A patient of Mr. Robert Dunn, to whom I gave chloroform in her confinement, was at the time in a state of insanity.
In one of the patients whom I have attended with Dr. Arthur Farre, there was separation of the recti muscles of the abdomen; which there is no doubt must have taken place gradually during pregnancy. The patient was but twenty years of age, and in her first labour. Quite early in the labour, before the pains were at all strong, Dr. Farre and I observed that the abdomen was of a peculiar form, the uterus projecting very much forwards, whilst there was a slackness in the flanks. The abdominal muscles did not assist the pains at all; and it was probably from this cause that the labour progressed slowly and was terminated at last with the forceps. The recti muscles recovered their position by careful bandaging.
The chloroform has always been left off as soon as the child was born, but a little has been administered again on several occasions during the expulsion of the placenta. The placenta has generally been expelled very soon in the labours in which I have given chloroform; usually in about five minutes. There has hardly ever been uterine hæmorrhage of any amount, except in patients who had suffered from it in previous labours. In a case attended by Mr. Nathaniel Ward, however, there was a slight hæmorrhage before the birth of the child, and about an hour afterwards there was a considerable hæmorrhage which made the patient feel rather faint for some hours. She afterwards went on favourably, however. She was a young woman who had had several children.
A patient, to whom I was recommended by Sir John Forbes, inhaled chloroform in three confinements. She recovered favourably from the two first; but on the third occasion, after going on favourably till the fifth day, she was attacked with puerperal fever, and died on the seventh day from her confinement.
I am not aware that more than one death has been recorded as having occurred from chloroform during labour; and this took place in England, in 1855, when no medical man was present.[[151]] The patient had inhaled chloroform in America in a previous labour; but her medical man, on the last occasion, who was her particular friend, forbad that agent, and said that if she was determined to have it, he would not attend her. She procured chloroform unknown to him, and a number of scents to put on her handkerchief and hide the odour of it from him. He went to bed in the house, and was not called up till his patient had been dead about an hour. The monthly nurse, who had procured the chloroform for the patient, said that she snored very loudly for an hour after she fell asleep. About five drachms of chloroform were used from the bottle, and the handkerchief from which it was inhaled remained close to the patient’s face till she died. The death seemed to have taken place very slowly, and the monthly nurse was extremely stupid to allow the patient to die. It may also be remarked that the accident would not have taken place except for the medical man’s extreme objection to the use of chloroform.
The chloroform has been occasionally blamed by the friends of patients, or medical men opposed to its use, in cases where patients have died from puerperal convulsions or other causes, so long after the vapour had been left off that it could not be the cause of death. The following case shows how easy it would be to make a mistake with respect to the effects of chloroform. Soon after its introduction, I was requested to administer it to the wife of a medical man who had a great desire for it in her confinement. Mr. Propert was to attend the lady. I was sent for late one evening, but as there were no pains at the time when I arrived, I was requested to go to bed in the house. After a time, I was called by a servant, who told me that the baby was born, and that Mr. Propert was sent for. I found that the birth had been so sudden that the husband, who was in the room, could not get to the bed side before the child was born. Mr. Propert arrived, and I went home, leaving the patient very well. Mr. Propert informed me, that after I left the patient went into such a state of syncope as to make him think she was going to die, and continued so for some time. She ultimately recovered. There was no hæmorrhage or any other cause to account for the faintness, and I understood Mr. Propert to say, that if the patient had inhaled chloroform, he should have blamed it for the condition into which she lapsed.
THE INHALATION OF CHLOROFORM IN MEDICAL CASES.
Neuralgia. When the pain of neuralgia is not extremely severe, it may be removed by the inhalation of chloroform without causing unconsciousness; but when it is very severe, it is necessary to make the patient unconscious before the pain is suspended. In some cases of neuralgia of the face, the pain is so severe that the signs of it remain after the patient is rendered unconscious, and only disappear when he is quite insensible; and then, as the insensibility passes off, the hand is raised to the face, and the contortions of the features return before the patient awakes to be aware of his suffering. When the mental branch of the fifth nerve is affected, the paroxysms of pain are accompanied by a motion and smacking of the lips. In a hospital patient I have seen this when he was awake, but in a gentleman only when his consciousness was removed by the chloroform, and before complete insensibility was induced; when awake, he restrained the impulse to this kind of motion of the lips.
In administering chloroform it is desirable to continue it steadily and gradually till the pain is relieved; and if the patient is rendered unconscious before the pain is removed, to continue it till all signs of suffering disappear. After the first inhalation of the vapour, the pain will generally return in a few minutes, but when again subdued, it will not return so quickly; and after it has been suspended a few times by the repetition of the chloroform during the space of an hour or so, the pain is usually removed either permanently or for two or three hours. In some cases I have had to repeat the chloroform occasionally throughout the day, and, on one or two occasions, for two or three days in succession. The chloroform can, in general, only be considered a temporary remedy, and therefore such other medicines should be applied as may be thought advisable.
When I have prescribed chloroform in a liniment, to be applied to the face, the patient has often found out that he obtained more relief by smelling at the liniment than by applying it. Chloroform generally gives great relief, however, when applied locally in neuralgia, either alone or mixed with camphorated spirit; it is advisable to apply it on a piece of lint or blotting paper, which should be covered over with tinfoil, or some other impermeable substance, to prevent the evaporation. It causes about as much heat and uneasiness as a mustard poultice, before it relieves the pain.