MEDICAL NEWS.
DEATH FROM CHLOROFORM DURING ITS ADMINISTRATION PREVIOUS
TO AN OPERATION FOR HERNIA.
[Under the care of Mr. Quain.]
Mr. Hillier, the resident Medical officer, has favored us with the fol-
lowing particulars of a case of death from chloroform which occurred
recently. The administration of the drug was, as usual, under the care
of Mr. Hillier, according to his appointment at the hospital. It will be
seen, that the patient had been of intemperate habits; and, as the au-
topsy revealed, the subject of extensive fatty degeneration of the muscu-
lar structure of the heart, and that, previous to the administration, she
had been nearly three day’s ill, fasting, exhausted, and suffering ultimately
from acute peritonitis. These considerations make the fatal result quite
comprehensible.
Particulars, etc.—E. R., aged 40, a woman of moderate height,
rather thin. Her general health has been pretty good ; she had not
been liable to palpitation or dyspnoea. Had been in the habit of drink-
ing pretty freely. Admitted on October 5, at 11 p. m. She was suffer-
ing from the symptoms of strangulated femoral hernia, which had exist-
ed two days and a-half. Efforts were made to reduce the hernia, both
without and with a warm bath, in which she was for upwards of half an
hour, without getting very faint. These efforts being unsuccessful, an
operation was at once determined on. Her pulse was at this time regu-
lar, and of tolerable strength.
Chloroform was administered in the usual way, on a piece of lint,
which was held at first three or four inches from the patient’s face, and
and then brought to within an inch and a-half of her nose and mouth,
leaving space around for the admission of air.
For three or four minutes nothing unusual presented itself; the pulse
and respirations proceeded normally. There was put on the lint, at first,
one fluid drachm of chloroform; and, at the end of three or four minutes,
40 minims more were added. This was the whole quantity of chloro-
form employed. Within a minute after the second quantity of chloro-
form was added ; the patient struggled violently both with her arms and
legs'. During these struggles I was holding her right hand, and was
unable to feel the pulse, in consequence of her constant motions. The
struggling lasted about a minute, and, on its ceasing, the patient com-
menced to breathe with loud, rough stertor. I at once removed the lint
from before the face, and felt for the pulse, which I could not find. Im-
mediately cold water was dashed on to her face. She breathed with,
this stertor for two or three short inspirations, and then two or three
long ones, and then breathing ceased. Immediately artificial respiration
was resorted to, and within a minute galvanism was applied to the back
of her neck and the diaphragm. Under the influence of these agencies,
the patient gasped about three times at intervals ; after this no further
signs of life were exhibited.
Tracheotomy was resorted to at the end of a few minutes, and the
artificial respiration continued through this opening for about three-quar-
ters of an hour.
At the time when the stertor commenced and the pulse failed, the
pupils were dilated, and the face of the patient was only slightly altered.
Her tongue was not retracted, for one of the bystanders at once put his
fingers into her mouth to ascertain this.
Chloroform from the same bottle had been administered by me on the
same day to five patients, in the same manner, without any unpleasant
results.
Autopsy made Ly Dr. Garrod, thirteen hours after Death.—Rigor
mortis well-marked in all the limbs. The blood very fluid in all parts
of the body.
Abdomen very tympanitic ; diaphragm extends up to opposite the
fourth rib on the left side, and to third interspace on the right. About
an ounce of colorless fluid in the pericardium. The heart quite col-
lapsed and empty,—this may have been due in some measure to the
fluidity of the blood.
Anterior aspect of heart covered with fat, muscular substance being
visible at one or two points only.
Weight of heart, 7f oz. ; valves healthy. Walls of right ventricle
flabby and pale ; mean thickness, one-eighth of an inch. At some parts,
the muscular substance is in a very thin layer, being much encroached
on by fat. In several places, there is scarcely auy muscular fibre visible.
This is chiefly the case near the apex. Examined by the microscope,
much fatty degeneration of the muscular fibres of the right ventricle
generally was discovered.
Wall of left ventricle flabby, dry in appearance and pale; very friable.
Old adhesions on both pleurae. No appearance of atheroma in thor-
acic aorta. Both lungs cripitant throughout; not much engorgtd.—
Brain not congested. The arachnoid exhibited marks of chronic thicken-
ing and opacity.
The intestines, above the strangulation, were much distended with
flatus, and inflamed. The strangulated portion was of a very dark color,
and had blood effused into its coats.
Liver, kidneys, and spleen normal.
[JVbte.—We are sorry to have to state, that another death from chloro-
form has occurred since the above was written. The patient, a woman,
aged 19, suffering from rodent ulcer of the vagina, under the care of Mr.
Paget, in St. Bartholomew’s Hospital, died on Thursday afternoon. The
intended operation was the application of the actual cautery. We shall
give further particulars next week.]—London Medical Times, October
22, 1853.
Death under Chloroform.—About a fortnight ago, while the
students were assembled in the operating theatre of the Infirmary, to see
Mr. Syme’s operation of perineal section performed by Dr. Dunsmure,
and while chloroform was being administered preparatory to the operation,
the patient suddenly expired. Every expedient that was possible under
the painful circumstances was immediately resorted to by Dr. Dunsmure
and his colleagues, but, unfortunately, without effect. I cannot but
think, that a great error in the administration of chloroform prevails in the
hospital here. Sufficient precautions are not used to allow a free ad-
mixture of atmospheric air with the anaesthetic. When this is attended to,
the patient can be put under the influence of the drug more easily and
with less suffering to himself, and can be kept under it for many hours
consecutively. In hospital practice its administration is commonly en-
trusted to some raw dresser, who thinking he cannot give enough of a
good thing, squeezes a towel saturated with it over the mouth, where it
is kept firmly applied, so that the admixture of chloroform with atmos-
pheric air is rendered impossible.—Ibid, October Loth.