in these two cases, and especially in the second one, is a remarkably
curious event. The respiration continued after the heart had ceased to
act in several cases of death from chloroform, but not for so long a
time as in these deaths from amylene. It is probable that there must
have been some little circulation going on through the brain whilst the
respiration lasted, and in fact, the slight fluttering pulse and feeble
sounds of the heart, once or twice perceived, indicate that the
circulation was not absolutely arrested. Under these circumstances, we
may inquire why the action of the heart does not recover. If the
circulation were going on in the coronary arteries, it might be expected
that the blood from the lungs, which has been aerated by respiration,
and freed from the narcotic vapour, would restore the action of the
heart. But it is probable, for the reasons stated at page 262, when
treating of accidents by chloroform, that the circulation through the
coronary arteries is arrested.
The accident clearly commenced at the heart in both these cases, and I
believe that the brain was never more than partially under the influence
of the amylene in either of them. In the _Medical Times and Gazette_ of
July 25th, 1857, M. Devergie is related to have expressed an opinion in
the Academy of Medicine of Paris, that the first of the above deaths
from amylene was caused, in great part, under the influence of true
asphyxia, using that term in its modern acceptation. Now that is
altogether an error, arising, probably, from M. Devergie not having seen
any original account of the case. There was no cause of asphyxia, either
internal or external; the patient breathed well until after his heart
had ceased to beat, unless in the most feeble and doubtful manner. The
valve which was closed only altered the direction, but not the amount of
air. In fact, the patient was throughout supplied with as much air as
could enter through a tube twice the size of his windpipe.
I had scarcely any hope of the patient in St. George’s Hospital from the
very commencement of the accident; for I felt that if he could be
recovered by artificial respiration, his own breathing would have
remedied the accident, even before it was discovered. From what has been
published respecting the pulse sometimes stopping and commencing again,
during the inhalation of chloroform, it is probable that many accidents,
in which the heart has been nearly paralysed, have happened, and
rectified themselves, without attracting much notice.
I have no doubt that in each of these accidents the patient must have
taken into his lungs at one moment air containing upwards of thirty per
cent. of vapour of amylene. And there is no doubt that the cause of this
was the unsteady boiling point of the agent. If the amylene with which I
was supplied had boiled steadily at the same temperature, there is no
doubt that the means which I was employing, and which had enabled me for
ten years, whilst exhibiting chloroform, to give four per cent. of the
vapour, probably without ever allowing the quantity to exceed six per
cent., would have enabled me to give fifteen per cent. of vapour of
amylene without permitting the quantity to exceed twenty per cent.
The alteration in the boiling point of a specimen of amylene from 86° to
115° Fah. would cause it to give off more than twice as much vapour in
the beginning of its evaporation as towards the end; and, moreover, the
different specimens of it did not always possess the same amount of
volatility.
The temperature of the external air as it influenced that of the
water-bath of the inhaler would have some influence over the evaporation
of the amylene, but I altered the amount of evaporating surface of paper
according to the season of the year for amylene, as I was in the habit
of doing for chloroform. The highest temperature of April 7, the day on
which the first accident happened, was at Greenwich, according to the
Report of the Astronomer Royal, 62°; and on July 30, the day on which
the second accident happened, was 78·7°. After the first accident, I had
reduced the surface of bibulous paper in the inhaler to one-half of what
it had previously been.
The first of the above accidents happened in the 144th case in which I
administered amylene, and the second in the 238th case. In the ninety
cases and upwards in which I administered amylene between these two
accidents, I never had occasion to feel a moment’s uneasiness about it.
In the future cases in which I employ amylene, it is my intention to
administer it from a bag or balloon, putting in so much of the liquid as
will make fifteen per cent. of vapour when the bag is filled up with
air. In this manner, the variability in the boiling point of the amylene
can have no influence whatever on the amount of vapour which the patient
breathes; and if the vapour be breathed over again, within certain
limits, in the manner of nitrous oxide gas, there will be a great saving
in the amount of amylene consumed.
In my first paper on amylene, which was read on January 10th, 1857, I
said: “While I cannot venture to predict for it the absolute safety
which seems to attend sulphuric ether under all circumstances, I trust
that it will be perfectly safe with careful management”[177] And I added
further on, “It is my opinion that the cold produced during its
evaporation would, in all the ordinary methods of inhalation, prevent
the air from taking up a quantity of the vapour which would be
dangerous.”
Although amylene was largely used in Paris, Strasbourg, Montpelier, and
Lyons, soon after I published my first account of it, and although I
have lately heard that it is still employed in Paris and Berlin, nearly
eighteen months after its first use in these places, I am happy that I
have not heard of any accident from its use except the two which
happened in my own hands.
M. Giraldis, of Paris, who was present at the operating theatre of St.
George’s Hospital when the accident happened at that institution, had
already employed amylene in 100 cases in children, and I believe that he
continues to use it. Given on a handkerchief or sponge, I believe that
amylene is safer than chloroform, owing to the greater cold produced
during its evaporation, and the limit thereby put to the amount of
vapour which is given off; but I have seldom given it in this manner, as
I do not think it would be certain and regular in its action, and any
doubt on these points would, with me, have quite overbalanced its other
advantages. In applying amylene on a sponge, M. Rigaud of Strasbourg
used 100 grammes (between four and five fluid ounces) in making an adult
patient insensible, although half a fluid ounce suffices with the
inhaler I employed.
Mr. Clarke, of Bristol, in a paper which he published on amylene,[178]
says: “It seemed impossible to get too much into the system, and with
this I have been greatly impressed; it is this fact that appears to me
to promise an immunity from danger.... It requires to be given almost
unintermittingly, and requires the same amount of attention to keep up
its effects as chloroform does to keep the patient safe. The direction
of the attention, however, is one less calculated to give anxiety.”
Dr. Debout stated, as the result of some experiments on animals, in
which he was assisted by M. Duroy, that if it sufficed to double the
quantity of chloroform in order to transform the anæsthetic dose of that
agent into a poisonous dose, it was necessary to quadruple that of
ether, and to quintuple that of amylene, in order to arrive at the same
result; and that, therefore, the innocuousness of the new agent was
still greater than that of sulphuric ether.[179]
In a paper which Professor Tourdes, of Strasbourg, read before the
Academy of Medicine of Paris, he came also to the conclusion, from a
series of experiments and observations, that “amylene was evidently much
less dangerous than chloroform, perhaps even than ether.”[180]
According to my experiments, amylene ought to be placed between
chloroform and ether in respect to its comparative safety by the
ordinary methods of administration; and by breathing it from a bag, in
the manner previously mentioned, it would be absolutely safe, so long as
the right quantity were put into the bag.
Papers on amylene were read to the Academy of Medicine of Paris by Dr.
Debout and M. Tourdes, and were reported on favourably. M. Giraldis
afterwards presented a paper in which he stated the very favourable
result of seventy-nine cases in which he had employed it. The Academy on
this occasion recommended the disuse of amylene on account of the
accidents which had happened in my hands, apparently overlooking the
circumstance that M. Giraldis himself had been much more successful in
the use of amylene than in that of chloroform. M. Jobert de Lamballe,
the reporter of the Commission, stated that amylene deprived the blood
of its red colour and that chloroform does not. But there is no
difference between these agents in this respect; the blood retains its
proper colour under the use of either of them, unless the effects are
carried so far as to interfere with the breathing.
THE MONOCHLORURRETTED
CHLORIDE OF ETHYLE.
This substance was discovered some few years ago by M. M. G. Regnault.
It is made by exposing to the sun’s rays a mixture of the vapour of
chloride of ethyle (muriatic ether) and chlorine gas. One equivalent of
the hydrogen of the chloride of ethyle is replaced by an equivalent of
chlorine. Its composition is four atoms carbon, four atoms hydrogen, and
two atoms chlorine. It has the same composition as Dutch Liquid, which
is made by the combination of olefiant gas and chlorine gas; the
specific gravity of its vapour, 3·42, is also the same as that of Dutch
liquid, which it resembles also in taste and smell. The boiling point is
however different, and it differs from Dutch liquid in not being
decomposed by an alcoholic solution of potassa.
I tried several times to make the monochlorurretted chloride of ethyle
in 1849 and 1850, but did not succeed in procuring more than a drachm or
two at once, owing to the constant over-action of the chlorine and the
production of other chlorurretted products. In 1851, however, these
products which result from the decomposition of muriatic ether by
chlorine gas were recommended in Paris as local applications in
rheumatism and other painful affections, and Mr. Mason was kind enough
to obtain for me from that capital a pint bottle of a liquid consisting
chiefly of the monochlorurretted chloride of ethyle. It was mixed with a
certain portion of the bichlorurretted and terchlorurretted products,
but I was able to separate by distillation as much of the
monochlorurretted product as enabled me to administer it to twenty-two
patients. Mr. Mason was, however, not able to obtain any more liquid
containing any of the monochlorurretted chloride. What he afterwards was
able to obtain had a very high boiling point, and consisted chiefly of
chloride of carbon; carbon four atoms, chlorine five atoms.
The monochlorurretted chloride of ethyle resembles chloroform very much
in taste and smell, and in its physiological properties. Its boiling
point is 149°, whilst that of chloroform is 140°; the specific gravity
of its vapour is also lower; for these reasons, it is considerably less
volatile than chloroform, and it is therefore pretty certain that it
would not be liable to cause the sudden deaths which have occasionally
been produced by the administration of chloroform, even if it were given
freely and with no great care. The difficulty of procuring it in a state
of purity is, however, a barrier to its introduction into practice.
I first administered this preparation in King’s College Hospital, on
June 20th, 1851, to a young woman, whilst Mr. Wm. Hewett, the house
surgeon, repeated the operation of paring off venereal warts and
applying nitric acid. The patient breathed it very readily without
appearing to suffer from the pungency. She was a little longer in
becoming unconscious than on former occasions from the chloroform, but
soon after becoming unconscious, the sensibility of the conjunctiva
diminished, and the operation was commenced. There was some flinching,
so that she required to be held, but there were no cries or other signs
of sensation. Consciousness returned almost immediately, and she seemed
more exhilarated than after chloroform. She had had her dinner just
before the operation, and at one time, soon after recovering her
consciousness, she said that she felt rather sick, but this feeling
passed off without vomiting, and she did not remember it afterwards. She
did not begin to cry out from the smarting till twenty minutes after the
operation, when she had been quite conscious, collected, and rational
for a quarter of an hour, although on the two former occasions, after
chloroform had been inhaled, she began to cry immediately after the
operation, and almost before consciousness had returned. Next day she
was very well.
On the following day I administered the same preparation to three
patients on whom Mr. Fergusson operated in King’s College Hospital. The
first was a boy seven years old, who had the forefinger removed,
together with part of the metacarpal bone, on account of a large
enchondroma. The second was an infant three months old, which was
operated on for hare-lip; and the third was a woman about thirty-five,
who had some venereal warts removed from the pudenda. There was no
sickness in either of the cases, although the little boy and the woman
had taken their dinners just before the operation.
On June 25th, I administered the preparation with the chloroform
inhaler, as in all the other cases, to a muscular young man, about 25,
whilst Mr. Henry Lee removed some piles, and applied nitric acid to the
raw surface. The patient was six feet three inches in height, and
weighed fourteen stone. He became insensible rather slowly, with low
muttering and a good deal of rigidity. The operation lasted about ten
minutes, during which the inhalation was repeated two or three times.
There was no pain. He recovered his consciousness in two or three
minutes after the conclusion of the operation; he said that he felt
drunk, and he appeared so for a few minutes. He was very cheerful, and
had no sickness, although he had had his dinner just before coming to
the hospital to have the operation performed. Half a fluid ounce of the
monochlorurretted compound was inhaled, being about the same quantity as
would have been consumed of chloroform.
The other operations in which I administered this preparation, consisted
of the removal of a tumour situated below the angle of the jaw in a
young woman, by Mr. Fergusson; an operation on the tibia and fibula of a
little boy, for ununited fracture, by Mr. Bowman; trephining the tibia
of a young man, and giving exit to a collection of pus, by Mr. Henry
Lee; an operation for necrosis of the tibia, by the late Mr. Avery; two
operations for hare-lip; two operations for fistula _in ano_; one for
nævus on the forehead; one for tenotomy; and one for removal of a fatty
tumour, by Mr. Fergusson.[181]
THE END.
INDEX.
A.
Absorption of vapours by fluids, 59
—— —— —— by the lungs, formula of, 59
Academy of Medicine of Paris, reports by, 132–4
Accidents from chloroform, treatment and prevention of, 248–62
Age, influence of, on effects of chloroform, 49, 50
Age in fatal cases from chloroform, 230–1;
from amylene, 401–2
Air, saturation of, with chloroform vapour, 68, 123;
with amylene, 376
—— amount of, in lungs, 108
—— respired during chloroform, 108
Allen, Mr., on a fatal case from chloroform, 195–6
Alleged fatal cases from chloroform, 201–12
Ammonia, use of, after chloroform, 104
—— use of, during accidents from chloroform, 258
Amputations under chloroform of thigh, 276–7;
of leg, 277;
of arm, 277–8;
of the ankle, 278;
of other parts, _ib._
Amylene, first application of, by author, 23
—— applications of, in Paris, Strasbourg, and Lyons, 24
—— discovery of, 372;
preparation of, _ib._
—— chemical and physical characters of, 373–7
—— volatility of different specimens of, 416
—— experiments with, 378–86
—— administration of, for operations, 386, 400
—— administration of, in parturition, 394–7
—— mode of administration of, 386–7, 405–6, 416
—— symptoms produced by, 399, 400
—— spasms and rigidity from, 401–2
—— does not produce vomiting, 406–7
—— effects of, on different persons, 401–2
—— effects of, on author, 384
—— amount of, required to produce insensibility, 384
—— effects of, on the heart, 384
—— time of inhalation of, to produce insensibility, 397
—— effects of, on consciousness, 398–403
—— promptitude of action of, 403
—— effects of, on respiration and circulation, 400
—— —— —— on the salivary glands, 400
—— chloroform, and sulphuric ether, effects of, compared, 403–5
—— after-effects of, 406–7
—— fatal cases from inhalation of, 408–16
—— amount of vapour of, inhaled in fatal cases, 415
Amylene, author’s prediction regarding safety of, 417
—— mode of administration of, by M. Rigaud, 417–18
—— Mr. Clarke’s remarks on, 418;
—— Dr. Debout’s remarks on, _ib._
—— Professor Tourdes’ remarks on, _ib._
—— author’s computation of safety of, _ib._
—— M. Giraldis on use of, 419
—— M. Jobert de Lamballe on use of, _ib._
Anæsthesia, modes of production of, 40–1
Anæsthetics, definition of, 34–5
Ancients, views of the, 3
Animals, various, experiments on, with narcotic vapours, 60 to 73
Anus, operations on, under chloroform, 307, 308–9
Animation suspended by chloroform, treatment of, 251–62
Apuleius on effects of mandragora, 2
Apoplexy, administration of chloroform after, 57
Aretæus’ description of mandragora, 3
Arnott, Dr. James, statistics of operations before and after
introduction of etherisation, 265–7
—— on pyæmia following chloroform, 267
Arteries, coronary, circulation of the, 262
Artificial respiration, value of, 121, 251–7, 260
—— —— applied in cases of death from chloroform, 139, 144, 151, 156,
159, 163, 166, 167–8, 173, 179, 181, 183, 185, 187–8, 190–1, 194,
196–7, 207, 210
Artificial respiration applied in case of death from amylene, 410–413
Arteries, ligature of, under chloroform, 289–291
Aschendorf, Dr., on alleged fatal case from chloroform, 204–5
Asphyxia idiopathica, 226
Asphyxia, death from, 235
Asthma, treatment of, with chloroform, 331
Athletics least susceptible of chloroform, 50
Augustus of Poland, operation on, without pain, 8
Aurelianus Cælius on mandragora, 3
B.
Balard, Professor, discovery of amylene, 372
Balloon for inhalation of chloroform, 80
Barlow, Mr. W. F., report on case of alleged death from chloroform, 208
Barrière, M., case of alleged death from ether, 364
Bath warm, use of, in fatal case from chloroform, 159
Beddoes, Dr., administration of gases in disease, 14
—— —— his pneumatic institution at Bristol, _ib._
Bell, Mr. Jacob, on chloric ether, 20
Belladonna, effects of, 4
Berthé, M., discovery of amylene, 378
Bickersteth, Mr., on supposed effect of surgeon’s knife on pulse, 240–3
—— —— on the pulse during inhalation of chloroform, 249–50
—— —— cases of resuscitation from over effects of chloroform, 253–6
Bigelow, Dr., use of sulphuric ether as an anæsthetic, 18
—— —— administration of chloric ether by, 20
Birds quickly affected by chloroform, 70
Black, Dr. Patrick, on asphyxia and syncope, 222
—— —— on closure of the glottis by chloroform, 236
—— —— on modes of inhaling chloroform, 236–7
Blood, serum of, absorption of chloroform by, 69
—— absorption of amylene by, 382–4
—— quantity of, in body, 73;
amount of serum, 74
—— chemical examination of, in alleged case of death from chloroform,
211
—— condition of, after death from chloroform, 247
—— saturation of, with ether, 354–5
Blood-letting in accidents from chloroform, 261
—— from external jugular, tried in case of death from chloroform, 151,
159, 168, 174
Body, temperature of, falls under chloroform, 70
Bolton, Mr. Andrew, case of puerperal convulsions treated with
chloroform, 338
Bone, removal of tumours of, under chloroform, 291
Boot, Dr., first operation in England without pain, 18
Bouisson, M., on a case of supposed death from ether, 369
Bowman, Professor, removal of pus from frontal sinus after inhalation
by chloroform, 302
Breathing modified by chloroform vapour, 69, 70
—— conditions of, under chloroform, 89, 90, 91, 92
Breast, tumours of, removal under chloroform, 285–7
Breton, supposed death of, from chloroform, 199–200
Brodie, Sir Benjamin, on use of chloroform in lithotrity, 274
Buck, Mr. Gurdon, report of death from chloroform by, 136–8
Bullock, Mr. Lloyd, manufacture of amylene by, 374–8
Bursa, the, operations on, under chloroform, 311
C.
Cahours, M. Auguste, invention of name of amylene, 372
Cancer of the lip, operation for, under chloroform, 294
Cases dangerous from chloroform, 258–60
—— of death from chloroform during labour, from neglect, 328
Cases, fatal, from inhalation of chloroform, 120–200
Case 1, of Hannah Greener, Winlaton, Newcastle, 123–7;
2, of Martha G. Simmons, Cincinnati, 127–30;
3, of Patrick Coyle, 130–1;
4, of Mdlle. Stock, Boulogne, 131–5;
5, of a woman at Hyderabad, 135;
6, of Charles Desnoyers, Hôtel-Dieu, Lyons, 135–6;
7, of a young gentleman at Govan, 136;
8, of John Griffith, New York, Hospital, 136–8;
9, of J. Verrier, Hôtel-Dieu, Lyons, 138–141;
10, of Samuel Bennett, Westminster, 141–2;
11, of Mdlle. Labrune, at Langres, 142–3;
12, of John Shorter, St. Thomas’s Hospital, 143–5;
13, of Mrs. Jones, at Shrewsbury, 145–6;
14, at Berlin, 146;
15, of William Bryan, Kingston, Jamaica, 147;
16, of an artilleryman, Mauritius, 147–8;
17, at Seraphim Hospital, Stockholm, 148–50;
18, of a boy of seven, Glasgow Infirmary, 150–1;
19, of Alexander Scott, Guy’s Hospital, 151–2;
20, of James Jones, Cavan Infirmary, 152–3;
21, of John Holden, Stepney Workhouse, 153–5;
22, of Mdme. Simon, Strasbourg, 154–5;
23, at Seaman’s Hospital, Greenwich, 155–7;
24, of Elizabeth Hollis, Chipping Norton, 157–8;
25, of Thomas Hayward, of Bartholomew’s Hospital, 158–61;
26, of Mdme. W., at Ulm, 161;
27, of Mr. John Atkinson, Melbourne, 162;
28, of Mr. Martin, at Melrose, 162–3;
29, of Henry Hollingsworth, Manchester Royal Infirmary, 163–4;
30, of Caroline Baker, of University College Hospital, 165;
31, of a French soldier, Hôtel
Dieu., d’Orléans, 165–6;
32, of John Mitchell, at Royal Infirmary, Edinburgh, 166–70;
33, of E. R., at University College Hospital, 170–2;
34, of Ann Smith, at St. Bartholomew’s, 172–4;
35, of a young man in Vienna, 174;
36, of a young girl at Neustedt, 174–5;
37, of Jane Morgan, Bristol Infirmary, 175–6;
38, of a woman, Hôpital St. Antoine, 176–7;
39, of Mrs. Harrup, Sheffield, 177–8;
40, of Walter Hollis, Lock Hospital, 178–80;
41, of a man, at Middlesex Hospital, 180–2;
42, of George Sands, University College Hospital, 182–4;
43, of a woman, in Guy’s Hospital, 185–7;
44, of John Cannon, Royal Ophthalmic Hospital, 187–8;
45, of a lady, London, 188–9;
46, of Mrs. H., Edinburgh, 189–90;
47, of a sailor, St. Thomas’s Hospital, 190–2;
48, of a boy, recorded by Mr. Paget, 192–4;
49, of a man, Liverpool Infirmary, 195–6;
50, of Ann Stoner, King’s College Hospital, 196–9;
cases, supposed, of death from chloroform, 199, 200;
case, fatal, during labour from neglect, 328
Cases, alleged fatal, from inhalation of chloroform, 201–12;
of Mr. Walter Badger, 201;
case reported by M. Malgaigne, 204;
of a woman, in Paris, _ib._;
of a child, in the hospital, Madrid, _ib._;
of a child, by Dr. Aschendorf, 204–5;
case by the author, 205–9;
case at St. George’s Hospital, 209–12
Cases, alleged fatal, from ether, 362–8
—— medical, inhalation of chloroform in, 329–44.
_See Medical Cases_
—— surgical, use of chloroform in different kinds of, 271–318.
_See Operations_
—— fatal, from inhalation of amylene, 408–16
Cats, experiments on, with chloroform, 61, 66, 109, 110, 111
Cat, experiment on, with amylene, 380–1
Cataract, operations for, under chloroform, 296
Cause and prevention of death from chloroform, 107–120
Causes, supposed, of death from chloroform, 228–45.
_See Death_
Cerebral diseases and chloroform, 56
—— —— treated by chloroform, 56–7
Chaffinch, experiments on, with chloroform, 73
Charrière, M., inhaler for chloroform by, 85
Chassaignac, M., on tolerance of chloroform, 92
Chevalier, M., on asphyxia idiopathica, 226
Chinese, use of Indian hemp by, 5
Chloroform, first experiments with, by Glover, 112;
first experiments with, by Flourens, 21
—— recommended by Dr. Simpson, 21
—— rapid introduction of, 22
—— first death from, 22
—— disused in Boston, Massachusetts, Philadelphia, Naples, and Lyons,
23
—— history and composition of, 27
—— analysed by M. Soubeiran, and named bichloric ether, 27
—— examined by Liebig, and named liquid chloride of carbon, 27
—— examined by Dumas, and named chloroform, 27
—— called chloroformyl in London Pharmacopœia, 28