The only explanation which the case admits of is that, in her eagerness to get relief, the patient took one or more inspirations of air very highly charged with vapour. The symptoms were those of death by cardiac syncope.
Case 46 occurred in the practice of Dr. Roberts, a surgeon dentist of Edinburgh. The patient was a lady, thirty-six years of age, to whom Dr. Roberts had administered chloroform on four previous occasions within a twelve-month. Dr. Roberts says the chloroform was administered in the usual way, by which he means on a handkerchief. He says: “Mrs. H. had only taken about nine or ten inspirations, obtaining but a partial influence of a quantity short of ʒiss poured out from the bottle, and inhaling it for a space of time certainly less than a minute, when she said, ‘You must not operate until I am quite insensible;’ and again, ‘I am not over yet;’ and immediately, even while speaking, she gave a convulsive start, and with a stertorous inspiration, and with the eyes and mouth open, sunk to the floor.” Dr. Simpson was sent for, and arrived within five minutes. Artificial respiration was resorted to, and after it had been applied for a time, there were a few spontaneous inspirations, and the pulse, it is said, could be perceived at the wrist; but these symptoms of reviving animation disappeared.
At the examination of the body, the right cavities of the heart were found gorged with blood. The walls of the right ventricle were thinner than natural, and affected to a certain extent with fatty degeneration.[[118]]
A paragraph was inserted in some of the Edinburgh newspapers, and forwarded by Dr. Roberts to the Lancet,[[119]] in which it was implied that death in this case was not caused by the chloroform. It is, however, like the preceding case, a well marked instance of the sudden and fatal action of this agent.
Case 47. A sailor, aged thirty, died whilst inhaling chloroform in St. Thomas’ Hospital, in October 1856, preparatory to having some necrosed bone removed from one of his fingers. “He did not appear to be in robust health; still there was no obvious reason against his having the chloroform, which was accordingly administered as follows. One drachm was poured on a sponge folded between two thicknesses of lint, and this held at a little distance from his mouth, while he was sitting in a chair. He appeared to be going off very comfortably, when the chloroform was left off for from half a minute to a minute, and then resumed. He now began to raise his hands and tremble, and kept spitting in the lint, and appeared as if about to vomit. Suddenly he was violently convulsed through his whole frame, as if in an epileptic fit. The chloroform was at once discontinued, and he was laid in a semi-horizontal posture. The convulsion only lasted for a few seconds, and when it had ceased he began to breathe with effort and puffing of the lips, and almost immediately to gasp irregularly. His pulse was almost imperceptible and intermittent. Artificial respiration was at once performed by alternate compression and relaxation of the walls of the chest, the tongue being held out of the mouth by the forceps. Ammonia was applied to the nostrils, and cold water dashed in the face, and in about a minute he rallied so as to breathe without assistance, but in a few seconds he relapsed, and could not be recovered.
“At the post-mortem examination there was found to be fatty degeneration of the heart, liver, and spleen, and the membranes of the brain were thickened. The lining of the ventricles presented a peculiar pitted appearance, apparently from inflammatory deposit. The brain itself was pale.”[[120]]
“It was ascertained after the man’s death that he had been of intemperate habits, and had had an attack of delirium tremens three weeks previously. In the report of this case in the Association Medical Journal, the following is the account of the appearances met with after death. In the autopsy in the present case, which we observed with particular care, the brain was in a state of œdema and bloodlessness, very like the brain in a patient who died from chloroform in the Ophthalmic Hospital. The liver was fatty; but the heart seemed the very model or type of the healthiest kind of heart. All the other organs were also healthy.”[[121]]
Case 48 is related by Mr. Paget as follows. “I am anxious to place before the profession, at the earliest opportunity, a narrative of a case in which chloroform proved fatal in my private practice.
“The patient was a boy, nine years old, of delicate constitution, and of nervous, timid disposition; but with no indication of any organic disease, except that for which the operation was to be performed: namely, a tumour of the scapula; for which it was proposed to remove the greater part of that bone.
“At half-past eight A.M., on February 28th, after the patient had passed a night of sound sleep, the chloroform was first administered in a room adjoining that in which the operation was to be performed. He was alarmed at the thought of being put to sleep, and of what would then be done, and was very averse from taking chloroform, but he was persuaded to inhale it; and, though not without resistance, yet with less than is commonly made by patients of the same age, he was brought under its full influence in about three minutes. He sat in bed during the first few inspirations, and after these, was recumbent. It was observed that two or three deep inhalations were quickly followed by complete insensibility; and the next few inspirations were stertorous. He was at once carried, in the horizontal posture, into the room, and laid on the table, arranged for the operation.