The heart was of normal size, and flaccid; the vessels on its surface strongly distended with blood. The left ventricle was empty; the left auricle, on the contrary, and the entire of the right side of the heart, with the great veins, were filled with thin uncoagulated blood. In the right ventricle only was a little loose coagulum found. The lungs, posteriorly, were highly congested, exhibiting here and there infiltrations of blood from the size of a pea to that of a small hazel-nut. The pulmonary tissue was otherwise sound; giving, however, when cut into, the odour of chloroform, but more feebly than the brain did. The mucous membrane of the larynx and bronchial tubes were slightly reddened from sanguineous congestion. The blood was everywhere of the same thin juice-like nature.[[86]]
Case 18. I am indebted for my information respecting this case to Dr. James Adams, of Glasgow, who was good enough to send me a copy of the notes respecting it, from the case book of his colleague, Mr. Lyon, in whose practice, in the Glasgow Infirmary, the case occurred, in March 1850. The patient was a boy seven or eight years old, from the Highlands, whose health was considerably impaired by years of suffering from calculus. Mr. Lyon says, “being laid in bed, I placed a piece of lint, moistened with chloroform, near to his face, when, in a few minutes, he ceased crying. I now told my clerk to take charge of the chloroform, and introduced the sound. I thought I detected a calculus, but could not hear the click distinctly, in consequence of the patient moaning. One of the bystanders held his hand between my ears and the patient’s face, when the click was at once heard. I withdrew the instrument, and was horror-struck with the livid countenance and vacant eye of the patient; the cardiac and radial pulses were gone, and, making one deep gasp, he was to all appearance dead.” Artificial respiration and other measures were employed without effect. “The external jugulars being remarkably turgid, and the face still very livid, the right jugular was opened, when several ounces of dark blood flowed rapidly.” This measure, and galvanism, which was applied afterwards, were of no avail.
Case 19. The subject of this case was Alexander Scott, aged thirty-four, a police constable, who died in Guy’s Hospital in June 1850, whilst undergoing an operation for the removal of a portion of the right hand. Mr. Cock, the operator, said that he was certain there was no disease about the patient. He described the accident as follows:—“The ordinary machine was used, and, as it had not the effect, witness directed that a napkin should be folded into the shape of a cone, which was applied with chloroform. The occupation of removing a portion of the bone occupied one minute and a half, but before it was completed, the blood which was gushing out, suddenly stopped, when witness directed Mr. Lacy to feel the pulse of deceased, and they found that deceased had expired.”[[87]]
The sudden stopping of the hæmorrhage shews that, in this case, as in the others, the action of the heart was suddenly arrested. The first attempt to cause insensibility failed in this as in some other cases.
Mr. Cock tried to dissuade his patient from having chloroform, severe as the operation would have been without it. In Guy’s Hospital and St. Thomas’s the medical officers had a strong objection to narcotism by inhalation for the first two or three years after the practice was introduced, and chloroform was used much less generally in these institutions than in any other of the hospitals of London; yet it was precisely in these two hospitals that two deaths from chloroform occurred, before any such accident had happened in any other hospital in this metropolis. This circumstance is worthy of the consideration of those who propose to limit the accidents from chloroform by restricting its use to a few great operations.
In this case the lungs were reported to be extremely congested. Heart flabby, not particularly distended; about two ounces of fluid blood on the right side; not more than half an ounce on the left. Head.—Much congestion of the dura mater; the grey matter of the brain was dark and congested; fluid was found in the subarachnoid space; and a considerable quantity of it in both ventricles. Kidneys congested.[[88]]
Case 20 occurred on September 20th, 1850, at the Cavan Infirmary, Ireland. The case occurred in the practice of Dr. Roe, and I am indebted to Dr. Robert Adams, of Dublin, for a manuscript account of it. The name of the patient was James Jones, and his age twenty-four years. Chloroform was exhibited with the intention of performing amputation below the knee, on account of scrofulous disease of the ankle, with ulceration of the cartilages. The patient was reduced to a state of great debility by the disease, and was suffering from hectic fever, but had no cough. The following is Dr. Roe’s account of the accident:—
“When placed on the operating table the heart’s action was very quick and weak, but he did not appear more faint or pale than usual. I then saw Mr. Nalty, the apothecary, measure one drachm of the chloroform in the small minim glass measure, and pour it upon a little folded lint, which was placed in an oval hollow sponge, held in the hand with a small towel. Recollecting I had used this chloroform in another case, and finding some delay in producing the anæsthetic effects, I directed Mr. Nalty to add thirty drops more to that already put on the lint. I then applied the sponge to the patient’s nose, directing him to keep his mouth shut, and gave the towel into the care of Dr. Halpin, who was on the opposite side of the table, while I went to prepare myself for the operation. Mr. Bird had scarcely screwed up the tourniquette, which had been previously placed on the thigh, while I was examining the state of the circulation in the tibial arteries, and which could not have occupied one minute,—certainly the patient could not have taken fifteen inspirations,—when Dr. Halpin told me the anæsthetic effects were produced. This struck me as being unusually quick and sudden, and on removing the towel from the face, we saw a slight convulsive action of the left eyelid (the eyelids were partially open), and a small quantity of frothy saliva at the mouth. I felt rather uneasy, but not much alarmed, as Dr. Halpin said he had often seen such symptoms from the effects of chloroform, although I had not met with them. On a more minute examination of the heart, the eyes, muscles of the limbs, &c. we found him dead.”
Energetic means were used with a view to restore the patient, but without effect. No inspection of the body took place.
Case 21. The next case of recorded death from chloroform occurred in the Stepney Workhouse. The patient, named John Holden, age not stated, was about to undergo an operation on the penis. It was stated at the inquest that half a drachm of chloroform was administered without effect, and then half a drachm more was applied, when the patient suddenly expired. This death occurred in April 1851.