This section is from the book "Dental Medicine. A Manual Of Dental Materia Medica And Therapeutics", by Ferdinand J. S. Gorgas. Also available from Amazon: Dental Medicine.
In children, the free admission of chloroform into the lungs causes nervous excitement; but the struggling and holding the breath can hardly be avoided, and one or two whiffs of chloroform may be sufficient to produce complete insensibility. They should always be allowed to inhale a little fresh air during the first deep inspirations which follow.
In struggling persons, but especially in children, it is essential to remove the inhaler after the first or second deep inspiration, as enough chloroform may have been inhaled to produce deep anaesthesia, and this may only appear, or may deepen, after the chloroform is stopped. Struggling is best avoided in adults by making them blow out hard after each inspiration during the inhalation. The patient is, as a rule, anaesthetized and ready for the operation to be commenced when unconscious winking is no longer produced by touching the surface of the eye with the tip of the finger.
The anaesthesia should never, under any circumstances, be pushed until respiration stops; but when once the cornea is insensitive, the patient should be kept gently under by occasional inhalations, and not be allowed to come out and renew the stage of struggling and resistance.
As a rule no operation should be commenced till the patient is fully under the influence of the anaesthetic, so as to avoid all chances of death from surgical shock or fright. The administrator should be guided as to the effect entirely by the respiration; and his only object, while producing anaesthesia, is to see that the respiration is not interfered with. If possible the patient's chest and abdomen should be exposed during chloroform inhalation, so that the respiratory movements can be seen by the administrator. If anything interferes with the respiration in any way, however slightly, even if this occurs at the commencement of the administration, if breath is held or if there is stertor, the inhalation should be stopped till the breathing is natural again. This may sometimes create delay and inconvenience, but experience will make any administrator so familiar with the respiratory functions under chloroform, that he will in a short time know almost by intuition whether anything is going wrong, and be able to put it right without delay, before any danger arises. If the breathing becomes embarrassed, the lower jaw should be pulled or pushed from behind the angles, forward, so that the lower teeth protrude in front of the upper. This raises the epiglottis and frees the larynx. At the same time it is well to assist the respiration artificially till the embarrassment passes off. If, by any accident the respiration stops, artificial respiration should be commenced at once, while an assistant lowers the head and draws forward the tongue with catch forceps, by Howard's method, assisted by compression and relaxation of the thoracic walls. Artificial respiration should be continued till there is no doubt whatever that natural respiration is completely reestablished. A small dose of morphia may be injected subcutaneously before chloroform inhalation, as it helps to keep the patient in a state of anaesthesia in prolonged operation. There is nothing to show that atropine does any good in connection with the administration of chloroform, and it may do much harm. Alcohol may be given with much advantage before operations under chloroform, provided it does not cause excitement, and merely has the effect of giving a patient confidence and steadying the circulation. And it is the opinion of the Commission that "if the above rules be followed, chloroform may be given in any case requiring an operation, with perfect ease and absolute safety, so as to do good without the risk of evil."
In operations on the mouth the chloroform vapor may be administered by passing a soft catheter into the nose and by means of a hand-bulb, or Junker inhaler and thus force the vapor into the post-nasal spaces.
Besides its use as a general anaesthetic agent, chloroform is internally administered in substance, as an anodyne and antispasmodic, for non-inflammatory affections, such as nausea and vomiting, seasickness, sick headache, flatulent colic, intermittent fevers, and in cholera, for which it is very efficient. The vapor is employed for the relief of hay asthma, whoopingcough, spasmodic asthma, and as a hypnotic in delirium tremens, and as an injection and lotion in neuralgia, and as a counter-irritant or vesicant, for which purposes it is applied to the skin, and evaporation prevented. Great care is necessary in the administration of chloroform in substance, as fatal effects have followed such use; 15 drops have destroyed life. Externally, chloroform is employed as a stimulating application to foul and indolent ulcers.
The A. C. E. mixture consists of 1 part of alcohol (sp. gr. .838), 2 parts of chloroform (sp. gr. 1.497), and 3 parts of ether (sp. gr. .735).
The object of this mixture is to produce the anaesthetic effect of the ether and chloroform without the cardiac and respiratory effects of either, the alcohol being added to act as a stimulant.
Schleich's mixtures are composed of chloroform, ether and petroleum ether, the latter boiling at 6o° to 650 C. The petroleum ether has no injurious effect, and appears to modify the effect of the chloroform and dilute the ether without changing the general influence of either. Such mixtures are said to cause less mucous secretion, less cyanosis and other disagreeable effects than any single anaesthetic.
Dr. Spark recommends highly, as a hemostatic agent, a solution composed of chloroform 2 parts, water 200 parts. He claims that it acts with a rapidity that is truly marvelous, and it has not the slightest disagreeable taste. It is useful in all operations upon the mouth and throat. Dr. A. Guerin, of Paris, claims that death from chloroform may be avoided if inhaled exclusively through the mouth, holding the nose. When death occurs from stoppage of the heart, the cardiac muscular fibres cease to contract under the influence of a reflex action exerted by the nasal nerves on the pneumo-gastric, stimulating the inhibitory power of the latter on the heart. When a rabbit is made to inhale chloroform directly through an opening in the trachea, the drug has no effect whatever on the heart. On the contrary, when the chloroform is held before the nose of the rabbit, the heart immediately stops.