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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.
78. Ibid., p. 712.
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.
105. Ibid., p. 450.
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.
110. Ibid., p. 187.
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.
115. Ibid., p. 442.
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.
131. Ibid., p. 517.
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.
145. Page 648.
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.
153. Med. Gaz., vol. xli, 1848, p. 102.
154. Association Med. Jour., 1853, p. 706.
155. See Med. Times and Gaz., 1853, vol. ii, p. 412.
156. Med. Times and Gaz., 1857, vol. ii, p. 553, and 600.
157. Med. Times and Gaz., 1856, vol. ii, p. 528.
158. Brande’s Chemistry, 5th ed., p. 1274.
159. Lond. Med. Gaz., Feb. 1842.
160. On the Inhalation of the Vapour of Ether in Surgical Operations. London,
1847.
161. Papers on Narcotism by Inhalation. Lond. Med. Gaz., vol. xli-ii.
162. Lancet, Jan. 1, 1848.
163. Vol. xxxix, p. 271.
164. Medical Gazette, vol. xxxix, p. 358.
165. Gaz. Médicale, Mars 4, 1848, p. 170.
166. Gaz. des Hôpitaux, Juin 18, 1853.
167. Medical Gazette, vol. xxxix, p. 414.
168. Ibid., vol. xxxix, p. 585.
169. Medical Gazette, vol. xxxix, p. 631.
170. Méthode Anesthésique, p. 394.
171. American Journal of Med. Science, July 1857, p. 284.
172. Annales de Chimie et de Physique, 3ème série, tom. xii, p. 320.
173. 15, Hanover Street, Hanover Square.
174. Bulletin Général de Thérapeutique, t. lii, p. 312.
175. L’Union Médicale, p. 175.
176. Less than an ounce of amylene was poured out, and it was not all used.
177. Medical Times and Gazette, 1857, vol. i, p. 84.
178. British Medical Journal, March 28th, 1857.
179. Bulletin Général de Thérapeutique, t. lii, p. 223.
180. Gazette Hebdomadaire, 1857, p. 164.
181. In the act of writing this last sentence, Dr. Snow was seized with his fatal
illness. The sentence required, however, but the addition of a word or two, to
render it complete.—[Editor.]
London, New Burlington Street,
September, 1858.
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