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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    Post-mortem Appearances noted in Ether Toxaemia. 1. —External covering of fat over the heart. Lungsjdightly congested. 2. —Lungs: tubercle in left pleura. 3. —Brain: cyst connected with old hemorrhagic clot. Granular con- tracted kidneys; calculus in pelvis of kidney on right side. 4. —Muscular structure of heart flabby. Lungs congested and bright red. 5. —Fat round heart: right auricle collapsed; walls of both ventricles thin ; endocardium very red ; membrane of aorta red. Clot of blood in trachea. 6 —Brain : hemorrhage under arachnoid on upper surface of middle portion of left hemisphere; extravasations of vessels of left hemisphere; large clot in right lateral ventricle; corpus striatum and optic thalamus softened and broken down ; small hemorrhage in left lateral ventricle ; atheromatous degenera- tion of vessels at base of brain. 7. —Lungs pale and cedematous. (Edema of membranes of brain. 8. —Feeble, flabby heart with fatty degeneration. Lungs emphy- sematous. 9. —Bronchial effusion ; pulmonary and serous effusion. 10. —Left ventricle of heart slightly contracted. Faecal staining of oesophagus and larynx. Kidneys slightly granular. 11. —Valvular lesions of heart. Arachnoid membrane of brain thickened ; effusion of serum beneath it. Cystic degeneration of kidneys. 12. —Heart slightly fatty ; cavities nearly empty. Lungs emphyse- matous ; posterior parts gorged with blood. 13. —Right side of heart dilated, containing post-mortem clots; con- centric hypertrophy of left ventricle, which was contracted and contained post-mortem clot. 14. —Heart dilated; slight hypertrophy; little fluid clot. Pleura covering left lung thick. Kidneys granular. 15. —Cancerous deposits in lungs. 16. —Pus in pleura; fistulous communications between bronchi and pleural cavity. 17. —Lungs deeply congested. One kidney slightly fatty. 18. —Small black mass inside pericardium at root of aorta. Right kidney contained a cyst. 19. —Heart fatty; white clot extending from right auricle into pul- monary artery. Cancerous pleuritis. 20. —Decolourised clot in right ventricle of heart; black clot and fluid blood in ventricular cavity. Calibre of trachea somewhat diminished by projection of goitre backwards. 21. —Heart enormously hypertrophied (31 oz.); mitral valve ossified with calcareous plates at base; aortic semilunar valves also ossified about base. Left lung cedematous. 22. —Heart flaccid ; right ventricle and auricle occupied by soft coagulum ; great increase of fat on surface of same, and very little muscular tissue ; valves slightly thickened ; pericardium adherent. Lungs emphysematous and congested. Bronchitis with quantity of mucus in tubes ; in lower lobes not much air, in upper parts more oedema. Trachea congested, with frothy secretion. 23. —Fibrinous clot in right ventricle attached to tricuspid valve. 24. —Dense infiltration of entire right lung; lobar pneumonia of right lung in state of bloody engorgement. 25. —Fatty heart. 26 —Pulmonary emphysema; chronic bronchitis. Chronic nephritis. 27. —Lungs collapsed. Long-standing and inflammatory disease in brain and medulla oblongata. 28. —Cystic degeneration of kidneys. 29 —Kidneys contracted and granular. 30. —Heart hypertrophied ; pericardium everywhere adherent; coronary arteries of small calibre; slight atheroma of aorta; mitral valve stenotic. Lungs: left pleura, few adhesions; right pleura, many adhesions. Kidneys: left atrophied, capsule adherent, markings indistinct, sclerosis above pyramids, pelves filled with fat; right same ; both surrounded with fat. 31. —Heart covered with fat, especially about apex; right side dilated and full of blood; left empty ard contracted; walls of right ventricle thin; fatty degeneration. Old adhesions in right pleural cavity. 32. —Wedge of meat bad been driven into and become fixed in trachea, occluding both bronchi. 33. —Heart flabby. Lungs much engorged. 34. —Myocardium very fatty ; straw-coloured clot in right ventricle and pulmonary artery. Both lungs very emphysematous and the seat of chronic bronchitis. 35. —Trachea greatly narrowed from the pressure of an enlarged thyroid body. 36. —Pneumonia. 37. —Pulmonary oedema. SERIES A, B, AND C.—CASES OF DEATHS OCCURRING UNDER ETHER. Series A.—In this series, that collected by the Committee of the Royal Medico-Chirurgical Society, no ether cases were recorded. Snow,'2 writing before 1858, says he had heard of only two deaths from ether, neither of which could be reasonably put down as having had any relation with it. Under these circumstances the ether cases recorded below have all been grouped in Series B and C, but Series B includes all cases of ether death recorded from the earliest date of its use. S'cries B and 0. 1.—Male, aged 55. In examination of hip-joint after being thrown out of vehicle. Ether given on handkerchief, 4oz. used. After ten minutes’ inhalation patient vomited twice, then became very weak and perspired profusely. Rallied and ether inhaled for ten minutes more. Examination of limb undertaken, but the patient seemed conscious and screamed. His lips became purple and his breath panting. Patient was then given water with vinegar, and subsequently whisky, but he drank very little. Seemed choking. Water was then thrown on his face, and powerful means for resuscitating him employed for 20 minutes. Death imputed to inhalation of ether, but also ascribed to extreme nervous susceptibility. The patient was clearly not completely under the influence of the ether. In this case the method was a bad one, and the effect of shock upon a diseased system was in no way obviated by the imperfect- anaesthesia. Post-mortem: Ilium fractured in several places; heart normal, except for external covering of fat ; lungs high’y congested. Patient corpulent and a hard drinker. 2.—Male, aged 55. Died instantaneously after inhalation. 3-4.—The recorder of these cases says : “ Decided cases of death from inhaling ether.” 5.—Female. Respiration failed before the pulse. Voluntary respiration ceased, countenance became livid, pulse rapid ; was carried to a window, but at end of 20 minutes was dead. 6-7.—No particulars. 8-15.—No particulars. 16.—No particulars. 17. —Without hemorrhage, but extreme muscular relaxation, coma, exhaustion, intermittent pulse. 18. —Female, aged 40. Removal of urethral polypus and two sebaceous cystic tumours on head. 30 grammes (under 1 oz of ether used). Anesthesia incomplete; ether not pushed further, because stage of excitement did not come on, and coldness and slowness of pulse were present. When operation completed, coldness increased, with clammy sweats, convulsions, and foaming at mouth. Attack passed away, but soon returned—more intense. After fourth attack patient died from eclampsia, attributed to etherisation. Had previously been subject to epileptic vertigo. 19. —Female, aged 48.—Correcting deformity of foot. Pulse and respira- tion failed together. Breathing failed, face pale, pulse ceased ; revived once, but relapsed and died. Syncope from general debility. Post-mortem: Tubercle in left pleura, spinal cord, and hip-joint. Patient of delicate constitution. Ether employed of more than 62 degrees ; contained no foreign substance save 3 per cent, of water. 20. —For excision of superior maxilla. Respiration failed first. Early in operation respiration ceased, and patient died, in spite of ail effort-sat- resuscitation. Death probably only partially influenced by ether. 21 —Male, aged 70. Reduction of fracture. Respiration failed first. Breathing became feeble and irregular ; etherisation suspended. In 4 or 5 minutes respiration and pulse became better. Ether re-administered; bad symptoms returned, and pupils became dilated. Heart still beating, but attempts to resuscitate of no avail. Patient suffering from fracture near trochanter of 18 days’ duration, and from pneumonia. 22.—Male, aged 84. On cancerous gland under jaw. Underwent operation quite satisfactorily, with no failure of pulse, the carotid artery (left side) having been compressed. He went to bed and never became actually conscious, though was able to leave bed to pass urine; sank into state of coma; was treated with mustard plasters on calves of legs and enema of turpentine. Could not swallow food, and was fed by stomach tube. Had several convulsive seizures. Died 40 hours after operation with cerebral symptoms, but post-mortem revealed no lesion of brain whatever, except cyst connected with old hemorrhagic clot on right side, whereas the spasmodic seizures he suffered from were on left side of face. Kidneys both granular, right more so; latter small and contracted; in its pelvis a calculus with moulded conical projections on one side. Chest not examined, but no symptoms from heart or 2 Anesthetics, p. 362.