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post mortem examination furnished for its solution.
"Autopsy, performed hy Mr. Paget, twenty-two hours after death.—The countenance was still bloaied and suffused; ihe post mortem rigidity was moderate in degree, or rather less than usual; there was much congestion and lividity of the skin of the depending parts of the body; the corpse was very fat. The thorax was first examined, and nothing whatever abnormal could be detected in any of its viscera. The lungs were healthy and crepitant in every part; their posterior lobes were not more congested than is seen in almost every examination. The heart, collapsed, but not contracted, and containing a small quantity of fluid blood in each cavity, was of normal size and proportions in every respect, and its muscular structure, examined by the microscope, showed no degeneration. Excepting that the exterior of the right kidney was puckered in places, as if from disease in early life, nothing worthy of note was ohserved in the abdominal viscera. The brain, its sinuses, ventricles, etc., were all carefully examined, and neither in texture nor quantity of blood was anything abnormal detected. The spine was not examined. In every part inspected — the heart, great Verscis, lungs, vessels within the abdomen, those of the scalp, pia mater, and brain—the blood was universally fluid, and without the slightest trace of coagulum, or even of inspissation. Collected in the quantity of an ounce or two. and allowed to stand in an open vessel, it did not coagulate, nor, in any material degree, change its dark purple colour. Looking then at these facts, and comparing them with the symp toms manifest during life, we seem compelled to seek in a humoral pathology the cause of the patient's death. There was no visceral disease, functional or otherwise. In all probability the blood, poisoned past recovery by the vapour it had received, had died; and ceasing then to afford to any of the organs their natural stimulus, the whole of the vital functions had ceased almost coincidently.
"This case, in common with most of those which occur in our metropolitan hos pitals, has one most especially melancholy aspect—a matttr, aa far as our knowledge goes, of pure accident, it teaches us nothing for the future. We need not recapitulate, to convince the attentive reader that the
patient was one to whom chloroform might, with the least of apprehension, be administered. She was in good health; she had taken it safely before. Then, again, in the manner of exhibition, every precaution was adopted, and, in the after treatment, all that science could suggest was perse veringly tried. In our large hospitals, the requisite skill, assistance, and appliances are always at hand; and there, if anywhere, an immunity from fataf results might be expected. It is mournful, indeed, to consider that from cases such as the last three or four which it has been our lot to record, the practical surgeon gains no knowledge calculated to authorize the hope that in future the like tragedies will be of less frequent occurrence.''
Death from Chloroform during its Administration prtvious to an Operation for Hernia, in University Callege Hospital. Under the care of Mr. Qdain.—The profession and the public at large are probably becoming alarmed at the repeated instances of death brought on by the inhalation of chloroform, and it is for ourselves a melancholy duty to report these unfortunate cases. In most of them, the autopsy has been performed with the greatest care, and pathologists have endeavoured to discover, in the morbid alterations of the solids and fluids, a clue to the sudden cessation of life inpatients who seek anaesihcsia in the inhalations of chloroform. Have these careful examinations led to the desired result? Are we in possession of rules by which we can foresee the danger ere the nervous pulp has been too completely narcotized? We are afraid not; and those well acquainted with the administration of chloroform will be obliged to confess that no very marked progress has been made as to the means of averting a fatal result.
It was thought for a while that a great ideal depended on the more or less aneesjthetic practice of the person who adminisi ters the chloroform, and much reliance j was placed on what are called experienced 'hands; but this confidence has proved fal. tacious, for fatal cases have occurred with the most practised and scientific chloroiformists. The fact probably is, that the j whole matter rests, not so much on actual ; pathological changes which may have taken j place in the organs of the patient before he ;inhales chloroform, as on idiosyncrasies. We are free to admit that this is an unsatisfactory expression, and that the word idiosyncrasy only covers our ignorance; but there nevertheless exists a more or less marked difference in the tendencies of individuals, both as regards healihy nutrition and morbid alterations; add to that the influence of habits and mode of life, and you will have the import of what may be called constitutional peculiarities. Now, it is plain that these peculiarities are extremely difficult of detection; and when we consider that they have, perhaps, more influence on the eventual results of chloroformic inhalations than the presence or ahsence of fatty heart, it may at once be seen that, in the present state of science and practice, such inhalations must be surrounded with a certain amount of hazard.
And yet it seems to be perfectly well known, from experiments upon animals, by what progressive steps chloroform produces the insensibility of the nervous power. Flonrens tells us that the anaesthetic effects travel from the lobes of the hemispheres to the cerebellum, then to the posterior half and roots of the nerves of sensation in the spinal marrow, then to the anterior half and roots of the nerves of motion, and lastly to the medulla oblongata and annular protuberance, or vital knot. The same author has shown that an animal, subjected to inhalations of chloroform, loses first the intellectual faculties, and the power of regular and well-poised motions; he afterwards loses feeling, and then the power of motion. At this period, the vital force, hunted, as it were, from place to place, becomes concentrated in the medulla oblongata. This, then, is the only portion of the encephalon which resists the anaesthetic influence, and the animal would soon perish by this last barrier being overcome; for, as M. Flourens says, very plainly, "chloroform takes away pain, but it also takes away life."
Emily R , aged forty years, and a
widow, was admitted, October 5, 1853, under the care of Mr. Quain. The patient was suffering from strangulated femoral hernia on the left side, which resisted the taxis with and without the warm bath; she had had severe vomiting, pain at the umbilicus, and constipation of the bowels, for two days before admission. The hernia had been existing for some time past, and a truss had been procured, but there is a doubt whether she wore it regularly. The
] patient's habits have been very intemperate. !She was intoxicated three days before the ;strangulation, and did not see any medical man until the morning of her admission. j Mr. Quain was sent for. He arrived about twenty minutes to two in the morning of October 6, and at once decided upon j operating. The patient had remained in j the bath about three-quarters of an hour, jand did not feel particularly faint whilst in it.
Mr. Hillier at once commenced giving ! chloroform in ward 5, and used a long piece of lint of about the extent of the hand, and folded twice. One drachm of chloroform j was then poured on the lint, and applied ! about one inch from the nose and mouth, i the apparatus being gradually approximated, jand the face covered with a towel. She inhaled the chloroform as patients generally 'do, said scarcely anything, and was not excited. The pulse remained very good for two or three minutes, when forty drops fof chloroform were poured on the lint and japplied as before. Within a minute of this (renewal of chloroform, the patient began to j struggle both with her arms and legs, which ishe moved about very actively. During j the struggle, Mr. Hillier had hold of her I right hand, keeping it steady, and trying (o feel her pulse; the task was, however, j difficult, owing to the struggles. The lati ter became very strong, but, after lasting .perhaps a little more than half a minute, j they ceased, and immediately stertorous breathing commenced. The stertor was very loud and rough, not at all of the common kind. Mr. Hillier at once removed the lint and towel from the patient's face, and observed that the pulse had stopped. She drew several short inspirations, then two or three long ones, and ceased to breathe.
Immediately the pulse was felt to be wanting, cold water was dashed on the face; as soon as the breathing stopped, galvanism was also applied within one or two minutes, and she drew distinctly three or four deep breaths after the ordinary respiration had ceased to go on uniformly. No pulse was felt afterwards, but artificial respiration was excited through a wound made into the trachea, and kept up for about half an hour. One of the bystanders stated that the patient's face was convulsed when first exposed. It was slightly livid, the depth of colour increasing pretty rapidly. The pupils were dilated, and the tongue was not retracted, for Mr. Hillier felt for it immediately.
The quantity put upon the lint was just one drachm and forty minims, and chloroform had been given in the same manner, and from the same bottle, to six patients, on the very day which preceded the patient's death. Five of these had been narcotized by Mr. Hillier himself, and they had mostly had more chloroform than the present patient.
Post-mortem examination, conducted by Dr. Garrod, thirteen hours after death.— Rigor mortis well marked in all the limbs; a great deal of fluid blood was seen in the thorax on removing the sternum; abdomen very tympanitic. On opening the pericardium, about an ounce of colourless fluid escaped. The heart was quite collapsed and empty, which circumstance was possibly due to the extreme fluidity of the blood which had escaped during the separation of the sternum. The parts have, however, not been much disturbed, and the head is lying at the upper part of the table, so that the blood would have had to flow upwards. Anterior aspect of the heart, chiefly the right ventricle, covered with fat, the muscular fibres being visible only in one or two places. The largest patch of muscle is seen towards the middle of the organ, a little to the right of the septum. The body generally is by no means remarkable for adipose deposit. No appear. ance of adherence in the thoracic aorta. The weight of the heart, without opening, is seven ounces and three-quarters. The aortic valves sustain a column of water well; so also do the pulmonary. The tricuspid valves are slightly beaded, but moderately healthy, and admit the tips of four fingers. The walls of the right ventricle are flabby and pale, their mean thickness being one-eighth of an inch. At some points, the parietes become excessively thin and encroached on by fat, and at other places there is scarcely any muscular fibre visible at all. This extreme thinness is mostly perceptible near the apex of the ventricle. Left ventricle: wall flabby, dry in appearance, pale in colour, easily rent; average thickness, half an inch; the mitral valve admits the thickness of three fingers, and is healthy. The right lung is crepitant throughout, there is no marked engorgement, and no tubercles are observed. Weight, seventeen ounces and a
quarter. Left lung, seventeen ounces and a half, the characters being the same as on the right side. Vessels on the convex surface of the brain not congested; some slight thickening of the membranes seen in places. Near the longitudinal sinus, the arachnnid was here and there thickened and opaque. On section of the hemispheres, the red points were not found numerous, and the contrast between gray and white matter was well marked There was no fluid in the ventricles, and the substance of the brain was firm. Other parts of the brain quite sound. No coagula are to be seen; all the blood is fluid and of a dark colour. The upper part of the small intestines was much distended with air, as well as the stomach. The portion of bowel below the strangulation, including part of the small, and all the large intestines, is very narrow and contracted. Pink streaks are noticed on the superior part of the small intestines, and are of very fine injection; no effusion of lymph; the strangulated portion of intestine was about the size of a hen's egg. > Other viscera of the abdomen healthy. j The fibres of the heart were examined by i Dr. Garrod under the microscope, and prej sented the usual appearance of fatty de; generation.—Lancet, October 28, 1853.
To Readers and Correspondents.—The present number contains the concluding pages of the first portion of the fourth part of Todd and Bowman's Physiological Anatomy, and our readers are now in possession of all that has as yet appeared of this valuable work. So soon as the next, which, it is said, is to be the final part, is published in England, arrangements will be made to place it within the reach of our subscribers.
In our next number we shall commence the publication of the valuable work on TAe Pathology and Treatment of Pulmonary Tuberculosis, by Jonn Hugnes Bennett, M. D., F. R. S., &.c.. Professor of the Institutes of Medicine and of Clinical Medicine in the University of Edinburgh. This will be found to be not only an extremely interesting, but a highly practical work, and is illustrated by a number of most beautifully executed wood-cuts.
Subscribers, who are not in possession of the commencement of Todd and Bowman's Fhysiological Anatomy (Parts I. II. II I.), can obtain it in one volume of 552 pages, free by mail, by remitting $2 50 to the publishers.
Acne and boils, treatment of, 27
- , proceedings
of, 23, 203
slavery and the medical profession,
io-eulphate of copper, 27
Aquatic vivarium, 148
Argentebil, prize for improvements in the
treatment of urinary diseases, 16
Baines, suppurative peritonitis, 64
Belladonna as a prophylactic in scarlatina,
Bemard, salivary glands, 29
Blaudet, chtoride of barium for preserving
animal subatances, 168
Czsarian section, 98
, operations for, 74
Cannon, life preserved for eight months by
food artificially introduced in the stomach,
Cataract, cure of, without operation, 73
Chapman and Horner, tribute to, 127, 164
at Berlin, 31
——— at Landon, 192
at Moscow, 100
, laws of, 187
Chloroform, adulteration of, 132
, deaths from, 12,14, 24, 71,131,
132, 190, 202, 204
, used in the labour of Queen Vic-
Chorea, ammonio-sulphate of copper in, 27
Cad-liver oil, 25
Calic, lecture on, 134
Conneau, notice of, 62
Caoke, infusoria in cancer of the mouth, 29
Caoper, irreducible hernia, 72
Copperhead snake, bite of, 40
Crosio, atropia in neuralgia, 147
Croup, contagious influence of, 168
Cups, gum-elastic, 13
Dalrymple on cure of cataract without opera-
Davis on organization of American Medical
Diphtheritic eiudation in scarlet fever, 28
Druitt, veaico-vaginal fistula, 28
Dubois, appointment as accouchenr to the
Dupetit, influence of spinal marrow on move-
Duplay, ovarian cysts, 77
Duty of medical men, 76
Elbow-joint, excision of, 33
Elsasser, condition of foetal circulation, 99
Empirical medicines, 11
Employers, liability of, for attendance on
Eiaminations real, not verbal, 61
Gairdner on homoeopathic hospital statis-
Gelatin, method of preparing, 45
Gorre, effect of milk in poisoning by nux
Hampden Sidney College, 71, 127
Hare, hereditary peculiarities, 45
nourishing new-born infants, 165
Hospitals of London, statistics of operations
Iliac, ligature of common, 147
Immigrant ships, mortality on board, 187,202
Insane institutions, proceedings of superin-
Intramural interments, 76
Intussusception of bowels, 39
Iodide of potassa, peculiar symptom pro-
Iodine injections, 29
Iris, influence of spinal marrow on move-
Jackson's anticipated discovery, 44
Kentucky State Medical Society, proceed-
King's College, resignation of Dr. Todd, 77
Langenbeck, accident to, 132
Laudanum, analysis of, 74
Lawrence on diseases of the eye, new edi-
Leeches, preservation of, 30
Leucorrhoea, epidemic, infantile, 153, 173,
Liebig, testimonial to, 77
Life prolonged for eight montbs by food arti-
Lupulin in painful erections, 28
Macgowan, empirical medicines, 11
department of U. S. Navy, 48
graduates, 60, 71, 127