N CIHM Microfiche Series (IMonograplis) ICMH Collection de microfiches (monographies) ~\ V i; Canadian Inatltuta for Historical IMicroraproductions / Inatitut Canadian da microraproductions historiquas c > Ttchnical and Bibliographic Notes / Not«f ttchniquas at btbtiogfaphiqiM* The Inttituta hat anamptad to obtain tha bast original copy available for filming. Faaturat of tttii copy which may ba bibliographically uniqiM. which may altar any of y / ./ V ; \ "Sj^" ' 1 .' 'v CHLOROFORM, AND ▲ U*< \ '^^*\jj?< NE^WT METHOD 01 ADMINISTERING IT. BV A. M. ROSEBRUofe, M.D., m TO in* 7OROIITO CHARITABU! «T1B DISrarSABY. llAad before the Medical Section of ih^ Canadiui Iiutitatf, Toronto, November 38th, 186^ anA publUhed by request ' '^ TORON' fss DAiLt nutaBAm nuorriMa aoiwlL ait^ oosi cnro 1809. 5&f ^3JW?raWE fcAiMMhihtt. ■>::■>/' ^^^^^ -'^ ih'^e \ 'hJ ^ I ■*5 * .'Jf \ \-.„. Il<« '■ ■■ V-"^""" *'s»i •■: 1 ¥ • .«• "I * ■■ ' - ■ . ■■••;■ •,f •; ■ . " - "^ '■'.■" .».. . . '. '-r ^> K 1 *^': f " ♦ J ^ 1 »■ .' 1 •^rTT^FS'ri"" M*MMMM«N|pMWI-« m'/-'-^ y.' CHLOROFORM, 'K. ' iMPURITfEt) OF ClILOKOFOIlM*. — ruTO ollloro form iH neutral to t«8t-|)a|K'r ; its HfjcKjifec gravity is 1.49 to 1.5, and it boils ut 1.40 F. If drop, pod into distilled water it colleciK ut tlto bottom ■in transparent globules. When it is mixed with an equal volume of oflicinal sulphuric acid in a glass-stoppered bottle, no heat in dvolvcd ; aitd^ after standing for twenty four houra, only a ftiint yellow colour is imparted to . the acid./ On evaporating three or four drachms of pure chlo- roform from a porcelain pluto, no pungency or empyreuma is observed, but a slightly aromatio odour; and the plate is covered with a film of moisture without odour or taste. The most common impurities and adultorationB of chlorGform are: alcohol; etlier; chlorinated pyrogenouB oils ; liydrochloric and hypochlorouB acids ; chloriiie,^ and Dutch liquid. *I am indebted for the clien»ical tc'sts in this section, to my assQclute L)r. K. A. liiune, late rrorctssjor of Che- mistry, Kingston. ' •^;.- :•>{% 1H^ ^ A L^'jfc'.^ &,- '?&.' ^^oohol and ether letfuce the apeeifio gam^ ^ <^lorofom below the non^al standard ; ««d the impure Ueetiiied .pirii., i, th, p„pj^ iwn o f cMorofoHn. '^ " ^^ — ; .;;-_'>\-,*--7!|?^y7r^l?^,Vi;vn^;^ 'M^a^^iii*** :• .;; ■ ^ Hjpochlomi tuoid and chlorine are recognized 1^ their odour and bleaching power. - Hydrochloric acid is detected by ita acid reao- tion, and, after its extraction with water, by the ordinary tests. The presence of Dutch liquid is revealed by the additl^ of an alcoholic solution of potassa ; Tolatile .chloride of acetyl is' evolved, of a dis- agreeable odpur. AcTioir OF Chlobofobm.— TariouB thepriet have been advanced to explain the physiological iKJtion of chloroform. A ccording to the tlitory Jbat was first advanced on^this subje^ chloro- forin exerted a primary action ujpontiie brain and central nervous system. It was believed that the chloroform was absorbed into the blood imchaiiged, and that the general insensibility was the result of its contact with the nervous •yitem foj^ which it seemed' to have an affinity cf election. In support of this theory, it was •hown that after death, fn>m etheilpr chloroform, It 8uJ>erabundant portion of the abse^etic is found in the brain and spinal cord. (Lfdlemand, Pwrin, Duroy, Dr. Austii) The following results of experiments on an- imab are opposed to this theory : .Utfjl %£-, -'^ 1 i ^l- J ' ^^;.- / 1. The brain inay be exposed and chlorofonn applied either to its external surface or tp its substance when divided, without pro- ducing/symptoms of narcotisnu • • . ' ■' \' lit 2. Chloroform may bo injected into the cait>ti4 arteries without bringing the animal under its influence. ,:^ • ^V ' ^3. An animal may be placed under the influenoe . of chlorofcrm, in the ordinary way, and portions of the brain removed^ and th© animal will awaken in; 4ue time as if nothing linusual had occurred. v \ li was also objected that although after death ^m chloroforin, a large quantity of the anteiSh tlietio is found in the brain, this arises simply irom the fact that its soft substance is favorably to exosmose, and the storing up of the fluid, and »ot from any special affinity that the br;^ has for toiesthetics. . ': j^:,-.^:^^-.^^^^^^^^^^^^ It was also pointed out that after death frott^ diloioform or ether, the ansesfchetic is found in iaige quantities in the liver, although we do not •ttribUteUie symptoms of an»i^hesia to its pv^ aen'■ 60, and one at 65. 4. The more healthyand vigorous the patient the greater is the danger from chloroform. 5. The largest proportion of deaths has occurred ^ in cases of the most trivial operations. B, The great proportion of deaths h^ been in cases wherein but little chloroform has been inspired (Sansom); in 6 cases collected by Dr. Sanson tiie amoimt used was only half » , drachm or less*; ■ ' y- wiXw ^ F'^wg^^d that, froiri the records of fatal caaeai Mid cf thoM m which signs of danger oeemtdi^wt^ .^.. l'JIHI^'«PJ"F',1"l *^ «V;i «t% 12 . \ •1 The " diseaseit conditions " which are A>iind to increase the danger from chloroform are : intern- parance, fatty defeneration of the hearty a {Mxi- .•pnedcondition of the blood) asurtemia, pyieinia, Uid delirium — shocks, hysteria, andnervousnoss. • A large number of de^hs have taken place in TMlients with fatty degeneration of the he^rt^ and in cases of habitual intemperance or ohronio alcoholism. Signs op ■DANOER.-:=In examining the re- te * '» *. ^ ^ , *■ ^ •V' . f -1^1*4' \'.-'i:-.'\:^pt IS •iof the chloroform ia indicated by irregular breathing and stertor. Actorditig to Dr. San- ' 8om "the history of all (fatal oaRes) is, that the heart's action ceased before the breathing; that in fact, death was due to syncope, u «., paralysis of the heart" Out of a total of ^058 cases in which chloroform wa» administered, alarming ' symptoms occurred in 21 <^ses: of these: 6 oo- curred within half a minute of the commence- ment of the inhalation. ' Post Mobtbm ApPEAiiANCBs.-^Froj^ 61 post mortem examinations in cases of death from chloroform, it was found that an "almost oon- jitant sign was darkness and fluidity of the blood," and that a "frequent sign was accumula- tion of blood in the right chambers of the . Modes OF DEATH.—In animals, death from chloroform, according to Dr. Sansapi, "occurs in a definite manner— by that form of asphyxia which is due to the suspension of the motor power supplied to the muscles df respiration ; death may be said to commence id tbe ipun, tn. man, death occurs by a more complex mode, modified by g e ne r al coriditiona of the syst^m y- by emotional infinebccis, and by the mode's liy •% -' 1'^, ^fWP'f? u •■<- which ohlorpfoiTn ii adminiaterod Defttlt & «ha human subject may take pUoe (from ohloi% form) hj ^Qope, by aq>hyzia and }^j jam , nmmik." .■■ ■■\-\, ' - ' ■.^__._^ ^^ , . ■ ■■ "/'■ •■' Ei80lBOit4Tioir.--The treatment of obms of ap« pMent death from chloroform has also qiocupie^ , *li« Attention of the Medical and Surgical^ooie^ of Enghmd, as well, as the Medical Society of Emulation of Paris. From their experiments and investigations wh learn that the only per^ fpot stimulus to the *< failing heart " is " suffidl ^tly aerated blood " and that *' the only mod« <*f producing it is the excitation of respiratioii/, (Sansom.) y tb9 Committee of the Medical and Surgical J^wi^ r©p<^ fiulrject as follows: 1^:; *'J!rdm experiments on animals, and also from ♦ consideration of cases of accidents with chlo- ' ; Wiform in the human subject, the' Committee is .•tfongly of the opinion that the first and most important means of resuiscitatimi is artificial jrespiration.** ♦ • #■''-• "It is of the most ixresi^ impdftanoe^ wtiflcial respiration should be commenced the ii^mt tihe alaAung symptoms exhibit them- ••hm !Qm delay, eren of m fow second^ iHU ■*«i V' % ,4 ■\^ }* T-^ ^,^ir' w fe ^i 'W' '* .^-.llt i^ ,* ,f ^, i^ . V y ' ^^: of y » V «' ..'C t^.. p^ i^ ■f " Si* J dcmbtloM, in lome omm, destroy tbe onlj obaiiot of life. AitiBoiAl reipiratioiri ■kould be praotiaed in the manner kpowri m Dr. Syhreiter^s method^ and M recommended by the Committee on BiUK pended Animation." • * *: • '* Mouth-to-mouth insufSatioh is a most talil^ able method of resutitation. By it sereral good xeooveries have been effected, a huge quantify of nearly pure i^r b^ing blown into the chest at each insufflaiibn. In all cases in which ii is employed the nostrels should be dosed, and th« larynx should be pressed against tho spine, lo prevent the escape of air down the oesophagus." Dr. Sylvester's method of produeing arftifidal respiration, recommended by this Oommittee for oases of apparent death from chlonjform, is also recommended by the Royal Humane Society as the best method of inducing respiration incases of apparent ^death from drowning, still-birth, noxious gases, dec This method may be briefly described as follows : The patient is placed with- out delay, on his back, on the floor, couch, or table, with an impromptu cushion uiulei^ the shoulders, and the body >^ slightly inclined froni the f ee t upwards." The t o ngn» should be d» w n fonrardand k^ in, position by ab sssistan ''.J V «' IS ■ 7..• 1.^?;.*;% i: ) y ^^tttiit there 18 gudden eollapse; or if thens ii •II tvident eipbarpossment of respiration, nl Oiioe remove the chloroform, and ___ 1. Bring the patient to the recumbent positiwL !: •The blood regui^itating from the system to the heart may induce in the latter renewed^ '# contractions. • 2. With the finger or with a pair of forceps, araw forward the tongue. 3. Make a few alternate pr^sui^es by both hand«^ «pori the lower part of the sternum. "i. Commence artificial respiration. Having first l>rought the pationt'H arms to the sides, and \ exerted pressure against the walls of the chest to expel some of the air, lift the arms •tmighfabove the head, then bring them again to the sides and compress. Repeat this fre- queptly, but be sure that it is done tho- roughly, the iinWj well extended and the Chest fimly pressed. It may be well to let •nother press the lower part of the sternum * ia INNiP fivor respiration. ^ 4 5. At the same time let wwm^A be applied to tlie body ; let no time be lost ; let no cold air ciroulate u<^r ; do not dash cold water upon ^ «hcBt Let fric^ be empl^^ jMi4i. t'!- ;''^: '■T-» A-. ¥'?^i ■ -r. ,-l' [;>*- IB i ^ ■^iy. Motion being from the toM n^nnur^ f f i be a poMibilitj, let the galvanic apparatua. .41* u \ wi' XlfUTe apparatuTiTat hand;^ pl^jB^ ^ duotor (covered with a urot clqthf.i^ch jji *• in contact with the ne^tive pole of the^ primaiy wire of the battery, oveir^ phrenic nerve on the right side of ihe/i^^ praning it well in ; the other oonductdr also wetted ■hoiild be pressed into the epigastrium ; now *** ^M'''^**®'^ "* action for one dr two ^ ■•oon* ; this will cause initantaneous boa- , traction of the diaphragm; remove either of the conduotoii for ten or fifteen seconds and repeat. * i 7, If, after five or ten minutes, there is ho recor- ory, or if the symptoms indicating duiger ;^?^ve been characteriatljp diflictilt relink tion, ojyKtoar, perfo myaBw rny ^^^ od&-^ tinue your efforts at iwlKl lesuscitation. Do not relax the efforts, even if no lign ol life return for at least hiMf *n hour. « y during the process, and if the patteal ^' >vflr suffieienUy to swallow^ a little itimv- ~ knt niay be a| onjto given.^ ^ ^^ - n ■ t' ,■ ■ •*%**■ •■■-s^ in «%■ * I would rimply jMld to the abov^ thut I obn- ■idw the uie of the galvanic batUrv lupeifluoui. B» different means of prodiioSf mechanical wapiration seema quite, iufficiontr The mouth- to-mouth insufflation answeni b«8t in children, And in caaes where the signs of danger are sud- den tod early. In other casei, particularly where it is necessary to continue ike respiration for a length of time, Dr. Sylveatee's method is ^ebest. 1 ADMiHisTRATioir.-^We now come to that part <^f the subject to which I wish more particularly >> direct your attention ; namely, to the method 9f administering chloroform. • The usimJ method is to pour one, two, or three drachms of chlor<\ form, upon a handkerohief or towel, and hold it^ near the mouth ; sometimes a towel m folded in the form of a cone; an^certain aimunt of chloroform is poured into it; and^the eoneii placed over the noap and mouth, without tkj knowledge of, or regard to, the strength of the tapour that is being administered. Whon we «m«ider how cbipmon it is to administer Moro- foam in this careless manner we can only wonder tiliit fetal cases are not more numeroi iff . Q nt pf m OMs OoUeotedby Dr. Anstiein whichchloroL Ibnn was givwi in the oirdinary way, 16 present* ■'> .« U: i •I •d signs of danger; or one inttiit^ »$; y^Mkixk 2200 oAses m which means were taken to uemat proper dihttion of the chloroform valour, th^to were dangerous symptoms in only 5 ; oronly 1 In every 44o,^--;-^--— -.;-;, ^ . -,,,;, '\^.-y. ,,./;,:;.:;■■/:.■ - The oljjecfcion to the brdinaiy met^iod principle of /* tolerance" and that of «« definite dilution." When the administration ia com- menced wiUi a very dilute atmosphere of chloro- form, and the strength very gradually increased, itlB found that the system will, in a few min;^ nt^^beir^rith safety the aneesthetio of a stren^ that would be dangerous to administw at the outset This is called by I>r. Saiisom the ^principle of tolerance/* f v Again, it is considered imperative to use due means to secure proper dilution of ehlqto. form vapour. The committee of the Kc^ Medical and Ohirurfflcal 806iety rep ort nt» %> Bubioob^sfoftows:--*^ ; ^ ;rfi f li^-'" -.^-: C,'* '*Tli6 several eflTecte pro4uoed by the admiiu^r tmtion of chlorofbnn, as well as other aiuesthe- tio% are tolerably nnifonn if the samestrengthr of "eaikour foe employed ; and there is muoli reason to suppose that the irregularities attributed to it have been in a great measure due to the tint oartain degree of its oonoentration. Experi- ments upon the lower animals/ however, equally with observations on man, prove that thero is Imt a narrow limit beliween tiiat strength in which the vapour mtiy W safely inhaled, and l^iat wh^b is likely to produce alarming syriip- 'tMa8;if not d6iL^*\y:\'\^H:^-:.i-v'how that it is as desirable to measure accurately the strengtb of the vapour as to weigh the dose of a medicinal agent adminis- ^«*d by the mouth." >5. Br. Snow consid^?ed it dangerous for tbd an subject to br e athe mo r e than five per Otot. of the vapour of chloroform. iMammiferft L'-%!i£ \ Bi Jnuni V flttit.^oblorrform vapour, but inU die flpeedOr ^ abito,o«iAer6 of eight |)6r cent The chloi^ fotm comttiittee recommend that *' la order Uuii ttmajr be administered (oontinuoualy) with com- ^tije safety it ia liecestery that the propbiw ^ of vapour should not exceed three and i "THut udminlrthttioii of a drfnitB di^iBBPo, Al<»«fonn vapour can be attained with exaJiSie* «nly by means of meohMii<*l ai.pa«ta» nieeiaUr Wapted to the purpose. Of auoh the inhaler «f ^yeri, the most perfect This apparatus ooa- W" of » huge bag or reservoir wbict la filled '^I-rWy filled, with a mixtnre „f «mo.ph„i, 1*&, and 4per centof chlo««form vappnr. Tothi. b^^irttaohed « flexible tube and Dr. Sib«m'e ^««mtfHp,ece. He mouth-piece is m> ammged ■ ^^\i^ ** "* *• «>»m«»oen.«nt of the iWuJ»i.onthepatlentin.piresnearlyp„„atmos. ^enaairj by degrees, a ralvo i, dosed, so that *^0 9rthr6e minute, fiom the eommencement of ;^«hal^on the patient imfpire, the mixta« ^theh.g«J„ %•»«"» of thi,.pp«rt., •* we enabled » to administw the ehloK,. ^CUipti«« c^ •»oJ»o«i«*t veiy^«iu,lij^ S* t-;, ^4; S'j^l m ^\ mi "t I ■ ,:«* '" • Ikd influetioe of the aniBBtl^o and we can admiQr kter the vapour of known and definite strengtli. Mr. Clover says of this apparatus,^* I hav^ Ibiind my inhaler produce the annsthesia mpr^ unifojmly than I have been able to e^eot 1^ any other means, v^tients very rarely oou^ or make any manifestation of the vapour bei^ too pungent, A large majority of Jbhe pa|ien^ are prepared for Ijie commencomW of the ope^tioa te le« than rix ,Z:^«.d>^^ eertainly recover from the effects of chlorofoi^' more readily^ and with less sickness and pros^ih . tidn than I have observed when t 'did not niaka use of the inhaler." Mr. Saiisom says, ^ ecmsider this to be the safest method of all ti the admimstration of chlorofofm f ^^ For y myself^ speaking theoretically, I believe that t)^ -means obviates the most urgent objecMon, to chloroform adn^inistrationi and is especially usefvi^ where patients are assembled together ready to /be operated on one after the ofcher.** Unfortunately Mr. Glover's apparatus is too cumbrous and expensive to be generally uMd by the profession. I submit however, thatit^ would be well i| it wei^^i^ed in all publio institutions wh e re chlorofo r m ia fragnfl t ifly ni^. ministered. Other inhalers are m use, suoli imi ,.'!«wv.'v,--^a^l»ble that the gr«»t J^^ Wrf pr»ct.t.one» ^m .tui nae the towel «^eha^dterd.ief. Ho next question Z^ j5tt«„^thu,;adnuttiB^ that the ^ objectioa r^«y. » It not poaaiMo ao td conduit the rf«uuataU.on with atowelorhan<,).erohief that «^«theaifimu.tive. And 'in p«,po^'; I^Ou^t wiU be the means of atUl foS «*«fnw the great boon of Professor Sim3t ^y^y^. ^^^, i^„„^ ^ J:;:;^^^' ( '.' A "( ,>*. - ., / w> tJli^ion of daorofom for the relief of Iraiai^ ■lifferiiig "by the immense prepondenmoe of it» W«ence for good, has been ft direct conaervfttw. of hunian;lile."-:^;^-r:rt^^ IforlJie kst wnrenyears I hftve'beiSl^aw h$Mt of administering chloroform gumim^ Inamaiiner similar to that Jcrfown as "pny. A*«pr Simpson^ method;" and, during ^ikp krt six or eight months, I have been en. endeavoring to reduce this seemingly inexact method to a system approaching veiy nearij Hk^ exactness that is attained by the most ad: mirable, though compUcated and cumbrous,, apparatus of Mr. Glover ;-.! have been conduct. % a series of experimentsHrith the object of ^ determining the minimum quantity of oUo-' .reform necessary for inducing narcotism at difn tBteat ages, and for different puiposes ; and to , administer the chloroform in such a manner as to •liable me to form a pretty correct estimate of the deigree of dilution of the vaj^r that i» ^^^administewl at a given time: In this I belwvel have not b©Mi unsuccessful. My method c^ administering chlorofom Mows ;— The parent is placed /on his bac^ -■■ -^ •:■"■;; ■■■■■ ■ •;;-..:. '"■ ■■• -. ■',■ ■■■■■: ■■■■,.*..: .•• ••■■ ii*her on a oouch or teWe ; «iicl|| iin«i napkin is placed over the face, lo that <»• tliicipiess. onlj coven it. A two^nwOim >ial ia filled with cUorofonn; an anistant obserrea the piUse, and hdl4« the watch in such a poaition thai the adminittiator may see tha ■eqondhand. ihe adminiatiator aaiumei a oon- ▼w»tot position at the head of the parent, and, everjrthing being ready, with the left hand ha^ ^^•ifle* the napkin so that it does not touch tka iiose, about one^ind-a^half inches from tika inouth. The chloroform is now carefully dropped ^pon the napkin, oVer tha mouth, a deOi^ta Iwunber of drops being allowad to fkU per minute, commencing with a minjmum quantity ^d graduaHy increasing tintil, in the third mijn- «*e, the maximum quantity is reached, oie* third the maximum dose is j^ven during thefiiifc ininute, and two-thirds during the second. Tb» inaximum dow Bhould Woon^^ from two to ■ix minutes, accordmg to the effect n !^: •^irf if *r linflo 1 I^H ' one ''iK^:^ ▼ial nrm ^^^H' ^^B h % < ^m th« ' 1 oon- ^ - ■ - lad^ t W ' *>■ til* '< ^H th« ^ ^1 ped Ty ^H oito *• ^^H* per '■ bitj \,' ^Bo it- ■*r /-■ liall^^ the mwmuilDi qiiMitf ^ iBaty l^ i^d^^ r To •dttim Ittre herer given more' than 35 4fope per inmut?, w a nim dose; sOdropi per minute, I jbave found in most caBee to bt •uffioient. For chUdron llor 12 years '.^v" .«i^ "7^ M. .^-'- . ,»r ft- 1' X tliink we have. We mAke atxwt 17 reapii«>v ^10118 per minute and inhale about 20 cubic inohea ) «f air at each inspiration ; this amounts to 840/ ettWo inches per minute. In throg minutes wb inhale, in round numbers, about 1000 oub|o laches. Wo will suppose that a patient inlia^ Sadropa per minute and in three minutes 99 liropfl, or in roiind numbers 100 drops. I have awwrtained by repeated trials that 100 drops er centage t)f 4J. If, therefore, iTpatient aaijjires 1000 cubic inches of "atmospheric air in 3 flmutes and at the same time inspires the ^ fWkoleof the vapour fiomlOOdrops of chiorofonn, lie will be inspiring 4 J per cent 4 chlorofoim' In administeriiog chloroform by this method there seems to b^ very little of Uie vapour wasted, probably from 10 to 20 per cent; if 20 per cent I S w as ted, that would r e duce the 4^ per cent — t^^lntA to above, to about 3^ per cent, whic^ liOiild \^M perfectly safe strength to adminiBt0r Mi / % to «n adult in^whom th«r« did not mdtt m^ «ontra indication for chlontfom inhalation ; ai^ ▼hen we administer 30 dropa or liM itia mi^at#^ ikB strength in only 3 per cent W leaa^ ^ The advantages which I thinS^nay be^ustitr Haimed for this method of admiiiSering chloio- Ibmare:.;..'.^:-^...,;:... ,-,... ::*;|'::W :: 1. The abiUty to attain with apiMirattis •■ iimple as that of the "ready method," vwy i»ayl:r if not quite the. precision attained fy D^r. v Plover's inhaler ;~to%|nmen^ the adminii^ tration with an i^lmosi imperceptible quantity of the vapour so as to eatablish toUnmc$ ' in the Bystem ; and Bubsequei^tly^ administer ihB ddorofiijpi vapour of knowk and dafi^t* dilution. .». i. Being able, with a very few drops, to ^fbm quietLy under the influence of the anaistKetic -young children who violently wsist the stioi^ atmdsphere of chloroform-vapour that ohamo. teriMS the commencement of ihe administrati '# '% ./' • U ■"> \ : <»•»■ t »< L** '^tW-o » *^ V^ \ •^: «.*■ '*'i»-?*'^ .;t < N tt _%'' ,+ * k Jto-'¥» • "i'.S <^ N''A^ -^ |»*«r-( \. •t ■Jy |s|^^^k,i« Ltf .>. '.*, i^*'^ Ji^ ''^$ /^ v \. ■', :.\- V