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tinge, which seems to be characteristic of death from asphyxia by chloroform. The left side
was firmly contracted and empty, the veins leading to the right side full of blood, the lungs
behind engorged with liquid blood of a dark pinkish tint. A general engorgement of the
veins of the liver and kidneys, and in some cases petechial spots formed by extravasated blood
in the serous covering of the heart and pleural lining of the ribs, and the covering of the
lungs. We find often similar petechial spots in new-born infants, who make a struggle to
breathe fully and freely, and fail from obstruction by pressure, &C.I n
t h e d e a t h s f r o m s y n c o p e ,
or failure of heart's action, there was found a flaccid heart with all the cavities empty. No
blood on the right side; no contraction of the left vent ricle. There was bl ood in the veins;
the cavæ were distended with blood. In some instances the heart was large, soft, and fatty,
and its tissue friable. Along with this condition of heart
was noted a more or less yellow,
soft, fatty liver. in other instances there was no evidence of any disease of the heart or other
organs:
all that was noticed was a flaccid empty heart, with venous engorgement in the lungs,
In one fatal case examined by Dr. Moore there was in addition to the empty flaccid heart,
complete adhesion all round to the pericardium. Death was due to syncope from failure of
the heart's action.D e a t h s f r o m a s p h y x i a ,
or preventable deaths, took place under two dis-
-tinct sets of circumstances. In one set the administration of the chloroform was too long
continued. The patient was too deeply under its influence from the beginning. There was
an overdose, th e breathing became shallower and shallower, the chest ceased to move, the
diaphragm and abdominal
walls only moving. The face and lips became livid, and death
ensued in spite of artificial respiration. In the second or other set the patient was placed
fairy- under the influence of chloroform, administered
with a due admixture of air, but
during the operation, owing to the patient appearing to come out from under its influence, a
further dose was administered, and this dose was excessive, and the patient died. The cause
of death was asphyxia through the lungs, This is not an uncommon blunder, even in the
hands or skilled men, and is due to want of care in the administration and the neglect of
watching the r es pi r at i on.
There are some conditions of lungs and other organs which render the administration
of chloroform specially hazardous, and which increase the risk of death from asphyxia. One
is a lung or lungs bound down to the walls of the chest and diaphragm by old adhesive ba n d s ,
the patient having had extensive pleurisy. The breathing capacity or volume of the weakened
lung being greatly diminished, a small or ordinary quantity becomes an overdose. With
lungs in this condition a very
little chloroform seems to embarrass the respiratory organs and
bring about a fatal result.
In two dental cases in which chloroform was administered by experienced men, who
had not, however, examined the chests, and did not know how imperfect a nd unsatisfactory
the respiratory machinery was, d e a t h
e n s u e d
e a r l y i n t h e a d m i n i s t r a t i o n a n d r a p i d l y .T
h e r e
was no help at hand of a proper kind to save l i f e by ar t i f i ci al r espi r at i on. I h a v e k n o w n
humpbacked patients giving great trouble from imperfect breathing apparatus. Another con-
- d i t i o n w h i c h i s e m b a r r a s s i n g , b u t i n a d i f f e r e n t w a y , i s a l b u m e n i n t h e u r i n e — B r i g h t ' s d i s e a s e .
In several of the fatal cases albumen was present in large quantity. Urine should always be
examined when possible- "forewarned isf o r e a r m e d . "
W i t h
k i d n e y a c t i o n d e f e c t i v e i n t h e