Case 13 occurred at Shrewsbury, to a Mrs. Jones, a patient of Mr. Clement, surgeon, who had partly performed the operation of excision of the eyeball, when his patient suddenly died. Mr. Clement has, I believe, not published any account of the case, but the evidence which he gave at the inquest was reported in various local newspapers, and copied into the medical journals. The death was very characteristic of the effects of chloroform vapour not sufficiently diluted. Mr. Clement is reported to have said: “He gave her but a small dose to commence with, imbibed from a sponge, and then commenced the operation. Finding that did not make her insensible, about a drachm more was poured on the sponge, which she inhaled again for a few seconds. He then went on with the operation, and shortly afterwards heard a peculiar sound, which he could not describe, and she died in a moment; all the attempts to rouse her proved ineffectual. She spoke in Welsh before she died, but so quickly that he did not know what she said; he had no doubt that she died from the effects of the chloroform.”[[83]]
Case 14 occurred at Berlin. The subject of it was a young lady twenty years of age, of good health, well made, and of a good constitution. The chloroform was inhaled for the extraction of a tooth. It was administered on a sponge, covered with a napkin. The dentist who administered it was not a medical man. He made five unsuccessful attempts to extract the tooth under chloroform. Three of these attempts were at nine in the morning, and two about noon, just before the accident. His patient suddenly died almost at the commencement of the last attempt to administer chloroform, stretching herself out, and frothing at the mouth at the moment of death; the countenance at the same time becoming livid.
An examination of the body took place fifty hours after death, when putrefaction had set in.
“The lungs presented nothing morbid; the bronchi contained a little bloody froth. The blood was of the colour and consistence of cherry juice. The heart was soft, flabby and collapsed. Its coronary vessels and cavities were empty, and presented the bluish-red discoloration of decomposition.”[[84]] The other organs were healthy.
Case 15 occurred in the public hospital of Kingston, Jamaica, on January 29, 1850. The name of the patient was William Bryan, his age is not stated, nor the nature of the operation he was about to undergo. He had previously, however, undergone the operation of amputation of the penis, on account of cancer of that organ, but it was performed without chloroform. Mr. Maygarth, the surgeon who administered the chloroform, stated as follows: “I had about a drachm poured on the sponge, and applied it over his mouth and nostrils, but at first not in close contact—at no period was the atmospheric air totally excluded. He bore it badly, and I was frequently obliged to withdraw it, to facilitate his breathing. The stage of excitement which is usual came on, and he struggled and kept away the sponge for some seconds; it was again reapplied, when, after a few more seconds, observing that he made one stertorous inspiration, I removed it altogether. He ceased to breathe; but after some seconds had elapsed, made another inspiration, and this occurred several times, until at length respiration ceased entirely.” The measures which were employed were of the usual kind, but were of no avail.
The brain and its membranes were found to be congested. The lungs were congested, especially posteriorly. The right side of the heart contained dark fluid blood, and the inner surface of its left cavities, and of the aorta, were stained with blood. There was some disease of the aortic valves, and the heart had undergone some amount of fatty degeneration.[[85]]
Case 16. In February 1850, a death from chloroform occurred on board ship at the Mauritius. A report of the case was sent to the Board of Ordnance, and also to the Admiralty. The secretary of Sir William Burnett first informed me of the case, and a day or two afterwards I had an opportunity, through the kindness of the late Marquis of Anglesey, of reading the report which was sent to him as Master of the Ordnance, and I made a note of the chief particulars as soon as I got home. As the report was a very able one, it is to be regretted it has not been published. The accident occurred to an artilleryman, aged 24, who required to have the last phalanx of the middle finger removed. In other respects, he was considered to be in good health. Two scruples of chloroform were first poured on the handkerchief with which it was administered, and then one scruple more. It was observed that the face turned pale, and the pulse and breathing ceased, soon after the chloroform was discontinued. The measures which were employed to restore him were of no service. The lungs after death were found to be emphysematous; and, upon inquiry, it was ascertained that he had been short of breath on exertion. The right cavities of the heart were filled with fluid blood. The sinuses of the dura mater contained less blood than usual, and the brain was pale. The medical man reporting the case considered that the emphysema was the cause of death, by interfering with expiration, and thus detaining the vapour; and it must be admitted that, if the vapour were not sufficiently diluted with air, the emphysema might increase the danger. I have, however, administered chloroform in several cases in which emphysema existed to an extreme degree, without any ill effects; consequently, when the vapour is properly diluted with air, this affection appears to be no source of danger.
Case 17 was that of a patient of Professor Carl Santesson, in the Seraphim Hospital at Stockholm. I was indebted to Mr. Paget for my first information about this case, and to Dr. W. D. Moore, of Dublin, for some further particulars respecting it.
The patient, a man thirty years of age, was affected with hydrocele, and there was some suspicion of disease of the testicle. It was consequently intended to operate on the hydrocele by incision, in order that the testicle, if diseased, might be removed. The chloroform was administered in the same way that Professor Santesson had seen it exhibited by Dr. Simpson, except that it was poured on a little cotton, which was placed at the small end of the cone, into which the folded towel he made use of was rolled. About a drachm and a half was first poured on the cotton, and the patient was told to inhale in long and deep inspirations. This quantity being nearly evaporated in two or three minutes, a drachm more was added. After a few inspirations rigidity and struggling came on: these subsided, but in a little time returned more strongly than before, and the towel was removed from the face until the struggling ceased. The patient, however, not being sufficiently insensible to undergo the operation with the necessary quietness, the towel was reapplied, when, after a few inspirations, the pulse suddenly ceased. The face and the whole surface of the body turned pale, the eyes rolled upwards and inwards, and the breathing became very slow, but full and deep, the intervals between the inspirations becoming longer, until the respiration ceased altogether. The patient died before the operation was begun, and within five minutes from the commencement of inhalation. During the application of various means of resuscitation, including the dropping of cold water guttatim on the epigastrium, the breathing returned, and continued for the space of three or four minutes; but the pulse and sounds of the heart did not return.
At the examination, thirty-two hours after death, the dura mater was found to be congested, and there was considerable serous effusion between the membranes of the brain. There were also some bony deposits under the dura mater, and some adhesions of the arachnoid, indicating long standing disease of the membranes.