The Lancet and the Hyderabad Commissions on Chloroform : being the report of the Lancet commission appointed to investigate the subject of the administration of chloroform and other anæsthetics from a clinical standpoint, together with the reports of the first and second Hyderabad Chloroform Commissions.

  • Lancet Commission on Chloroform.
Date:
[1896?]
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Licence: Public Domain Mark

Credit: The Lancet and the Hyderabad Commissions on Chloroform : being the report of the Lancet commission appointed to investigate the subject of the administration of chloroform and other anæsthetics from a clinical standpoint, together with the reports of the first and second Hyderabad Chloroform Commissions. Source: Wellcome Collection.

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    spiration became suddenly arrested. Half an hour afterwards, t amongst other means for restoration, he was bled, and gas was observed in the stream which flowed from the vein. Half an hour later he made his first, independent inspiration. SO.—Male, aged 24. Cautery for injury to spine. I'ulse and respira- tion failed together. At first pulse and breathing good, but respiration ceased suddenly and completely. Mouth and rima glottidis cleansed from mucus ; head allowed to hang over edge of bed for few seconds; body placed on floor and needle and thread passed through tongue which was held forwards; artificial respiration, cold water thrown on body and ammonia to nostrils. After 6 minutes with more artificial respiration heart began beating but no breathing'. Hard slaps, cold water on face and chest, blowing down fauces, trial, hut useless. At last deep inspiration, then others. Galvanic battery tried with (accidentally) full force of current from 50 cells, but this sud- denly and successfully resuscitated patient. This was I be 5tli time the operation had been performed, each time under chloro- form. Patient cheerful and intelligent. Spare, fair and boyish- looking. Had lost all sensation and voluntary movement below waist. 91. —Female. Ovariotomy. Pulse and respiration failed togethng Operation had just been commenced when respiration suddenly stopped and the heart ceased to beat—bleeding ceased and lips of wound bloodless. Mouth cleansed from mucus, tongue drawn forwards, patient’s head thrown well hack and artificial respiration for 10 minutes—without result. Case almost des- perate when surgeon put large cloth in boiling water and applied it to cardiac region. Pulse and respiration returned, operation not terminated. 92. —Female. Removal of uterine polypus. Pulse and respiration failed together. Operator had just passed hand into vagina and was about to apply ecraseur when pulse suddenly stopped. Respiration ceased almost simultaneously. Jaw dropped and tongue lay between teeth. Percussion of heart, artificial re- spiration (Silvester’s method), cold affusion, and hypodermic of ether tried with no avail for 3 or 4 minutes. Patient then seized by shoulders and placed on fioor and legs elevated. Pulsation in neck began. Was placed on bed. Distinct car- iliac action but respiration suspended ; again pulse grew feeble. Re-inverted for 2 minutes ; strong palpitation began, followed by few gasps. Several distinct clonic convulsions of right side. Respiration became natural, and after 5 minutes of quiet sleep patient awoke. Operation deferred. Had been put under chloroform for same operation on 31st of October, 1S80. Took anaesthetic well. Present operation took place 6th of March 1 881. How far interference with genital organs provoked the syncope could not be said. Operations on testicle not thus provocative if chloroform narcosis deep enough. Midwifery experience against such a presumption. It was possible that the powerful stimulating- properties of the ether was overbalanced by the addition to the narcosis. 93. —Male, aged G6. Removal of upper jaw. Chloroform given through nasal catheter. Respiration failed before pulse. Short time after commencement of operation, respiration be- came shallow and at length ceased. Heart’s action kept up with vigour. Artificial respiration. Patient recovered, hut did not make any efforts at breathing till the artificial respiration, had been kept up 10 minutes, together with tickling his sides, which had the chief effect. Operation then proceeded with ; only small quantity of amesthetic given; respiration occasion- ally threatening to cease. Patient died 2 days after operation, apparently from exhaustion. Post-mortem. Lungs emphyse- matous, right adherent. Heart: slight fatty degeneration of muscle. 94. —Male. For cleft palate (1 hour). Pulse failed first. Had been on table nearly 1 hour when pulse began to flag, which at last could not be felt at wrist. Cessation of respiration followed. Gag being removed and head lowered, preparatory to artificial re- spiration, both pulse and respiration were established Patient not deeply under influence of chloroform, owing to depressed condition, vomiting and loss of blood. 95. —Male. For relief of nephritic colic. Pulse probably failed first. Pulseless, gasping for breath; apparently dead. 1 dose of morphine (hypodermic) had been given (with hot bath) before chloroform, and with chloroform a dose of morphine by the mouth and dose of morphine and atropine (hypodermic). Pain suddenly relieved (probably by passing the calculus from ureter into bladder), but “ sudden relief from pain caused narcotics to have the greatly increased effect.’’ Was resusci- tated after efforts of 2 hours. See also New York Medical Record, September 2, 1882, p. 274. Here it is considered that the well nigh fatal result was due to inhalation of chloroform while giving morphine. 96. —Female, aged 19. Excision of el bow-joint for anchylosis. 2-4 drs. given. Respiration failed first. Operation hardly begun when breathing completely stopped. Face became pallid, but pulse was felt in radials throughout. Artificial respiration (first direct, then Silvester’s method) was kept up with momentary stoppages; windows opened ; chest with shoulders raised, and head thrown hack and lowered; was flipped with cold water towels, &c.; faradaic current applied, one pole over phrenic, oilier over epigastrium. This brought on action ot diaphragm and abdominal muscles of expiration, greatly aiding voluntary resp! ration, now almost restored. This followed by prolonged drowsiness; stimulants administered ; cold water dashed in face and ribs kneaded. After restoration from efleets of chloroform, heart examined and prc-systolic roughness found in mitral area. Had scarlet fever when ID years old. Her father died of heart disease, aged 58. Patient had taken chloroform well 3 (lays before. Operation successfully performed under ether a week later. 9 7.—Female, aged 5. For diagnosis for vesical calculus. 1 dr. of chloroform given. Pulse and respiration failed together. Greyish lividity, gasping for breath, cessation of heart-heat. Ether injection in leg; inversion ; intermittent pressure on chest walls; holding lower jaw forward. Breathing and pulse returned, hut both very feeble for J hour. Inversion continued for 1 hour. When patient was laid down (which was twice in hour), face became pale and pulse flickered. Full restoration after 2 or 3 hours. Heart and lungs healthy. 98.—Male, young adult. Removal of right middle linger at centre of metacarpal bone. Chloroform given on handkerchief formed into cone. I’ulse and respiration failed together. No blood flowed from wound, and expression of face became deathlike. Pulse barely perceptible, and had almost ceased to breathe. Strong friction w ith turpentine on the limbs and trunk towards the heart after a time restored animation. 90.—Patient, aged 3. For cancer of left eye. Pulse and respiration failed together. Operation had proceeded no further than division of the conjunctiva when respiration ceased, and also pulse at wrist. 3 or 4 times anesthesia had to he stopped, child being held head downwards, and operation being per- formed while child thus suspended. Inverted position kept up *| hour. 100. —No particulars. 101. —Boy. For crushed thigh. Appeared to be dead. Was inverted till life re-appeared. 102. —Death seemed imminent, from stoppage of heart. Heart stimulated to contraction by pretty heavy blows administered with open palm over the cardiac region. 103. —Male, aged 10. Extraction of teeth. Pulse failed first. Before operation was begun, pulse very weak. Chloroform withdrawn, and pulse became strong. Chloroform re applied ; pulse again failed, but returned when chloroform removed. 10 minutes after, ether used, with Clover's inhaler, and pulse became full and strong. Teeth successfully extracted. 104. —Female, aged 5. (.1 minute.) Pulse and respiration failed together. Appeared quite dead, pulse and respiration ceasing at same moment. Artificial respiration ; but as natural colour was leaving face, and replaced by livid pallor, nitrite of amyl also used, being held to mouth as air produced by artificial respiration was passing in and out. At last there was a sound as if vocal cords were moving; artificial respiration still kept up, hut upon cessation lor a moment patient was found to be naturally breathing. It was 5 minutes after the commencement of taking measures before signs of life appeared, it was con- sidered that without the nitrite of amyl the child’s life would not have been saved. The cause of apparent death was that although utmost pains had been taken to keep the child from eating anything, she had managed to devour an apple,of which, on becoming' conscious, she vomited stalk, core, and part of skin. The indigestible matter appeared to have caused reflex paralysis of cardiac and pulmonary centres, as at no time was there any obstruction to passage o£ air. Child laid apparently taken no food, and clothes were loose when chloroform given and everything in order. Had been anaesthetised 3 times before without anything unusual occurring. 105. —Male, aged 14. Cauterising chronic ulcer. Respiration failed first. While dressing was being applied and after chloroform had been removed patient suddenly ceased to breathe. Rolling (Marshall Hall’s method); this done for several minutes, but hands became cold and lips purple. Nelaton’s method re- sorted to; the boy's legs were flexed over shoulders of admin- istrator, head and legs dangling to the floor ; was tints carried, at running pace, round room for 3 minutes, until respiration returned by degrees. Was again laid on table. Breathing again became arrested; resort had a second time to sus- pension, which was followed soon again by restored respira- tion. Vigorous and healthy ; taking the amesthetic kindly ; all being effected without auy difficulty. 10G.—Female, young adult. For entropion. Respiration failed first. Wlieu about half through operation respiration suspended, and all efforts to restore it ineffectual. Suspension resorted to, as in last case, and breathing at length restored. Was of large size. Took anaesthetic badly. 107. —Female, aged 7. Tenotomy for strabismus. Probably respira- tion failed first. Struggling during administration, but no untoward symptom till operation completed, when respiration failed and pupils became dilated at same time. Marshall Hall’s method commenced with no success. After some time the child was suspended, and carried round the room by surgeon, then placed on table, and it was found that breathing was noiseless and regular, and the period of consciousness was almost reached. 108. —Male, adult. On testicle. Respiration failed first. Towards