The Sun.
London, England, 1864-08-08 00:00:00

GEL OROFORM MISADVENTCRES,

(From the .3fedical limes and Gazette.)
We don't in the least object to professional responsibility.
When a man does any given act, on the due performance of
which hangs the life of a fellow-creature, he ought to be,
and to feel himself answerable for any bad consequences
which may:follow from want of care and skill. But then ho
must have discretionary powers to match ; he must be a free
agent and not a mere tool of others, and must have his hands
quite unshackled in all that relates to his department. Any
one who administers chloroform will do well to bear this in
mind for the future, and may take more than one useful hint
from the proceedings at a late inquest at St Mary's Hos-
pital. It was a great toe case—an operation highly painful,
but not dangerous to life, and unluckily not surrounded
with surgical interest which begets intense caution at every
step. It was, too, just on that part of the body which is
shown to retain its morbid sensibility the longest. The
chlohform was administered, and in a short time the
patient was found to be dead. The post mortem ex-
amination showed that there was fatty degeneration of the
heart, which would enfeeble its action. Mr Edwards, the
chloroformist, said he examined the chest of the patient be-
fore the operation, and although he thought him an un-
favourable subject, he thought he had not the right to re-
fuse chloroform, as ho was called upon to do so. On the
other hand, Mr. A. B. Wall, who had attended the patient
many years, thought there was no extra risk ; neither did
Mr. Lane, who significantly said that Mr. Edwards
had not expressed any unfavourable opinion of the
patient, and that if he had he would have
been relieved of the responsibility of administer-
ing. the chloroform; for, of course, if the surgeons had de-
termined on giving it after hearing his objections, they
would have taken on themselves a responsibility which was
plainly inferred now rested with the chloroformist. The
jury, after along consultation, returned a verdict affirming
that the patient died " from the mortal effects of chloroform,
administered whilst he was labouring under organic disease
of the heart, and that the said death arose from misad-
venture." Not much in this, some may think; but they
would be wrong. The verdict is not a verdict of " acci-
dental death," but implies a grave censure, and so we once
heard it laid down by the late Mr. Wakley at an inquest on
a death from the same cause. "In a case of misadventure
(a) the law presumes negligence, or at least a want of sufli-
ee may shades be t , manslaughter" at by which what is
another; so chloroformists had better beware in time, and
cient caution in him who was so unfortunate as to commit
it; who, therefore, is not altogether faultless." But the
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take care that their degree of responsibility is clearly laid
down, and that a commensurate degree of authority go
therewith.

It will never do for the future that the chloroformist shall,
on the one hand, find himself saddled with a verdict of mis-
adventure ; and, on the other, that he shall be able to say to
the jury, as Mr Edwards did, "My duty is only to give the
chloroform, and I know nothing of the patient." The first
point every chloroformist ought to have cleared up is, who is
responsible for the patient's fitness? All justice and common
sense show that this usually lies at the door of the persons
who know the patient, and have treated him, and recom-
mend an operation. It is absurd to require a young man,
called upon to administer chloroform to a dczen patients in
succession whom he has never before seen, to pronounce
off-hand that each has no organic disease of the heart. In
this very case the practitioner who had attended the de-
ceased for years, and the surgeon who operated, knew
nothing of it, and it would be preposterous to censure Mr
Edwards on this ground. It is quite clear that some one
ought to be called on to say whether a patient is or is not
fit to take chloroform, and that if this is to be the task of
the chloroformist, he ought to be called in in consultation
beforehand, and enabled to learn all the patient's history.
But with respect to this " disease of the heart." Let us
be frank ;—it is a little too like the "cat in the cupboard"
that devours the cream and breaks the crockery.
What are the evidences of diseased heart ? Breathless-

ness, faintness, angina, or even gouty palpitation? But
if these be evidence, where is the person past middle
life who has a sound heart ? It we except the most
athletic young men in the prime of life, where is the
man whose heart would not, if it could be got at, betray
"traces of fatty degeneration ?" As for the fat and lazy
men, the lean and haggard over-anxious men, the studious
sedentary men, and the fast men,—the women of all ages
who lead town lives, the " motherly,women," full-bosomed,
the "fat, fair, and forty, or " fat, puffy, and sixty," and the
people of either sex who have been long ill or bedridden,---
what kind of hearts have they ? We cannot see the heart,
but we can see the calves of the legs, and judge that what
makes the one wasted and scft will not spare the other.
Then if we recollect the tricks of acute rheumatism and
gout, we suspect that there are not 5 per cent of the popu-
lation above 30 whose hearts, if carefully cut up, would not
betray some " traces of fatty degeneration," to solace the
misadventures of the chloroformist. And are all these, the
suffering and invalid part of our race, par excellence, to be
denied chloroform in labour, or operation, or injury ?
Most assuredly not. We entreat cur dear brethren the
chloreforroists just to take for granted that all hearts are
fatty, and to take their time ; and then the patient will be
safe, though his heart be ricketty, and there will be no mis-
adventure. The chlorofermist rust make himself master of
the situation. He ought to have the imperturbability of a
Turk, and be as incapable of hurry as a German postillion.
It is the fifth operation of the day! the theatre is crammed !
the air vaporous and carbonised the s'udents anxious to
get off to their afternoon lecture 1 and one of the great
ornaments of surgery, who has a dozen consultations before
dinner, waits to get his last operation done I Never mind.
The chloroformist should not budge an inch. The opera-
tor must wait for him. The timid young practitioner at-
tends Lady Frail at her dentist's, and spares her ladyship's
consciousness the horrors of feeling a stump extracted. The
patient is a little flurried, and sitting upright—all bad for
chloroform. She gets a little noisy. " Can't you push
it ?" says the dentist, looking at his watch, Take
your time, good chloroformist, we say, or there will be
a misadventure. Entice the patient into sleep, slowly
and gently. He cannot resist even a feeble
vapour if given long enough. Put your faith in
the rule of three. If 3 per cent. of vapour
will stop a degenerate heart in four minutes, halve the vapour
and double the time and the heart will not stop.
Festina lento. Put this label on your chloroform bottle)
and there will be an end of misadventure.