On chloroform and other anæsthetics: their action and administration

by John Snow

“Half-past three. The membranes were ruptured; and brisk uterine action ensuing, a dead child was expelled, immediately followed by the placenta. She regained her senses during the expulsive efforts, but appeared entirely ignorant of her previous condition. Recovery followed without any bad symptom.

“In conclusion, I would remark, that the convulsions were in no measure mitigated by the depletion, which was carried to the utmost; nor was there any yielding of the os uteri until the chloroform was inhaled.”

The urine was not examined in either of the above cases, and it is not stated that œdema was present.

Hysterical Paralysis and Contractions. In December 1851, I administered chloroform in Charing Cross Hospital to a young woman about twenty-five, a patient of Dr. Chowne. She kept her left knee in a semiflexed position, and would not allow it to be moved. She had been in bed in the hospital for two months. She inhaled the chloroform reluctantly, and, after becoming unconscious, she breathed and sobbed in a hysterical manner. When insensible, the limb went down flat on the bed, the knee being quite movable. A straight splint was applied, and the limb was secured to it with bandages. I was informed that in a few days she contrived to get her leg bent again. She was the domestic servant of a nobleman. It was evident that there was nothing the matter with her limb, and that it was only influenced by her volition, which was perverted by the hysteria under which she was labouring.

In November, in the same year, I administered chloroform in the same hospital to another patient of Dr. Chowne, whose case was more obscure and complicated. The patient was a woman, aged thirty-three, who represented that for several months she had been unable to open her mouth, or to speak, and that she had, for the same length of time, been paralyzed in the left arm and leg. The affection, it was said, came on suddenly, in a kind of fit, which was followed by unconsciousness for three or four weeks. It was also said, that she had one or two fits the previous year, after which she was unconscious for a long time. The patient was quite conscious before inhaling the chloroform, and replied to questions by nodding or shaking the head, or by writing on a slate. She was unmarried, and had not menstruated for some months past. The chloroform was administered with a view to ascertain whether or not she was feigning. On first becoming unconscious, the patient breathed in a sobbing and hysterical manner. The chloroform was given very gradually; and as she became more affected, there were some struggling and rigidity, when the right arm and leg were moved about a good deal. The left arm and leg were also distinctly moved, but not above a tenth part as much as the extremities of the opposite side. When the patient was quite insensible, the limbs being relaxed, the pupils turned upwards, and the conjunctiva insensible, attention was turned to the jaws, which were still firmly closed, but they were opened by using a moderate degree of force with the fingers. The effect of the chloroform having been allowed in a great measure to subside, it was again administered, when the movements of the limbs recurred, and there was the same difference between the motion of the right side and that of the left, as before. When I left the patient, more than half an hour after the chloroform was discontinued, she had not opened her eyes or answered questions; and she did not do either for six days. I saw her five days after the chloroform. The pulse was very rapid on my first going to the bedside, but its frequency subsided in a few minutes. On my raising the eyelid, she turned her eye about, as if endeavouring to hide the pupil under the lid. On the following day she answered questions by nodding and writing on a slate, and was, in other respects, the same as before inhaling the chloroform.

The great difference in the amount of motion in the limbs of this patient, under the influence of chloroform, showed that the paralysis of the left side was not a mere pretence. It is, indeed, possible that the absence of motion in the limbs of the left side, for several months, would cause them to move less than the opposite ones during the action of chloroform; but it is not to be supposed that the patient would keep these limbs in one posture during the night, and when no one was present, without ever moving them, unless she herself believed that they were paralyzed. I looked on the woman as a sick person, and not a mere impostor; for although she appeared to exaggerate her symptoms, and to have a good deal of pretence and affectation, this circumstance arose, no doubt, from her complaint.

In April 1853, I administered chloroform four times to a patient of Dr. Arthur Farre, a girl of fifteen years of age, who was affected with a contraction of the flexor muscles of the left thigh and leg, of the muscles which bend the body to the left side, and those which bend and turn the head to the same side, in consequence of which the leg was drawn up, and the body and head were curved greatly to the left side. The contraction of the muscles had lasted for several weeks, but she had been ill for a much longer period, her illness having commenced with a fever. She took an extremely small quantity of nourishment, and was very thin. Her bowels were moved with difficulty. The pulse was very feeble and small, and there was a tendency to coldness of the surface. An eminent surgeon in the provinces had expressed his opinion that the distortion of the limbs and trunk was a feigned disorder; but the action of the chloroform proved that he was altogether in error. The muscles became completely relaxed when the patient was quite insensible, and the limbs and trunk and head could be readily moved into any position; but as the effects of the chloroform subsided, the deformity returned on each occasion before the patient recovered her consciousness. Neither the chloroform nor any other measures were of any service, and Dr. Farre informed me that the patient died a few weeks after I saw her.

Mania. I have been informed of several cases in which chloroform has been administered in acute mania, with the effect of calming the patient and procuring sleep. I have administered it in two cases with the same temporary advantage. In one of the cases, the patient was persuaded to inhale it; in the other, he had to be held by three keepers till he was unconscious. An eminent and well-known scientific man, who became insane some years ago, refused to take food. It was found that after being made unconscious by chloroform, he would take a meal just as he recovered from its effects, and the chloroform was given before every meal for a long time.

Spasmodic Pain. In August 1851, I administered chloroform to a woman who was labouring under a severe paroxysm of spasmodic pain in the abdomen. The pain was completely removed, without altogether causing unconsciousness. An opiate was given to prevent the pain from returning.

I have not had the opportunity of administering chloroform during the passage of calculi down the ureters, or of gall-stones; but there can be no doubt that it would be of the greatest service in such cases. If Dr. Griffin had been provided with chloroform when he attended the late Mr. Augustus Stafford with an attack of gall-stones,[^[156]] he would have been able to relieve his patient in five minutes, instead of taking two or three hours to produce relief by opium. There would have been no occasion for the venesection, which was carried to thirty ounces. And at the end of the attack, on Dr. Griffin leaving his patient for the night, if chloroform had been employed, he would have left him without any appreciable amount of the narcotic in his system. As it was, however, he left him with a quantity of opium unabsorbed from the alimentary canal. The bandage got displaced from the arm; there was an additional hæmorrhage, the opium became absorbed more quickly, and a dangerous state of narcotism was induced.