The Project Gutenberg eBook of On Chloroform and Other Anæsthetics, by John Snow

1. Messrs. Maule and Polyblank have an excellent photographic portrait of Dr. Snow in their “Scientific Portrait Gallery” series. Mr. Empson has also a bust, which has been greatly admired for its correctness and for its superiority as an artistic work.

2. Dr. Murchison, who with Dr. Budd rendered Dr. Snow all that able assistance which the best of medicine can offer, has kindly given me several particulars in regard to the fatal illness, which I embody in the text, with many thanks.

3. Dr. Murchison has also given me an outline of the post-mortem appearances, which is subjoined. “The post-mortem examination revealed slight white softening, only detectable by the microscope, in the right corpus striatum and optic thalamus, and fatty degeneration of the minute cerebral vessels. The heart was slightly fatty, but there was no valvular disease, nor atheromatous disease of aorta. The lungs were congested, and showed marked evidence of old disease at the apices. Both the kidneys were much contracted and granular, with numerous cysts, the right organ being almost entirely converted into cysts; with the uriniferous tubes either denuded, or containing granular disintegrating epithelium. There was distinct cicatrix of an old ulcer in duodenum, and the stomach was much congested, with numerous hæmorrhagic spots.”

4. See Monthly Journal of Med. Sc., vol. viii, p. 452.

5. Liber iv, cap. 76.?

7. Natural. Hist., lib. xxv, cap. 13.

8. De Herbarum Virtutibus, cap. 131.

9. Medical Botany, p. 236.

10. De Causis Morb. Diut., lib. i, cap. 6.

11. De Morbis Acutis, lib. i, cap. 4.

12. Vet. Acad. Handl., 1763, vol. xxiv, p. 229.

13. Comptes Rendus de l’Acad. de Sc., t. xxviii, 1849, p. 195.

14. See Herodotus, book iv, 73–5.

15. Lib. iv, cap. 8.

16. Med. Gaz., vol. xli, p. 515.

17. Observations sur la Physique, tome xvi (1780), p. 256.

18. Method of preventing or diminishing Pain in several Operations of Surgery. Lond. 1784.

19. Gazette des Hôpitaux, 1st April, 1854.

20. Hypnotism is the term employed by Mr. Braid of Manchester for the peculiar sleep produced by the Mesmerists.

21. Record of Cases treated in the Mesmeric Hospital. Calcutta, 1848.

22. Cary’s Herodotus, book i, 202.

23. Book iv, 73–5.

24. Liber viii, cap. 1.

25. Translated into Latin by Father Angelus, Paris, 1681, p. 21.

28. See Medicinal Use of Different Kinds of Airs, by Dr. Pearson. Birmingham, 1795.

29. Researches concerning Nitrous Oxide, p. 556.

30. See 32nd Congress, 2nd Session [Senate] Rep. Com. No. 421, p. 17.

31. Vol. iv, p. 158.

32. A Defence of Dr. Charles T. Jackson’s Claims to the Discovery of Etherization. Boston, 1848.

33. The Inhalation of the Vapour of Ether in Surgical Operations. By John Snow, M.D. 1847.

34. Pharmaceutical Journal, Feb. 1847, p. 357; and Med. Gaz., 1847, vol. xl, p. 939.

35. Quoted in Med. Gaz., 1847, vol. xl, p. 1153.

36. Lancet, Nov. 27, 1847, p. 575; and Med. Gaz., 1847, vol. xl, p. 1031.

37. Dr. Pereira in Pharmaceutical Journal, March 1846, vol. v, No. 9.

38. Silliman’s American Journal of Science and Art, vol. xxi, p. 64, Jan. 1832.

39. Ann. de Chim. et de Physique, t. xlviii, p. 131.

40. Ibid., t. xlix, p. 146.

41. Ibid., t. lvi, p. 134.

42. Formic acid is so named because it was originally obtained from the red ant (Formica rufa). It is now made from starch.

43. Turner’s Chemistry, 8th ed., p. 1009.

44. Nearly all the chloroform used in Great Britain and her colonies is made in Edinburgh, where the spirit duty is lower than in England. The London druggists have almost ceased to make it, as they find it cheaper to get it from the trade in Edinburgh.

45. The Edinburgh druggists suffered a great loss in 1850 from purifying their chloroform in this way on the recommendation of Dr. Gregory, who was not aware of the consequences, although they had been stated by Dumas (Ann. de Chim. et de Physique, t. lvi, p. 117).

46. I have seen some specimens of chloroform that left a white, limy-looking stain on the hand, which I believe was a minute quantity of crystalline chloride of carbon. These specimens were unobjectionable for all practical purposes, and had the merit of keeping remarkably well.

47. See Med. Gaz., vol. xl, p. 1092.

48. Dr. Letheby in Med. Gaz., vol. xlvi, p. 1037.

49. Lancet, Feb. 12, 1848.

50. Since the above was written, I have met with an instance in which the pulse was only 40 in the minute, as the effects of the chloroform were subsiding. There was neither sickness nor loss of blood. The case was that of a gentleman in good general health, who inhaled chloroform whilst Mr. Brodhurst endeavoured to make forcible flexion of the femur on the pelvis. He woke without any unpleasant symptoms, and the pulse resumed its natural frequency.

51. Gazette des Hôpitaux, 20 Mars, 1847.

52. Medical Gazette, vol. xli-ii.

53. According to Professor Miller, chloroform was given, at one time, in the Royal Infirmary of Edinburgh, in a somewhat slovenly, and not very cleanly manner; he describes the means of applying it as, “anything that will admit of chloroform in vapour being brought fully in contact with the mouth and nostrils; a handkerchief, a towel, a piece of lint, a worsted glove, a nightcap, a sponge.” He says, “In the winter season, the glove of a clerk, dresser, or onlooker, has been not unfrequently pressed into the service.... The object is to produce insensibility as completely and as soon as we can; and there is no saying, à priori, whether this is to be accomplished by fifty drops or five hundred. We begin with generally two or three drachms spilt on the handkerchief or lint; and we refresh that, or not, from time to time, as circumstances require.” Surgical Experience of Chloroform, Edin., 1848, pp. 16 and 17. The italics are not in the original.

54. Curious arguments are sometimes used in support of the idea of peculiarities and idiosyncrasies. A medical man informed me, one day, that he had seen a patient inhale an ounce of chloroform without any effect. I expressed my opinion that if she had taken the vapour of one drachm into her lungs within four minutes, or the vapour of a little more than half a drachm within two minutes, she would have been insensible; and that the chloroform had mostly evaporated into the room, without entering the patient’s lungs. Then, he said, it would have made all of us insensible. Now to charge the air of a moderate sized room of twenty feet square and ten feet high, uniformly with only a grain and a half of chloroform to each hundred cubic inches, so that, if all the crevices were closed, a person inside might, in course of time, absorb about eighteen minims of the medicine, and be rendered insensible, would require nearly fifteen pounds of chloroform.

55. The increase of effects of chloroform after the inhalation is discontinued, was pointed out by Prof. Sédillot of Strasbourg and myself almost simultaneously. I explained the circumstance in a paper read to the Westminster Medical Society, on January 8th, 1848, and M. Sédillot announced it to the Academy of Sciences of Paris, on January 10th. My remarks were published in the Medical Gazette of January 14th, and those of M. Sédillot in the Gazette Médicale of January 15th.

56. I have reason to conclude that the increased secretion of saliva is caused, not so much by the action of the chloroform on the mucous membrane of the mouth, and the extremities of the gland ducts, as by its action on the capillary circulation of the glands themselves; for on inhaling the vapour carefully by the nostrils, so that none enters the mouth, I still find that there is an increased secretion of saliva.

57. London Journal of Medicine, April 1852.

In one of the latest communications of Dr. Marshall Hall to the Lancet, he did me the honour to quote the account of the three following experiments, together with some accompanying remarks from the London Journal of Medicine, and to make the following observation respecting the pages from which he quoted.

“I have no hesitation in affirming that the first three pages of this paper are amongst the most able and valuable in physiology, and I beg to be allowed to reproduce them in the pages of the Lancet.” (Lancet, April 18th, 1857, p. 397.)

58. Edin. Med. and Surg. Journal, vol. lviii.

59. Lond. Med. Gaz., vol. xlii, p. 414.

60. London Journal of Medicine, April, 1852.

61. London Medical Gazette, vol. xlii, 1848, p. 109.

62. On the Inhalation of the Vapour of Ether, p. 82.

63. Medical Gazette, vol. xlii, p. 415.

64. See l’Union Médicale, 1855, No. 13.

65. London Medical Gazette, vol. xli, p. 255.

66. Opus cit., p. 253.

67. Opus cit., p. 341.

68. London Medical Gazette, vol. xli, p. 75.

69. London Medical Gazette, vol. xlii, p. 80, from Western Lancet, and Phil. Med. Exam. April 1848.

70. Vol. xliii, p. 682.

71. Gazette Médicale, 8 Juillet, 1848; and London Medical Gazette, vol. xlii, p. 211.

72. Proceedings of Academy on Feb. 6th, 1849. See London Journal of Med., 1849, p. 307.

73. London Journal of Medicine, 1849, p. 324.

74. Lond. Med. Gaz., vol. xliii, p. 694.

75. London Med. Gaz., vol. xlii, p. 84.

76. Bouisson, Traité de la Méthode Anesthésique, p. 398.

77. London Med. Gaz., vol. xliii, p. 41.

79. Ibid., p. 747, from l’Union Médicale.

80. Lancet, 1849, vol. i, p. 205.

81. L’Union Médicale, Sept. 8th, 1849; and Med. Gaz., vol. xliv, p. 478.

82. Lond. Med. Gaz., vol. xliv, p. 757.

83. Journal of Prov. Med. and Surg. Assoc., 1849, p. 698.

84. Casper’s Wochenschrift, Jan. 12, 1850; and Lond. Med. Gaz., vol. xlv, p. 483.

85. Edin. Monthly Journal, April 1850, p. 377.

86. Hygiea, October 1850, p. 602.

87. Lond. Med. Gaz., vol. xlvi, p. 39.

88. Lancet, 1850, vol. ii, p. 21.

89. L’Union Médicale, January 29, 1852.

90. Medical Times, 1851, vol. ii, p. 98.

91. Medical Times, 1851, vol. ii, p. 620.

92. Medical Times and Gazette, vol. i, p. 293.

93. Medical Times and Gazette, p. 318.

94. See a clinical lecture by Mr. Stanley, Med. Times, Nov. 22, 1851.

95. Gaz. Médicale, 1852, p. 630, from Medicinisches Correspondenz Blatt.

96. Medical Times and Gazette, 1852, vol. ii, p. 531.

97. Monthly Journal of Med., vol. xv, 1852, p. 377.

98. Lancet, 1853, vol. i, p. 21.

99. Lancet, 1853, vol. i, p. 307.

100. Med. Times and Gaz., 1853, vol. ii, p. 47.

101. Monthly Journal, Nov. 1853, p. 427.

102. Since writing the above, I have noted by the watch the time which a surgeon occupied in shaving the perinæum before the operation of lithotomy; it was twelve seconds.

103. Medical Times and Gazette, 1853, vol. ii, p. 422.

104. Medical Times and Gaz., 1853, vol. ii, p. 449.

106. Edin. Monthly Jour., vol. xix, 1854, p. 372.

107. Med. Times and Gaz., 1854, vol. i, p. 19, from Med. Zeitung von den Vercine für Heilkunde in Preussen, No. 44, Berlin, Nov. 2, 1853.

108. Association Med. Jour., 1854, p. 109.

109. L’Union Médicale, 1854, p. 171.

111. Association Medical Journal, 1854, p. 315.

112. Medical Times, 1854, vol. i, p. 572.

113. Medical Times and Gazette, 1854, vol. ii, p. 86.

114. Med. Times and Gaz., 1854, vol. ii, p. 390.

116. Med. Times and Gaz., 1854, vol. ii, p. 501.

117. Medical Times and Gazette, 1855, vol. i, p. 363.

118. Edin. Med. Jour., 1855, p. 524.

119. 1855, vol. ii, p. 479.

120. Medical Times and Gazette, 1856, vol. ii, p. 442.

121. Association Med. Jour., 1856, p. 903.

122. Medical Times and Gaz., 1856, vol. i, p. 236.

123. Lancet, 1857, vol. i, p. 429.

124. Med. Times and Gaz., 1857, vol. ii, p. 171.

125. Med. Times and Gaz., 1852, vol. i, p. 627.

126. Gaz. Médicale, 1853, p. 304.

127. Lancet, 1848, vol. ii, p. 47.

128. Bouisson, Méthode Anesthésique, p. 398.

129. Casper’s Wochenschrift, September 6, 1850; and London Med. Gaz. vol. xlvii, p. 261.

130. Medical Times and Gazette, 1854, vol. i, p. 516.

132. Chloroform: How shall we ensure Safety in its Administration? Pamphlet. London: 1855.

133. See some interesting papers on the value of recumbent position in syncope, by Dr. Richardson, in the Association Medical Journal for 1854. I entirely agree with Dr. Richardson that no kind of syncope commences at the brain, and that, during recovery, the heart always resumes its functions before consciousness is restored. The restoration of the heart’s action in ordinary syncope by the re-supply of blood to its cavities, without any alteration in the condition of the brain, was well proved by Dr. Richardson by means of some interesting experiments on animals which I had the opportunity of witnessing.

134. Oration before the Hunterian Society. Pamphlet, 1855.

135. Hydrochloric acid gas and ammonia are no exceptions to this rule, for they cease to exist as gases so soon as they come in contact with the moist lining membrane of the air-passages. Carbonic acid gas will be treated of in another part of this work.

136. See Med. Times and Gaz., 1853, vol. ii, p. 562.

137. See above, p. 75.

138. Edin. Monthly Jour., 1853, vol. xvii, p. 220.

139. Med. Times and Gaz., 1852, vol. i, p. 627.

140. L’Union Médicale, 1850, p. 411.

141. Lond. Med. Gaz., vol. xliii, p. 230.

142. Medical Times and Gaz., 1856, vol. ii, p. 413.

143. Med. Times and Gaz., 1856, vol. ii, p. 478.

144. Ib., 1857, vol. i, p. 559.

146. Practical Surgery, 3rd ed., p. 682.

147. I never allow of a cork or any such substance being put into a patient’s mouth when insensible unless it is well tied to a string, lest it should be swallowed.

148. Fourth edit., vol. ii, p. 467.

149. It was made by Mr. Matthews, Portugal Street. It was not contrived by me.

150. London Journal of Medicine, vol. i, pp. 54, 976.

151. See Medical Times and Gaz., 1855, vol. i, p. 361.

152. Dr. Watson defends the original name of this complaint, delirium tremens. He says:—“But they who object to delirium tremens appear to see no harm in delirium ferox: whereas it is just as incorrect to say delirium is fierce, as to say that it trembles: it is the patient who is furious, even as it is the patient who trembles.” Now, in speaking of a patient, we may speak either of his mind or his body: we may say that a person is learned, or that he is fat. A patient may be fierce on account of the kind of delirium with which his mind is affected, and the term ferox applies both to him and the complaint; but the act of trembling affects only his body.