Spasmodic Asthma. On November 12th, 1850, I administered chloroform in the Hospital for Consumption, at Brompton, to a married woman, aged thirty-five, a patient of Dr. Cursham. She was in a fit of spasmodic asthma, but was the subject also of chronic bronchitis. Twenty minims of chloroform were inhaled from an inhaler. It gave immediate relief, producing a momentary state of unconsciousness, or a state bordering on it. In a few minutes the difficulty of breathing gradually returned, but not to the same extent, and the inhalation was repeated with a like effect. The difficulty of breathing returned less quickly and severely; and after a third inhalation of twenty minims she was completely relieved, and could lie down. The patient had a good night, and was better next day. On the 14th, she had another fit of spasmodic asthma, which was relieved completely by the chloroform in the same manner as the previous one. This patient inhaled extract of stramonium every evening, by a method which will be described further on.
Other cases of spasmodic asthma have been relieved as readily and completely; but in one or two cases, in which the difficulty of breathing seemed to depend on disease of the heart, the relief was not so great; the patient went to sleep, but the breathing remained embarrassed.
Spasmodic Croup. I have administered chloroform in seven cases of this complaint. It was recommended in every instance by Dr. Ferguson, and all the cases ended in recovery. The children were from eight months to two years of age; the majority being about a year. I always gave enough chloroform to cause a state of unconsciousness, for which a few minims suffices in a young child, and when the effect passed off, or nearly so, I repeated the dose. I generally gave five or six doses in the course of about half an hour, after which the child would often sleep for two or three hours. In the milder cases it was repeated once a day; but in the more severe cases it was continued, in the above manner, twice a day. I administered it to a patient of Dr. Van Oven, respecting whom Dr. Ferguson had been consulted, for fifteen days, twice every day, excepting the last three days. This child was very ill when the treatment was first commenced, having a severe fit of spasmodic breathing every five minutes. When the chloroform is given during the spasm, it is desirable to give it very cautiously.
Mr. W. J. H. Cox read a paper on the treatment of laryngismus stridulus, with chloroform, at the London Medical Society, in 1850. He had entrusted the administration of it to the mother or nurse, and directed it to be given whenever the spasmodic breathing should come on. I am inclined to think that this would be the best way of giving it, if one could be quite sure of the intelligence of the party to whom it was entrusted.
Hooping-Cough. I have only administered chloroform in two cases of this complaint. It was recommended in both cases by Dr. Ferguson. One of the children was extremely ill of bronchitis, and it died. The other child recovered, but the chloroform was not continued. I am not aware that chloroform has had any fair trial in hooping-cough. It should be given whenever a fit of coughing comes on.
Infantile Convulsions. I have administered chloroform in two cases of this disease, with the effect of relieving the convulsions, but the children died. They were both extremely ill before the chloroform was administered. One was the patient of Mr. Walter Bryant, and Dr. Seth Thompson was consulted about it. A case has been related by Dr. Simpson of Edinburgh, in which the chloroform was continued for a day or two, and in which the infant recovered.
Delirium cum Tremore.[[152]] Some cases have been related in the medical journals, in which this complaint was treated successfully by chloroform alone; but I prefer to use this agent only as an adjunct to the treatment by opium. Sometimes the patient is so violent and suspicious that he cannot be made to take opium; but it is much easier to make a person breathe a medicine, than swallow one. It is only necessary to hold a patient, and to apply the chloroform near his face, and he is obliged to breathe it, and as the effect of it subsides, he recovers the power of swallowing before his delirium returns; for whilst he is still unconscious, he will swallow whatever is poured into his throat. Opium can be administered, and the chloroform can be repeated occasionally so as to keep him asleep for an hour or two till the opium takes effect and prolongs the sleep. It is a great advantage of chloroform that the delirium may be subdued in a few minutes by it, and can be kept away till opium takes effect.
In certain cases of delirium cum tremore, such a quantity of opium is taken without procuring sleep, that the medical attendant has, what I believe to be, a well-grounded fear of giving more. A patient whom I saw with Mr. Peter Marshall, in April 1850, had taken ten fluid drachms of laudanum and two grains of acetate of morphia, within twenty-four hours of my seeing him, without any sleep being procured. He was put to sleep immediately by chloroform, which was repeated on the following day. The patient got quite well in a few days.
In December 1851, I saw a patient who had had no sleep for four days, except three intervals of a quarter of an hour each, although a great deal of opium had been given. He was very violent; and for the last twelve hours had spat out all the medicine that was given to him; his pulse was small and very rapid. He was made insensible in a few minutes, and the chloroform was repeated, at intervals, for half an hour, so as to keep him unconscious. Fifty minims of tincture of opium were given in one of the intervals. I waited an hour and a quarter after the chloroform was discontinued; the patient was still sleeping, and his pulse was less frequent. I learnt that when he awoke he was quite free from delirium, and he was well in a few days.
Delirium in Fever. In November 1857, I administered chloroform to a youth of seventeen, who had been ill of typhoid fever for sixteen days. He had been in a state of constant delirium for upwards of forty-eight hours without having the least sleep, although he had had tincture of opium in divided doses to the extent of forty-five minims, and had taken a tablespoonful of wine every four hours. The chloroform was continued gently for half an hour; he slept for an hour afterwards, and at intervals during the night. He was a little better in the morning; and the delirium was not again so violent as it had been. He died on the nineteenth day of the fever, from a recurrence of diarrhœa.