Graves's disease and peripheral neuritis.

Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Graves's disease and peripheral neuritis. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    obvious advantages, and by imperceptible means become on their part warm and perhaps able, if not altogether sincere, supporters of it. Lastly, there is a third set to whom cycling comes as a business. For the sake of saving time, or of carrying loads or other useful task, they train themselves into cycling labours and cycling habits—become, without offence, cycling animals—and find they can perform labours otherwise impossible with comparative immunity from injury. The evidence which men of science can alone accept lies between these three sources, the last probably affording the best; and the evidence is to the effect that, excluding those who are not fitted by constitution to ride at their own physical and mental expense, cycling is as safe as any other exercise if it be taken in a moderate and common-sense manner. TWO CASES OF DEATH DURING THE ADMINIS- TRATION OF CHLOROFORM. We regret to again have to chronicle two of these sad catastrophes—one at Cardiff and the other at Halifax. The circumstances of the Halifax case are as follows. The patient, a female aged seventy, was put under chloro- form in order to remove a small malignant growth from the left labium major. A similar operation had been performed some five months previously, also under chloro- form, and with success. The second operation was entered upon at the patient’s request, the attendant pain being so intense. An examination preparatory to the second administration showed the patient, who was in good health and spirits, to have a regular and strong heart beat and pulse, with absence of any abnormal sounds in the chest. She was somewhat corpulent, and the cheeks were a little puffy and lax. Chloroform was administered on a single layer of lint, a few drops at a time at short intervals. The left temporal artery was kept under constant observation, and all the ordinary precautions were taken. The patient took the vapour well for about ten or twelve minutes, the breath- ing and heart's action remaining regular and unembarrassed, and the pupils acting to light and touch. Increase in rapidity of breathing and some movements of the limbs indicated the stage of excitement, which lasted about a minute and a half. Unconsciousness then followed, the pulse and breathing still remaining good and the pupils contracted and insensitive. The operation was then commenced, and when, upon the primary incision round the growth being completed, the patient suddenly stopped breathing the pulse at the wrist disappeared, the pupils rapidly dilated, and the face became cyanosed. The operation was at once stopped, the tongue drawn out, and artificial respiration resorted to. The heait sounds were perceptible for some five minutes after the breathing had stopped. Nitrite of amyl, hot and cold water, and hypodermic injection of ether and brandy were resorted to, but all in vain. Artificial respiration was kept up for about an hour, but there was no reappearance of the pulse or lessening of cyanosis. Death, it appeared, resulted from paralysis of the respiratory centre. The reasons for giving chloroform in preference to ether were the successful administration on the previous occasion, the fact that she had suffered from a little bronchitis in winter times, and the desirability of avoiding vomiting after the operation. Duncan and Flockhart’s chloroform, sp gr. 1497, was used to the total amount of three drachms and a half to four drachms. The patient had been properly prepared for the operation. No necropsy was made, but an inquest was held, and a verdict in accordance with medical evidence was returned. The case at the Cardiff Infirmary has, it will be seen, points in common with the Halifax case, and certainly no efforts towards resuscitation were spared. The patient in his case was a female aged twenty-eight, married, childless, rd was admitted to the Infirmary on July 25tb, suffering !/ from gastric ulcer. Certain symptoms rendered it desirable that a vaginal examination should be made under an anaes- thetic, and on Aug. 24th chloroform was administered on a single thickness of lint from a drop bottle. Not half a drachm had been given when the patient, who had passed through a short struggling stage, became pallid, respiration took place by short gasps, and the pupils became dilated, although but a second or two previously the patient had been moving. The administration was immediately dis- continued, the head was lowered, the foot of the bed was raised, and the toDgue was drawn forward. The heart was at once listened to, and its sounds could not be heard. Natural breathing ceasing, artificial respiration was commenced Brandy and ether were injected under the skin, and an enema of brandy was given ; flannels wrung out of very hot water were applied over the heart, and hot bottles to the ex- tremities. The patient was inverted. The interrupted current was used with both poles over the heart and also with one pole over the diaphragm and the other over the phrenic nerve. Two aneurysm pins were fixed to the battery terminals and passed into the heart itself through the chest wall. Artificial respiration was kept up for one hour and a quarter, but all efforts to restore animation failed. No steps had been taken to commence the examination of the patient, who had not been disturbed in bed. The heart had been several times examined previously, and no abnormality, func- tional or organic, was detected. A limited post-mortem examination was made, and the heart cavities were found to be empty and the walls somewhat thin and flabby, but the muscle was of a good colour, and there was no excess of fat. An inquest was held on Aug. 25th, and a verdict of death from failure of the heart’s action under chloroform was returned. THE CREMATION OF INFECTED AIR. Some twelve years ago Professor Burdon Sanderson, in hie evidence before the Royal Commission upon Small-pox and Fever Hospitals, suggested that the risk of aerial convection of disease might be met by disinfecting the air passing from infectious wards. He proposed that the foul air should be drawn along definite channels and sterilised by exposure to heat. In view of the steadily increasing body of evidence which goes to show that, as regards small-pox at all events, the daDger is a real and pressing one, attempts have been made of late to carry this suggestion into practice, and notably in the hospitals recently erected by the Nottingham, Barnsley, and Bradford Corporations. How far these attempts have been successful may be learned from a memorandum just issued by the Local Govern- ment Board, in which Dr. Barry recounts the results of a series of careful experiments made at each of the institutions in question. In each case the architect had sought by means of furnaces in the course of the outlet shaft to secure the double object of artificial ventilation by extraction and the “cremation” of the outgoing air. At Barnsley and Nottingham gas-furnaces were employed for the purpose, and air was admitted to the wards by windows and ordinary inlet-ventilators, while at Bradford extraction was effected by a powerful furnace to which the outlet flues were conducted, and special inlet flues were provided through which alone air was permitted to enter. In the two former places the results were in no sense satis- factory. The extraction was insufficient to prevent occasional outflow of air from the ward through openings meant to serve as inlets only, and the air, after passing the furnaces, was found to be by no means sterile, but, on the contrary, to contain microbes capable of cultivation on agar-gelatine. The draught, too, tended to extinguish the gas jets, and at the Nottingham Hospital bits of cotton-wool and tissue paper were carried through intact. At Bradford, again, the