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The following case may be here quoted as a good example of the class of chloroform
accidents, upon which is based the theory of the action of chloroform on the heart:
—
The patient was a strong, healthy labourer, who required an anæsthetic, while some
adhesions were broken down in his knee-joints; he had taken chloroform successfully three
months previously. The case is reported by the surgeon who was superintending the adminis-
-t rat i on of t he anæst het i c. Chl oroform was admi ni st ered by a t owel . ( B r i t i s h M e d i c a l J o u r n a l ,
1884, Vol. II., p. 811.)
"The patient showed not the least sign of nervousness . . . and commenced in--
haling by several rapid shallow breaths, as if determined to get quickly under the influence of
the anæsthetic. Following immediately upon the shallow movements were three or four deep
inspirations. Feeling that this method must have entailed a large and rapid consumption of
chloroform, I directed the house surgeon to remove the cloth, when the patient, though still
breathing, was seen to have his eyes wide open, the pupils rapidly dilating, and the conjunctiva
insensible. The face was neither livid nor pale; the lips, indeed, were of their normal pink
hue, and the cheeks slightly flushed. In fact, beyond the condition of the eyes, there was
nothing in the facial aspect to excite alarm. Up to this point, the time of the inhalation could
not have exceeded one to two minutes. On feeling the right radial no pulse could be detected.
The head was lowered, respiration then ceased; not, however, until three or four breaths had
been drawn after the recognised cessation of the pulse. After the commencement of artificial
respiration, the patient spontaneously made several gasps, but there were no father signs of vitality."
This case is valuable because it is reported, not by the administrator of the anæsthetic,
but by one who was merely watching the case, and who had ample time accurately to note the
events which occurred; and the absence of struggling, so common in suddenly fatal cases,
made the observation of the symptoms easy.
Taken in conjunction with the numerous reported cases in which the patient passes
suddenly from a condition of active struggling to a state of collapse, with gasping respiration
and absence of pulse, it proves that chloroform, if it does not actually paralyse the heart, may
cause death by some means equally sudden and certain; and that in such cases, the heart is
practically stopped, as far as its functional value is concerned, before the respiration. The case
indicates also that observation of the respiration alone will not give adequate warning of
danger, for the respiratory movements may be perfect one second, and the next be on the verge
of extinction, and hopelessly beyond recovery. It also shows that fatal damage may have been
wrought on the system before there is any outward sign.
This case is also noteworthy as contradicting the statements made by the first Hydera
-bad Chloroform Commission that since 1856, no death from chloroform has occurred in which
the respiration, and the respiration alone, was attended to throughout the administration.
The patient was breathing perfectly, and there was no sign of respiratory failure when
the administration was suspended, so that was the respiration alone observed it would only
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