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CHLOROFORM ;
ITS PROPERTIES AND SAFETY
CHILDBIRTH.
EDWARD WILLIM_JURPHY, A.M., M.D.
PBOFESSOR OF MIDWIFERY, UNIVERSITY COLLEGE ; OBSTETRIC PHYSICIAN,
UNIVERSITY COLLEGE HOSPITAL;
FOBJIERLT ASSISTANT PHYSICIAN DUBLIN LYING-IN HOSPITAL;
LATE PRESIDENT MEDICAL SOCIETY OF LONDON ;
ETC., ETC.
" Nj^Of^of "Ytcvqc, \ii.v Ka(TiyvT]Tog Qavdroio.''
" Take thou this phial, being then La bed.
And this distilled liquor, drink thou off.
"WTien presently through all thy veins shall come
A cold and drowsy humor, which shall seize
Each vital spirit. * * *
And then awake as from a pleasing sleep."
Romeo and Juliet.
^^ LONDON:
WALTON AND MABERLY,
UPPER GOWER STREET, AND IVY LANE, PATERNOSTER ROW.
M.DCCC.LV.
2 4r.4). a.oHc(^
LONDON:
rUINTKI) By WERTHKIMKR AX'D CO.
CIKCUS PLACK, FIVSBURY.
DEDICATED
TO
SIR JAMES CLARK, BART.
PHYSICIAN IN ORDINARY TO
HER MAJESTY.
Digitized by the Internet Archive
in 2010 with funding from
Open Knowledge Commons and Harvard Medical School
http://www.archive.org/details/chloroformitsproOOmurp
PREFACE.
The following observations on Chloroform — its
properties^ mode of administration^ and advan-
tages — are intended for those who are willing
to use this agent, provided they are satisfied that
they can do so with safety. The object of the
Author is not to . continue a controversy on the
merits or demerits of this ansesthetic, but rather
to assist the inquirer who is anxious to give it a
fair trial, but who may be intimidated from want
of experience of its mode of action. There may
be some, also, less hesitating, who will boldly
administer chloroform, but who err from want
of knowledge, and give it both more rapidly and
in larger quantity than is required. Such reck-
lessness may be fatal.
If these pages contain anything that may cor-
vi PREFACE.
rect these errors^ either from rashness or timidity,
and, at the same time, lead to the general adoption
of a most valuable means of assuaging the sorrows
of childbirth, the object of the Author is fully
attained. In his experience, he cannot speak too
highly of its advantages, and trusts that the period
is not far distant when, as the prejudices which
surround it gradually subside, its value will be
more correctly appreciated.
12, Henrietta-street, Cavendish-square,
November, 1854,
CONTENTS.
CHAPTEE I.
Introduction.
PAGE
Professor Simpson's Introduction of Chloroform as an
Ansesthetic in 1848 — Used by the Author with Com-
plete ^Success in a Case of extremely difficult Labour,
immediately after the Appearance of Dr. Simpson's
Pamphlet — Prejudices against its Administration — Ob-
jections both Moral and Medical — Hostility too violent
— the Public gradually arrive at the Truth — it becomes
generally employed — A Spirit of Inquiry excited in
the Profession, to meet which the following Remarks
are put together , . 1
CHAPTER II.
Properties of Chloroform.
One of many Hydro-Carbons that possess Anassthetic Pro-
perties — Difference in their Mode of Action — Alcohol —
Sulphuric Ether— Chloroform — Hydro-Cyanic Acid —
Carbon the Anaesthetic Element — Action on the Animal
Tissues — The Stomach, Lungs, Skin — Chloroform,
conveyed by the Blood, but not incorporated with it
— Blood not poisoned nor altered by Chloroform
— Action on the Nerves — On the Cerebro-Spinal — On
the Reflex — On the Ganglionic Nerves — Action on the
Uterus— On the Heart — Death from Chloroform — Its
Cause 8
Vlll CONTENTS.
CHAPTER IIL
Obstetric Use of Chloroform.
PAGE
Chloroform Progressive in its Effect — First Stage sufficient for
Ordinary Cases of Labour— Second, transitory — Third
Stage induced for Severe Operations— Influence of Chlo-
roform on the Parturient Woman — Mode of Adminis-
tering the Vapour — with a Sponge and Handkerchief —
by Inhalers. Inhaler for the Mouth used by the Author
— its Advantages— Quantity of Chlorofoi'm required —
Time to commence Inhalation — Constitutional Dififer-
ences in the Effect — Action of the Uterus under
Chloroform — its Use in Severe Obstetric Operations —
Dr. Fleming's Inhaler — Cautions necessary in inducing
Sopor 25
CHAPTER IV.
Advantages, Disadvantages of. Objections to,
Chloroform.
Constitutional Irritability — Exhaustion from Intense Pain
— its advantage in diminishing both — Rapid Recovery
after Chloroform — Pain relieved without Sleep — Value
of Chloroform in Military Surgery — Objections raised
against Chloroform — Sudden Death — only in Surgical
Practice — Drunkenness — Violence to the Person — In-
sanity — Rules for its Administration . . . .44
CHLOROFOEM IN CHILDBIRTH.
CHAPTEE I.
INTRODUCTION.
On the fourth, of November^ 184^_, Professor
Simpson discovered the anaesthetic power of
chloroform. Eegardless of all risk and in the true
spirit of science_, he became the subject of his first
experiment^ inhaled the vapour to test its value ;
and having thus ascertained its properties^ this
agent was applied by him to assuage the sufierings
of parturition. Its power was soon demonstrated;
and Dr. Simpson at once published his discovery
to the world.^
Very soon after the appearance of his pamphlet,
I was summoned to a case of most difficult labour
caused by extreme deformity in the pelvis. It
was necessary to submit this patient to a most
painful and tedious operation, and I determined
to test the influence of chloroform. The vapour
was administered, she fell into a tranquil sleep, the
operation was performed and everything settled
before she awoke. When she regained con-
* " An Account of a New Anaesthetic as a substitute
for Sulphuric iEther in Midwifery and Surgery," by
J. Y. Simpson, M.D., Edin. 1847.
2 CHLOROFOEM IN CHILDBIRTH.
sciousness she looked up^ recognised me^, said she
lelt no pain tlien, but was evidently in expectation
of its return. When told that all was over, she
was incredulons, but, at length convinced by her
altered appearance, her countenance lighted up
with an expression of thankfulness difficult to
convey. The value of chloroform was proved ; its
subsequent effects, if any, remained a question :
the case was watched most anxiously, and it was
found that the prostration and restlessness so
frequent in such cases were altogether absent;
neither was there the slightest trace of inflammation
which might naturally be expected from *a labour
unusually severe and prolonged. Her recovery
was so complete that she was walking about in
three weeks afterwards.
Encouraged by this success, chloroform was ad-
ministered in several cases in which obstetric
operations were required, and with the same results.
These cases with remarks were published in 1848.'^
The introduction of such an agent into practice
was not, however, very flattering; clouds of disappro-
bation were collecting on the horizon, which soon
increased and burst in such a storm of controversy,
that we were reminded of the polemics of the
middle ages; only that in these later disputes,
rather less attention was paid to logic.
Parturition is complicated with many accidents,
both at the time of and after delivery : all these
were attributed to chloroform, if the patient hap-
* " Chloroform in the Practice of Midwifery," by Edward
W. Murphy, A.M., M.D. Taylor and Walton, 1848.
OPPOSITION TO CHLOROFOEM. 3
pened to inhale this vapour. Thus it became the
cause of hemorrhage, convulsions, sloughing of
the passages from the impacted head, craniotomy,
puerperal fever, puerperal mania, as if these com-
phcations were never heard of until tliis so called de-
structive vapour was introduced. Those who were
bold enough to use it, were held up to public
odium, nay, it was even questioned, whether the
act might not be considered criminal according to
law. It was said that to render a parturient
woman in this way, ^^ drunk and incapable '^ was
certainly a misdemeanour, and no matter what
might be its advantages, we had no business to use
such a means of abrogating what they were pleased
to call " physiological pain."
The aid of the Church was summoned : it was in-
sisted that the pains of labour were the ^^ sorrows"
of childbirth, and that to relieve the one, was to
remove the curse signified by the other. It was
assumed that the decrees of Omnipotence could be
neutralized by this new power, and that the fore-
knowledge of the Deity did not extend to the
discovery of anaesthetics. In vain it was urged,
that the sorrows of childbirth signified much more
than the pains of parturition ; that man who was
destined '^^to eat bread in sorrow all the days of
his life," contrived to dine as comfortably as his
means permitted, notwithstanding the curse ; that
in fact, the term sorrow could not be understood
in so restricted a sense. Such reasoning availed
but little j and, even at the present moment, there
are pious persons whose judgment is shaken by
4 CHLOROFOKM IN CHILDBIRTK.
this interpretation of Scripture, who look upon
Etherization as sinful.
Pamphlets_, tracts, essays accumulated; and in
midst of this war of words, some further obser-
vations^ were published by me, in the hope of re-
moving by a fair statement of experience, some of
the many erroneous notions entertained about it.
The tract was thrown upon troubled waters ;
the opposition to chloroform increased; at least
so far as its use to relieve labour was concerned.
In surgical practice it was employed extensively :
a death sometimes happened; but, in the majority
of instances, the cause was understood and ap-
preciated, and chloroform continued to be used.
These deaths were sedulously reported in the jour-
nals, both daily and medical, and thus the pre-
judice was strengthened.
With the aid of such facts, the obstetric oppo-
nents of the vapour excited no little alarm among
the fairer portion of the public, who were naturally
anxious to receive relief in their hour of trial. It
was whispered that such a lady took chloroform
in her confinement and became maniacal; some
were obliged to be delivered with instruments,
others were seized with epilepsy. In a third series
of cases, it was said that fatal phlebitis and peri-
tonitis were the consequences of its administra-
tion. Such were the rumours privately circulated,
* Further observations on " Chloroform in the Practice
of Midwifery," by Edward W. Mur^jhy. A.M., M.D.
London, Taylor, Walton & Maberly, 1850.
OPPOSITION TO CHLOROFOEJil. 5
and even openly published : the public, however,
were never informed that all these casualties, so
confidently attributed to chloroform were the well
known accidents of labour^ which might have
taken place if chloroform had never been given.
It was sufficient for these opponents that the pa-
tient inhaled the vapour to make it responsible for
every evil consequence of parturition.
Notwithstanding the violence of this hostility —
too violent to con\dnce — the public were gradually
arriving at the truth. A few plain facts assisted
them in forming an opinion. The deaths from
chloroform all occurred in the practice of surgery_,
yet they did not find surgeons hostile to its nse.
In the London hospitals chloroform had been ad-
ministered in upwards of nine thousand cases.
About nine deaths occurred^ not afterwards^ but in
the moment of administration_, nevertheless sur-
geons were not discouraged. As to subsequent
injuries^ which were so sedulously reported from
the practice of midwifery^ they knew nothing
about them^ and yet had such presented them-
selves it would be impossible to overlook them.
If chloroform caused hemorrhage^ it could not fail
to induce secondary hemorrhage_, the great dread
of the surgeon. If it produced a greater suscepti-
bility to the risks that arise from inflammation
and fever^ here were cases in which either might
be fatal ; yet surgeons did not find chloroform on
this account dangerous. If it caused alarming
prostration of the vital powers, nothing could be
more calculated to interfere with the success of a
6 CHLOKOFORM IN CHILDBIRTH.
capital operation, nevertheless chloroform was
used in such cases^ and with a precisely contrary
effect : it was observed that the shock of an ope-
ration, being by this means so much diminished,
the chances of the patient were greatly increased.
As for insanity, epilepsy, &c. these were found
exclusively in obstetric reports, and hence the sus-
picion that to chloroform were attributed effects
of parturition, which were known from the days of
Hippocrates.
Those also who had the deepest interest in the
question, who looked forward to their period of
suffering with no little anxiety, and who made
their inquiries, did not find these reports sup-
ported by facts. On the contrary, they heard
from their friends who had experience of chloro-
form very different histories from those in general
circulation. Ladies recovered better from their
confinements after they had taken it than when
they had not. They knew, also, that if deaths
had occurred, if recoveries were protracted, if the
catalogue of mischiefs attributed to this vapour
had the slightest foundation in facts, it would be
impossible to continue its use in midwifery, such
objections could not be concealed, and would soon
overwhelm those who adopted it with disgrace.
Yet the distinguished discoverer of this valuable
anaesthetic has not suffered in this way, nor others
in the habit of using it. Hence the young mother
began to doubt, then to disbelieve, and, lastly, to
suspect, this too vigorous hostility.
Thus, notwithstanding this opposition, the use of
SPIEIT OF INQUIRY. 7
cliloroform in midwifery has become general. It
is universaUy employed in Edinburgh ; has made
conA^erts in London among its warmest opponents,
and has found its way even within the precincts of
the palace.
The profession are beginning to open their eyes
to the truth. They know the great responsibility
which would be incurred by allowing chloroform
to be administered to the highest personage in the
realm, if there was the slightest risk, hence they may,
perhaps, have some suspicions that these statements
might possibly be but exaggerations, and conclude
that its use is, at least, a proper subject for inquiry.
They are prepared to admit that if its safety can be
proved, it should be recognised as a means of re-
lieving the sufferings of the parturient female.
Such . seems to be the present position of this
question; and in order to meet such a spirit of
inquiry, I have ventured a third time to address a
few remarks on chloroform, with the object of
pointing out its influence on labour and its mode
of administration, rather than with the desire of
continuing any controversy regarding its merits.
If the following observations are of any value, in
aiding the inquirer anxious to know the properties
and uses of the agent he wishes to administer,
their object is fully accomplished.
CHAPTER II.
PROPERTIES OF CHLOROFORM.
Chloroform is one of many substances that
possess similar properties only differing in degree."^
Hydrogen and carbon form the base, which may
exist alone, or be united to a third element, and
thus form a ternary compound. They all possess
ansesthetic properties, they influence the nervous
system in a similar manner, but differ essentially
in the degree and rapidity with which their effects
are produced. Alcohol, sulphuric sether, chloro-
form, hydrocyanic acid, are examples of these ter-
nary compounds which have anaesthetic properties,
but of very different degrees of power.
* Anesthetics,
o
d
o
Chlorine.
Oxygen.
CI
o
u
ft in
02 C5
1^-
Benzin, or Benzole
2
1
—
—
—
0-8500
187<>
Chloroform . .
2
1
3
—
—
1-4800
1400
Dutch liquid
2
2
2
—
—
3-4484
1800
Sulphuric sether
4
5
—
1
—
0-7154
960
Alcohol . . .
4
6
—
2
—
0-7960
1720
Hydrocyanic acid
2
1
—
—
1
0-6969
800
Chloride of carbon
4
4
—
—
—
1-5520
2480
Chloric aether
A m
ixture of chloroform and alcohol-
ANAESTHETICS— DEGREES OF POWER 9
For instance^ the ansetliesia of alcohol is slow in
appearing; nor is it nntil the potations are pro-
longed and deep^ that such an effect manifests
itself; nevertheless cases have occurred in which
an inordinate draught of brandy has been followed
by instant loss of nervous power^ and the drunkard
has fallen down perfectly insensible in a state of
ansesthesia.
Sulphw'ic (Ether acts more promptly, and is pre-
ceded by a stage of excitation not so prolonged,
nor so boisterous, but still not dissimilar to that
of alcohol.
Chloroform is yet more rapid in annulling sensa-
tion, and its exciting stage much shorter than
sulphuric aether : and lastly.
Hydrocyanic acid acts with a rapidity that ren-
ders it a poison of most fatal power j there is no
intervening stage but sensation, motion, con-
sciousness; all ners^ous energy is instantly de-
stroyed by it.
The third element of the compound seems not
to be essential to, but rather to regulate the in-
tensity of, the ansesthetic effect. The same hydro-
carbon base combined with oxygen (alcohol, sul-
phuric sether) has less power than when united
with chlorine (chloroform), and again the com-
bination with nitrogen (hydrocyanic acid) forms
an ansesthetic of the highest intensity. So also of
the compounds Avith oxygen. Alcohol, which con-
tains two volumes, has less power than sidpliuric
sether, having only one of oxygen. Ansesthesia
seems to be at its maximum when the hydro-
B 5
10 CHLOROFORM IN CHILDBIRTH.
carbon is combined with nitrogen_, and a minimum
with oxygen.
It has also been proved_, that in the hydro-
carbon base hydrogen is not the essential element,
because chloride of carbon (carbon and chlorine)
and benzole (carbon and hydrogen) produce simi-
lar eflPects ; and hence the inference that carbon is
the anaesthetic element which remains dormant
until called into activity by the gases with which
it may combine.
The action of chloroform on the animal
TISSUES has been the subject of close observation.
Ansesthetics differ in their mode of action. Alcohol
acts with most power through the stomach ; less
by inhalation, least, if at aU, by the skin. Chlo-
roform acts chiefly by inhalation, less through the
stomach, and least by the skin, its action being
only partial, and limited to the surface to which it
is applied. Hydrocyanic acid conveys its influence
by all these channels, and, if pure, will destroy life
when dropped on the skin as rapidly as when
received into the stomach or inhaled.
When the vapour of chloroform is received into
the lungs, it is quickly expanded over all the air-
cells ; these are surrounded on every side by the
ultimate capillary ramifications of the pulmonary
arteries and veins, and also by the fine fibrillar
expansions of the pneumo-gastric nerves; thus its
influence may be conveyed to the nervous centres,
either directly through these nerves, or indirectly
through the blood, but the former belong to a
division of the nervous system not susceptible to
CHLOEOFOEM IN THE BLOOD. 11
its action imless in large closes^ so large as to
become dangerous. The blood is the channel,
therefore, through which it exhibits its phe-
nomena j by this means it is conveyed with great
rapidity to every portion of the body, and hence
its manner of combining with the blood becomes
a question of importance.
Chloroform is not very soluble in the blood, not
at all so much so as alcohol, and consequently a
large proportion of free chloroform travels through
the circulation. This is supposed to exert a strong
affinity for oxygen, which is inspired, not suffi-
cient however to absorb it and form new com-
pounds, yet enough to prevent the usual affinities
taking place. Carbonic acid is not, therefore,
formed in the same proportion, and carbon not
being sufficiently removed from the tissues, the
ansesthetic element remains to exhibit its influence.
Several facts seemed to prove the relation between
anaesthesia and the expiration of carbonic acid.
Dr. Snow has shewn, by numerous experiments,
that the quantity of carbonic acid evolved from
the lungs is diminished under the influence of
sether and chloroform. Dr. Prout has demonstrated
the same fact in dninkards ; and again, it is found
that extreme cold reduces the proportion of car-
bonic acid expired, and becomes an anaesthetic.
It acts precisely as chloroform. There is the
same loss of sensation (numbness) and prickly
pain followed by drowsiness; the same inability
to regulate voluntary motions, and ultimately
complete sopor. Hence we infer that anaesthetic
12 CHLOEOFORM IN CHILD-BIETH.
force is in inverse proportion to tlie quantity of
carbonic acid expired.
This disturbance of the respiratory function
necessarily modifies the colour of the bloody but
the degree and manner in which such changes
are effected must depend,, in a great degree, upon
accidental causes^ as well as on the power of the
anaesthetic. Carbonic oxyde is one of the most
powerful of these agents, and Mr. Nunneley
observed, in animals poisoned by it, " that both
venous and arterial bloods were bright floridJ'
Dr. Snow remarks, that " when the blood which
flows from the arteries and veins can be separately
examined, whilst the patient is well under the in-
fluence of the narcotic [chloroform)^ it is seen that
the arterial blood is somewhat less florid, and the
venous less dark, than under ordinary circum-
stances," AgaiUj it has been found in animals
slowly put to death by chloroform, for instance,
after several experiments, that the blood in the
arteries was as dark as in the veins.
It is probable that, in the first case, carbonic
oxyde perfectly neutralized the oxygen, which
passed freely through both sides of the circulation^
and rendered the blood equally florid. In the
second, chloroform did so to a certain extent, but
only partially, hence that a certain proportion of
free oxygen entered the veins, and an equal
quantity of carbonised blood passed through the
lungs unchanged to the arteries; and lastly, in
the third case, in which there was sufficient time
for the oxygen to be otherwise disposed of^ all
BLOOD NOT POISONED. 13
the blood became carbonized by carbon which
could not be removed. This^ however, remains a
question of enquiry ; but there is no doubt that
chloroform does not dissolve in the blood, as is
the case Avith alcohol, nor does it make any
change in its properties.
The large number of experiments (three hundred
and sixty-three) performed by Mr. Nunneiey on
the lower animals render his remarks of the
highest authority. He does not think that blood
is changed, or, as it is said, "poisoned." *^It does
not lose its power of coagulating j nor is that which
is taken from an animal in so complete a state of
ansesthesia as to be presently fatal, or even imme-
diately after death has been occasioned, when
examined under the microscope, seen to be much,
if at all, altered in its character, consequently,
neither the fibrine nor the globules can be much
changed ; and unless the ansesthesia be very pro-
found, or prolonged, the blood does not vary much
in its color. That which flows from a wound during
an operation is as bright as usuair^
The action of chloroform on the nerves, and its
manner of causing ansesthesia, is best observed by
the effect of small doses of the vapour gradually
increased. The blood conveys the vapour to the
heart : the heart transmits it to every nerve in the
body. But these are not all equally under its
influence. Of the three divisions of the nervous
system, the cerebro-spinal is the first affected, then
the reflex, and lastly the ganglionic nerves.
* Trans. Pro v. Med. & Surg. Association, vol. xvi. p. 359.
14 CHLOROFORM IN CHILD-BIRTH.
The first communicates sensations_, motive
power, volition^ reflection; a small dose of chloro-
form will annul sensation without disturbing the
power of motion or consciousness. An example
will explain this. A lady sufiered intense pain
from abscess of the breast which was on the point
of bursting. She could not bear to have it touched