NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
27
showed conclusively that it has no such effect. In one instance only*
the inhibition seemed to be intensified as the chloroform was commenced and
diminished when it was discontinued; but apart from the fact that the supposed
effect ceased much too suddenly, a repetition of the experiment on the same and
other animals showed that there was in reality no such effect. The increased
inhibition in this instance was due to the chloroformist compelling the attend
ant who was holding the electrodes to change his position and thus making
him unconsciously apply them more efficiently. When the chloroformist with
drew they were restored to their former position. This affords an instance of
the care that has to be taken in making experiments if one is not to be deceived.
(36) To test the effect of shock due to vaso motor change rather than
affection of the heart Goltz's experiment, on. the frog was repeated on three
dogs. In one there was slight lowering of pressure which was not extensive,
and in the others no effect was produced at all. Other operations which seemed
likely to produce shock, such as violent blows upon the testicle, were singu
larly devoid of effect. Failing to lower the blood-pressure by any of these
methods recourse was had to section of the splanchnies, but the low condition of
blood-pressure this produced appeared, like stoppage of the heart from vagus
irritation, to be a source of safety rather than of danger during chloroform
administration. In this connection Experiment No. 111 may be studied. There
was not much external hæmorrhage, but the Splanchnics were divided,—a pro
ceeding which, as is often said, bleeds tile animal into his own vessels. The
pressure was after this extremely low, but chloroform was repeatedly given,
and various other actions taken, and then chloroform had to be pushed on a
saturated sponge enclosed in a cap for eleven minutes before respiration ceased.
(37) The experiments on dogs that had been dosed with phosphorus for a
few days previously show that the fatty and consequently feeble condition of
the heart and other organs so produced has no effect in modifying the action of
chloroform. The case with which vagus irritation and the Glasgow trace could
be produced in these animals, by even slight degrees of asphyxia (vide 148),
was very remarkable, but this was equally the case in dogs that had been given
phosphorus only a few hours before the experiment and whose organs were not
yet fatty (vide 156). Many of these cases were in the last stage of phosphorus
poisoning, and several of their companions died without any experiment having
been performed on them before or on the same day as they did ( vide the low
N o , 1 1 7 F i c k r e a d i n g 6 .
28
state of blood-pressure in No. 163). Numerous attempts were made in these
animals to produce shock by operations in the recumbent and vertical posi
tions, but without any more result than in those that were healthy.
(38) The truth about the fatty heart appears to be that chloroform per se
in no way endangers such a heart, but., on the contras, by lowering the blood-
pressure, lessens the work that the heart has to perform, which is a positive
advantage. But the mere inhalation of chloroform is only a part of the process
of the administration in practice. A patient with an extremely fatty heart may
(lie from the mere exertion of getting upon the operating table, just as he may
(lie in mounting the stops in front of his own hall door, or from fright at the,
lucre idea of having chloroform or of undergoing an operation, or during his
involuntary struggles. Such patients must inevitably (lie occasionally during
chloroform administration, and would do so even were attar-of-roses or any
other harmless vapour substituted for chloroform.
(39) The effect of hæmorrhage was tested by opening the femoral artery
and allowing a considerable quantity of blood (8 to 12 oz.) to escape. An
immediate lowering off the blood-pressure result, and this is very lowly re-
covered from. tech an accident., however dangerous it may be in itself, in no
way affects the action of chloroform, except in so far that a patient. who has
been nearly bled to death would require less chloroform in his system to put
him into a state of anæsthesia. The low condition of his blood-pressure produc
ed by the hæmorrhage would tend to prevent. the too rapid intake of chloro
form, exactly as in the case of cutting the splanchnies. (Vide supra sub. para. 36.)
(40) When the hind feet are lowered on to the floor, so as to place the
animal in. the vertical position, a considerable fall of blood-pressure in the
carotid artery occurs but when the animal is replaced on th e table in the
recumbent position the pressure is fully restored. Various operations were per
formed on animals in the vertical position. but in no ease was anything re
sembling dangerous shock produced. Inversion of the body, so that the animal
stands on its head, has exactly the opposite effect,—the pressure rising in the
carotid archery and again falling to its former state. when the animal. is replaced
in the horizontal position. Inversion of the body failed to restore an animal
that was in the last stage of chloroform poisoning.* though it raised tile pressure
in the usual way as long as it was continued. The change in the pressure of
* Vide 106.
29
the blood of the carotid, which occurs when the position of the body is changed
appears therefore to be due simply to the effect of gravity.
(41)
As regards the effect of chloroform upon different animals, it may be
said to be the same as far as its anæsthetic action is concerned. There are cer-
tain peculiarities in its effect on the respiration and circulation connected with its
local irritant action on the nostrils and fauces which are interesting to notice.
Thus, when concentrated chloroform vapour is applied to the nostrils of rabbits
they hold their breath and the heart’s action is slowed at once. This is always
said to be due to reflex inhibition of the heart from irritation of the nasal branches
of t he t r i gemi nus r ef l ect ed t hr ough t he vagus , and i s by no means pecul i ar t o
chloroform, but is produced equally by any irritant vapour, such as ammonia
or acetic acid.
(42)
In some dogs, and especially in those to which phosphorus had been
given, stoppage of the respiration and slowing of the heart occurred immediately
after the application of the chloroform to the face, or on forcibly pulling out the
tongue,* and this suggests that the mechanism of cardiac arrest in them is pre-
cisely the same as it is in the rabbit. On the other hand, in rabbits, as in all other
animals, it is possible to give chloroform so gently that no spasm of the chest
occurs, no reflex effect is produced, and then the pressure falls in the same
regular curve and with the same succession of phenomena (anæsthesia, cessation
of the respiration, and, lastly, cessation of the heart-beat) that was above des-
cribed as typical of chloroform inhalation.†
(43)
Goats have a great tendency to hold their breath while inhaling
chloroform, and monkeys resemble dogs rather than rabbits, as when ammonia
was held before a monkey’s (No. 98) nose it did not cause immediate stoppage
of the respiration and heart as it does in rabbits.
(44)
The experiments with ether show that it is impossible to produce
efficient anæsthesia with this agent. unless some form of inhaler is used which
thoroughly excludes the air. If an ordinary cap containing a sponge saturated
with ether is applied very closely to the face, the animal generally holds its breath
and struggles, and we at once get the fall of blood-pressure and slowing of the
heart that invariably occurs under these circumstances. ‡ If the ether is continued
in this way after the animal has recommenced breathing, a condition of semi-
anæsthesia results, in which the cornea is sometimes sensitive and sometimes in-
* Vide 185. † Vide end of No. 172. ‡ Vide 148 and 261.
30
sensitive, and the pressure rises and falls alternately to a slight amount and forms
a wavy trace, which may be continued right round the drum* without any parti-
cular change. As soon as air is rigidly excluded the pressure commences to fall
gradually exactly in the same way as with chloroform, and with the same succes-
sion of phenomena, viz., first anæsthesia, then cessation of the respiration,
then of the heart movements, and, finally, death.* How far this is due to
ether and how far to the results of asphyxia it is impossible to say, but an exactly
similar succession of events can. be brought about by making the animal inhale
carbonic acid gas alone (vide 160).
(45) If surgeons choose to content with a condition of semi-anæsthesia.
it can no doubt be produced with perfect safety, though with discomfort to the
patient, by ether held rather closely over the mouth. Such a condition of imper-
feet anæsthesia would never be accepted by any surgeon accustomed to operate
under chloroform. If more perfect anæsthesia is required, it can be procured
by excluding the air more rigidly; but then there is exactly the same danger as
in giving chloroform. How very suddenly and rapidly tile pressure may fall
and death ensue is well shown by Experiment No. 33. Ether injected into the
jugular vein produces a fall of blood-pressure and anæsthesia in the same way
as chloroform does (vide 93);but in all cases in which it was so injected, large
clots were found in the heart immediately after death. It is interesting to
note that Claude Bernard seems to have formed a very similar opinion with regard
to ether as the following quotations from his work entitled " Leçons sur les Anes-
thésiques et sur L'Asphyxie,” published in 1875 show. The first quotation
(page 50) is as follows:—“Aussi un certain nombre de chirurgiens proposè-
rent-ils d’abandonner le chloroforme pour revenir á l'éther, dont l’usage para-
issait moins à craindre.Aujourd’hui encore, les chirurgiens de Lyons emplo-
ient préférablement l’éther. On croyait le chloroforme plus dangereux que
l'éther parce qu’il était plus actif; mais, en réalité, la fréquence relative des
accidents par le chloroforme tenait peut-étre tout simplement à ce que e’était cet
agent anesthésique qu’on employait dans l'immense majorité des cas. Plusieurs
discussions out été provoquécs par les partisans de l'éther, surtout par les re-
présentants de l’ecole de Lyons, et il a été constaté que l'éther, lui aussi,
avait produit un certain nombre d’accidents mortels. Les deux agents
anesthésiques usités peuvent done, l’un comme l’autre, entrainer quelques
risques de mort, et la chirurgie humaine à conservé presque partout
chloroforme, dont I’action est plus rapide et plus compléte." The second
1 4 6 .
31
quotation, to be found on page 101 of the same work, runs:—"Quant à
l'éther et au chloroforme, leur action est à peu près la même au point de vue
physiologique, sauf une différence d'intensité en faveur due chloroforme, ce qui
nous fera généalement employer ce dernier corps de préférence à l'éther.”
(46) The A. C. E. mixture given gently with plenty of air and the other
conditions mentioned before under chloroform produces the typical chloroform
trace.* Given freely to a struggling animal, it can produce a very rapid and
dangerous fall, of blood-pressure.† In Experiment. No. 52, Fick 4 shows very
perfectly the effect on the heart of holding the breath.
Part IV.—ACCIDENTAL DEATHS.
31. The notes of the cases of accidental deaths that occurred during our
experiments have been left amongst the other notes in the position in which each
occurrence took place, and they can be readily found by a reference to the
index. The fatal result was brought about either by neglecting to watch the
condition of the respiration during or after the administration of chloroform,
especially while the carotid artery was being exposed, or from a reckless admin-
istration of chloroform in the endeavour to check or prevent, struggles. In
all the cases of accidental death the usual chloroformist was absent, and no one
was attending to the chloroform. The notes would have been more complete
if some one could have watched the condition of the animal and noted the gradual
but unheeded cessation of respiration without calling attention to it. As it is, one
has to be content with the remark that the breathing was noticed to have stopped
at some particular time, but there is nothing to throw any light upon the condition
during the important period that immediately preceded this discovery. A similar
hiatus appears in the account of accidental deaths in the human subject, and is
unavoidable. These cases are probably identical with the instances referred to by
Snow, “in which animals died in a sudden and what was thought unaccountable
manner whilst chloroform was given to prevent the pain and struggles which
would be occasioned by physiological experiments.”‡ The death was not really
sudden, but only rapid, and the result of reckless administration of concentrated
vapour in the first instance, and careless neglect of the condition of the respiration
in the second. There is no evidence whatever that a single one of them was due
* Vide Experiment No. 45,
†
Vide
Nos. 47 and 52.
‡ V
ide Snow on Anæsthetics¸ page 123.
32
to paralysis or sudden stoppage of the heart, as Snow assumes to have been
the case.
32. It must be remembered, in studying the tracings, that, except when it
is expressly stated to the contrary, chloroform was throughout administered very
freely.* The degree and rapidity of the fall of blood-pressure is in almost all
cases much greater than should be the case in administering chloroform to human
beings. To avoid complicating the notes the inhaler was kept on much more
persistently, with none of those little interruptions while the cornea is being
e x a mi n e d , &a mp ; c . , wh i c h a l wa y s o c c u r i n p r a c t i c e . Th e wh o l e s e r i e s , wi t h f e w
exceptions, may be characterized as examples of reckless administration of chloro-
form, and accidental. deaths would. have been much more numerous had it not
been that, when once the animal was connected with the manometer. it was kept
under the most careful observation. Experiment, No. 79 affords a most inter-
esting exception. The chloroformist, though present in body was absent in
mind, and failed to observe and report the cessation of the respiration. The
chloroform was in. consequence pushed much further than it should have been,
and the animal died sooner than was intended,
33.
These cases are of themselves quite sufficient to show that animals are
Just. as liable to death from the careless administration of chloroform as human.
b e i n g s ; a n d t h e a c c i d e n t a l d e a t h s w h i c h o c c u r r e d d u r i n g t h e e x p e r i m e n t s o f t h e
Commission afford the best possible proof that the effects of chloroform are identical
in the lower animals and in the human subject. The statement so frequently
made that dogs are more resistant to chloroform than human beings is entirely
incorrect.
* It may be noted that one hundred and nine pints of chloroform and eleven pints of ether were used during
the experiments of the Commission.
Part V.—DESCRIPTION OF MANOMETER EXPERIMENTS.
I n t h e s e e x p e r i m e n t s t h e l e f t c a r o t i d a r t e r y w a s c o n n e c t e d w i t h t w o m a n o - m e t e r s b y m e a n s o f a
Y t u b e — t h e L u d w i g o r s l o w m a n o m e t e r , t h e t r a c i n g o f
which runs from left to right, and the Fick or rapid manometer, the tracing of
which runs from right to left. The connection of the artery with the Ludwig
manometer was continuous, except at short intervals, shown in the Ludwig
tracing by a horizontal line with a figure above it. In these short intervals
the Ludwig connection was shut off, and a tracing was taken on the Fick.
For example, in Experiment 148 at 3h, 32m. 0s. the Ludwig was turned off ;
this is shown by a horizontal line with the figure 4 above it, The figure 4 in
Fick tracing I. shows the tracing taken on the Fick ; during the interval marked
4 in the Ludwig at 3h. 32m. 0s.; and so on. As a rule, the Ludwig manometer
was cut off by turning the tap while taking a reading with the Fick manometer ,
but as the drum was allowed to run, each Fick reading is represented by a
straight line on the Ludwig tracing.
October 25th.—No. 25.
Full-sized strong pariah. Into the box with chloroform freely on blotting
paper in order to quiet him at 2h. 25m. 10s. Taken out of the box at 2h. 36m.
and fastened upon the dog-board. chloroform being given from tine to time on
Junker’s inhaler to keep him quiet. Connection between carotid artery and
manometer effected at. 2h. 57m. Five tracings with the Ludwig or mercurial
manometer* made showing the effects on the blood-pressure of the following
proceedings noted ;—
(a) Ordinary chloroform inhalation.
( b) Pushing chloroform until respiration ceased.
(c) Artificial respiration until natural breathing was restored.
(d) Evulsion of three toe-nails.
(e) Ligature of mucous membrane of the anus.
(f) Snipping off two portions of anal skin.
(g) Free opening of the abdomen and complete ligature of intestine.
(h) Continued administration of chloroform until death.
*The Fick elastic spring manometer was not connected in this experiment.
5
34
Respiration ceased at 4h. 30m. 50s., after which the pulse continued
feebly, but owing to clotting has not been recorded on the tracing. Death
after a few minutes, but not exactly recorded,
October 26th—No. 29.
Large cream-coloured dog chloroformed in the box at 2h. 15m. Taken
out of the box and put on the dog-board at 2h, 39m. 40s., and kept under
chloroform in the ordinary way with Junker's inhaler. Canula inserted into
carotid artery at 2k. 51m., and connection made with both the Ludwig and
Fick manometers through a Y tube* at 2h. 58m. Trace No. I. Ludwig shows
the effect of evulsion of the toe-nails. Trace No. II. Ludwig the effect of snip-
ping the anus, the administration of large doses of chloroform, and of killing
the dog with chloroform. A clot formed in the canula at 3h. 15 m . 55s. shortly
before the dog died. Four readings were taken with the Fick manometer—
1 and 2 while the dog was quietly under chloroform, and 3 and 4 during the
operation of snipping the anus.
October 26th.—No. 30.
Full-sized healthy pariah. Into chloroform box at 3h. 39m. Taken out
of the box and put on the table at 3h. 4m. 50s. and kept under chloroform in
the usual way. Dog fully under at. 3h. 50m. 40s., and tying of the carotid artery
commenced. Canula inserted at 3h. 58m. 50s., and connection made with the
manometers at 4h. 3m.
Tracing I. Ludwig shows effect of a large dose of chloroform but it was
soon turned off, and the observations until the death of the animal recorded on
the Fick tracing I.
October 28th.—No. 31.
Temperature of the room 18.5 to 20.5 Cent. Full-sized pariah which had
a daily dose of phosphorus (about a quarter of a pot of James' phosphorus
paste) for the previous three days, and was consequence, very weak and
thin. Chloroformed in a box at 7h. 35m. Fell down at Th. 41m. 50s. Placed
on dog-board at 7h. 45m. and kept quietly under chloroform. Carotid tied
* For a full description of the arrangement of the manometers, ride Appendix.
35
and canula inserted at 7h. 55m. 30s. Connection with manometers made at
8h. 1m., at which time the cornea was still sensitive, and the animal breathing
quietly, but very slowly, about 8 times per minute. Two tracings Ludwig, one
Fick. Trace I. Ludwig shows effect of (a ) evulsion of the nails, (b) snipping
of the anus, ( c) extraction of teeth, and includes four Fick readings. Trace
II. Ludwig (commeneing at 8h. 32m. 34s.) shows effect of ( d ) change to the
vertical position, and while in that position ( e) extraction of teeth, and ( f )
administration of chloroform until death. Post-mortem—Heart flabby, but other-
wise normal ; lungs—lower and middle lobes, right side, consolidated ; licer—
drier than in other animals, mottled, bull-colour; kidneys—congested, pyramidal.
portion of a yellowish colour ; stomach—distended with dark fluid, not appa-
rently inflamed.
Obsercations.
H. M. S.
A. 8 3 50.—Evulsion of nail.
B. 8 8 20. —Anus snipped.
C. 8 15
0
—Evulsion of nail.
D. 8 23 25. —Extraction of tooth.
E. 8 33
0.
—Change to vertical position.
F. 8 38
0.
—Tooth extracted.
G. 8 41 50.—Artery cut, pressure fell to zero.
In Experiment 31 all attempts to produce shock under chloroform in any
stage of the administration failed.
October 28th.—No.
3 2 .
Large black dog, well nourished and believed to be healthy. Into chloro-
form box at 10h. 46m. 15s, Struggling violently at 10h. 52m. 30s. Breathing
stopped and artificial respiration resorted to until 10h. 54m., when he began
again to breathe spontaneously and was placed on the dog-board. More
chloroform in cap at 11h. 1m. 30s. Dog struggling, Chloroform stopped at
11h. 2m. 30s. Stertorous breathing, Carotid ligatured at 11h. 7m. 30s.
Canula inserted 11h. 10m. 35s. Trace No. I. commenced at 11h. 12m. 20s.
Dog struggling. Drum changed and trace No. II commenced at 11h. 37m. 15s.
Canula taken out at 11h. 52m. 15s. Dog not quite dead heart pulsating,
chloroform stopped, and an attempt made to reintroduce canula, but dog dead.
Two Ludwig and one Fick tracing. Trace I. Ludwig shows effect of ( a ) ad-
ministration of chloroform, (b) artificial respiration, ( c ) evulsion of nails, (d)
placing the animal in the vertical position and includes Fick readings Nos. 1 to 6.
36
Trace II, Ludwig shows effect of (e) continued administration of chloroform
with at the same time ( f) hemorrhage from the femoral artery, and includes
Fick readings Nos. 7 to 9.
Observations, II. M. S
A. 11 12 20.—Chloroform pushed to stoppage of respiration and re-
-
covery with artificial respiration.
B. 11 18 O.—Chloroform again and evulsion of nails at 11h.21m. 0s.,
11h, 21m, 40s., 11h, 22m, Os. and 11h, 22m. 30s.
without any effect.
C . 1 1
2 3 4 0 . — C h l o r o f o r m i n . v e r t i c a l p o s i t i o n .
D. 11 25 0 and 11h, 25m. 40s. evulsion of nails.
E. 11 40 0. —Chloroform: during this administration the femoral
artery was opened and the effects of bleeding ob- -
served. The experiment ended at. 11h, 52m. 15s.
October 28th.—No. 33.
Strong, full-sized dog. Put under chloroform at 2h.. 48m. 30s. Dog
removed from the box and put on the table at 2h. 56m., and kept quiet with
chloroform on the cap hem time to time. Carotid tied at 3h. 1m. 30s. Arti- -
ficial respiration at 3h. 3m. 15s. Breathing naturally again at 3h. 4m. 30s.
Canula inserted at 3h. 7m. 30s. Still having chloroform from time to time.
Connection made with the manometer at 3h. 8m, 30s. The Ludwig tracing
shows the effect of (a) ordinary chloroform inhalation, ( b ) pressure on the abdo
-
men, (c) inversion of the body, (d) administration of ether until death resulted.
Post-mortem—Vegetations on pulmonary valves, one of the valves being
adherent, to the wall of ventricle. The Fick tracing has seven readings in it,
which. are fully explained on the tracing. Fick 7. taken when ether was pushed,
shows exactly the same slowing of the pulse when the respiration has stopped
as occurs with chloroform.
Experiment 33 shows the condition of semi-anæsthesia produced by ether
held rather closely over the mouth. If more perfect anæsthesia is required it
can be procured by more rigid exclusion of air; but then there is exactly the
same danger as in giving chloroform. How very rapidly the pressure may
fall and death ensue from ether is shown when the anæsthetic was pushed
and air excluded at the end of the experiment.
October 28th.—No. 34.
Full-sized, fairly-nourished pariah dog. Chloroform in box 3h. 52m. 15s.
Removed from the box and put, on the table and kept under chloroform in the