On narcotism by the inhalation of vapours. Parts eight to sixteen / by John Snow.

  • Snow, John, 1813-1858.
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: On narcotism by the inhalation of vapours. Parts eight to sixteen / by John Snow. Source: Wellcome Collection.

    11/54 (page 7)
    Seat of Amputation, No. of Cases. No. of Recoveries. No. of Deaths. Deaths per cent. 34 25 9 26 17 13 4 23 4 2 2 Fore-arm .... 2 2 0 Total .... 57 42 15 26 If the two cases of amputation of the fore-arm be withdrawn, the total mor- tality will be 27 per cent, instead of 26. None of the albove amputations were performed immediately after an acci- dent, but were all either for disease or injuries sustained some time previous- ly,* The mortality in the above cases is a little higher than shewn in a return by Dr, Lawrie of the amputations (pri- mary ones being excluded) at the Glasgow hospital a few years ago,t but is much lower than a similar return by Prof. Malgaigne, from the Parisian hospitals, J In a collection of cases of amputa- tion, from various hospitals, under ether and chloroform, in the Monthly Journal of Medical Science, April 1848, by Dr.^impson, the mortality appeared much lower than in any previous tables ; but as Dr, Simpson gave no instructions in his application for the return of amputations, that cases still under treatment should be excluded, there is reason to apprehend that he may have included such cases in his table, some of which may have since ended fatally. The returni I furnished to him of operations under ether at St. George's Hospital is not correctly inserted in his table. Against the seven cases of amputation of the leg, there is a cypher in the column for deaths, where the number 1 ought to stand. This death arose from slough- ing phagedena of the stump. I con- clude that the discrepancy was occa- sioned by some mistake, and that, as I have mentioned it to Dr. Simpson, it ■will be corrected in his future tables; for I cannot suppose that it was inten- tionally withdrawn from the deaths, on * There have been eig^ht amputations in St. George's Hospital performed immediately after inuiries, in which ether or chloroform has been admmistered by one of the resident medical officers. Five of the patients recovered, two on ftvourab?;.8^°'^ t Med. Gaz. vol. xxvii. p. 394. i Archiv, G6n. de Medicine, torn, Iviii. p. 40, patient succumbed. 4. In amputations at the ankle-joint, or tarsus, it is of course as needful to give chloroform as when the limb is divided higher up. Amputation of a finger or toe is an operation in which it is generally very desirable to inhale the vapour, as the pain of an amputa- tion by no means diminishes in the same proportion as the size of the part on which it is performed. No parti- cular directions are required respecting the mode of giving chloroform in the minor amputations, as what I have said concerning the larger ones is equally applicable to them. 5. Lithotomy is an operation in which I believe that every surgeon now considers it desirable, if not almost a duty, to have his patient made insen- sible. The practice of tying the hands and feet together with a bandage, to retain the patient in the required posi- tion, is still very properly resorted to. It is better to give the chloroform, so as to remove consciousness, before either the bandaging or introduction of the sound. This is especially de- sirable in the cases of children, and it is also the best plan in adults, as they begin the inhalation more at their ease. During the bandaging and sounding the efl'ect of the vapour partially goes off, and therefore the inhalation must be resumed for a short time, so as to insure complete insensibihty when the incision is made. The symptoms of insensibility were described in the last paper treating of the larger amputa- tions. The patient should not be allowed to recover either consciousness or sensibility till the operation is com- pleted by the extraction of the stone; and therefore, except when the opera- tion is concluded in an unusually short time, it is necessary to give a little vapour from lime to time, when- ever the eyes shew that the patient is about to wake, or any slight shrinking or moaning indicates the beginning of