Part 1

ON CHLOROFORM AND OTHER ANÆSTHETICS: THEIR ACTION AND ADMINISTRATION.

JOHN SNOW, M.D. LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS.

EDITED,

WITH A MEMOIR OF THE AUTHOR,

BY BENJAMIN W. RICHARDSON, M.D., LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS.

LONDON: JOHN CHURCHILL, NEW BURLINGTON STREET. MDCCCLVIII.

PREFACE.

The book here presented to the reader is the legacy to science of Dr. JOHN SNOW. The completion of the work was his last act and deed. In editing the book, therefore, all that remained to be done consisted in the construction of the index, and in this a plan suggested by the author himself has been followed.

In contributing the memoir, I have performed a painful and unexpected duty: the fulfilment of a promise given at a moment when two friends who often enjoyed close companionship met at one of their happiest meetings. The promise was given with the idea of fulfilment far distant, or improbable altogether, and, as connected with a more extended biographical survey, reserved for the work of years long in the future; it is called for now hastily and in deep sorrow.

Writing with the fact of my late friend’s death not as yet fully realized; with the sensation still on me at intervals (like one who has lost a part of his own body, and yet at times conceives the lost present), that he cannot possibly be so far away; I may, perchance be pardoned for any deficiencies in style or matter. I have done my best, and leave it so.

B. W. RICHARDSON.

12, Hinde Street, Manchester Square. August 6th, 1858.

CONTENTS.

HISTORICAL INTRODUCTION 1 to 24 GENERAL REMARKS ON INHALATION 25–26

CHLOROFORM 27–344 History and composition of 27–8 Mode of preparation 28–9 Chemical and physical properties 29–30 Adulterations 30–32 Vapour of 32–34 PHYSIOLOGICAL EFFECTS OF CHLOROFORM 34–48 Degrees of narcotism 35–43 Effect of chloroform on the pulse 43–4 Action of chloroform on the nervous system 44–8 CIRCUMSTANCES WHICH INFLUENCE OR MODIFY THE EFFECTS OF CHLOROFORM 48–58 Age 49–50 Strength or debility 50 Hysteria 50–2 Epilepsy 52–3 Pregnancy 53 The menstrual period 53 Diseases of lungs 53–4 —— —— heart 54–6 Cerebral disease 56–7 Insanity 57 Hard drinking 57–8 AMOUNT OF VAPOUR OF CHLOROFORM ABSORBED TO CAUSE THE VARIOUS DEGREES OF NARCOTISM 58–74 Experiments 60–73 PREPARATIONS FOR INHALING CHLOROFORM 74–78 MODE OF ADMINISTERING CHLOROFORM 78–97 Signs of insensibility 87–97 Repetition of chloroform during an operation 97 RECOVERY FROM THE EFFECTS OF CHLOROFORM 97–100 OCCASIONAL SEQUELÆ OF THE INHALATION OF CHLOROFORM 100–107 Sickness 100–3 Faintness and depression 103–4 Hysteria 104–7 CAUSE AND PREVENTION OF DEATH FROM CHLOROFORM 107–120 FATAL CASES OF INHALATION OF CHLOROFORM 120–200 ALLEGED FATAL CASES OF INHALATION OF CHLOROFORM 201–212 SYMPTOMS IN FATAL CASES OF INHALATION OF CHLOROFORM 212–217 MODE OF DEATH IN THE ACCIDENTS FROM CHLOROFORM 217–222 THE TWO KINDS OF SYNCOPE 222–228 SUPPOSED CAUSES OF DEATH FROM CHLOROFORM 228–245 Idiosyncrasy 231–2 Alleged impunity of chloroform 233 Apparatus employed 233 Alleged exclusion of air 233–4 Alleged closure of glottis 234–8 Alleged exhaustion from struggling 238–9 Sitting posture 239–40 Effect of surgeon’s knife 240–3 Sudden death from other causes 243–5 Falling back of the tongue 245 STATE OF THE CHIEF ORGANS AFTER DEATH FROM CHLOROFORM 245–8 FURTHER REMARKS ON THE PREVENTION OF ACCIDENTS FROM CHLOROFORM 248–251 TREATMENT OF SUSPENDED ANIMATION FROM CHLOROFORM 251–262 EFFECT OF CHLOROFORM ON THE RESULTS OF OPERATIONS 263–270 ADMINISTRATION OF CHLOROFORM IN THE DIFFERENT KINDS OF OPERATIONS 271–318 Lithotomy 271–4 Lithotrity 274–5 Perinæal section 275–6 Stricture 276 Amputation of thigh 276–7 —— —— leg 277 —— —— arm 277–8 —— —— ankle 278 Other amputations 278 Operations for necrosis 278–9 Excision of head of femur 279 Excision of elbow 279–80 —— —— knee 280 —— —— wrist 280 Removal of tumours of upper jaw 280–5 —— —— —— of lower jaw 285 Tumours of female breast 285–7 Other tumours 287–9 Nævi 289 Ligature of arteries 289–91 Tumours of bone 291 Hare-lip 291–3 Cancer of the lip 294 Division of nerves 294–6 Operations on the eye 295–8 —— —— —— ear 298 —— —— —— nose 298–9 —— —— —— mouth 299–300 Plastic operations 300–1 Raising depressed skull 301–2 Operations for ununited fracture 302 Reduction of dislocations 302–3 Forcible movement of joints 303 Tenotomy 303–4 Operations for hernia 304–5 —— —— —— hæmorrhoids and prolapsus 305–7 Fissure of anus 307–8 Fistula in ano 308 Operations on ovarian tumours 308–10 Operations for cancer of vagina 310 —— —— —— rupture of perinæum 310 Removal of testicle 310–1 Operations for phymosis 311 Removal of bursa 311 Evulsion of nails 311 Laryngotomy 312 Extraction of teeth 313–18 Secondary hæmorrhage after operations 318 CHLOROFORM IN PARTURITION 318–329 THE INHALATION OF CHLOROFORM IN MEDICAL CASES 329–344 Neuralgia 329–31 Spasmodic asthma 331 Spasmodic croup 331–2 Hooping-cough 332 Infantile convulsions 332–3 Delirium cum tremore 333–4 Delirium in fever 334–5 Hydrocephalus 335 Tetanus 335–6 Epilepsy 336–7 Puerperal Convulsions 337–9 Hysterical paralysis and contractions 339–41 Mania 342 Spasmodic pain 342–3 Frequent and long continued use of chloroform 343–4

SULPHURIC ETHER, OR ETHER 345–371 History and composition 345 Chemical and physical properties 345–9 Physiological effects 349–55 Administration of ether 356–61 Great safety of 362–9 The combination of chloroform and ether 369–71

AMYLENE 372–410 Preparation and properties 372–7 Physiological effects 378–86 Use in surgical operations 386–94 Use in parturition 394–7 Its effects 397–419

THE MONOCHLORURRETTED CHLORIDE OF ETHYLE 420–23

ILLUSTRATIONS. Chloroform inhaler 82 Ether inhaler 349

THE LIFE OF JOHN SNOW, M.D.

There is not much credit in the mere acts of living and dying; in being driven by unavoidable fate through the common journey, with shoulders uncovered and the whip over them; in doing nothing save the drudgery of existence; in enjoying, in an approach to the recognition of enjoyment, the brief dreams of childhood; in struggling into manhood; in battling through the after-strife obedient to the castigator behind; and in dying at last, as though life had never been; dead to-day, wept for tomorrow, and forgotten by the morrow’s succeeding sun. There is not much credit in this surely, for credit must be earned by something done beyond that which all must perforce do. But, in the face of all the struggles incidental to the existence, so to have managed as to have stolen out of time hours which other men knew not in their calendar—so to have defied the inexorable taskmaster as to perform more than is included in his demands; so to have willed and acted as to live on when death has done his worst; to assist all coming wayfarers in their conflict wherever they may meet it; to prove that there is something more in life than labour lost, and nothing more in death than an idea—Hoc opus hic labor est—in this there is achieved the grand attainment; the perpetual life.

He whom I, with poor biographer’s pencil, put forward now in brief sketch, is one amongst the few who have thus realized the ideality of death. It were but little matter, therefore, though no biography should appear at all; it is of but little count that such biography, as the recollections of friends and intimates shall call forth, be scanty in its details; it is of but little count that the life of him who is to be shadowed forth is destitute of incident fitted for the taste of wonder-loving, passion-courting, romance-devouring, readers. Biographies for these are common. Good men are scarce.

JOHN SNOW, the subject of the present memoir, was born at York, on the fifteenth day of June, 1813. He was the eldest son of his parents. His father was a farmer. His mother, who is living, resides still at York. As a child, he showed his love of industry; and increasing years added only to the intensity with which he applied himself to any work that was before him. He occasionally assisted his father in agricultural pursuits, and often in later life spoke with great naïveté of the recollections of those early winter mornings when his boy’s fingers were too intimately to be pleasantly acquainted with the effects of benumbing cold. He was first sent to a private school at York, where he learned all that he could learn there. He was fond of the study of mathematics, and in arithmetic became very proficient. At the age of fourteen, he went to Newcastle-on-Tyne, as an apprentice to Mr. William Hardcastle, surgeon, of that place. He had also the opportunities of studying at the Newcastle Infirmary. During the third year of his apprenticeship, viz., when he was seventeen years old, he formed an idea that the vegetarian body-feeding faith was the true and the old; and with that consistency which throughout life attended him, tried the system rigidly for more than eight years. He was a noted swimmer at this time, and could make head against the tide longer than any of his omnivorous friends. I have heard him tell that so long as he continued to qualify his vegetables with milk and butter, the vegetarian plan supported him fairly. But on one unfortunate morning, when taking his milk breakfast, some quizzical friend, learned in botany, cross-examined him as to the vegetable on which he was then feeding. The joke went home; and the use of milk, as food for a pure vegetarian, became too absurd for consistency. The milk, therefore, must be put aside, and the butter and the eggs. The experiment did not answer; the health of our pure vegetarian gave way under the ordeal, and although in after life he maintained that an approach to the vegetarian practice was commendable, in that it kept the body in better tone for the exercise of the mind, he admitted that in his own case his health paid the forfeit of his extreme adherence to an hypothesis. Amongst his earlier scientific readings was a book in defence of the vegetable regimen by John Frank Newton. This book is annotated by himself, 1833. It is an useful book, full of curious arguments, facts and suggestions, many of which, as his own after writings indicate, he had carefully studied and applied.

At or about the same time that he adopted his vegetarian views, he also took the extremity of view and of action, in reference to the temperance cause. He not only joined the ranks of the total abstinence reformers, but became a powerful advocate of their principles for many succeeding years. In the latter part of his life, he occasionally and by necessity took a little wine, but his views on the subject remained to the end unchanged; he had strong faith in the temperance cause, and a belief that it must ultimately become an universal system.

In 1831–32, cholera visited Newcastle and its neighbourhood, and proved terribly fatal. In the emergency, Mr. Snow was sent by Mr. Hardcastle to the Killingworth Colliery, to attend the sufferers from the disease there. In this labour he was indefatigable, and his exertions were crowned with great success. He made also on this occasion many observations relating to this disease, which proved to him of immense account in after years.

He left Newcastle in 1833, and engaged himself as assistant to Mr. Watson of Burnop Field, near Newcastle. Here he resided for twelve months, fulfilling the assistant duties; regarding which it can only be said, and that from analogy, that they were neither without their anxiety nor their reward. Leaving Burnop Field in 1834–5, he revisited his native place, York; made a short stay, and thence, to a certain half-inaccessible village called Pately Bridge, in Yorkshire, to assistant it with Mr. Warburton, surgeon there. Some few years ago a friend of mine went to the same village, by the recommendation of Dr. Snow, as assistant to the present Mr. Warburton of that place, a son of Dr. Snow’s “old master”. The circumstance of this recommendation often led Dr. Snow to refer to his life at Pately Bridge in our conversations. He invariably, on such occasions, spoke of Mr. Warburton, his “old master”, in terms of sincere respect, and depicted his own life there with great liveliness. He was a vegetarian then, and his habits puzzled the housewives, shocked the cooks, and astonished the children. His culinary peculiarities were, however, attended to with great kindliness. Eighteen months at Pately Bridge, with many rough rides, a fair share of night work, a good gleaning of experience, and this sojourn was over. Now back again went our student to York, to stay this time a few months, and—not to be idle—to take an active share in the formation of temperance societies. In leisure days during this period it was his grand amusement to make long walking explorations into the country. In these peregrinations he collected all kinds of information, geological, social, sanitary, and architectural.

At last York must be again left; the London student life was in view. In the summer of the year at which we have arrived, 1836, he set off from York to Liverpool, and, trudging it afoot from Liverpool through the whole of North and South Wales, turned London-ward, calling at Bath by the way, on a visit to his uncle, Mr. Empson, to whom, to the end of his life, he was devotedly attached. October 1836—eventful October—brought him to the “great city”, and placed him on the benches of the Hunterian School of Medicine in Windmill-street: a school long since closed, and now almost a myth; like the mill which gave the name to the locality.

I am indebted to the courtesy of Mr. Joshua Parsons of Beckington, near Bath, for an insight into the life and manners of my beloved friend during his student career. Mr. Parsons had the happiness to be the special fellow-student of Snow. Their friendship, cemented early in life, never declined, but had added to it, “on my part,” says Mr. Parsons, “respect and admiration for the solid talents and industry of my old colleague.” Speaking of their common labours, Mr. Parsons writes as follows: