WELLINGTON COLLEGE

E.C. Wickham
1886 The Lancet  
662 does, produce at times alarming and even fatal symptoms. I have seen sudden syncope occur during the administration of ether with Clover's smaller apparatus, and active measures called for to recover the patient. I am convinced that in some cases of strangulated hernia (not necessarily in elderly people) a fatal termination has been hastened by the administration of ether; and though ether rarely kills suddenly, it assuredly does so in some cases-it may be a few hours, or even days, after
more » ... even days, after its administration. As regards chloroform especially, ought it not, perhaps, to be more fully recognised than it is at present that its administration in surgical operating practice requires a very special study and experience ? And, perhaps, it is not justifiable to recommend to a patient that anyone is competent to give chloroform. To enforce the truth of this it is only necessary to refer to the diverse ways in which chloroform is administered. In many cases the attention of the administrator is, unconsciously perhaps, .divided between the chloroform and the operation. In the hands of one who is careful at every moment to watch the respiration of his patient and to ignore the operation, and who gives enough and no more chloroform to produce a quiet unconsciousness, and who avoids pushing it to the degree of stertor, and who also does not neglect the position of the lower jaw and the state of the pulse, chloroform is a comparatively safe and most reliable anaesthetic. The operating surgeon, or his assistant, should assist in its careful administration by avoiding sudden alterations in the position of the patient. It is not justifiable to give chloroform in the sitting or, as I believe, in the semirecumbent position, and perhaps chloroform should be abolished in dental practice. A subcutaneous injection of one-sixtieth of a grain of atropia with one-twelfth of a grain -of morphia should be given about ten minutes before commencing the administration of chloroform. Considering the enormous benefits conferred by chloroform, I would say that, in my humble opinion, what is wanted is not so much a safe anaesthetic as a safe anaesthetist, and to urge that in the hands of those experienced in its use chloroform possesses many advantages both to the patient and the administrator that ether does not. In conclusion, Sir, I write of chloroform as I have found it, and in all humbleness and lowness of spirit, and with no desire to stir up the wrath of the champions of ether v. chloroform. I am. Sir. vour obedient servant.
doi:10.1016/s0140-6736(02)03702-9 fatcat:mxv6aghtrzhvlfdisqxuxcjloy