33 CHLOROFORM. Here Lethargy, with deadly sleep oppressed, And taught withouten pain and strife to yield the breath. THE desire to drown pain has existed from the time that suffering became the inheritance of fallen man; and the discovery of means by which it can be averted has justly been regarded as one of the greatest triumphs of modern science, for in it are alike interested high and low, rich and poor; and it is this general interest which leads us to draw aside, in some degree, the veil from the chamber of suffering for the comfort of some, perhaps, and the information of many who are desirous of knowing in what way people are affected by Chloroform. The most usual effect is to produce a profound sleep; so profound that volition and sensation are alike suspended, and this is often attended with a symptom very alarming to relatives or bystanders unprepared for it; we allude to a loud snoring or stertorous breathing which conveys the idea of much suffering to those who are not aware that in itself it is direct evidence of the deepest unconsciousness. It is not however invariably produced: we have seen a fine child brought in-laid down with its hands gently folded across its body-have chloroform administered-undergo a severe operation, and be carried to bed without once changing its attitude, or its countenance altering from the expression of the calm sweet sleep of infancy. Sometimes, however, strange scenes are enacted under anæsthetics, one of which we will describe. The uninitiated have a vague idea that the operating theatre of hospitals is a very dreadful place; certainly, patients having once given their consent to enter it may, so far as escape goes, say in the words of Dante, 'Lasciate ogni speranza voi ch' entrate,' but every consideration is shown to soften down as much as possible the terrors inseparable from a chamber of torture. Imagine then a lofty semicircular apartment, lighted from above, with a large space railed off on the ground, and railed steps in tiers, sweeping half round, and affording standing room for more than a hundred spectators, principally students, who, conversing in low tones, are awaiting the expected operation. In the centre of the open space is a strong couch, or table, now covered with a clean. sheet, and beneath its foot is a wooden tray, thickly strewn with yellow sand. On another table, also covered with a white cloth, are arranged, in perfect order, numerous keen and formidable look VOL. XXXIV. D ing instruments, the edge of one of which, a long, sword-like, double-edged knife-a gentleman with his cuffs turned up, is trying, by shaving off little bits of cuticle from the palm of his hand, and two or three assistants are quietly threading needles, and making other preparations. The gentleman with the knife being satisfied as to its condition, gives a glance round, and seeing everything in perfect readiness, nods, and a dresser leaves the room. After a minute or two, a shuffling of feet is heard, the folding doors are thrown open, and a strong, surly-looking, bull-headed" navvy," whose leg has been smashed by a railway accident, is borne in and gently placed on the table. His face is damp and pale, he casts an anxiouseager look around, then with a shudder closes his eyes, and lies down on his back. The chloroform apparatus is now applied to his mouth, and a dead silence marks the general expectancy. The man's face flushes-he struggles, and some muffled exclamations are heard. In a minute or two more the gentleman who has charge of the chloroform examines his eyes, touches the eyeball--the lids wink not, the operator steps forward, and in a trice the limb is transfixed with the long bistoury. Some intelligence now animates the patient's face, which bears a look of drunken jollity. "Ha! ha! ha! Capital!" he shouts, evidently in imagination with his boon companions, "a jolly good song, and jolly well sung! I always know'd Jem was a good un to chaunt! I sing! dash my wig if I ain't as husky as a brokenwinded 'os. Well, if I must, I must, so here goes." By this time the bone has been bared, and the operator saws, whilst the patient shouts "'Tis my delight o' a moonlight night-' whose that a treading on my toe? None o'your tricks, Jem! Hold your jaw, will you? Who can sing when you are making such a blessed row? Toll-de-rol-loll. Come, gi'e us a drop, will ye? What! drunk it all? Ye greedy beggars! I'll fight the best man among ye for half a farden!" and straightway he endeavours to hit out, narrowly missing the spectacles of a gentleman in a white cravat, who steps hastily back, and exclaims, "hold him fast!" The leg being now separated is placed under the table, and the arteries are tied, with some little difficulty, on account of the unsteadiness of the patient, who, besides his pugnacity in general, has a quarrel with an imaginary bull-dog, which he finds it necessary to kick out of the room. He, however, recovers his good humour whilst the dressings are being applied, and is borne out of the theatre shouting, singing, and anathematising in a most stentorian voice; when in bed, however, he falls asleep, and in twenty minutes awakes very subdued, in utter ignorance that any operation has been performed, and with only a dim recollection of being taken into the theatre, breathing something, and feeling "werry queer," as he expresses it. Now this scene is a faithful description of an incident witnessed by the writer at one of our county hospitals to which he is attached, and those who have seen much of the administration of ether and chloroform will remember many resembling it. The man was a hard drinker, and a dose of chloroform which would have placed most persons in deep sleep, deprived him of sensation, but went no further than exciting the phantasms of a drunken dream. A writer in the North British Review says that "experience has fully shown that the brain may be acted on so as to annihilate for the time what may be termed the faculty of feeling pain; the organ of general sense may be lulled into profound sleep, while the organ of special sense and the organ of intellectual function remain wide-awake, active, and busily employed. The patient may feel no pain under very cruel cutting, and yet he may see, hear, taste, and smell, as well as ever, to all appearance; and he may also be perfectly conscious of everything within reach of his observation -able to reason on such events most lucidly, and able to retain both the events and the reasoning in his memory afterwards. We have seen a patient following the operator with her eyes most intelligently and watchfully as he shifted his place near her, lifted his knife, and proceeded to use it-wincing not at all during its use; answering questions by gesture very readily and plainly, and after the operation was over, narrating every event as it occurred, declaring that she knew and saw all; stating that she knew and felt that she was being cut, and yet that she felt no pain whatever. Patients have said quietly, 'You are sawing now,' during the use of the saw in amputation; and afterwards they have declared most solemnly that though quite conscious of that part of the operation they felt no pain." We may here remark, that a very common, but erroneous supposition is, that sawing through the marrow is the most painful part of an amputation; this has arisen from confounding the fatty matter of the true marrow with the spinal corda totally different thing-the sensation of sawing the bone is like that of filing the teeth, and is not to be compared with the first incision, which is very much as if a red-hot iron swept round the limb. When ether was used, such scenes as that described, occurred; but, with rare exceptions, chloroform effectually wipes out the tablets of the brain, and prevents any recollection of the incidents that occur during its influence; we have often heard a person talk coherently enough when partially under its influence, yet afterwards no effort of memory could recall the conversation to his mind. An able London physician, Dr. Snow, has paid great attention to the administration of chloroform, and has satisfied himself by actual observation, that when there are obscure indications of pain during an operation, there is no suffering, properly so to speak, for sensation returns gradually in those cases where complete consciousness is regained before the common sensibility. Under these circumstances the patient when first beginning to feel, describes as something pricking or pinching, proceedings that without anæsthetics would cause intense pain, and does not feel at all that which would at another time excite considerable suffering. The disposition to sing is by no means uncommon during the stage of excitement; we well remember the painful astonishment of a grave elderly abstinent divine, who, on being told after an operation that he had sang, exclaimed, "Good gracious, is it possible! Why, my dear Sir, I never sang a song in my life, and is it possible I could have so committed myself-but what could I have sung?" A little badinage took place, it being insinuated that the song was of a rather Tom-Moorish character, till his horror became so great that it was necessary to relieve his mind by telling him that" Hallelujah" was the burden of his chaunt. The general condition of the patient as regards robustness or the contrary, has been found by Dr. Snow to exercise a considerable influence on the way in which chloroform acts; usually the more feeble the patient is, the more quietly does he become insensible; whilst if he is strong and robust there is very likely to be mental excitement, rigidity of the muscles and perhaps struggling. Dr. Snow has frequently exhibited chloroform in extreme old age with the best effects, and does not consider it a source of danger when proper care is taken; old persons are generally rather longer than others in recovering their consciousness, probably because, owing to their circulation and respiration being less active, the vapour requires a longer time to escape by the lungs, and it may be remarked, that chloroform passes off unchanged from the blood, in the expired air. The usual and expected effect of chloroform is to deprive the individual of consciousness; but it occasionally fails to do this and gives rise to a very remarkable trance-like condition. We were once present when chloroform was administered to a lady about to undergo a painful operation on the mouth; the usual phenomena took place, and in due time the gentleman who administered the vapour announced that she was perfectly insensible; the operation was performed, and during its progress the bystanders conversed unreservedly on its difficulties and the prospects of success. When the patient came to,' she, to our utter astonishment, asserted that she had been perfectly conscious the whole time, though unable to make the least sign or movement, had felt pain, and had heard every word spoken, which was proved by her repeating the conversation; she stated that the time seemed a perfect age, and that though hearing and feeling what was going on she lived her life over again, events even of early childhood long forgotten, rising up like a picture before her. It is said, and truly, that in the few seconds between sleeping and waking, some of the longest dreams take place, and that a drowning man has just before the extinction of consciousness reviewed as in a mirror, every action of his life. So in the case of this lady, years appeared to move slowly on and to be succeeded by other years with all their events, each attended with corresponding emotions, during the few minutes she was fairly under the chloroformic influence: yet with all this the prominent feeling was an intense struggling to make us aware that she was not insensible; of which condition there was every outward indication. Our readers must all be familiar, from observation or description, with the mimosa pudica or sensitive plant; now it is a curious fact that the influence of chloroform is not confined to the animal kingdom, but extends to the vegetable world, for Professor Marcet of Geneva has ascertained that it possesses the power of arresting for a time, if not of altogether destroying, the irritability of the sensitive plant. Thus we find from time to time striking illustrations of the identity which exists in the irritability of plants and the nervous systems of animals. Among the ancients the mandrake, or mandragora, held a high reputation for utility in drowning pain. Pliny tells us that "in the digging up of the root of mandrage there are some ceremonies observed; first, they that goe about this worke looke especially to this, that the wind be not in their face but blow upon their backs; then with the point of a sword they draw three circles round about the plant, which don, they dig it up afterwards with their face into the west. ** It may be used safely enough for to procure sleep if there be a good regard had in the dose, that it be answerable in proportion to the strength and complexion of the patient; it is an ordinary thing to drink it against the poison of serpents; likewise before the cutting or cauterizing, pricking or launcing, of any member, to take away the sense and feeling of such extreme cures: and sufficient it is in some bodies to cast them into a sleep with the smel of mandrage, against the time of such chirurgery."* The discovery of chloroform, as an anæsthetic agent, was made by Dr. Simpson of Edinburgh, and was attended with some very amusing circumstances, as narrated by Professor Miller. Dr. Simpson had long felt convinced that there existed some anæsthetic agent superior to ether, which was then all the rage, and in October 1847 got up pleasant little parties quite in a sociable way, to try the effects of other respirable gases on himself and friends. The ordinary way of experimenting was as follows. Each guest was supplied with about a teaspoonful of the fluid to be experimented on, in a tumbler or finger-glass, which was placed in hot water if the substance did not happen to be very volatile. Holding the mouth and nostrils over the open vessel inhalation was proceeded with slowly and deliberately, all inhaling at the same time, and each noting the effects as they arose. Late on the evening of the 4th November 1847, Dr. Simpson, with his two friends Drs. Keith and Duncan, sat down to quaff the flowing vapour in the dining room of the learned host. Having inhaled several substances without much effect, it occurred to Dr. Simpson to try a ponderous material which he had formerly set aside on a lumber table as utterly unpromising. It happened to be a small bottle of chloroform, and with each tumbler newly charged, the inhalers solemnly pursued their vocation. Immediately an unwonted hilarity seized the party-their eyes sparkled-they became excessively jolly and very loquacious. The conversation flowed so briskly, that some ladies and a naval officer who were present were * Philemon Holland's Translation of Pliny. Part II. p. 235. |