About Chloroform as an Anaesthetic Agent

Surgical procedures are painful, no doubt. Even with the advancement of medicine in the field of anaesthetic, certain complications are to be expected among patients who were receiving anaesthesia (regardless of types) such as bradycardia, post-puncture headache, hypotension and feeling pain despite an adequate dose of analgesia. How do we know exactly whether the patient who is being operated is in pain? Most of the indications were clinical (there is no machine which can tell you with an absolute certainty that the patient is in paint) and often judged based on the patient's vital signs which can be quite suggestive of pain, for example, increase in blood pressure and heartbeat could indicate that the amount of analgesia being given to the patient was inadequate. Eventually, an anaesthetist in-charge will increase the analgesic's/any other drugs dosage to achieve stabilisation which will provide a less painful experience for the patient.

Being sedated during surgery is the main principle of anaesthesia (although some procedures don't require sedation; local anaesthetic for example) coupled with other agents which could alleviate pain and reduce movement to provide surgeons with optimal surgical conditions thus reducing post-operative complications. There are a lot of fine arteries, veins and nearby organs that can potentially be damaged during operation if patients were moving thus usage of muscle relaxants (either depolarising or non-depolarising) are justified to facilitate certain procedures. Even though nowadays, there are a lot of chemicals which can be used as anaesthetic agents, back in the day, the number of options to alleviate pain is quite limited. In 2250 BCE, most of the toothache cases experienced by Babylonians were treated by giving Henbane, a type of plant which is quite poisonous, often being used to treat some medical conditions such as asthma, cough, nervous system-related diseases and sure, a toothache.

If you were thinking, sedation before operative procedures are only practised after we discovered modern medicine, you were wrong.

• In 650 BCE, most of the priestesses utilise ethylene fumes to induce sedation among patients before any kind of procedure.
• In 400 BCE, Assyrians discovered that they can induce unconsciousness temporarily by compressing the carotid artery to carry out a few simple surgical procedures such as cataract surgery and circumcision without too much fuss.
• In the year 160, Hua Tuo performed surgery after patients have been induced with a method resembles the general anaesthesia by utilising a mixture of wine and herbs called Mafeisan.

People generally understand the importance of putting patients in an unconscious state before starting an operation but as there were a lot of complications (including death) which have been documented in a lot of journals associated with certain types of anaesthetic agents, people grew restless. There are a lot of modern anaesthetic agents which are not being used anymore due to their fatal complications but people in the past don't have much choices on that matter, really. In this article, we will discuss regarding one of the anaesthetic agents which have been held in high regards in the past after it was used to ease up Queen Victoria, during her childbirth. Let's talk about @chloroform.

Exploring A 170 Years Of Controversy

Even though chloroform was discovered by three independent researchers in 1831, people are not aware of its anaesthetic properties until it was eventually demonstrated in 1847 by a Scottish obstetrician named Professor James Simpson. He tried to search for an "ideal" anaesthetic chemical that can be used to anaesthetise patients during operation while imposing minimal side effects (pain, for most of the parts). His determination stemmed from his bad experience of witnessing a breast-removal operation that was carried out in 1827 when he was a medical student. Back then, reliable anaesthetic agents were yet to be discovered thus surgical procedures were usually carried out with speed and precision to reduce patient's suffering. Feeling pain was considered inevitable so patients depend heavily on surgeons' skills while they were held down by devices to prevent movements.

Throughout the surgery, Simpson felt traumatised as he had to witness suffering from the patient as surgical cuts were made. Her movements were restricted by both leather straps and a few other attendants, so it was pretty much messed up gores that had to be dealt with as soon as they were able. It's not a sight that you would have admired or cherished and he nearly quitted medical school because of that; fortunately, he didn't. Instead of quitting, he pledged himself to find a suitable anaesthetic agent that could alleviate suffering among patients especially in a surgical setting. Most of the answers he acquired from his professors when he was a medical student were discouraging and only when he was a full-pledged medical officer that he could experiment with a number of chemicals and procedures to test their efficacies on his patients; he ever tried mesmerism!

People often used the word mesmerism and hypnosis interchangeably, but both of them induced trance (an altered state of consciousness) through different methods. Mesmerism focused on using non-verbal cues like gaze, strokes etc. while hypnotism used verbal cues. Of course, mesmerism is not a good choice when it comes to medicine, even its founder, Franz Anton Mesmer was chased out from Venice for practising it, but Simpson was willing to try anything for the sake of improving the current state of surgical protocols; still, none of it works. In 1846 he heard about a chemical called ether which can be used as an inhaled agent to alleviate pain during dental procedures. He tried to use it in his medical practice but he soon realised that there are a lot of side effects caused by that particular volatile agent, not to mention back then, a huge portion of the medical community opposed to the usage of volatile agents as anaesthesia. Despite the frustration, he learned a considerable amount of experience and knowledge regarding volatile compounds.

Exposure to all kind of volatile compounds brought him to chloroform in 1847, a year after his failed attempt at using ether as an anaesthetic agent. Mind you, volatile compound is a hot topic since the discovery of chloroform in 1831, but their potential benefits were regarded less than what they deserved. On November 1847, he revealed chloroform as a potential anaesthetic agent that can be used to induce patient pre-operatively. His discovery is so significant to the point that he was credited for discovering it and responsible for saving Queen Victoria during her childbirth from suffering; neither of which is true. According to the history press, although Simpson's works after the discovery of chloroform can be thought as significant or probably greater than chloroform, it received less attention by the medical community and public alike; everyone wanted to celebrate or hate him for the discovery of chloroform; so unfortunate.

He recognised the fact that chloroform is a powerful agent that can be used to sedate people during surgery and at the same time, took lives if the dosage applied to an individual were excessive. There were a lot of debates, quarrels and confusion regarding the usage of such agent which requires a careful consideration of patients condition which can ultimately cause death if it was to be miscalculated. It is, however, worth noting that, the usage of chloroform has revolutionised battlefield medicine due to its quick onset of action, ease of use and high rate of success which has been documented on numerous occasions during wars.

In the war in the Crimea, the British used chloroform almost universally in their operations; the French also exhibited it very extensively, and Baudens, one of their leading military surgical authorities, declares that they did not meet with one fatal accident from it, although it was given to them during the Eastern campaign, thirty thousand times at least.

In America, however, chloroform was only recognised as one of the most effective anaesthetic agents after a civil war in 1861 thus being used by physicians for routine surgeries. It was kinda appropriate to start using such inhaled agent after it was documented in the records regarding the use of chloroform as a preferred agent to treat 80,000 people (through surgical methods) without too much fuss; they either used chloroform alone or mixed it up with ether to enhance its therapeutic effects. Even though the success rate seems high, there were a lot of deaths that have been documented as a part of the consequences caused by chloroform, starting with a child in 1848, a year after Simpson started using it as a preferred anaesthetic agent. Miscalculation or overextending the exposure of such chemical to patients can cause cardiac arrest and thus death within 2 minutes. When Simpson first discovered the anaesthetic property of chloroform, he tried it on himself, putting him in a deep sleep. Fortunately, he woke up the day after or the world will be deprived of such anaesthetic agent a few decades after his announcement.

Chloroform In Criminal-Related Activities

I think people are quite familiar with the idea of chloroform being used by criminals to induce their victims' into an unconscious state so that they can be abducted or killed with ease. Even though this idea is quite popular, most of the papers out there seem to agree with the fact that applying chloroform to a handkerchief and such is considered a poor tool to be used in abductions and any related crimes that are required unconsciousness of non-consenting individuals. There are a few cases that can be given as evidence but most of the popular press seems to hate if this fact proved wrong; they still believe that in any criminal activity which used chloroform, the chemical itself is the reason for people to be unconscious. Well, the method of inducing victims seem to resemble the act of inducing patients before an operation but there are a lot of factors that can be considered before saying chloroform is the root of all evils.

In 1850, an elderly clergyman stayed in Temperance Hotel located in Kendal, Cumbria, England. He was on a mission of collecting donation for the needy and successfully collected eleven gold sovereigns which are considered a lot. Unfortunately for him, a young man who travelled alongside him planned to steal those sovereigns so he soaked a towel with some chloroform and hid inside a closet while the clergyman was busy doing something else. When the clergyman about to go to sleep, he tried to lock the door by using a chair since the lock is broken and a few seconds after, the young man attacked him while covering his face with the towel, attempted to knock him down. It will be easier for him to hit the clergyman's head rather than using chloroform, the clergyman scream and fight violently and the other guests from other rooms came to see what happen. The young man was arrested and he was sentenced to 18 months of jail time. There are many cases which resemble this one but none of it was accepted as the truth by the public presses in 1865. People wanted to hear that chloroform can actually be used to commit crimes.

In 1854, an ophthalmic surgeon named William Wilde began treating Mary Travers for a few years until later in 1862, she claimed, allegedly, that she was raped under the influence of chloroform by the surgeon himself. The thing that was interesting regarding this case is, although she claimed that she was raped in 1862, the report which was written by her to the presses was submitted in 1864 when William Wilde was awarded a knighthood for his contribution in Irish census. She was treated by him for those 2 years and this accusation seems suspicious. Moving on, William Wilde's wife submitted a letter to Mary Travers who's at the time working as a professor of medical philosophy in Dublin. When Mary Travers found out about this, she sued Lady Wilde for defamation. Mary Travers won that case but the penalty imposed on William Wilde was so low that it wouldn't affect his reputation at all. People started to become suspicious as to why this was the case. This case was then discussed by two journalists which favoured Sir William Wilde and they were sued for defamation by Mary Travers too; only this time, she lost.

There are a few possibilities that could have influenced Mary Travers as of why she behaved that way. The rape accusation might be alleged but when we are talking about the truth, Mary Travers might have spoken it, I mean the truth; only it never happened in the first place. A lot of this kind of accusations have been received throughout the years and some research which are conducted much later proved that chloroform can induce sexual hallucination. This effect, however, is not specific to chloroform but also the other inhaled anaesthetic agents. Apart from making you happy, it can strengthen sexual emotions which lead to hallucinations that can be considered erotic. In 1888, a paper written by Buxton DW described a case whereby a patient achieved sexual orgasm during induction with an inhaled anaesthetic agent. Quite interesting, isn't it? Oh yeah, chloroform also is quite addictive. There is some documentation (quite old) which described patients who are addicted to inhaled anaesthetic agents to improve sexual performances.

Conclusion

Even though chloroform was proven to be a great anaesthetic agent in the past, it was replaced by much better gases that would be able to maintain unconsciousness with fewer side effects. If someone said they were being raped under the influence of chloroform, that case needs to be investigated first. Even though chloroform is a poor tool to be used by a criminal, people can be knocked out by it; they just need to be still for a few minutes as the concentration of the chloroform used might have been mild than what have been calibrated for surgical uses.