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.

    7/12 (page 7)
    withdrawing the finger a blunt hook was inserted and held by the assistant, so as to keep the wound patent and support the fundus of the bladder. In¬ deed, of so much importance was it deemed to prevent the possibility of the bladder falling down by collapsing into the pelvis, that the spring forceps allowed to retain its original hold, was confided, along with the blunt hook, to the assistant, and the means proved admirably suited. The forceps were then introduced, and in succession two stones of large size, each weighingtwo ounces, were extracted with extreme facility. A curved silver tube, with a shield at its outer end was inserted at the lower angle of the wound, the edges of which were then neatly closed by three stitches and isinglass plaster. Another tube with a sigmoid flexure was inserted per urethram, and both secured by an abdominal belt and perineal band. The whole operative procedure occupied six minutes, during which the patient slept soundly, and never moved a muscle. He was carried to bed, and continued to dose on with only sufficient interrup¬ tion to enable him to take a drink, until 2 p.m., when he wakened up, and de¬ scribed the ease and comfort with which he went under the influence of the chloroform, and the entire absence of sensation, mental or corporeal, ever since the hour of eleven. Eight p.m.—Has slept with little intermission. Feels easy. Pulse 76. Urine clear, and flowing freely by the suprapubic tube ; the other tube appearing to serve no good purpose is withdrawn, and the abdominal belt with the perineal band also laid aside. The wound neatly closed between the stitches with isin¬ glass plaster, painted over with collodion, and a small square of oil-silk, with the tube-shield protruded through a slit in its centre, made to cover the whole, and convey the urine clear away from the abdomen. November 26, Ten a.m.—Has slept well—urine copious. Pulse 80, soft. Skin and tongue both moist. The abdomen soft, easy, and in no degree tumid. The dressings guarded by the oiled silk are completely protected from mois¬ ture, and the skin all around sheathed by repeated smearings with lard. The urine finds a free and constant escape by the tube above the pubis. Nov. 28, 7 a.m.—Continues to do well. Slept soundly all night; pulse 88 ; tongue slightly furred, but moist ; bowels have not moved. To have half an ounce of castor oil for the second time ; urine copious. 10 a.m.-—Removed the stitches from the wound ; union complete up to the tube : reapplied isinglass plaster. 2 p.m.—Belly rather tumid, but no complaint made on pressure being applied ; a purgative enema administered. 6 p.m.—The enema repeated. 9 p.m.—Bowels not relieved ; belly more tense ; admits now that there is some pain on pressure ; pulse 120, full and hard ; skin soft, but the tongue dry ; urine quite copious and limpid, distilling incessantly from the tube ; the tube removed ; bled to sixteen ounces ; repeat the enemata ; give five grains of calo¬ mel immediately, and one grain every hour after; strong mercurial ointment to be rubbed perseveringly into his thighs. A warm cataplasm applied over the abdomen, to be renewed every two hours. 10 p.m.—The lower guts emp¬ tied by the enemata; the belly felt somewhat relaxed. Pergat. 11 p.m.— Blood drawn at 9, very thickly buffed ; says he feels easy : the expression of his countenance is anxious ; breathing hurried ; pulse 180. He continued the remedies until 4 a.m., his breathing becoming more and more hurried. At 5 a.m., on the 29th November, he expired. At 11 a.m., the same day, an inspection was made. The abdomen appeared full, but neither tense nor much distended. The lips of the wound were easily separated ; the tract of the wound downwards to the bladder was brown look¬ ing, showing a few scattered points of commencing granulation. The duplica- ture of peritoneum lay entire in a loose fold, at the upper angle of the wound. A semicircular incision, passing from the crest of one ilium to the crest of the other, and above the umbilicus, afforded a flap, which, when thrown down over the pubis, allowed the viscera to come into full view. The intestines were distended by flatus ; slight traces of congestion were noticed, and it was thought that their peritoneal coat did not present its usual glossy appearance. There