213
LETTER FROM MR . EWEN J. MACLEAN.
TO THE EDITORS OF "THE LANCET."
SIRS,—The following notes of a case in one's experience of the use of chloroform may
be of interest at the present time. J. G, aged fifty-nine, army pensioner ; has seen a good
deal of foreign service: had malaria. Operation by colleague: evulsion of the right great
t oe- nai l . Pat i ent had
b e e n l o w - s p i r i t e d f o r f o m e t i m e . B o w e l s r e g u l a r . H a d n o f o o d f o r
four hours previously to operation. Chloroform administered by myself on an ordinary soft
b e d - r o o m
t o w e l , f o l d e d
c o n e
fashion, after the heart had been examined as a matter of form and
found normal. The head was kept low. It was a considerable time before the anætheti
c
took any visible effect, and the patient was very quiet both in speech and movement and took
d e e p b r e a t h s f r
e e l y . S o m e w h a t m a r k e d c o n g e s t i o n o f t h e e x t e r n a l j u g u l a r a n dt
e m p o r a l
veins
was noted. Three times the operator tested the seat of operation after the conjunctival reflex
appeared abolished and muscular relaxation present, but found sensibility to pain still retained.
The fourth time, however, there was no response, and the operation was proceeded with . In
t h e
c o u r s e o f f i v e m i n u t e s o r s o , w h e n t h e t o e w a s b e i n gs
p o n g e d , w h i l e t h e
pulse remained
steady, though a trifle rapid, the breathing became quicker and somewhat shallow. The
a d m i n i s t r a t i o n o f c h l o r o f o r m w a sa
t , o n c e s t o p p e d a n d
the cloth put away to a safe distance.
The breathing, however, became increasingly shallow and soon stopped entirely. In the mean
time the lips and face generally had become distressingly livid and the pupils widely dilated.
The pulse, however, kept going, though its character or frequency cannot be reliably noted
from the fact that artificial respiration was at once resorted to. Silvester's method was
employed, the tongue being drawn forwards with forceps by my colleague. The windows of
the room were widely opened to admit air freely. After about two minutes of this treatment
the artificial respiration was stopped, to see if auto-respiration would be re-established, but still
no breathing. There was no time to examine the characters of the heart or pulse. Cold water
was next dashed in abundance over the chest and throat, and this undoubtedly effected
t h e
turning point in t h e c a s e , a s , a f t e r a f e w mo r e p a s s e s o f t h e Si l v e s t e r me t h o d , auto-respiration
returned—at first very shallow, but rapidly improving. The recovery seemed accelerated by
the application of flannels wrung out of boiling water to the præcordia. The patient was next
g o t c o m f o r t a b l y i n t o b e d w i t h h o t - w a t e r b o t t l e s t o f e e t a n d f l a n k s a n d b r a n d y a n d e t h e r
w e r e
administered. He recovered without any apparent ill-effects, and next day, when told of our
a n x i e t y a st
o h i s w e l f a r e o n t h e p r e v i o u s d a y , s t a t e dt
h a t i t w a s t h e s e v e n t h
t i m e
in
his
varied
e xpe r i e nc e s he ha d na r r owl y e s c a pe d wi t h l i f e . Thi s c a s e , amongst other things, impresses on
one:—(1) The necessity of watching with special care those cases where anæthesia is difficult
t o e s t a b l i s h . ( 2 ) T h e i m p o r t a n c e o f n o t i n g t h e c h a r a c t e ra
n d f r e q u e n c y
of the respiration. (3)
The fact that chloroform paralyses the respiratory before the cardiac centre. (4) The value in
these cases of Silvester's methods of artificial respiration. (5) The great value of cold-water
a f f u s i o n
i n
r e c o v e r i n g a u t o - r e s p i r a t i o n . ( 6 )T
h e
moral duty of being thoroughly well acquaint
-
ed with the treatment of emergencies incident to chloroform administration.
I am, Sirs, yours very truly,
E W E N J . M A C L E A N , M . B .B
i r s t o l , F e b r a u r y 1 8 9 0 .