Dr. Fairbrother, of Bristol, gave small doses of chloroform by inhalation, with the best effects, in a case of typhus fever, in the Bristol Infirmary. The patient was delirious and worn out for want of sleep, her life being in fact despaired of. She inhaled the chloroform occasionally for several days, sleep being always procured when it was applied, and she recovered without any other medicine.[[153]]
Hydrocephalus. I administered chloroform on two occasions, for half an hour at a time, to a child, seven years old, when delirious and screaming violently, in this complaint. The child was much relieved by the inhalation, but it died on the fourteenth day of the disease.
Tetanus. I have notes of three cases of tetanus in which I have administered chloroform. The first was a patient of the late Mr. Keate, in St. George’s Hospital, in February 1849. It was a girl, fourteen years old, who had received some severe burns in the face and various parts of the body, a fortnight previously. Four days before inhaling the chloroform, she was attacked with symptoms resembling those of chorea, but for the last two days the complaint was recognised to be tetanus. There was rigidity of the spine and jaws, and of one arm, which was flexed. Spasms came on every minute or two, affecting, more particularly, the head and the arm. I commenced to give chloroform very gently at four in the afternoon. It prevented the spasm before consciousness was quite removed. Whenever the spasm offered to return, the inhalation was repeated with the effect of stopping it. The chloroform was continued till half-past five, with the effect of keeping the spasm away; and the patient took some drink during this time, better than she had done previously. I saw the child again at eight o’clock in the evening, and found that the spasms had returned soon after I left, and had continued as before. The chloroform was given again at intervals for an hour and a half, with the effect of keeping away the spasms, and inducing sleep; but I found that the child was getting weaker, and would die even if the spasm was entirely prevented. She died at a quarter past eight the following morning. There was no inspection of the body.
The next case was a patient of Mr. Propert, a boy, ten years of age, who had suffered from sloughing of the skin of the inferior extremities. The tetanus came on during the healing process, whilst the greater part of both extremities was in a state of ulceration, and covered with healthy granulations. The patient was in a very irritable and feeble state, and his pulse was 150 in the minute. He was made insensible, and the chloroform was repeated twice in the space of half an hour. No relaxation of the muscles of the jaws was produced, although the effect of the chloroform was carried as far as seemed safe in such a subject. He died twelve hours afterwards.
I administered chloroform lately to a patient of Mr. Salmon in St. Mark’s Hospital. He underwent an operation by ligature for prolapsus ani and hæmorrhoids on March 1st; on March 5th tetanus commenced, and on March 7th chloroform was administered whilst Mr. Salmon removed some sloughs from the anus; and it was repeated occasionally afterwards. The patient was a man, fifty-two years of age; he was the subject of kidney disease, and the tetanus was extremely severe. He had had four doses, each containing a fluid drachm of laudanum, between the time when the tetanus commenced and his inhaling the chloroform. His pupils were contracted, and he was made insensible by an extremely small quantity of chloroform. He was, in fact, very much under the influence of opium, although the spasm of the tetanus prevented his sleeping.
Chloroform affords great relief to the patient affected with tetanus, and it probably increases the prospect of recovery in cases which are not too severe and acute.
Epilepsy. Dr. Todd at one time had chloroform administered by inhalation, in King’s College Hospital, to the extent of causing insensibility, at stated intervals, in cases of epilepsy, and he thought with advantage. I have frequently administered chloroform for surgical operations to patients who were subject to epilepsy, and have very rarely found it produce any approach to a fit.
In July 1850, I administered chloroform to a boy, seven years old, in an epileptic fit, which had lasted about an hour when the inhalation was commenced. He had had fits previously, the last of which had occurred a year before, but none of them had lasted so long as the existing one. He had eaten nine new potatoes for his dinner, at one o’clock, and the fit came on about eight. I found the abdomen swollen and very tympanitic. There was constant convulsive motion of the right arm, and of the neck; the latter drawing the head to the right side. The mouth was also drawn to the right at each convulsive motion. The chloroform was given by putting a few minims at a time on a handkerchief, and holding it to the mouth and nostrils. It caused immediate cessation of the convulsions every time it was applied. The convulsions, however, returned again in a minute or two. In the intervals that he was partially under the influence of the vapour, he breathed easily without stertor. The convulsions became gradually less severe, and ceased entirely ten or fifteen minutes after the commencement of the inhalation.
Puerperal Convulsions. I have not been called to any case of this complaint since chloroform has been in use; but some cases have been related in the medical journals in which the inhalation of chloroform has been employed with a favourable result. One case is related by Mr. Henry Rudge, of Leominster.[[154]] When the chloroform was administered, the patient was in violent convulsions which came on in frequently succeeding fits. The os uteri was dilated, and the head presenting. The pains were entirely arrested. The chloroform was administered by twenty minims, at intervals, on a folded handkerchief. The convulsions, after a few inhalations, entirely ceased, and Mr. Rudge extracted the child without difficulty. There was another child with the head presenting: it was delivered with the forceps. The placenta was delivered with the hand on account of smart hæmorrhage. There was only one attack of convulsions after delivery, and the patient recovered favourably. It was her first labour, and her age was twenty-three years.
A case of puerperal convulsions was related by Mr. Andrew Bolton to the Newcastle and Gateshead Pathological Society.[[155]] His patient, aged twenty-two, was at the full period of her first pregnancy. The os uteri was high, slightly dilated, and extremely rigid. She was treated at first by blood-letting, and full doses of morphia. Mr. Bolton says: “As her condition appeared hopeless should the paroxysms continue, chloroform was administered on a piece of linen, in half-drachm doses, and its full effects kept up for three hours. At two P.M., there was a slight return of convulsion; skin warm and perspiring; the os uteri was found steadily dilating; and from her uneasy movements, it was apparent that uterine action had begun.