Case 10 was that of a labourer, named Samuel Bennett. It occurred on February 20th, 1849, at a dispensary in Westminster. The patient inhaled chloroform for amputation of one of the toes. Half an ounce of chloroform was “sprinkled on a handkerchief, and held over the mouth and nose.... This quantity of the agent failed, however, to produce anæsthesia, having caused only the ordinary excitement and struggling.” After a delay of two hours, more chloroform was procured, and half an ounce was again applied on a handkerchief, “care being taken to allow the entrance of air at short intervals.” Insensibility was induced, and the toe was amputated; the chloroform being applied, as I was told, during part of the time of the operation. At the close of the operation, no blood escaped when the pressure was removed from the arteries; the patient was in fact dying, and in a short time expired. “A few inspiations were noticed after the pulse had ceased at the wrist.”[[80]]
The lungs were of a dark venous hue throughout, a large quantity of blood escaping from them when cut into. Mucous membrane of trachea and bronchi congested. Heart rather large but flabby; auricles empty; each ventricle contained about an ounce of semi-fluid blood (the lungs had been inflated). Head: sinuses and veins contained blood, but not to any remarkable amount. But few bloody points occurred in cutting into the cerebral mass. Kidneys congested.
The failure of the first attempt to cause insensibility in this case, when so large a quantity of chloroform was used, illustrates very forcibly the uncertainty and irregularity of the way in which it was administered. On the first occasion only excitement and struggling were produced, and on the next the patient died suddenly.
Case 11 occurred on August 23rd, 1849, at Langres, France. The subject of it, Madame Labrune, was reported to be a healthy married woman. She inhaled chloroform with the intention of having a tooth extracted. “Complete insensibility was not produced at the first trial: more chloroform was placed on the handkerchief, and she drew a full inspiration. Her countenance immediately became pallid; her features were visibly altered; there was dilatation of the pupils, with a convulsive rolling of the eyes; and no pulse could be felt. Every attempt was made to restore life, but without success. She died as if struck by lightning.”[[81]] The instantaneous arrest of the circulation, on a full inspiration being taken, immediately after more chloroform had been placed on the handkerchief, is particularly worthy of notice. The heart was paralysed, in this instance, as quickly as in experiment No. 25, above related.
No inspection of the body is reported in this case.
Case 12 is the first which occurred in any of the hospitals in this metropolis. The following is the account of it.
“John Shorter, aged forty-eight, a porter, known to Mr. Solly for some time as a very active messenger, habits intemperate, but apparently in perfect health, was admitted into George’s ward, under Mr. Solly, on the 9th October, 1849, suffering from onychia of the left great toe, which had existed some time. It was determined to remove the nail, the man having decided before entering the hospital on taking chloroform.
“On Wednesday, October 10th, at a quarter to two P.M., he began to inhale the chloroform with one drachm in the inhaler. It had no visible effect for about two minutes; it then excited him, and the instrument was removed from the mouth, and about ten drops more were added; he then almost immediately became insensible; the chloroform was taken away, and the nail removed. He continued insensible; and, his face becoming dark, the pulse small, quick, but regular, respiration laborious, his neckerchief was removed, and the chest exposed to fresh air from a window near to the bed; cold water was dashed in his face, the chest rubbed, and ammonia applied to the nose. After struggling for about a minute, he became still, the skin cold, pulse scarcely perceptible, and soon ceased to be felt at the wrist; respiration became slow and at intervals, but continued a few seconds after the cessation of the pulse. Immediately on the appearance of these symptoms, artificial respiration was commenced by depressing the ribs with the hands and then allowing them to rise again until the proper apparatus was brought, when respiration was kept up by means of the trachea tube and bellows, and oxygen gas introduced into the lungs by the same means. Galvanism was also applied through the heart and diaphragm, but all signs of life ceased about six or seven minutes after the commencement of inhalation. These means were persisted in until a quarter past three, but to no purpose. On removing the inhaler, the sponge, which only contains one drachm, fell upon the floor, and the chloroform splashed about,—thus showing that a considerable part of the chloroform remained unused; so that the patient could not have inhaled more than a drachm. Every endeavour was made to procure a post-mortem examination, but in vain.”[[82]]
The above account is published in the Medical Gazette as communicated by Mr. Solly, but it is clearly not written by him, and it presents a very confused narrative of what occurred. If we are to understand the events in the sequence in which they are related, we must conclude that the patient became insensible and had the operation performed, that he then exhibited alarming symptoms for which cold water was dashed in his face and other measures were employed, and yet that after this he struggled for about a minute. This would be a state of things inconsistent, in my opinion, with death from chloroform; but possibly the proper sequence is not observed in detailing what occurred. There is some obscurity also about the amount of chloroform used in connection with what remained on removing the inhaler. If the sponge was adapted to hold a drachm in the proper manner, the chloroform could not splash about on its falling, unless there was a good deal more than a drachm in it. But whatever was the quantity of chloroform remaining in the sponge, as it was in a condition to splash about, it is difficult to perceive what prevented the liquid chloroform from dropping into the patient’s throat, as he lay on his back in bed. Chloroform is as pungent as the essential oils. I have been informed of a case in which a patient was nearly suffocated by one drop falling into the throat; and the narrative of what occurred to Mr. Solly’s patient is not at all inconsistent with death from spasm of the glottis arising from this cause. If, however, the patient died from the vapour of chloroform, we must conclude that he inhaled it at one moment not sufficiently diluted with air.
The chloroform in this case was administered by a non-medical person—a sort of surgery-man. After this accident, however, the chloroform in St. Thomas’s Hospital was always entrusted to some one belonging to the profession.