Medical Uses of Chloroform _Ynhalat~on. By DR. C. KIDD. 83

ART. IV.--The Medical Uses of Chloroform Inhalation. CHARLES KIDD, M.D.; M.R.C.S.E., London.

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THE medical uses of chloroform, or rather its administration in medical as contrasted with surreal cases, begins to assume a form of very considerable interest and importance to the practising physlcian--not so much as an agent capable of removing slight or severe pain in neuralgic or purely spasmodic affections, as in controlling dangerous convulsions in the adult or infant, as a remedy also, or auxiliary of great usefulness in various forms of epilepsy, though not so effectual in simple hysteria, chorea, or delirium tremens. The medical uses of chloroform, in a word, have not been recognized sufficiently ; its far wider and more brilliant aid to the operating surgeon having somewhat eclipsed its occasional applicability in the less demonstrative clinical wards of the physician. In cases of puerperal convulsions--which come under the notice of the general practitioner or young obstetric physician--the varied experience of all, or of the best obstetricians, agrees that whether we have albumen in the urine or not, the careful, skilful adminis- tration of chloroform, even before adoption of the lancet, seldom fails to afford marked relief, and that in a majority of cases we may dispense with the excessive veneseetions of former times; chloroform in such cases, of course, is not to supersede other means usually had recourse to, such as delivery, &e.

In cases of severe agony, and jaundice attending the passage of gall-stones, the inhalation of a drachm or two of chloroform will often act llke a sudden charm in affording relief from paln and spasm. I t is probable here, that there is produced a relaxation of the ductus choledicus, and associated muscular or nervous fibres of the adjacent diaphragm, duodenum, abdominal muscles, &c., all thrown into spasm by an irritating calculus ; it is curious, too, that jaundice has been occasionally produced by chloroform, especially when given in small or irritant doses ; but this is a much more rare phenomenon than the cure of jaundice by it.

A case of the following kind has come under not ice: - -A gentleman in the higher circles of society, an old gentleman subject to bad attacks of jaundice and gall-stone, in the country, was supposed to be at the point of death from "black jaundice" and impacted gall-stones; an entire week of horrible agony had passed; warm baths, blisters, purgatives, globulistic remedies, ipecacuanha,

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84 The Medical Uses of Chloroform Inhalation.

and every other conceivable remedy had been tried in vain. Opium had made things worse, and emetics no better; a fair trial, in one word, was given, or supposed to be given, to the good old classic abracadabra of Copeland and Watson, that

"Old Experience which doth attain To something of prophetic strain."

Experience of all kinds had been summoned from the nearest country town; but with amiable suavity, Old Experience had pro- nounced the ease incurable; it ht~ been well excogitated that the bile secreted by the hepatic cells had probably regurgitated along the cystic duct into the gall-bladder; there stored up it became concentrated; how cholesterine (not Dr. Th~dieum's blood cor- puscles) had formed a calculus, with much more, all pointing to sadly established organic disease of the worst kind. In this emergency, as a matter of "ridiculous form," as it was said by Old Experience, a young but eminent city physician was summoned by telegraph--a man of the new school, eclectic and sensible, who are glad to adopt remedies from whatever side of the compass they come.

"Have you tried chloroform," he ventured to ask in consultation ? "Nothing like leather--of course not; but perhaps you would like to do so." To which he replied in the affirmative.

A few drops &chloroform, in fine,were tried, with the best possible result; the agony of the gall-stone yielded as if by some potent spell, the simple rationale of the cure being that it relaxed the muscular fibres, perhaps, of the pylorus and duodenum, the gall-ducts, diaphragm, &c., and allowed the gall-stone to pass, whereas previous purgatives, blisters, opium, &c., had only tended to derange the healthy sympathy which usually exists between the mucous membrane of the duodenum and the bile passages. In a sad case of this kind, not very long ago, it will be remembered, one of our most eminent members of Parliament died of the agony of gall- stones, and the derangement brought on by large doses of opium; it is probable one drachm of chloroform would have saved his life.

In some of the worst sufferings of uncomplicated asthma and in hooping-eough I have known the inhalation of chloroform to prove very beneficial; indeed it is clear that the often-vaunted popular cures of hooping cough, by children inhaling the" vapour at gas works, is easily and only to be explained by the calming influence on the glottis of some of the many gaseous carbo-hydrogens

By DR. CHARLES KIDD. 85

belonging to coal-gas, so like chloroform. I have known also the popular specific, or liniment of oil of amber, camphor, &e., for hooping cough, to prove far more useful when chloroform and ether were added to the formula--the liniment rubbed*o the chest and neck, rather than in the time-honoured method, to the spine of the child. I f hooplng cough (as it often is) happens to be mixed up with bronchitis, ~r if asthma be associated with emphysema, the chloroform will cause disappointment if it does not aggravate matters. _& little antimony for the bronchitis may, however, be com- bined with ~he inhalation method, and will never disappoint in the bronchitis of children ; the direct application of solution of nitrate of silver to the glottis, in hooping cough, is also facilitated by the use of chloroform.

Again, in various forms of epilepsy, though theory at first contraindicated the administration of anesthetics, subsequent expe- rience has fully established the fact, that, contrary ~o presupposed views, chloroform in full doses controls the epileptic fit; and while good breathing is kept up there is no cause of apnea, or alarm from suffocation. I t is however as an auxiliary--ln allowing a full examination as to the peripheral origin of the epilepsy, and surgical interference, by caustic or knife, leading to the cure of hundreds of such cases--that, chloroform has remodelled the entire practice of epileptic diseases; the mechanism of the epileptic fit has no~ been so well explained by Brown-S~quard, Reynolds, and others; and the fit itself so often found to depend on external or peripheral sources; for instance, irritation of bad teeth, worms, external excitement of the gcnito-urlnary organs, that a trial of chloroform, especially in female epileptics, seldom fails to yield suggestive results. Chloroform, on the other hand, is of less value (if not attended with positive risk) in hysteria and chorea; it is also of questionable safety in the debility of delirium tremens and puerperal mania; but in the other affections detailed--convulsions, asthma, hooplng cough, gall-stones, obstetric practice generally, and many other purely medical cases--it will seldom fail to give most beneficial results.

In these observations I have not dwelt on the use of chloroform, except by inhalation. Every one, however, now knows the great usefulness of " chlorodyne" in all the several varieties of which Roscoe and others have shown that chloroform is the active agent, though at first denied.