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?]
Catalogue details

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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    76.—Female, aged 44. For cancer. Pulse failed first. Sudden stoppage of pulse. Every means of artificial respiration tried, but death took place in less than a minute Operation | not begun. Patient not completely anaesthetised. Syncope j Heart examined prior to administration and found to be sound. 76. —Male, aged 46. For relief of over-distended bladder. Clover’s inhaler. Pulse failed first. Before operation commenced pulse suddenly became very feeble, hardly perceptible at wrist; ; lips pale, breathing gasping, pupils normal. Measures re- sorted to were : Drawing out tongue, stimulation of cardiac i area and chest, artificial respiration for £ hour; but pallor 1 increased, and death took place. ? Syncope. No post-mortem j allowed. Hard drinker. Had had tight stricture of urethra for 8 months, and had refused treatment. Heart hyper- trophied, double aortic and mitral murmurs could be heard. Pulse feeble and irregular. Chest barrel-shaped from em- physema Bladder enormously dilated, and urine dribbling away. Penis and scrotum swollen, and almost gangrenous from extravasation Would have no operation without anaesthetic. 77. —Female, aged 41. Removal of intra-uterine fibroid (£ hour). Pulse probably failed first 25 minutes after anajsthetisation it was noticed that the lieait was acting feebly. About 5 minutes later death supervened. Artificial respiration main- tained for 1 hour, a few weak respiratory efforts made after heart stopped. Hypodermic of tincture of digitalis (10 minims) and nux vomica (10minims) also given. Heart failure. Patient was very anaemic, but heart, lungs, and kidneys were in good condition. Had had ether twice before for similar operations. One teaspoonful of aromatic spirit of ammonia and a table- spoonful of brandy were given \ hour before amesthetisation. 78 —Male, aged 50. For tumour in side. Heart examined before administration and nothing abnormal detected. 79.—Male, aged 56. Reduction of fracture of tibia and fibula. Pulse failed first. After operation had been successfully performed, heart suddenly ceased beating, then respiration stopped and patient died. Heart ceased beating 3 minutes after cessation of administration of ether. ? Syncope. Post-mortem : Lungs much engorged ; flabby heart and fatty liver. Was a drunkard. After admission on account of fracture, suffered from deliiium tremens for 10 days. Operation then undertaken. Deaths remotely due to the Administration of Ether. As in the case of chloroform so in that of ether, a certain number of fatalities have occurred while ether was being administered, or after its exhibition, which have been attri- buted to its effects, immediate or remote. These “ remote deaths,” as we may term them for the sake of brevity, have been recorded as of about equal frequency in hospital and private practice. The deceased have been of ages ranging from 8 to 72 years, but most were over 35, and more fatalities have been recorded among women than men. Records have reached us from various parts of England, from France and Spain, but most instances come from the United States, where this anaesthetic is used perhaps more largely than elsewhere. The pulse appears to have failed either after the cessation of respiration or simultaneously with it, although instances are recorded in which primary failure of circulation is said to have occcurred. Operations with which Remote Deaths were Associated, etc. Amputation of arm, of finger : about abdomen : hernio- tomy, lumbar colotomy, ovariotomy ; extirpation of vaginal glands ; for empyema ; removal of tumour from upper jaw ; plastic operation on upper lip ; castration ; forcible move- ment of joints ; operations about rectum ; removal of teeth. With the possible exceptions of the two operations for the relief of empyema, and of the operations for the removal of the maxillary tumour, none are operations which would be regarded as rendering the use of ether fraught with especial danger or difficulty. Of Predisposing Causes for such casualties we have but few records. Only one individual is specially mentioned as having been intemperate ; pulmonary emphysema is recorded in two cases, and several more cases are mentioned in which bronchial inflammatory conditions of the lungs complicated the operation. Vomiting occurred on three occasions, and was probably the immediate cause of death. The Causes Assigned for Death were : asphyxia, either simple or mechanical, as in the cases in which masses of food or vomit entered the air passages and produced suffoca- tion : a case in which bronchitis supervened and proved fatal in a week ; oedema of the lungs; congestion of lungs ; pneumonia ; cerebral haemorrhage ; surgical haemorrhage ; ileo-colitis following rectal etherisation: cardiac syncope (3 weeks after taking the anaesthetic). The Methods of Administration were: a sponge contained in a folded towel; a sponge in a bladder ; Allis’s inhaler : Ormsby’s inhaler; Squibb’s inhaler; an extemporised appa- ratus for rectal anaesthesia. The Measures Adopted for Resuscitation were simply the employment of artificial respiration, the adoption of the dorsal decubitus, stimulation of the praecordium by hot water and the internal administration of stimulants. The Facts Elicited by Post-mortem Examination may be summarised as follows : —Circulatory System, distension of right side of heart; clot in coronary artery (said to have been 3 weeks old); fatty conditions of the heart in 3 cases. Pulmonary System : inflammation, recent in one case ; lobar pneumonia ; engorgement and inflammation of lungs ; foreign bodies in air passages—vomit, food, blood, pus, &c. No renal lesions. In one case cerebral haemorrhages are noted with extensive atheroma present. Series d, No cases. Series B. I. —Male, aged 50. The patient gradually sank and died 4 hours after operation. J-5.—Three males and one female. In each of these cases death occurred 3 hours after operation; hut no particulars are given. 6.—Female, aged 8. Extraction of teeth (20 minutes). Patient vomited, but ether resumed, when she vomited again. The face became livid; was “black in the face.” She was laid on the floor, the tongue drawn forward, and artificial respiration by Marshall Hall's method commenced. She ceased breathing after a few efforts at respiration. Asphyxia was stated to be the cause of death. Post mortem: Mass of undigested liver firmly impacted in rima glottidis.” Was highly nervous. Had no organic disease. Every care used in giving ether, and there was a due admixture of air. Patient had taken no meal for some hours. Ether quite pure, 7. —Female, adult. While lying on back under the ether, vomited and some of the vomit getting into trachea killed her, Asphyxia. 8. —Female, aged 48. Iridectomy. 2o/.. given in Squibb’s apparatus. Inhaled ether and passed through operation well. Five minutes after attempted to vomit, and became cyanotic and unconscious, with stertor, and great perspiration. Seemed suffering from cerebral hemorrhage. Improved 4 hours later, and became conscious, but with hemiplegia of left side, passing urine in- voluntarily. Next day before midnight symptoms became more serious, and death occurred next morning, 37 hours after operation. Cerebral haemorrhage following administration of ether. Post mortem : Large hemorrhagic patch under arach- noid on upper surface of middle portion of left hemisphere Vessels of left hemisphere much fuller than those of right, with numerous capilliform extravasations. Large clot in right lateral ventricle, corpus striatum and optic thalamus softened and broken down; small hemorrhage in left lateral ventricle; extensive atheromatous degeneration of vessels at base of brain. No other organs than brain examined. Moderately stout, pale complexion ; complaining of no previous sickness. 9. —Female, aged 35. For contracted knee. Ether given in Ormsby’s inhaler. Passed through operation and etherisation with no untoward results, but 1.1 hours later became cyanotic and pulseless with rales all over thorax. Symptoms came on at 2.45 p.m : all attempt; to rally fruitless, and patient died at 4.15 same afternoon. CEdema of lungs, though complete re- covery from ether narcosis. Post mortem: (Edema of mem- branes of brain; no thrombosis of pulmonary artery. Heart healthy, with little blood in right auricle. Lungspale and oedematous. After operation was carried across a court in open air t,o ward. Whether this exposure was really the de- terminating cause of death could not be decided. 10.—Aged 19. (20 minutes.) Operation performed, but death followed 2 hours later. Post mortem : Bronchial mucus, pulmonary and serous effusion found. Had contracted chest, and lungs restricted by adhesions, which bound them down in all directions. II. —Male. Amputation of finger.. Vomiting; part of vomited matter went into windpipe and lungs causing suffocation. Windpipe opened and every effort made to save life. Asphyxia. 12. —Male. Amputation of arm (more than ) hour). Respiration failed first. Great difficulty in inducing anaesthesia. Opera- tion very simple and very rapid. All went well till next day, when patient began to cough and respiration was hurried. The asphyxia became progressively marked, and in about a week the man oied suffocated. Cause assigned for death : asphyxia. Post mortem: No lesion of any organ except that the lungs were very vascular, red, and inflamed. No hepatisa- tion of lungs. The wound kept the same appearance from the time of opeiation to death ; it did not suppurate nor did it heal; only a little serous fluid trickled from it. The patient was very fat. 13. —Male. Amputation of leg above ankle-joint: injured by gun- shot wound. Ether given on a sponge in cone of folded towel. Pulse failed first. Operation was being performed when