NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
384
H . M . S .
E. 9 54 20.—While more chloroform was added to cap, took
three breaths of pure air.
F. 9 54 40.—Coughing ; one breath of pure air
.
G. 9 55 10.—Do.
do. do.
H. 9 55 30.—Noisy expiration.
I. 9 55 50.—Holding breath ; cap entirely removed.
J. 9 56 15.—Gasped in pure air; cap re-applied ; regular breathing.
K. 9 56 25.—Moaning.
L. 9 56 45.—Stertorous breathing ; cornea at same time insen-
sitive. Stopped chloroform ; afterwards con-
tinued until 10h. 1m. 5s.
September 2nd. 1891.—No. 312.
Temperature of room 72.9° F. Delicate Hindoo child, Baloo, ætat. 4. Disease
—phymosis. Operation—circumcision. Chloroformed at the Afzulgunj Hos--
pital at 7h. 22m. 35s. by student Miss Williams. Full anæsthesia at 7h. 24m. 0s..
administration ended at 7h. 28m. 30s.
Obsercation.
H .
M .
S .
A. 7 22 35.—Chloroform on cap ; crying.
B. 7 23 25.—Regular respirations, 24 a minute.
C. 7 24 0.—Cornea insensitive ; stopped chloroform ; anæsthesia
afterwards kept up in the usual way until the
operation was finished at 7h. 28m. 30s.
S e p t e m b e r 2 n d , 1 8 9 1 . — N o . 3 1 3 .
Temperature of room 73.0° F. Healthy young Mahomedan female, Abbass
Bee, ætat. 20. Disease—cystic tumour. Operation—excision. Chloroformed
at the Afzulgunj Hospital at 8h. 0m. 45s. by Miss E. A. Lawrie. Full
anæs-thesia at 8h. 6m. 20s. Anæsthesia maintained until the operation was finished
at 8h. 15m. 30s.
385
Observations.
H.
M.
S.
A. 8
0 45.—Chloroform on cap ; regular gentle blowing, 24
times a minute.
B. 8
1 30.—Cap close to face.
C. 8
1 40.—Talking ; breathing regular.
D. 8
2 45.—Regular respirations, 20 a minute.
E. 8
3 10.—Took three breaths of pure air while more chloro--
form was being added to the cap.
F. 8
4
0.—Regular respirations, 20 a minute.
G. 8 4 55.—Snoring ; took two breaths of pure air while more
chloroform was being added to the cap.
H. 8
5 10.—Moaning.
1. 8
5 45.—Snoring.
J. 8 6 20.—Cornea insensitive ; stopped chloroform. Anæsthesia
was subs quently kept up in the usual way until
8 h .
. 1 5 m . 3 0 s .
S e p t e m b e r 2 n d 1 8 3 1 . — N o . 3 1 4 .
Temperature of room 77.4° F Sickly old Hindoo Syanna, ætat. 75.
Disease—panophtbalmitis Operation.—excision of the eye-ball.
Chloroformed at the Afzulgumj Hospital a 8h. 44m. 5s. by Miss E. A. Lawrie. Full
anæsthesia at 8h. 48m. 50s. Continued until 8h. 55m. 15s.
Obervations.
H. M. S.
A. 8 44 5.—Chloroform on cap ; blowing 32 times a minute
.
B. 8 44 35. cap close to face; regulart breathing.
C. 8 45 55—More chloroform; three breaths of pure air.
D.8 4
6 45.—Moving arms.
E. 8 47 15.—More chloroform; two breaths of pure air
.
F. 8 47 20.—struggling; regular breathing.
G .
8
4 8
5 . — N o i s y e x p i r a t i o n .
H. 8 48 30.—Snoring.
I . 8 4 8 5 0 . — C o r n e a i n s e n s i t i v e ; s t o p p e d c h l o r o f o r m ; a n æ s t h e s i a
a f t e r w a r d s k e p t u p i n t h e u s u a l w a y u n t i l t h e
operation was finished at 8h. 55m. 15s.
386
September 2nd, 1891.—No. 315.
Temperature of room 77 . 8° F. Strong healthy male, Kishen Singh, ætat. 28.
Disease—necrosis of lower jaw. Operation—removal of dead bone. Chloroform-
ed at the Afzulgunj Hospital at 9h. 3m. 40s. Full anæsthesia at 9h. 10m. 10s.
Observations.
H . M .
S .
A. 9 3 40.—Chloroform on cap ; rapid blowing, 54 a minute.
B. 9 4 25.—Cap brought close to face ; respirations regular, 28 a
minute.
C. 9 5 30.—Regular breathing, 24 a minute.
D. 9 6 0.—Took three breaths of pure air while more chloroform
was poured into the cap.
E. 9 6 45.—Coughing.
F. 9 7 15.—Moaning.
G-. 9 10 10.—Cornea insensitive ; stopped chloroform.
September 3rd, 1891.—No. 316.
Temperature of room 73 . 6° F. Healthy Mahomedan male, Syed Abdul
Wahab, ætat. 32. Disease—stricture of the urethra and retention of urine.
Operation—catheterism. Chloroformed at the Afzulgunj Hospital at 7h. 56m.
40s. by Shivram Balkristna. Full anæsthesia at 8h. Om. 20s. ; continued until
8h. 2m. 30s.
Observations.
H. M. S.
A. 7 56 40.—Chloroform on cap ; blowing rapidly 40 times a minute.
B. 7 57 0.—Cap close to face ; regular breathing 32 a minute.
C. 7 57 40.—Holding breath ; stopped chloroform ; cap entirely
removed.
D. 7 57 58.—Gasped pure air ; chloroform again.
E. 7 58 15.—Regular respirations, 20 a minute.
F. 7 58 40. —Took t wo br e a t hs of pur e a i r whi l e c hl or of or m wa s
being poured into cap.
387
H. M. S .
G. 7 58 55.—Irregular breathing ; one breath of pure air.
H. 7 59 15.—Regular breathing, slow and moaning, 16 a minute,
I. 7 59 40.—Prolonged moaning expirations.
.j. 8 0 20.—Cornea insensitive ; chloroform stopped. Immediately
afterwards the chest was heaving, but no air w a s
entering. The jaw was pushed forward, and the
breathing became at once normal.
September 3rd, 1891.—N0. 317.
Temperature of room 74 . 5° F. Sickl y Mahomedan male, Nanna Sahib, ætat.
64. Disease—suppurating hydrocele. Temperature in rectum 103 . 4° F . before
the
operation. Operation—excision of part of sac. Chloroformed at the
Afzulgunj Hospital at 8h. 44m. 30s. by Shivram Balkristna. anæsthesia
at 8h. 48m. 30s.; continued until 8h. 51m. 15s.
Observations.
H . M . S .
A. 8 44 30.—Chloroform on cap ; rapid noisy blowing, 56 times a
minute.
B. 8 45 20.—Cap close to face.
C.
8 4 5
4 0 . — A p n œ a ; c a p r e m o v e d .
D. 8 45 55.—One breath of pure air. Chloroform again.
E. 8 46 15.—Regular respirations, 20 a minute.
F.
8 46 50. —Took t hr ee br eat hs of pur e ai r whi l e mor e chl or of or m
was added to the cap.
G. 8 47 20.—Moving arms and legs ; talking incoherently.
H. 8 47 45.—Struggling ; one breath of pure air.
I. 8 48 20.—Spluttering and snoring.
J. 8 48 30.—Cornea insensitive ; stopped chloroform.
K. 8 48 50.—Stertorous breathing; jaw pushed forward ; normal
respiration.
L. 8 51 15.—Operation finished.
388
September 3rd, 1891.—No. 318.
Temperature of room 74 . 5° F. Very sickly Hindoo male, Kristna, ætat. 25.
Disease—spreading gangrene. Operation—exploration. Chloroformed at the
Afzulgunj Hospital at 9h. 24m. 50s. by Shivram Balkristna. Full anæsthesia
at 9h. 30m. 5s.
Observations.
H . M
.
S .
A. 9 24 50.—Chloroform on cap ; blowing 40 times a minute.
B. 9 25 20.—Cap close to face ; coughing.
C. 9 26 10.—Took one breath of pure air while more chloroform
was added to the cap.
D. 9 26 45.—Struggling ; one breath of pure air.
E. 9 27 10.—Regular respirations, 28 a minute.
F. 9 28 55.—Took three breaths of pure air while more chloroform
was poured into the cap.
G. 9 29 10. —Snori ng.
H . 9 3 0 5 . — C o r n e a i n s e n s i t i v e ; s t o p p e d c h l o r o f o r m .
September 3rd, 1891.—No. 319.
Temperature of room 74 . 5° F. Old decrepit Mahomedan. Sayyad Ashraf,
ætat. 82. Disease—senile hypertrophy of the prostate. Operation—perinea
l
section. Chloroformed at the Residency Hospital at 11h. 30m. 15s. by student
Ismail Khan. Full anæsthesia at 11h. 33m. 50s. ; continued until the Operation
was finished at 11h. 37m. 15s.
Observations.
H . M
. S .
A. 11 30 15.—Chloroform on cap ; blowing gently 36 times a
minute.
B. 11 30 45.—Cap close to face.
C. 11 31 5.—regular breathing, 28 times a minute.
D. 11 31 30.— Do.
do.
20 do.
do.
E. 11 31 50.—Took two breaths of pure air while more chloroform
was added to the cap.
389
H. M. S.
F. 11 32 45.—Holding breath ; cap entirely removed.
G. 11 33 15.—Gasped pure air ; chloroform again.
H. 11 33 40.—Irregular breathing ; one breath of pure air.
I . 1 1 3 3 5 0 . — S n o r i n g ; c o r n e a i n s e n s i t i v e ; s t o p p e d c h l o r o f o r m .
Continued afterwards till the operation was finished
at 1111. 37m. 15s.
September 4th, 1891.—No. 320.
Temperature of room 72 .9° F. Weakly emaciated Hindoo male, Lutchannah,
ætat. 31. Disease—liver abscess. Operation—aspiration. Chloroformed at
the Afzulgunj Hospital at 7h. 5m. 25s, by Shivram Balkristna. Full anæsthesia
at 7h. 9m. 30s. ; continued until 7h. 12m. 30s.
Obserations.
H .
M . s .
A. 7 5 25.—Chloroform on cap ; blowing rapidly, 50 times a
B. 7 6 15.—Cap close to face ; regular respirations, 44 a minute.
C. 7 7 45,—Regular respirations, 20 a minute.
D. 7 8 25.—Took three breaths of pure air while more chloroform
was added to the cap.
E. 7 9 15.—Noisy expiration.
F. 7 9 30.—Cornea insensitive ; stopped chloroform ; continued
afterwards until 7h. 12m. 30s.
September 4th. 1891.—No. 321.
Temperature
of room 72.9° F. Weak 1y Hindoo male infant , Gunguloo,
ætat. two months. Disease—abscess. Operation—incision. Chloroformed at the
Afzulgunj Hospital at 8h. 34m. 45s. by Miss Williams. Full anæsthesia at
8h. 36m. 5s. Continued until 8h. 39m. 30s.
Obsercations.
H . M . S .
A. 8 34 45.—Chloroform on cap ; crying and coughing.
B. 8 35 15.—Regular respirations, 48 a minute.
C. 8 36 25.—Cornea insensitive; stopped chloroform. Continued
afterwards until 8h. 39m, 30s.
390
•
September 5th, 1891.—No. 322.
Temperature of room, 74 . 5° F. Sickly Hindoo male, Sayboo, ætat. 25.
Disease-bubo. Operation—excision of the inguinal glands. Chloroformed at
the Afzulgunj Hospital at 8h. 32m. 10s. by Shivram Balkristna, Full
anæsthesia at 8h. 36m. 35s. Continued until 8h. 42m. 30s.
Observations.
H . M . S .
A. 8 32 10.—Chloroform on cap; blowing gently, 44 times a minute.
B. 8 32 50.—Cap close to face ; regular respirations, 20 a minute.
C. 8 33 20.—Irregular breathing, one breath of pure air.
D. 8 33 30.—Regular respirations, 24 a minute.
E.
8 34 30.—Took two breaths of pure air while more chloroform
was added to the cap.
F.
8 35 0.—Struggling, one breath of pure air.
G. 8 35 15.—Regular breathing, 28 times a minute
H.
8 35 55.—Snoring.
I. 8 36 20.-Spluttering.
J . 8 36 35. —Cor ne a i ns e ns i t i ve a nd br e a t hi ng s t e r t or ous s i mul -
taneously ; stopped chloroform ; anæsthesia after-
wards kept up till 8h. 42m. 30s.
September 5 th, 1891.—No. 323.
Temperature of room 74 . 5° F. Weak Hindoo child, Nursoo, ætat. 2.
Disease—abscess. Operation—incision. Chloroformed at the Afzulgunj
Hospital at 8h. 45m. 55s. by Miss Williams. Full anæsthesia at 8h. 47m. 50s.
Continued until 8h. 51m. 30s.
Observations.
H . M . S .
A. 8 45 55.—Chloroform on cap ; crying.
B. 8 46 30.-Cap close ; regular respirations, 27 a minute.
C. 8 47 40.—Took four breaths of pure air while more chloro-
form was added.
D. 8 47 50. — Cor nea i nsensi t i ve ; st opped chl or of or m ; con-
tinued afterwards until the dressings were
applied at 8h. 51m. 30s.
•
391
September 6th, 1891.—No. 324.
Temperature of room 77 .4° F. Very old Hindoo female, Kundee, ætat. 84.
Injury—compound fracture of the right leg. Operation—amputation below
the knee. Chloroformed at the Afzulgunj Hospital at 9h. 45m. 55s. by Miss
E. A. Lawrie. Full anæsthesia at 9h. 48m. 10s. Continued until the operation
was finished at 10h. 25m. Os.
Observations.
H .
M .
S .
A. 9 45 55.—Chloroform on cap; breathing regularly and talking.
B. 9 46 5.—Struggling ; regular breathing.
C. 9 46 25.—Cap close to face ; regular respirations, 20 a minute.
D. 9 47
0.—Irregular respiration and struggling ; one breath of
pure air ; regular breathing,
E. 9 47 15.—Took three breaths of pure air while chloroform
was being poured on to cap.
F. 9 47 30.—Spitting.
G. 9 47 35.—Regular breathing, 24 a minute.
H. 9 48 5.—Cornea insensitive ; stopped chloroform.
A n æ s t h e s i a a f t e r w a r d s m a i n t a i n e d i n t h e u s u a l w a y
till the operation was finished and the dressings
applied at 10h. 25m. 0s.
September 7th, 1891.—No. 325.
Temperature of room 74 . 9° F. Strong, muscular Mahomedan male,
excessively excited and nervous, Rusool Mahomed, ætat. 28. Disease
epithelioma of skin of back. Operation—excision. Chloroformed at the Afzul-
gunj Hospital at 8h. 52m. 35s. by Shivram Balkristna. Full anæsthesia at 8h.
57m. 0s. Continued until the operation was finished at 9h. 15m. 30s. Vomited
a small quantity of bile at 9h. 16m. 10s.
392
Observations.
H. M.
S.
A. 8 52 35.—Chloroform on cap ; blowing 42 a minute.
B. 8 53 10.—Cap close to face.
C. 8 53 50.—Struggle ; one breath of pure air.
D. 8 54 40.—Violent struggling ; one breath of pure air.
E. 8 54 55.—Screaming; breathing regular
.
F. 8 55
5.—One breath of pure air.
G. 8 56 0. —Took t wo br e a t hs of pur e a i r whi l e mor e c hl or of or m
was added to the cap.
H. 8 56 45.—Snoring loudly.
I. 8 57
0.—Cornea insensitive ; stopped chloroform.
J. 8 57 35.—Breathing stertorous ; jaw pushed forward, breath--
ing regular at once.
This case is another example a anæsthesia deepening after discontinuance
of the inhalation of chloroform. This appears to occur in patients who are
excited aid in whom
it is make difficult to make the
respiration quite regular.
it is
patients of this kind that over-dosing is so liable to take place ; and
the explanation of what happens is to be found in Experiment No. 64.
S e p t e m b e r 7 t h ,
1 8 9 1 . — N o . 3 2 6 .
Temperature of room 77 . 7° F. Weak sickly anæmic Hindoo male, Bala
Prasad, ætat. 28. Disease—strangulated inguinal hernia. Operation—hernio-
tomy and the radieal cure. Chloroformed at the Afzulgunj Hospital at 9h. 23m.
40s. by Shivram Balkristna. Full anæsthesia at 9h. 28m. 15s. ; continued until
the operation was finished at 10h. 0m. 45s.
Observations.
H . M . S .
A. 0 23 40.—Chloform on cap; blowing rapidly, 56 times a
minute.
B.
9 24 5. —Cap cl os e t o f ace ; r egul ar r es pi r at i ons , 32 a mi nut e.
C.
9 2 5 3 0 . — R e g u l a r r e s p i r a t i o n s , 2 8 a m i n u t e .
D. 9 25 50.—Short struggle; one breath of pure air.
E.
9 27 35. —Took t wo br eat hs of pur e ai r whi l e mor e chl or of or m
Was added.
394
is all the chloroformist has to produce, chloroform syncope will become a
figment of the past. The clinical and experimental data of the Hyderabad
Commission completely expose the fallacy underlying the wide-spread belief in
the direct action of chloroform upon the heart, a belief which is founded
mainly on fatalities under chloroform that have never been proved to be due to
anything but abnormal inhalation.
Much discussion has taken place lately with reference to the quality of
the chloroform as a factor in anæsthesia. It may therefore be as well to note
that in all the second and in more than half the first series of cases reported in
this section, the anæsthetic employed was Duncan and Flockhart's methylated
chloroform, and that vomiting occurred in less than five per cent. of the admini-
strations.
The Commission does not attempt to make its conclusions retrospective.
It is sufficient to recall the fact that deaths with chloroform have, with few
exceptions, happened in the practice of those who take the pulse as a guide
as to its effects, and to repeat that the pulse can only give indications of actual
danger and of abnormal administration. When it is considered how universal
has become the custom of taking the pulse as a guide in chloroform inhalation,
more especially during the last ten years, it is evident that but for natural
safeguards which surround the administration of chloroform, namely, lowering
of the blood-pressure, stoppage of the respiration, and stoppage of the heart
the mortality from abnormal inhalation would have been considerably higher
than the one in so many hundreds or thousands shown in the useful statistics
o f Mr . R o g e r Wi l l i a ms a n d P r o f e s s o r Wo o d .
The Commission desires to prove that in the practice of surgery death
from chloroform should be impossible. The question is : Will any surgeon
henceforth accept the responsibility of refusing to follow the teaching of the
Hyderabad Chloroform Commission. seeing that it demonstrates how normal
anæsthesia can invariably be secured ?
PART X.—PRACTICAL CONCLUSIONS.
The following are the practical conclusions which the Commission think
may fairly be deduced from the experiments recorded in this report :—
I. The recumbent position on the back and absolute freedom of respira--
tion are essential.
II. If during an operation the recumbent position on the back cannot,
from any cause, be maintained during chloroform administration, the utmost
attention to the respiration is necessary to prevent asphyxia or an overdose.
If there is any doubt whatever about the state of respiration, the patient should
be at once restored to the recumbent position on the back.
Ill. To ensure absolute freedom of respiration, tight clothing of every
kind, either on the neck, chest, or abdomen, is to be strictly avoided ; and n o
assistants or by-standers should be allowed to exert pressure on any part of
the patient's thorax or abdomen. even though the patient be struggling
violently. If struggling does occur, it is always possible to hold the patient
down by pressure on the shoulders, pelvis, or legs without doing anythin g
which can by any possibility interfere with the free movements of respiration.
IV. An apparatus is not essential, and ought not to be used as, being
made to fit the face, it must tend to produce a certain amount of asphyxia.
Moreover, it is apt to take up part of the attention which is required elsewhere.
In short, no matter how it is made, it introduces an element of danger into the
administration. A convenient form of inhaler is an open cone or cap with a
little absorbent cotton inside at the apex.
V. At the commencement of inhalation care should be taken, by not
holding the cap too close over the mouth and nose, to avoid exciting
struggling, or holding the breath. If struggling or holding the breath do occur
great care is necessary to avoid an over-dose during the deep inspirations which
follow. When quiet breathing is ensured as the patient begins to go over, there
is no reason why the inhaler should not be applied close to the face ; and all
that is then necessary is to watch the cornea and to see that the respiration is
not interfered with.
396
VI. In children crying ensures free admission of chloroform into the lungs ;
but as struggling and holding the breath can hardly be avoided, and one or two
whiffs of chloroform may be sufficient to produce complete insensibility, they
should always be allowed to inhale a little fresh air during the first deep inspira--
tions which follow. In any struggling persons, but especially in children, it is
essential to remove the inhaler after the first or second deep inspiration, as enough
chloroform may have been inhaled to produce deep anæsthesia, and this may only
appear or may deepen after the chloroform is stopped (ride supra sub-paragraphs
2 and 9 of conclusions in paragraph 30). Struggling is best avoided in adults
by making them blow out hard after each inspiration during the inhalation.
V I I . T h e p a t i e n t i s , a s a r u l e , a n æ s t h e t i s e d a n d r e a d y f o r t h e o p e r a t i o n t o b e
commenced when unconscious winking is no longer produced by touching the
surface or the eye with the tip of the finger. The anæsthetic should never,
under any circumstances be pushed till the respiration stops ; but When once the
cornea is insensitive the patient should be kept gently under by occasional inha--
lations and not be allowed to come out and renew the stage of struggling and
resistance.
V111. As a rule, no operation should be commenced until the patient is
fully under the inifuence of anæsthetic so as to avoid all chance of death from
surgical shock or fright.
IX. The administrator should be guided as to the effect entirely by the
respiration. His only object, while producing anæsthesia, is to see that the
respiration is not interfered with.
X. If possible, the patient's chest and abdomen should be exposed during
chloroform inhalation, so that the respiratory movements call be seen by the
administrator. If anything interferes with the respiration in any way, however
slightly. even if this occurs at the very commencement of the administration ; if
breath is held, or if there is stertor, the inhalation should be stopped until the
breathing is natural again. This may sometimes create delay and inconveni--
ence with inexperienced administrators, but experience will make any adminis--
trator so familiar with the respiratory functions under chloroform that he will
, i n a s h o r t t i m e , k n o w a l m o s t b y i n t u i t i o n w h e t h e r a n y t h i n g i s g o i n g w r o n g , a n d
be able to put it right . without delay before any danger arises.
XI. If the breathing becomes embarrassed, the lower jaw should be
pulled, or pushed from behind the angles, forward, so that the lower teeth
protrude in front of the upper. This raises the epiglottis and frees the larynx.
397
At the same time, it is well to assist the respiration artificially untiì the embar-
rassment passes off.
XII. If by any accident the respiration stops, artificial respiration should
be commenced at once, while an assistant lowers the head and draws forward the
tongue with catch-forceps, by IIoward ' s method, assisted by compression and re-
laxation of the thoracic walls. Artificial respiration should be continued until
there is no doubt whatever that natural respiration is completely re-established.
XIII. A small dose of morphia may be injected subcutaneously before
chloroform inhalation as it helps to keep the patient in a state of anæsthesia in
prolonged operations. There is nothing to show that atropine does any good
in connection with the administration of chloroform and may do a very great
deal of harm.
X I V . A l c o h o l m a y b e g i v e n w i t h a d v a n t a g e b e f o r eo
p e r a t i o n s U n d e r
c h l o r o f o r m , p r o v i d e d i t d o e s n o t c a u s e e x e i t e m e n t , a n d m e r e l y h a s t h e e f f e c t o f
giving a patient confidence and steadying the circulation.
The Commission has no doubt whatever that, if the above rules be
followed, chloroform may be given in any case requiring an operation with
perfect ease and absolute safety so as to do good without the risk of evil.
The practical conclusions are reproduced here in their original form. They
were written before the Commission had had time to realise the full meaning of
their experimental data or opportitnity tO put them to tie test of clinical
expe-rience. They were not regarded as final by the Commission, as it was hoped
and expected that surgeons and physiologists would examine the tracings and
deseriptions of the experiments for themselves, and draw their own conclusions
from them.
It only remains for the Commission to show, by comparison o f S y m e ' s p r i n c i -
ples with the facts established that it has accomplished the object for which it
was appointed. " The Commission was applied for because it was felt that
Syme's principles, which both experience and experiment had shown to be
pra-tieally sound must be founded upon a firm physiological basis." In his original