"No sickness, vomiting, headache, salivation, uneasiness of chest, in any of the cases. Once or twice a tickling cough took place in the first breathings."

I have, up to this date, exhibited the chloroform to about fifty individuals. In not a single instance has the slightest bad result of any kind whatever occurred from its employment.

EDINBURGH, 15th November, 1847.

CHAPTER II.

ANESTHETIC AND OTHER THERAPEUTIC PROPERTIES OF

CHLOROFORM.'

Ar the first winter meeting of the Edinburgh Medico-Chirurgical Society, 10th November, I directed the attention of the members to a new respirable anæsthetic agent which I had discovered a short time previously, viz., Chloroform, Chloroformyle, or Perchloride of Formyle. In this limited notice, I shall state briefly some of the principal facts pertaining to its history, composition, effects, &c.

Chemical History and Composition.-Chloroform was discovered at nearly the same time by Soubeiran (1831), and Liebig (1832). Its chemical composition was first ascertained by Dumas and Peligot (1835). It consists of 2 atoms of carbon, 1 of hydrogen, and 3 of chlorine; or, to express it otherwise, of 1 atom of formyle, and 3 of chlorine. Hence its chemical formula is C,HCl,; or FoCl ̧.

Modes of Preparation.-It may be obtained by various processes. 1. By the distillation of a mixture of diluted spirit, pyroxylic or wood spirit, or acetone, and chloride of lime (bleaching powder); or 2. By making milk of lime, or an aqueous solution of caustic alkali, act upon chloral; 3. By leading a stream of chlorine gas into a solution of caustic potass in spirit of wine, &c.

Physical and Chemical Properties.—It is a clear, limpid liquid, as heavy as 1-480; not inflammable; very volatile; and boils at 141°. It has a fragrant, fruit-like odor; and a sweet saccharine taste.

Therapeutic History.-It has been used internally. Guillot employed it in asthma, diluted with water one hundred times (1844). My friend, Dr. Formby, of Liverpool, told me, about two years ago, that he used it often in a diluted form as a diffusible stimulant; and I have, since that period, frequently prescribed it instead of valerian, camphor, &c. But I am not aware that any person has used chloro1 From Edinburgh Monthly Journal of Medical Science, December, 1847, p. 415. 2 Since first publishing on the subject of chloroform, Dr. Glover, of Newcastle, has pointed out to me, that, in an essay on Bromine, in the 152d number of the Edinburgh Medical and

form by inhalation, or discovered its remarkable anæsthetic properties, till the date of my own experiments.

Advantages as an Anaesthetic Agent.-In producing insensibility to pain in surgical and obstetric practice, chloroform possesses various important advantages over sulphuric ether. 1. A greatly less quantity of chloroform is required; 2. Its action is much more rapid, more perfect, and generally more persistent; 3. Its exciting or exhilarating stage is far shorter, insensibility commonly supervening in a minute or two, or less; hence, 4. The time of the surgeon is saved; 5. The inhalation and influence of it are more agreeable and pleasant; 6. Its odor is evanescent; 7. No special instrument is required for its employment.

Dose and Mode of Exhibition. A fluid drachm or two of the liquid, diffused upon the interior of a pocket-handkerchief, arranged in a concave or cuplike form in the hand of the exhibitor, and applied over the nose and mouth of the patient, generally suffices to produce rapid and complete anesthesia. A few patients may require more, others less. The edges of the cup or cone are not to be wetted, or the patient's face will be irritated. To keep up its action, when that is necessary, the handkerchief must be again besprinkled with the fluid when the first quantity is evaporated. The moistened handkerchief should be at first held at the distance of about half an inch from the face, and gradually approached nearer. The patient should, if possible, be placed easily and upon his back, and advised previously to take full inspirations. All noises and excitement around the patient should be strictly and peremptorily forbidden.'

Physiological Effects.-After the first two or three full inspirations, a feeling of warmth and excitation, radiating from the chest to the extremities; followed by whirring noises in the ears; a sensation of vibratory thrilling and benumbing throughout the body; with, betimes, rapid loss of sensation and of motion, and, at last, of consciousness. Often before total unconsciousness supervenes, the patient, guided by instinct rather than by volition and reason, makes an effort to get rid of the inhaling vapor and handkerchief, as if it interfered with free respiration. This temporary effort must be resisted by the exhibitor. During the full anæsthetic sleep proSurgical Journal, he mentions having poisoned several animals with chloroform, by injecting it into their blood vessels, stomach, and the cavity of the peritoneum, and has investigated its physiological mode of action.

1 Nothing can be more absurd than the way in which some dentists proceed. The muscles of the jaws often close under the use of chloroform and ether; and they try to open the mouth partly by persuasion, partly by force-irritating and rousing the patient. A cork or gag placed between the teeth, before the inhalation is commenced, saves all this, and expedites and facilitates the whole process.

VOL. II.

42

duced by chloroform, sometimes no mental action goes on, or at least is remembered; in many others, the mind is active as in dreams. The respiration is usually at first soporose; the pupil sometimes natural, in others slightly contracted, in others dilated. The pulse is usually quickened ten or twenty beats at first, but afterwards falls to its normal rate, and if the vapor is exhibited very long in very powerful doses, it comes down more and more below the natural standard; muscles of voluntary motion in general relaxed; more rarely cataleptic; still more rarely clonically contracted, as happens also occasionally with ether.

In small doses, given slowly, its effects are exhilarating, and exactly like those generally following the inhalation of nitrous oxide gas. Of course, when exhibited in this way, the patient is in a state of excitement quite unfit for a surgical operation. When given for surgical operations, it should be exhibited rapidly in large doses, and the patient sent over into a deep soporose or stertorous sleep before the incisions are begun.1

Uses in Surgery-1. To relax the muscles in reducing dislocations, &c.; 2. To avert the sufferings attendant on deep probing, and other painful but necessary modes of diagnostic examination and dressing; and 3. and principally, To annul the pain of operations by the caustic, ligature, or knife.

Examples.-I. A child of ten weeks old had a very large nævus behind the ear. Dr. Duncan destroyed its internal organization by passing large red hot needles in different directions through it. While the tumor was hissing and decomposing under their action, the infant lay quietly and placidly asleep on my knee, under the influence of chloroform. This is the youngest subject to whom I have given it. II. A boy of four or five had a necrosed radius cut down upon and removed by Mr. Miller. He slept soundly during the operation; and, without moving, he was carried out of the operation theatre of the hospital-still fast asleep. When visited some time afterwards, he was found awake in bed, with a bright merry eye, as if just out of a refreshing sleep. No pain even then. III. A nervous woman, a patient of Mr. Miller's, was to undergo partial amputation of the foot in the hospital-afraid both of the operation, and of being carried in before a crowd of medical men for the purpose. I apathized her with chloroform in the consulting room of the hospital, and had her carried into the operation room in that state, and did not allow her to awake till the amputation was performed, and she was removed back again to bed. She was

I believe all the reputed failures and misadventures are attributable to two causes, viz, 1. Using an impure and imperfect variety of chloroform; and, 2. Not giving it in sufficiently large and rapid doses.

thus entirely spared both the moral shock and physical pain which she dreaded. IV. A boy had his elbow-joint excised by Mr. Syme. The operation, which is always a very painful one, was prolonged in consequence of the very diseased state of the parts operated on. He slept soundly, and remained perfectly and passively still during the whole operation, &c. &c.

Uses in Midwifery.—To diminish and annul the physical pains attendant on labor, and more especially those which accompany the passage of the child's head through the pelvic cavity and outlet— (the second stage of Denman).

Examples.-I. The lady to whom it was first exhibited had been previously delivered in the country by craniotomy, after a very long labor. Her second confinement took place a fortnight before the full time. Chloroform was begun to be inhaled when the os uteri was becoming well expanded, and the pains very severe. In twentyfive minutes the child was born. The mother did not awake till after the placenta was removed; and was perfectly unaware that her child was born and alive. She stated her sensations to be those of awaking from "a very comfortable sleep." II. I exhibited it, with Mr. Carmichael, to a patient who had, at her preceding confinement, been in severe labor for twenty hours-followed by flooding. She began the inhalation when the dilatation of the os uteri was half completed. The child was born in fifty minutes afterwards. She was kept under its influence for a quarter of an hour longer, till the placenta was removed, and the binder, body, and bed-clothes all adjusted. On awaking, she declared she had been sleeping refreshingly; and was quite unconscious that the child was born. No flooding. An hour afterwards, she declared she felt perfectly unfatigued, and not as if she had borne a child at all. III. Patient unmarried. A first labor. Twins. The first child presented by the pelvis; the second with the hand and head. The chloroform was exhibited when the os uteri was fully dilated. The passages speedily became greatly relaxed (as has happened in other cases placed under its influence), and in a few pains first child was born, assisted by some traction. I broke the membranes of the second, pushed up the hand, and secured the more complete presentation of the head. Three pains expelled the child. The mother was then bound up; her clothes were changed; and she was lifted into another bed. During all this time she slept on soundly, and for a full hour afterwards; the chloroform acting in this, as in other cases of its prolonged employment, as a soporific. The patient recollected nothing from the time of the first inhalations, and was greatly distressed when not one, but two living children were brought by the nurse to her. Dr. Christison saw this case with

me. I have used it in several operative deliveries with similar

success.

In labor it does not require to be given in such large doses as in surgery. After the first full dose, a few inhalations before each returning uterine contraction is generally sufficient. It should be made more deep as the head is passing the perineum and vulva. If the state is extremely and unnecessarily deep, it will no doubt diminish and even temporarily stop uterine contractions; and I have taken advantage of this, in one case, to facilitate the operation of turning, &c. Besides thus:-1. Diminishing or annulling the more severe part of the sufferings attendant on natural labor, it will, 2. Abolish those more agonizing pains which accompany the use of the forceps, and other modes of operative delivery; 3. Enable us to extract the placenta artificially when required, without resistance or suffering; 4. Give us the power of making an accurate and full examination of the presentation, when necessary early in labor, as in placenta prævia, preternatural presentations, &c.

Uses in Medicine.-1. As an antispasmodic; as in asthma, laryn gismus, tetanus, and other spasmodic diseases, &c.,' I have used successfully the inhalation of ether to arrest the paroxysms of hoopingcough, dysmenorrhoea, colic, and the pains attendant on the passage of biliary calculi. In a case of the most severe, at the same time painful, spasmodic twisting and convulsions of the extremities attending a second attack of chorea, I allowed the patient ether inhalation; and sometimes she lay under its influence for hours, with

1 In various trials at Morningside, at which Dr. Christison, Dr. Skae, and Dr. Wingett were present, Dr. S. had sent violent patients over into a soporose sleep in a minute or less. As to what its therapeutic effects, if any, might be in insanity, we had, he believed, no power yet of judging. It could not be expected to be of any marked service at least in any short time-in such chronic cases, as it had been tried. But it had this effect: the patients could be kept asleep under, it for a long series of hours. In this way, it had already apparently cured some cases of delirium tremens, and, he believed, also of puerperal insanity, and might yet be found useful in other forms of acute mania. At all events, it was a means of restraining a furious maniac; as powerful as, and, perhaps, it would be found far more safe than a strait-jacket or the grasp of a number of keepers. Once set a patient over (and that was the work of a minute), and a nurse with a pocket-handkerchief and some chloroform might keep him under perfect and complete restraint. Nor need he add how useful the same means might be in enabling a riotous and resisting patient to be removed to an asylum, or from one place to another. It would be tedious to discuss all the other diseases in which it had already been tried. Dr. S. was most anxious to observe its effects in acute local inflammations, but he had, as yet, had few opportunities of doing so. He mentioned a case he had seen with Dr. Dease (apparently an extra-uterine conception bursting into the abdomen), where the accompanying severe abdominal pain, and its dreadfully depressing effects, were kept at bay by the anaesthetic and contra-stimulant effects of the chioroform. He mentioned a case of extremely severe cholera, where, after all things had failed and the patient was apparently sinking, the inhalation of chloroform had induced sleepdispelled the spasms and vomiting-and restored the patient.-(From the Discussion at the Medico-Chirurgical Society of Edinburgh, December 15, 1847. See Monthly Journal of Medical Science for January, 1848.)