Other tomes: Petersen
Chloroform is Methyl Ter-chloride, CHCl3, prepared by the action of Chlorinated Lime upon Alcohol. It was discovered by Samuel Guthrie, of Sackett's Harbor, N. Y., in 1831.
Properties. It is a colorless, neutral fluid, practically non-inflammable, soluble in alcohol, ether, olive oil and turpentine, and in 200 of water. Its density and weight are about four times those of air , and its sp. gr. not below 1.490 at 59° F. It consists of 99 to 99.4 p. c. by weight of absolute Chloroform and 0.6 to 1 p. c. of Alcohol. It dissolves caoutchouc, gutta percha, oils, fats, resins, many of the balsams, and most of the alkaloids. Dose, internally, ♏ij-xx; by inhalation, ℨj mixed with air and repeated until anaesthesia.
- Aqua Chloroformi, Chloroform Water,—a saturated solution, containing one-half percent. Dose, ℥ss-ij.
- Emulsum Chloroformi,—4 p. c. Dose, ℨj-℥j.
- Spiritus Chloroformi,—6 p. c. Dose ♏x-ℨj, diluted.
- Linimentum Chloroformi,—30 p. c. in Soap Liniment 70.
- *Linimentum Chloroformi Compositum, Compound Chloroform Liniment,—Chloroform 1, Oil of Turpentine 1, Laudanum 1/2, Tinct. Aconite 1/4, Soap Liniment 2 parts by volume. An excellent anodyne application.
- *Chlorodyne, Chlorodyne,—A secret and very dangerous proprietary preparation, supposed to contain Chloroform, Ether, Morphine, Cannabis Indica, Hydrocyanic Acid, Treacle, etc. Dose, ♏v-xxx. Imitations are prepared by several manufacturing drug-houses, and are sold under the names Chloranodyne, Elixir Chloroformi Compositus, etc. A comparison of the published formulae of ten different samples, shows that they contain Morphine in various proportions, namely from 1/4 gr. to 8 1/2 grains in the fluid ℥;—or, taking the average dose at ♏xv, the contained quantity of Morphine would vary from gr. 1/128 to gr. 1/4 per dose. A similar preparation was introduced into the last edition of the British Pharmacopoeia, under the title Tinctura Chloroformi et Morphinae, of which each 10-minim dose contains ♏1 1/4 of Chloroform, gr. 1/48 of a Morphine salt, and ♏5/8 of Dilute Hydrocyanic Acid, with other ingredients.
- *Anaesthetic Mixtures. That of Nussbaum has of Ether 3 parts, Chloroform 1, Alcohol 1. Another, much used, contains of Ether 3 measures, Chloroform 2, Alcohol 1.
Action of Chloroform compared with that of Ether. Chloroform is much more irritant to the mucous membranes, and causes violent gastro-enteritis if swallowed undiluted. It is less of a stimulant, and more depressant to the heart and circulation. It clots the blood outside the body, making a mass like sealing-wax. In dose of ℥j internally, it will cause death. By inhalation it is considered much more dangerous than Ether, its vapor requiring admixture with 96 1/2 p. c. (?) of air to produce anaesthesia with safety. Its vapor is less irritant, however, to the air passages, uninflammable, more pleasant, more prompt in action, has a shorter stage of excitement and a more profound narcosis, and does not cause so much vomiting. Its mortality is much greater, being about 1 in 3000, against 1 in 16,000 for Ether, and fatal cases are constantly reported, none of which, however, were in obstetrical practice.
The results of the labors of the Hyderabad Chloroform Committee show that both these agents act in the same manner upon the heart and respiration, paralyzing the latter first, but Chloroform acting more quickly and powerfully than Ether in both directions. Prior to this investigation it was taught that death from Chloroform inhalation is almost always sudden, and by cardiac paralysis,—from Ether, slow and usually by paralysis of respiration.
Modes of Dying from Anaesthetic vapors.
- Death may occur early in the inhalation, from sudden paralysis of the cardiac ganglia. Or by a small quantity of Chloroform given for minor operations the cerebral hemispheres may be suspended, but not the basal or medullary ganglia, permitting the irritation of a sensory nerve (especially the 5th) to transmit reflex inhibition over the pneumogastric upon the heart, thus arresting the action of its motor ganglia. The state of incomplete anaesthesia is always a dangerous one in which to perform any operation, especially when the 5th nerve is implicated therein, as in the extraction of teeth.
- In the stage of rigidity, from fixation of the respiratory muscles, the blood backing up on the venous side and arresting the heart's action.
- In the stage of complete relaxation, by paralysis of respiration; or by paralysis of the tongue, causing obstructed respiration.
- In the same stage, by paralysis of the cardiac ganglia.
- From depression of the functions, or shock, in the anaesthetic state, or afterwards.
Contra-indications for the use of Anaesthesia. Fatty degeneration or dilatation of the heart, kidney disease, emphysema of the lungs, very enlarged tonsils, tumor of the brain, and chronic alcoholism—particularly the first and last named.
Treatment of Dangerous Symptoms. The vapor should be withdrawn and the patient inverted, head downwards, if cardiac failure occurs. Drawing the tongue forwards, artificial respiration, and faradization of the respiratory muscles, if breathing ceases. Warmth to the body and limbs. Atropine by hypodermic injection.
If swallowed, the stomach should be evacuated, and the case treated as one of poisoning by an irritant. There is no chemical antidote.
Therapeutics of Chloroform. It is used for the same conditions as is Ether, and is much employed locally in liniments, as a rubefacient and anodyne, as in—
- Rheumatic and Neuralgic Pains of chronic character,—with Oil of Turpentine or Camphor, in a soap liniment. See Linim. Chlorof. Comp. p. 139.
- Cholera,—The Spirit, or Chlorodyne, has been more efficacious in true cholera than any other single remedy.
- Respiratory Neuroses, as hay fever, spasmodic asthma, reflex cough, etc.,—the vapor of ℨj of the Spirit inhaled from hot water.
- Sciatica, Tic-douloureux and other neuralgiae of important nerves,—the deep injection of ♏v-xv (?) of pure chloroform into the vicinity of the nerve is most efficient treatment (Bartholow). In my only case it caused dangerous local disturbance (H. C. Wood).
As an Anaesthetic its use is lessening every year in favor of Ether, except in obstetrical practice and for young children. Its vapor being four times denser and heavier than air, and its effective use requiring not more than 3 1/2 per cent. (?) of Chloroform vapor, its administration requires most careful management. Dr. Sayre ignores the foregoing rule and always shuts off all atmospheric air, claiming a more complete anaesthesia from a very small quantity (♏xv-xx) of Chloroform.
An ounce of Brandy, and a subcutaneous injection of Morphine, gr. 1/5, and Atropine, gr. 1/120, twenty minutes before commencing the inhalation, are means of great utility in sustaining the heart and respiration, and in rendering the anaesthesia more profound.
A Compend of Materia Medica, Therapeutics, and Prescription Writing, 1902, by Sam'l O. L. Potter, M.D., M.R.C.P.L.