On December 17, 1897, a fatality occurred during the administration of
ether. The patient, a woman aged forty-four years, who suffered from
"internal cancer," was admitted for operation into the new hospital
for women, Euston Road. It was considered that an operation would
afford a chance of the prolongation of her life. At the time of
admission the patient was in a very exhausted condition. Mrs. Keith,
the anæsthetist to the hospital, administered nitrous oxide gas,
followed by ether, which combination of anæsthetics the patient took
well. After the expiration of thirty minutes and while the operation
was in progress the patient became so collapsed that the surgeon was
requested by the anæsthetist to desist from further surgical procedure
and she at once complied. Resuscitative measures were at once applied,
but the patient died after about ten minutes from circulatory failure
arising from surgical shock and collapse. We have not received any
particulars as to the means adopted to restore the woman or whether
hemorrhage was severe. In all such cases posture, warmth and guarding
the patient from the effects of hemorrhage are undoubtedly the most
important points for attention both before and during the operation.
The fact is established that both chloroform and ether cause a fall
of body temperature, and so increase shock unless the trunk and limbs
are kept wrapped in flannel or cotton-wool. The fall of temperature
under severe abdominal and vaginal operations again is considerable. A
profound anæsthesia allows of a considerable drop in arterial tension,
which has been shown to be least when the limbs and pelvis are placed
at a higher level than the head. Again, saline transfusion of Ringer's
fluid certainly lessens the collapse in such cases when the bleeding,
always severe, has been excessive. We do not doubt that such a severe
operation undertaken when the patient was in a dangerous state of
exhaustion was as far as possible safeguarded by every precaution, and
we regret we have not been favored with the particulars of the methods
employed. A death following the administration of ether is reported
from the Corbett Hospital, Stourbridge.[1] The patient, aged
thirty-nine years, was admitted on September 21, 1897, suffering from
fracture of the right femur. A prolonged application of splints led to
a stiffness with adhesions about the knee joint which were to be dealt
with under an anæsthetic on December 8. Ether was given from a
Clover's inhaler; one ounce was used. The induction was slightly
longer than usual but was marked by no unusual phenomena. No sickness
occurred during or after anæsthesia and no respiratory spasm was seen.
There was a short struggling stage followed by true anæsthesia when
the operation, a very brief one, was rapidly performed. The patient
was then taken back to the ward and the corneal reflex was noticed as
being present. Voluntary movements were also said to have been seen.
Later he opened his eyes "and seemed to recognize an onlooker." After
this no special supervision was exercised. A hospital porter engaged
in the ward noticed the man was breathing in gasps; this was twenty
minutes after the patient had been taken from the operating theater
and half an hour subsequent to the first administration of the ether.
The surgeons were fetched from the operating theater and found by that
time that the man was dead. "He was lying with his head thrown back,
so that no possible difficulty of breathing could have arisen due to
his position. The eyes were open and the lips slightly parted; nor was
there any sign of any struggle for breath having taken place." The
ether was analyzed and found to fulfill the British Pharmacopoeia
tests for purity. The necropsy revealed that the right heart was
distended with venous fluid blood. The lungs also were loaded with
blood, as were all the viscera. We cannot but feel that the fact shown
at the post mortem examination seemed to indicate that the man died
from asphyxia and not from heart failure. No doubt patients appear to
resume consciousness after an anæsthetic and even mutter
semi-intelligible words and recognize familiar faces. They then sink
into deep sleep just like the stupefaction of the drunken, and in this
condition the tongue falls back and the slightest cause--a little
thick mucus or the dropping of the jaw--will completely prevent
ventilation of the lungs taking place. Two very similar cases occurred
in the practice of a French surgeon, who promptly opened the trachea
and forced air into the lungs, with the result that both patients
survived. In his cases chloroform had been given. A death under
chloroform occurred at the infirmary, Kidderminster. The patient, a
boy, aged eight years and nine months, suffered from a congenital
hernia upon which it became necessary to operate for its radical cure.
The house surgeon, Mr. Oliphant, M.B., C.M. Edin., administered
chloroform from lint. In about eight minutes the breathing ceased, the
operation not having then been commenced. Upon artificial respiration
being adopted the child appeared to rally, but sank almost immediately
and died within two minutes. The necropsy showed no organic disease.
At the inquest the coroner asked Dr. Oliphant whether an inhaler was
not a better means of giving chloroform, and whether that substance
was not the most dangerous of the anæsthetics in common use, and
received the answer that inhalers were not satisfactory for giving
chloroform and that it was a matter of opinion as to which was the
most dangerous anæsthetic. We so often hear that the Scotch schools
never meet with casualties under anæsthetics because they always use
chloroform, and prefer to dispense with any apparatus, that we can
readily accept the replies given to the coroner as representing the
views current among the majority of even the thoughtful alumni of
those great centers of medical training. A glance over the long list
of casualties under chloroform will unfortunately show that whatever
charm Syme exercised during his life has not survived to his
followers, and overdosage with chloroform proves as fatal in the hands
of those who hail from beyond the Tweed as well as "down south." A
death from chloroform contained in the A.C.E. mixture occurred at the
General Hospital, Birmingham, on December 15. The patient, a girl,
aged five years and ten months, suffered from hypertrophied tonsils
and post-nasal adenoid growths. She was given the A.C.E. mixture by
Mr. McCardie, one of the anæsthetists to the institution, and
tonsillotomy was performed. As consciousness was returning some
chloroform was given to enable Mr. Haslam, the operator, to remove the
growths. She died at once from respiratory failure, in spite of
restorative measures. A necropsy showed absence of organic disease.
The anæsthetist regarded the death as one from cardiac failure due to
reflex inhibition by irritation of the vagus. We are not told the
posture of the child or the method employed.--The Lancet.
[Footnote 1: We are indebted to Mr. Hammond Smith, honorary
surgeon to the hospital, and Mr. Edgar Collis for the notes of the
case.--Ed. Lancet]
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The resistance of nickel steel to the attack of water increases with
the nickel contents. The least expanding alloys, containing about 36
per cent. of nickel, are sufficiently unassailable, and can be exposed
for months to air saturated with moisture without being tainted by
rust. With a view of testing the expansion of nickel steel,
experiments have been carried out by allowing measuring rods to remain
in warm water for some hours, according to The Iron and Coal Trades
Review. They were not wiped off when taken out, but were exposed for a
longer period to hot steam, but the lines traced on the polished
surfaces were not altered. The rough surfaces, when exposed to steam,
were covered after several days with a continuous, but little
adhesive, coat of rust.
* * * * *