On the safety and suitableness of chloroform as an anæsthetic agent in some of the more complex and serious operations in surgery : with illustrative cases and remarks on lithotrity, and on the lateral and high operations of lithotomy / by William Keith.

  • Keith, William, 1802 or 1803-1871.
Date:
1849
Catalogue details

Licence: Public Domain Mark

Credit: On the safety and suitableness of chloroform as an anæsthetic agent in some of the more complex and serious operations in surgery : with illustrative cases and remarks on lithotrity, and on the lateral and high operations of lithotomy / by William Keith. Source: Wellcome Collection.

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    found so difficult to restrain the flow; but even were the bladder emptied, as there would be neither suffering nor resistance by the patient, the bladder could be again filled by injection with great ease, and the operation resumed. Usually, from the loss of consent between those parts necessary for the successful accomplishment of the effort, urine cannot be made for some hours after the operation, and accumulates so much to the discomfort of the patient, as often to require the catheter,—doubtless, owing to the painful stretching and struggle of parts connected with that important function. Un¬ der chloroform, the bladder is seen to contract itself promptly and completely, and continues to do so afterwards. It ought at the same time to be noted, that this active state of the bladder is in its way no less useful than is the passive state of the sphincter, in as far as, by keeping the bladder tense around its fluid contents, no loose folds can exist for fragments to lodge between. In the second case,—that of the child subjected to lithotomy,— the operation was more than usually prolonged. Had it not been for chloroform, the struggles of the child might have added to the difficulties, and the shock to the constitution would have been pro¬ portionality severe. As it was, the child lay without a movement, slept without once awaking, and made an uninterrupted, a rapid, and a perfect recovery, having been dismissed cured on the eighteenth day thereafter,—the child’s reminiscence of the whole proceeding being, that u the doctor gave him snuff, and took away his stone.” The observation made on these two cases, and the experience ac¬ quired, will induce the writer now to practise lithotrity on children also, an operation which he never did deem safe for them previous to the introduction of the use of chloroform. In the third case,—another of lithotomy,—the whole proceeding occupied so brief a space, that there was little time to make obser¬ vations. The emptying of the stomach, noticed so invariably if food has been taken recently, should induce attention to the precau¬ tion of making every patient fast for two hours at least before hav¬ ing chloroform administered. The quiescence during the operation was absolute ; the comfort to the patient every thing that a total insensibility could secure ; the recovery since was steady and pro¬ gressive. In the fourth case,—where the high operation was performed,— the comfort to the patient from the use of the anaesthetic agent, was immense, and little less so to the surgeon. The whole presented the semblance of a clean, calm, nice dissection ; the patient suffer¬ ing as little pain, and the surgeon as little interruption, as if what was realised had been only semblance. The favourable progress of the case for so many days after the operation, demonstrates the fact, that death did not result from any thing immediately connect¬ ed with the operation itself. The infiltration of urine is supposed to have taken place on the night between Monday and Tuesday, when, being tired lying on his back, he turned on his left side, and