suddenly arresting the action of the heart when it is mixed with the
respired air to the extent of eight or ten per cent., or upwards; and we
must therefore conclude that, in the fatal cases of its inhalation, the
air the patients were breathing just before the accidents occurred
contained this amount of vapour. There was no means adopted, so far as
is reported, to regulate the proportion of vapour in the inspired air,
in any case in which an accident happened; and there was the liability
in every case that ten per cent. or more of vapour might be present in
the air the patient breathed; and in no case did death occur in the
manner that it occurs when the vapour of chloroform does not exceed five
per cent. of the inspired air.
TABLE OF FATAL CASES OF INHALATION OF CHLOROFORM.
───┬────────────┬────┬───────────────┬──────────┬───────────────
No.│ Patient. │Age │ Operation for │ Position │Means by which
│ │ in │ which the │ whilst │the chloroform
│ │yrs.│chloroform was │inhaling. │was exhibited.
│ │ │ inhaled. │ │
│ │ │ │ │
│ │ │ │ │
│ │ │ │ │
───┼────────────┼────┼───────────────┼──────────┼───────────────
1│Girl │ 15 │Removal of │Sitting │Towel
│ │ │ toe-nail. │ │
2│Married lady│ 35 │Extraction of │Sitting │Inhaler
│ │ │ teeth. │ │
3│Patrick │ │Operation for │Lying on │Handkerchief
│ Coyle │ │ fistula in │ the side│
│ │ │ ano │ │
4│Single lady │ 30 │Opening of │Lying │Handkerchief
│ │ │ sinus in │ │
│ │ │ thigh │ │
5│Young woman │ │Amputation of │ │Handkerchief
│ │ │ the middle │ │
│ │ │ finger │ │
6│Young man │ 22 │Transcurrent │ │Inhaler
│ │ │ cauterisation│ │
│ │ │ of wrist │ │
7│Young man │ │Intended │ │Probably
│ │ │ removal of │ │ handkerchief
│ │ │ toe-nail. │ │
8│Seaman │ 31 │Removal of │Lying on │Napkin
│ │ │ hæmorrhoids │ the side│
9│Miner │ 17 │Intended │Lying │Handkerchief
│ │ │ amputation of│ │
│ │ │ middle finger│ │
10│Labourer │ 36 │Amputation of │ │Handkerchief
│ │ │ toe │ │
│ │ │ │ │
11│Married lady│ 33 │Intended │Sitting │Handkerchief
│ │ │ extraction of│ │
│ │ │ tooth │ │
12│Porter │ 48 │Removal of │Lying │Inhaler
│ │ │ toe-nail │ │
│ │ │ │ │
13│Married │ │Removal of │Probably │A sponge
│ woman │ │ eyeball │ lying │
│ │ │ │ │
14│Young lady │ 20 │Intended │Sitting │A sponge
│ │ │ extraction of│ │ enclosed in a
│ │ │ tooth │ │ napkin
15│A man │ │ │ │A sponge
│ │ │ │ │
│ │ │ │ │
16│Artilleryman│ 24 │Amputation of │ │Handkerchief
│ │ │ middle finger│ │
17│Bookkeeper │ 30 │Intended │Lying │Napkin
│ │ │ operation on │ │
│ │ │ testicle │ │
18│Boy │ 8 │Sounding the │Lying │Piece of lint
│ │ │ bladder │ │
19│Policeman │ 34 │Removal of │ │Napkin
│ │ │ portion of │ │
│ │ │ hand │ │
20│Man │ 24 │Intended │Lying │Folded lint in
│ │ │ amputation of│ │ a hollow
│ │ │ leg │ │ sponge
21│Man │ │Intended │Lying │
│ │ │ operation on │ │
│ │ │ the penis │ │
22│Married lady│ 36 │Extraction of │Sitting │Handkerchief
│ │ │ teeth │ │
23│Mulatto │ 45 │Removal of │Lying │Napkin
│ seaman │ │ testicle. │ │
24│Married │ 37 │Removal of │Lying │Handkerchief
│ woman │ │ impacted │ │
│ │ │ fæces │ │
25│Man │ 23 │Ligature of │Lying │Inhaler
│ │ │ vessels near │ │
│ │ │ vascular │ │
│ │ │ tumour │ │
26│Married lady│ 32 │Intended │Sitting │Sponge
│ │ │ extraction of│ │ surrounded by
│ │ │ tooth │ │ handkerchief
27│Man │ │Intended │Lying │Handkerchief
│ │ │ operation for│ │
│ │ │ fistula _in │ │
│ │ │ ano_ │ │
28│Cattle │ │Applic. of │ │Handkerchief
│ dealer │ │ potassa fusa │ │
│ │ │ to ulcers of │ │
│ │ │ leg │ │
29│Factory │ │Removal of │Lying │Inhaler
│ operative │ │ malignant │ │
│ │ │ tumour of │ │
│ │ │ thigh. │ │
30│Single woman│ 28 │Intended │Lying │Folded lint
│ │ │ application │ │
│ │ │ of nitric │ │
│ │ │ acid to │ │
│ │ │ ulcers of │ │
│ │ │ pudenda │ │
31│Soldier │ 25 │Removal of │Lying │Hollow sponge
│ │ │ small tumour │ │
│ │ │ from cheek │ │
32│Tobacconist │ 43 │Intended │Lying │Handkerchief
│ │ │ perineal │ │
│ │ │ section │ │
33│Woman │ 40 │Intended │Lying │Folded lint
│ │ │ operation for│ │
│ │ │ strangulated │ │
│ │ │ hernia │ │
│ │ │ │ │
34│Single woman│ 22 │Intended │Lying │Inhaler
│ │ │ application │ │
│ │ │ of actual │ │
│ │ │ cautery to │ │
│ │ │ sore of │ │
│ │ │ vagina │ │
35│Young man │ 19 │Intended │Lying │Inhaler
│ │ │ forcible │ │
│ │ │ extension of │ │
│ │ │ knee │ │
36│Girl │ 13 │Removal of │Apparently│
│ │ │ tumour from │ sitting │
│ │ │ back │ │
37│Married │ 59 │Intended │Lying │Hollow sponge
│ woman │ │ reductionof │ │
│ │ │ old │ │
│ │ │ dislocation │ │
│ │ │ of humerus │ │
38│Woman │ 40 │Removal of │Lying │Folded lint
│ │ │ uterine │ │
│ │ │ polypus │ │
39│Married │ 45 │Intended │Lying │Sponge,
│ woman │ │ removal of │ │ handkerchief,
│ │ │ breast │ │ and inhaler
40│Tailor │ 18 │Intended │Lying │Inhaler
│ │ │ operation for│ │
│ │ │ phymosis │ │
41│Labouring │ 65 │Intended │Lying │Inhaler
│ man │ │ amputation of│ │
│ │ │ thigh │ │
42│Shoemaker │ 39 │Catheterism │Lying │Folded lint
│ │ │ │ │
│ │ │ │ │
│ │ │ │ │
43│Woman │ 56 │Intended │Lying │Folded lint &
│ │ │ amputation of│ │ piece of
│ │ │ leg │ │ oiled silk
44│Man │ 40 │Intended │Lying │Inhaler
│ │ │ excision of │ │
│ │ │ eyeball │ │
45│Married lady│ 29 │Inhaled to │Sitting │Inhaler
│ │ │ relieve │ │
│ │ │ neuralgia │ │
46│Married lady│ 36 │Intended │Sitting │Handkerchief
│ │ │ extraction of│ │
│ │ │ teeth │ │
47│Sailor │ 30 │Intended │Sitting │Sponge and
│ │ │ removal of │ │ folded lint
│ │ │ necrosed bone│ │
│ │ │ from finger │ │
48│Boy │ 9 │Intended │Lying │Cotton wool &
│ │ │ removal of │ │ folded lint
│ │ │ tumour of │ │
│ │ │ scapula │ │
49│Labourer │ 35 │Intended │Lying │Folded lint
│ │ │ amputation of│ │
│ │ │ thigh │ │
50│Young woman │ 17 │Application of │Lying │Inhaler
│ │ │ nitric acid │ │
│ │ │ to syphilitic│ │
│ │ │ sores │ │
───┴────────────┴────┴───────────────┴──────────┴───────────────
───┬────────────┬────┬──────────────┬────────────┬────────────
No.│ Patient. │Age │Time from the │ Apparent │ Previous
│ │ in │ commencement │ mode of │inhalations.
│ │yrs.│of inhalation │ death. │
│ │ │ to the │ │
│ │ │ beginning of │ │
│ │ │ dangerous │ │
│ │ │ symptoms. │ │
───┼────────────┼────┼──────────────┼────────────┼────────────
1│Girl │ 15 │Half a minute │Cardiac │Ether once.
│ │ │ │ syncope │
2│Married lady│ 35 │About two │Cardiac │None.
│ │ │ minutes │ syncope │
3│Patrick │ │About one │Cardiac │One.
│ Coyle │ │ minute │ syncope │
│ │ │ │ │
4│Single lady │ 30 │Probably half │Cardiac │None.
│ │ │ a minute │ syncope │
│ │ │ │ │
5│Young woman │ │A very short │Cardiac │None stated.
│ │ │ time │ syncope │
│ │ │ │ │
6│Young man │ 22 │Five minutes │Symptoms not│None stated.
│ │ │ │ described │
│ │ │ │ │
7│Young man │ │Not stated │Death very │None stated.
│ │ │ │ sudden │
│ │ │ │ │
8│Seaman │ 31 │About ten │Cardiac │One.
│ │ │ minutes │ syncope │
9│Miner │ 17 │About five │Cardiac │None.
│ │ │ minutes │ syncope │
│ │ │ │ │
10│Labourer │ 36 │Died at the │Cardiac │A previous
│ │ │ close of the│ syncope │ attempt.
│ │ │ operation │ │
11│Married lady│ 33 │A very short │Cardiac │One.
│ │ │ time │ syncope │
│ │ │ │ │
12│Porter │ 48 │A little more │Probably │None.
│ │ │ than two │ asphyxia │
│ │ │ minutes │ │
13│Married │ │Died during │Cardiac │None stated.
│ woman │ │ the │ syncope │
│ │ │ operation │ │
14│Young lady │ 20 │Just after │Cardiac │Previous
│ │ │ beginning to│ syncope │ attempts.
│ │ │ inhale │ │
15│A man │ │Died before │Probably │None.
│ │ │ the │ cardiac │
│ │ │ operation │ syncope │
16│Artilleryman│ 24 │ │Cardiac │None.
│ │ │ │ syncope │
17│Bookkeeper │ 30 │Within five │Cardiac │None.
│ │ │ minutes │ syncope │
│ │ │ │ │
18│Boy │ 8 │A few minutes │Cardiac │None.
│ │ │ │ syncope │
19│Policeman │ 34 │Died during │Cardiac │None.
│ │ │ operation │ syncope │
│ │ │ │ │
20│Man │ 24 │A few minutes │Cardiac │None.
│ │ │ │ syncope │
│ │ │ │ │
21│Man │ │ │“Suddenly │None stated.
│ │ │ │ expired” │
│ │ │ │ │
22│Married lady│ 36 │Less than a │Cardiac │None.
│ │ │ minute │ syncope │
23│Mulatto │ 45 │About seven │Cardiac │None.
│ seaman │ │ minutes │ syncope │
24│Married │ 37 │Eight or nine │Symptoms not│Two.
│ woman │ │ minutes │ observed │
│ │ │ │ │
25│Man │ 23 │Five to ten │Cardiac │One.
│ │ │ minutes │ syncope │
│ │ │ │ │
│ │ │ │ │
26│Married lady│ 32 │Four or five │Cardiac │None stated.
│ │ │ inspirations│ syncope │
│ │ │ │ │
27│Man │ │Not more than │Cardiac │None.
│ │ │ a minute │ syncope │
│ │ │ │ │
│ │ │ │ │
28│Cattle │ │Died during │Probably │None.
│ dealer │ │ operation │ cardiac │
│ │ │ │ syncope │
│ │ │ │ │
29│Factory │ │About twelve │Probably │None.
│ operative │ │ minutes │ cardiac │
│ │ │ │ syncope │
│ │ │ │ │
30│Single woman│ 28 │ │Cardiac │None.
│ │ │ │ syncope │
│ │ │ │ │
│ │ │ │ │
│ │ │ │ │
│ │ │ │ │
31│Soldier │ 25 │Five minutes │Cardiac │None.
│ │ │ │ syncope │
│ │ │ │ │
32│Tobacconist │ 43 │A few minutes │Cardiac │Two.
│ │ │ │ syncope │
│ │ │ │ │
33│Woman │ 40 │About five │Simultaneous│None.
│ │ │ minutes │ deep coma │
│ │ │ │ and │
│ │ │ │ cardiac │
│ │ │ │ syncope │
34│Single woman│ 22 │About five │Cardiac │One.
│ │ │ minutes │ syncope │
│ │ │ │ │
│ │ │ │ │
│ │ │ │ │
│ │ │ │ │
35│Young man │ 19 │Fifty seconds │Cardiac │None.
│ │ │ │ syncope │
│ │ │ │ │
│ │ │ │ │
36│Girl │ 13 │ │Cardiac │None stated.
│ │ │ │ syncope │
│ │ │ │ │
37│Married │ 59 │About five │Deep coma │None.
│ woman │ │ minutes │ and │
│ │ │ │ cardiac │
│ │ │ │ syncope │
│ │ │ │ │
38│Woman │ 40 │A few minutes │Cardiac │None stated.
│ │ │ │ syncope │
│ │ │ │ │
39│Married │ 45 │Three-quarters│Cardiac │None.
│ woman │ │ of an hour. │ syncope │
│ │ │ │ │
40│Tailor │ 18 │About seven │Cardiac │None.
│ │ │ minutes │ syncope │
│ │ │ │ │
41│Labouring │ 65 │Between 13 and│Cardiac │None.
│ man │ │ 14 minutes │ syncope │
│ │ │ │ │
42│Shoemaker │ 39 │A few minutes │Deep coma, │None.
│ │ │ │ apnœa, and│
│ │ │ │ cardiac │
│ │ │ │ syncope │
43│Woman │ 56 │About three │Cardiac │None.
│ │ │ minutes │ syncope │
│ │ │ │ │
44│Man │ 40 │About five │Cardiac │None.
│ │ │ minutes │ syncope │
│ │ │ │ │
45│Married lady│ 29 │A few seconds │Cardiac │Two or
│ │ │ │ syncope │ three.
│ │ │ │ │
46│Married lady│ 36 │A few seconds │Cardiac │Four.
│ │ │ │ syncope │
│ │ │ │ │
47│Sailor │ 30 │Three or four │Deep coma │None.
│ │ │ minutes │ and │
│ │ │ │ cardiac │
│ │ │ │ syncope │
48│Boy │ 9 │A few minutes │Cardiac │None.
│ │ │ │ syncope │
│ │ │ │ │
│ │ │ │ │
49│Labourer │ 35 │A few minutes │Cardiac │One.
│ │ │ │ syncope │
│ │ │ │ │
50│Young woman │ 17 │ │Symptoms not│Two.
│ │ │ │ observed │
│ │ │ │ │
│ │ │ │ │
───┴────────────┴────┴──────────────┴────────────┴────────────
There is in a great number of the cases an evident connection between
the accident and the probable strength of the mixture of vapour and air.
In six cases the accident occurred just after the commencement of the
inhalation; in two of the cases, Nos. 27 and 37, the fatal symptoms
occurred just after fresh chloroform had been applied on the
handkerchief and sponge; and in several cases, in which the circulation
was suddenly arrested just after the patient had been rendered
insensible, the insensibility had been induced so quickly as to prove
that the vapour must have been inhaled in a very insufficient state of
dilution.
THE TWO KINDS OF SYNCOPE.
Dr. Patrick Black has made an objection to the fact of the patients
having died of paralysis, or over-narcotism of the heart, in the
accidents from chloroform.[132] He says that paralysis of the heart
would be death by syncope, but that the symptoms before death, and the
conditions of the organs met with afterwards, are not in accordance with
such a view of the case. In order to show that both the symptoms and the
after death appearances, in the fatal cases of inhalation of chloroform,
are consistent with paralysis of the heart, it is necessary to point out
the difference between ordinary syncope and cardiac syncope. One of the
best examples of ordinary, or what may be called anæmic syncope, is that
which occurs in a common blood-letting, whilst the patient is in the
sitting posture. When the bloodvessels, especially the veins, which at
all times contain the greater part of the blood in the body, do not
accommodate themselves fast enough to the diminished quantity of blood,
the right cavities of the heart are supplied with less and less of the
circulating fluid; and in a little time are not supplied at all, when
the heart ceases to beat, in accordance with the observation of Haller,
that it does not pulsate when it is not supplied with blood. The moment
the heart ceases to supply blood to the brain there are loss of
consciousness and stoppage of respiration; but on the patient being
placed in the horizontal position the blood flows readily into the right
cavities of the heart from the great veins of the abdomen and lower
extremities; the heart immediately recommences its contractions; the
brain is again supplied with blood, and respiration and consciousness
return.[133]
The blood may remain in the ordinary quantity; but if the bloodvessels
do not keep up their usual support, and exert a sufficient pressure on
their contents, the same kind of syncope will occur as that from
blood-letting. The late Sir George Lefevre related the case of a lady
who fainted whenever she left her bed, and assumed the upright posture;
no cause could be found for this until it was ascertained that she
suffered from varicose veins of the legs: bandages to these extremities
prevented the fainting. It is obvious that in this case the mechanism of
the syncope was the same as that in blood-letting; the distension of the
varicose veins under the weight of the superincumbent blood had the same
effect in preventing the supply to the right cavities of the heart, as
if the blood had been entirely removed. The faintness which often occurs
on first rising, when a person has long kept the recumbent posture from
any local cause, is probably of the same kind; the veins not having had
to support the weight of the usual column of blood for some days or
weeks, lose their tone we may presume, and yield when they are all at
once subjected to the weight of a column of blood extending from the
lower extremities to the heart, so that this organ ceases to be properly
supplied with the circulating fluid.
In cardiac syncope, on the other hand, the cavities of the heart, or at
all events the right cavities of this organ, are always full, whether
the syncope depend on paralysis of the heart by a narcotic, or inherent
weakness of its structure, or on its being overpowered by the quantity
of blood with which it is distended. After death from this kind of
syncope, if the blood have not been displaced by artificial respiration
or other causes, the right cavities of the heart and the adjoining great
veins will be found filled with blood, and the lungs will in many cases
be more or less congested. The appearances in short will be very much
the same as in asphyxia by privation of air, which ends in a kind of
cardiac syncope, the stoppage of the heart being partly due to
over-distension of its right cavities, and partly to loss of power in
its structure, from the want of a supply of oxygenated blood through the
coronary arteries. In death by anæmic syncope, on the contrary, all the
cavities of the heart are found empty, or nearly so, and the same is
frequently the case with the adjoining great veins, whilst the lungs are
usually pale.
The syncope occasioned by some kinds of mental emotion is of the
ordinary or anæmic kind, and consequently the condition of the brain
must act first on the bloodvessels, and not directly on the heart.
Certain persons are liable to faint on witnessing a surgical operation.
Now if the mental emotion of these persons acted directly on the heart,
whilst the rest of the vascular system was unaffected, the distribution
of the blood would be nearly the same as in asphyxia, where the
circulation is first impeded in the lungs, and is ultimately arrested by
loss of power in the heart. If the action of the heart were weakened, or
stopped, in the first instance, by the kind of emotion under
consideration, the arteries would be emptied by their contractility and
elasticity, and the blood would accumulate in the right cavities of the
heart and the great veins leading to them. In a medical student fresh
from the country, who is by no means deficient in blood, the jugulars
would become distended and the face livid, and the recumbent posture
would probably do but little towards removing the symptoms. The
phenomena which are witnessed, however, indicate a very different
condition of the vascular system. The person about to faint from the
cause indicated, frequently becomes pale before he feels anything wrong;
and when requested to retire and sit down, often says that there is
nothing the matter with him. In a short time he faints, and falls, if no
one catches hold of him; but the moment he is in the recumbent posture
he recovers. In such a case as this, the effect of the mental emotion
must be first exerted on the veins, or the veins and capillaries,
through the nerves which supply these vessels; they allow themselves to
become distended, and the heart ceases to act for want of its supply of
blood, as in syncope from blood-letting, and anæmic syncope from any
cause.
Several authors have attributed the empty state of the heart met with
after death, in certain cases of fatal syncope, to want of power in the
left ventricle to supply the right cavities of the heart; but this is to
argue as if the blood passed out of the body after leaving the right
ventricle, and the left ventricle had to supply a newly formed fluid.
The effects of want of power in the left ventricle are the same as those
of an obstruction at the origin of the aorta; the lungs become
congested, and the right cavities of the heart more or less distended,
from the blood not being able to pass readily through the lungs.
Patients who die of heart disease die with the cavities of that organ
full. Some patients, indeed, with fatty disease of the heart, die
suddenly of anæmic syncope, and the heart is found empty; but in these
cases it is evident that death is not occasioned by the disease of the
heart, but by some condition of the bloodvessels which accompanies it.
Chevalier was, I believe, the first to draw marked attention to cases of
sudden death arising from an empty state of the heart, in a paper in the
first volume of the Transactions of the Royal Medical and Chirurgical
Society; and he rightly attributed the emptiness of the heart to a loss
of power in the bloodvessels. His words are as follow:—
“The disease I have now described may, perhaps, be termed _asphyxia
idiopathica_. The essential circumstances of it evidently denote a
sudden loss of power in the vessels, and chiefly in the minuter ones, to
propel the blood they have received from the heart. In consequence of
which, this organ, after having contracted so as to empty itself, and
then dilated again, continues relaxed for want of the return of its
accustomed stimulus, and dies in that dilated state.”
The word asphyxia has become so closely connected by physiologists with
death by privation of air, where the symptoms and appearances are the
reverse of those in Chevalier’s case, that it is necessary to discard
his name of the disease which he describes, although it is
etymologically correct. His cases come under the definition of what is
now universally called syncope, and what I have called anæmic to
distinguish it from cardiac syncope.
Chevalier speaks of a want of power in the vessels to propel the blood,
and as it is not now believed that the vessels take any active share in
the propulsion of the blood, this may be the reason why the views of
this author have received less attention than they deserve; but it is
very obvious that a want of tone in the vessels, or any great diminution
of that power which enables them to support and compress the blood, is
an adequate cause why the blood should be unable to reach the right side
of the heart. In the case of varicose veins, previously mentioned, it
was physically apparent that the cause of the syncope lay in the
vessels. Disease of the arteries is well known to be usually associated
with degeneration of the heart; the veins are also large and distensible
in old people, who furnish the greater number of those who are liable to
anæmic syncope; but the pathology of the veins, as regards both their
functions and structure, is not yet sufficiently known.
Persons with disease of the heart, who die suddenly in a fit of anger,
probably die always with the heart distended; that is, of cardiac
syncope. Dr. Joseph Ridge, however, in his able and interesting remarks
on the disease and death of John Hunter,[134] states his belief that
that celebrated man, who had been long subject to attacks of angina
pectoris, died at last of syncope, with an empty heart. He died, as is
well known, during a fit of anger, and the coronary arteries were found
ossified. It is not said that the heart was empty, but that it was
small, and that there were no coagula in any of its cavities. It is
probable that there was not much blood in its cavities, at the time of
the post mortem examination, but the body of Hunter was conveyed in a
sedan-chair, from St. George’s Hospital to Leicester Square, a little
more than an hour after his death, so that the fluid blood would
gravitate downwards. It is related that the stomach and intestines were
unusually loaded with blood, and that those parts which were in a
depending position, as in the bottom of the pelvis and upon the loins,
were congested in a greater degree than the others; and that “this
evidently arose from the fluid state of the blood.”
In syncope from muscular exertion, the cavities of the heart are
distended, and its walls have occasionally been ruptured, both from
violent exercise and fits of anger.
Fear probably occasions each kind of syncope in different cases. In some
cases, the right cavities of the heart become distended owing to impeded
respiration, and possibly to a diminution of power in the heart itself.
More frequently, the syncope appears to be of the ordinary or anæmic
kind, the effect of the mental condition acting first on the more
distant parts of the circulation. The pallor caused by fright is
proverbial.
Pain is also capable of causing both kinds of syncope. I have alluded to
cases (page 55) in which the patients strained and held their breath
till the pulse became intermittent, and the action of the heart was
temporarily suspended by the arrested breathing; on the other hand,
patients often become pale, if they are undergoing any slight operation
when seated, and syncope of the anæmic kind occurs, without any previous
disturbance of the respiration, but passes off as soon as they are
placed in the horizontal posture. I have seen an apparently strong man
faint in this manner, during the removal of a tumour from the back not
larger than a nut, and where only a few drops of blood were lost.
Chloroform was not employed.
SUPPOSED CAUSES OF DEATH FROM CHLOROFORM.
Many writers have supposed that the deaths from chloroform have arisen
from some peculiarity in the patient; and when any notable change of
structure has been met with after death in any of the vital organs, this
has been thought to afford a sufficient explanation of the event; whilst
in the cases in which the organs were in a healthy state, surprise has
been expressed at the occurrence. In looking over the account of the
cases in which the inhalation of chloroform has been fatal, there is
reason to conclude, however, that the subjects of them were, as regards
health and strength, quite equal to the average of the multitude who
have inhaled this agent without ill effects. In fifteen out of the fifty
cases above related, there was no examination of the body after death.
In one of these fifteen cases, the patient was in a state of debility,
and had hectic fever, apparently from the disease of the ankle-joint,
for he had no cough; in another of these cases, the patient was reduced
to a state of great debility from cancerous disease of the uterus. In
fourteen out of the thirty-five cases, in which an examination of the
dead body took place, all the chief organs were found to be healthy, if
we except the local congestions of blood connected with the mode of
dying, and a flabby state of the heart in a few of the cases, which
probably depended on its being full of blood at the time of death, or
its not being in a state of post-mortem rigidity, at the time it was
examined.