahn, Mr. Vasey, Mr. Sercombe, Mr. Fletcher, and several others; and there is one dentist in the City, Mr. West of Broad Street, whom I have frequently assisted. The number of teeth, or stumps of teeth, extracted in these 867 operations, has been about 3021. In some cases in which several teeth have been removed, I have not been sure of the exact number, but have put down about the number.