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.
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.
“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.
_Frequent and long continued Use of Chloroform._ Many patients have
inhaled this agent hundreds of times, and it continued to produce
insensibility as readily as at first. The dose does not require to be
increased on account of its long use. I was informed of the case of a
lady who was affected with a painful cancer, and was attended by the
late Mr. Keate and Mr. Henry Charles Johnson. She inhaled chloroform at
frequent intervals, by day and night, for a very long time, consuming
three or four ounces in the twenty-four hours.
In November 1851, a surgeon in the north of England wrote to me
respecting one of his patients, a lady, who had inhaled a great deal of
chloroform, on account of neuralgia of the uterus. He said that, during
that year, and principally within the last six months, she had inhaled
at least two hundred ounces; that she often inhaled as much as three
ounces in a day; and that it seemed to have produced very little effect
on her general health, except that she seemed to be more susceptible of
pain. He said that he had reluctantly yielded to the entreaties of his
patient to administer it so often, and he wished for my opinion
respecting the propriety of continuing its use, and what effect it would
be likely to produce.
I advised that the chloroform should be continued as long as the
severity of the pain rendered it necessary; and expressed my opinion,
that it would produce as little ultimate effect as any other narcotic
which might be used to relieve the pain. I saw the surgeon in September
of the following year. He informed me that the chloroform was continued
for some time after he had written to me; but that his patient had
recovered from her complaint, and had left off the chloroform, and was
in good health.
Mr. Garner, of Stoke-upon-Trent, has related the case of a lady,
affected with neuralgia, who inhaled sixty-two ounces of chloroform from
her handkerchief, in twelve days.[157]
SULPHURIC ETHER, OR ETHER.
_History and Composition._ “This liquid is first described by Valerius
Cordus, in 1540, under the name of _oleum vitrioli dulce_. The term
_ether_ was applied to it a hundred and ninety years afterwards by
Frobenius, who, in a paper in the _Philosophical Transactions_,
described its singular properties; at the end of this paper is a note by
Godfrey Hankwitz, Mr. Boyle’s operator, mentioning the experiments that
had been made upon it by Boyle and by Newton.”[158]
The present chemical name of ether, or sulphuric ether, is oxide of
ethyle. It consists of four atoms carbon, five atoms hydrogen, and one
atom oxygen. Its atomic number is consequently 37.
The usual way of making ether, is to distil common alcohol (the hydrated
oxide of ethyle) with sulphuric acid.
_Chemical and physical Properties._ Ether is a clear, colourless liquid,
of the specific gravity of 0·715 at 68°. It boils at 96° Fahr.; and the
specific gravity of its vapour is 2·565. It is soluble, in all
proportions, in alcohol, and it is soluble in nine parts, by measure, of
water. Water is also soluble in nine parts, by measure, of ether, so
that after ether has been agitated with water, it retains one-tenth of
its volume of that fluid. Ether is very inflammable, and, as it yields
its vapour very freely, great care is required in pouring it out by
artificial light. Its vapour is also very explosive when mixed, in
certain proportions, with atmospheric air.
The ordinary ether of the shops contains a portion of alcohol which has
distilled over with it; the alcohol should be removed by agitating the
ether with twice its volume of water, before it is used for inhalation.
The ether which has been treated in this way is called washed ether. The
water which it takes up during the washing can be removed by distilling
it from lime, or dry carbonate of potassa; but this is unnecessary, as
the water does not interfere with the action of the ether when inhaled;
and part of the water evaporates and is inhaled with the ether, when the
atmospheric air is not already saturated with moisture.
Ether has a peculiar and very strong odour; in this respect it differs
extremely from chloroform. The odour of a single drop of ether can be
distinctly perceived all over a large operating theatre, whilst a pint
of chloroform may be spilt without its odour being much noticed. The
strong odour of ether is, indeed, one of the greatest objections to its
use, since another agent has been discovered which is free from this
objection. As was previously stated, the odour of chloroform cannot be
perceived in the breath, after the lungs are emptied by one or two
expirations of the vapour just taken in; whilst the smell of ether can
be perceived in the breath for twenty-four, and sometimes for
forty-eight, hours after the patient has inhaled it. The surgeon, and
others who have been about the patient, also smell of the ether to a
less degree. When a rabbit has been killed by the inhalation of ether, a
starving cat will not eat its flesh even after it has been boiled;
whereas the odour of chloroform cannot be perceived in the bodies of
animals that have been killed by it.
If ether is exposed to atmospheric air by being kept a long time in a
bottle but partly filled, it is apt to be decomposed into acetic acid
and water.
The following Table shows the result of experiments which I made to
ascertain the quantity of vapour of ether that 100 cubic inches of air
will take up, when saturated with it, at various temperatures, the
barometric pressure being 30 inches of mercury. The ether I employed in
the experiments was washed, but not dried. It was, therefore, saturated
with water, of which it contained one-tenth of its volume. It had a
specific gravity of 0·735 at 60° Fahr., and it boiled at 98°.
Temp. Fah. Cubic inches of vapour. Minims of ether.
50° 52 64
51 54 66
52 56 69
53 59 72
54 62 76
55 65 80
56 68 84
57 72 88
58 76 93
59 80 98
60 84 102
61 88 107
62 92 112
63 97 117
64 102 122
65 107 128
66 112 134
67 117 140
68 123 147
69 130 156
70 138 165
In the above Table the air is a constant quantity of 100 cubic inches,
which becomes expanded to 152, and so on; but the following Table shows
the quantity of vapour in 100 cubic inches of the saturated mixture of
vapour and air at different temperatures:—
Temp. Fah. Air. Vapour.
40° 73 27
42 72 28
44 70 30
46 69 31
48 67 33
50 66 34
52 64 36
54 62 38
56 60 40
58 57 43
60 54 46
62 52 48
64 49 51
66 47 53
68 45 55
70 42 58
72 40 60
74 37 63
76 34 66
78 32 68
80 29 71