A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

    200/554 (page 188)
    1RR LOCAL THERAPEUTICS. Chloroform in bulk is rubefacient and parasiticide. In the form of vapor It ,s anaesthetic, sedative, and antispasmodic ^ Chloroform was introduced into practice as an anaesthetic by the late James Y. Simpson in 1847, and from that date to the present time it has held a foremost place with English and Continental surgeons. Notwith standing adverse criticisms, chloroform holds its own against many claim^ ants for favor. In most cases its administration is agreeable to the patient and rapid m action ; complete insensibility is obtained with little larvn geal or bronchial irritation, and almost entire absence of nausea • it is economical both in the amount required to be used in each administra- tion as well as in the first cost, while its concentrated character makes it invaluable for field operations. But these advantages are overbalanced by the danger which attends its use, so that its employment under ordi- nary circumstances is unjustifiable. It causes death without warning and so suddenly that no forethought or skill can guard against the result It IS fatal alike to the robust and the weak, to the well and the diseased Previous harmless inhalations are no guaranty against its treacherous action. When death from chloroform-inhalation takes place, it is from one of two causes : First, from a gradual paralysis of the respiratory muscles induced by the action of the drug on their controlling centres ; second, from cardiac syncope, the heart at one moment beating well, and at the next moment ceasing to beat forever. This cardiac syncope constitutes the great danger of chloroform, since, when the respiratory centres are affected, we can watch the state of the breathing, and following out certain rules, danger can be averted; but when death takes place from cardiac syncope, there is no warning. Chloroform narcosis is usually divided into three stages. The first of these IS similar to alcoholic intoxication ; it usually is very short, but in persons of intemperate habit it may be violent and prolonged, and to entirely overcome this may be fraught with danger. In this stage, although consciousness be not lost, sensation is blunted. It is soon followed by the second stage, which is that of complete anaesthesia. Consciousness and the sensibility are abolished, the muscles are relaxed, and the patient lies quiet. This is the stage in which operations are performed. The third stage is one of profound narcosis, with stertorous breathing, muscu- lar relaxation, and abolition of all reflexes. This condition is accom- panied with great danger, and the anesthetic should never be pushed so far, except under peculiar circumstances. The pulse in chloroform narcosis is not always a reliable guide. At first it is apparently strengthened or quickened ; in the second stage it is about normal in frequency, but weakened; in the third stage it may be rapid and weak. Chloroform is best administered on an empty stomach, or three or four