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Clinical Researrches ON CHLOROFORM.
FEBRUARY 21, 1857.
Clinical
Researrches ON
CHLOROFORM. BY M. SURGEON TO THE
CHASSAIGNAC,
HOPITAL
LARIBOISIERE,
FACULTE
DE
PROFESSEUR
AGREGE AT THE
MEDECINE DE PARIS.
Translated by BENJAMIN BALL, ESQ., Interne des Hôpitaux de Paris; and JOHN CRAVEN, ESQ., M.R.C.S.E. & L.A.C.
CHAPTER III. ON THE CYANOSIS OF THE BLOOD BY CHLOROFORM. REMARKS UPON SOME CONSECUTIVE EFFECTS OF
SHIVERING,
CHLOROFORM
AND ON ANÆSTHETIC STUPOR.
with a shivering of short duration in some of them, and which, in others, may go on increasing into a progressive, and even fatal, coldness, if the surgeon does not struggle early and very energetically against this dangerous tendency. I have had already many times occasion to call the attention of my colleagues, at the " Societe de Chirurgie," to this kind of acci. dent. The first time that I observed it was in a patient at the Hopital St. Antoine, upon whom I had performed the operation for stone by the bi-lateral method, with the lithotome of Dupuytren. , The patient had been taken back to his bed after the operation, no accident had taken place, he had recovered consciousness, and I had recommended perfectly " my internes" to attend to the state of the patient. Nevertheless, at the moment of leaving the hospital, I wished to I found him seized with a shivering so see him once more. intense and determining such deep prostration, that I had no doubt, if unattended to, at the end of half an hour, or perhaps an hour, it would have infallibly proved fatal. I occupied myself then to establish the calorification by all the means that I had at my disposition at the moment. The first attempts produced but a slightly-marked effect; but, in persevering in the use of the same means-viz., friction, with hot brandy and camphor, hot sheets, bottles of hot water to the feet, hot sugared wine internally, I succeeded in reanimating my patient; and when I left the hospital, he was in a
I HAVE often remarked, in performing operations, and princi pally amputations of the leg and thigh, upon patients undei the influence of chloroform, that the blood jet coming from the arteries presented, in place of its bright scarlet colour, a deep dusky tinge, almost like to that of venous blood. This colour proved evidently that the blood had not undergone in favourable condition. This man was perfectly cured. I have the lungs a sufficient revivification or oxygenation, and that not the least doubt that if I had not returned he would have there was from that time a commencement of asphyxia. But infallibly succumbed. Therefore, since that event, not only this does not only exist in cases where the method of adminis- have I always thought it necessary to direct the attention to tration of chloroform is defective, but it is positively esta- the kind of danger which it portends, but I have also imposed blished in those cases where all precautions had been taken to upon myself to watch with particular care for the re-establishavoid asphyxia. It has been necessary, then, for us to conclude, ment of calorification after inhalations of chloroform. from the above, that, even with an inhalation very woll parOn Anœsthetic Stupor.-In certain patients, the action of formed, the blood of patients submitted to the action of chloro- chloroform has consecutive effects, not far removed, but which form does not undergo, to the normal extent, the changes in nevertheless do not produce their peculiar dangerous conseconsequence of which the blood becomes arterial from quences, until about sixteen, twenty-four, or forty-eight venous. In looking at this more closely, we have seen that this effect, hours. It would seem in these cases that the injury done to called by us, improperly, perhaps, " cyanosis of the blood," was the vital forces by the chloroform has been so profound that it is true, observed, at its highest degree during the period of collapse, to the patient could not recover from it. He recovers, in such a state of from the he remains but anaesthesia; primitive diminish afterwards in proportion as the respiration resumed he in the and succumbs short that half-stupor prostration, its normal type. If, from motives that wehave previously that we have just mentioned, without our being able periods have the we not considered state of deduced, might already account for it by the fact of hsemorrhage or of penetration collapse as a serious condition during anaesthesia, this circum- to of air into the venous system; nothing, in a word, can stance of the cyanosis of the blood attaining its maximum the cause of death if one does not attribute the fatal tergive during the period of collapse would have been sufficient to mination to a certain extent to chloroform. The only circumfix our opinion on this subject. But that is not the point in the cases of which we have just spoken, could stance which, which we insist at this moment. That which we upon be as the cause of death, except chloroform, would mentioned wish to prove is, that the inhalation of chloroform, at the time be that exhaustion of the nervous power noticed in his time even when we practise it in a manner the most discreet and by Dupuytren, but which will remain always something very well managed, is accompanied always with a certain degree of very mysterious, and very contestable. vague, in incomplete asphyxia, attested by a change the colour of the The cases in which we have observed what we should call arterial blood, the alteration being much more pronounced consecutive deaths-a species of slow poisoning by chloroform, during the collapse. refer to operations performed upon old persons or upon subjects There is an experiment that we have never made, but it debilitated. It was also at the end of those operaextremely would not be difficult to try it in certain operations. The extions that we call 11 sidirantes," to show to what degree they consist suffiin in would periment receiving, graduated tubes, cient quantities of blood thrown out by the arteries, and col- act upon the general state of the powers and upon the entire lected at different periods of the anæthesia. Unless we are economy; for example, operations for strangulated hernia, for of large tumours from old and debilitated permuch deceived we should find remarkable differences in the the removal
sons, and upon persons wounded with fire-arms. The number colour of the blood in different tubes. of these facts (still inconsiderable)-their doubtful interpretaHitherto this question has been too little studied for us to coincidence of the employment of chloroform with tion-the treat it more at length. We propose to ourselves to exan operation in itself very grave, impose upon us a great reamine it more completely, but, provisionally, it has seemed and do not permit us to form conclusions. These are to us that this circumstance of the cyanosis of the blood, even serve, in slightly-established degrees of anaesthesia, deserved to be suggestions which we submit to the consideration of practi; because we believe it our duty to do so at present, pointed out to medical practitioners; and still more so the sen- tioners order to awaken their attention to a cause of death so much ; in sible increase of this cyanosis during collapse. more formidable that it remained unperceived. Until more the On Anæsthetic Shivering.-There are a certain number of fully informed, we will admit the possibility of a slow or consubjects who, after the employment of chloroform, are seized secutive poisoning by chloroform. No. 1747
Clinical
Researrches ON
CHLOROFORM. BY M. SURGEON TO THE
CHASSAIGNAC,
HOPITAL
LARIBOISIERE,
FACULTE
DE
PROFESSEUR
AGREGE AT THE
MEDECINE DE PARIS.
Translated by BENJAMIN BALL, ESQ., Interne des Hôpitaux de Paris; and JOHN CRAVEN, ESQ., M.R.C.S.E. & L.A.C.
CHAPTER III. ON THE CYANOSIS OF THE BLOOD BY CHLOROFORM. REMARKS UPON SOME CONSECUTIVE EFFECTS OF
SHIVERING,
CHLOROFORM
AND ON ANÆSTHETIC STUPOR.
with a shivering of short duration in some of them, and which, in others, may go on increasing into a progressive, and even fatal, coldness, if the surgeon does not struggle early and very energetically against this dangerous tendency. I have had already many times occasion to call the attention of my colleagues, at the " Societe de Chirurgie," to this kind of acci. dent. The first time that I observed it was in a patient at the Hopital St. Antoine, upon whom I had performed the operation for stone by the bi-lateral method, with the lithotome of Dupuytren. , The patient had been taken back to his bed after the operation, no accident had taken place, he had recovered consciousness, and I had recommended perfectly " my internes" to attend to the state of the patient. Nevertheless, at the moment of leaving the hospital, I wished to I found him seized with a shivering so see him once more. intense and determining such deep prostration, that I had no doubt, if unattended to, at the end of half an hour, or perhaps an hour, it would have infallibly proved fatal. I occupied myself then to establish the calorification by all the means that I had at my disposition at the moment. The first attempts produced but a slightly-marked effect; but, in persevering in the use of the same means-viz., friction, with hot brandy and camphor, hot sheets, bottles of hot water to the feet, hot sugared wine internally, I succeeded in reanimating my patient; and when I left the hospital, he was in a
I HAVE often remarked, in performing operations, and princi pally amputations of the leg and thigh, upon patients undei the influence of chloroform, that the blood jet coming from the arteries presented, in place of its bright scarlet colour, a deep dusky tinge, almost like to that of venous blood. This colour proved evidently that the blood had not undergone in favourable condition. This man was perfectly cured. I have the lungs a sufficient revivification or oxygenation, and that not the least doubt that if I had not returned he would have there was from that time a commencement of asphyxia. But infallibly succumbed. Therefore, since that event, not only this does not only exist in cases where the method of adminis- have I always thought it necessary to direct the attention to tration of chloroform is defective, but it is positively esta- the kind of danger which it portends, but I have also imposed blished in those cases where all precautions had been taken to upon myself to watch with particular care for the re-establishavoid asphyxia. It has been necessary, then, for us to conclude, ment of calorification after inhalations of chloroform. from the above, that, even with an inhalation very woll parOn Anœsthetic Stupor.-In certain patients, the action of formed, the blood of patients submitted to the action of chloro- chloroform has consecutive effects, not far removed, but which form does not undergo, to the normal extent, the changes in nevertheless do not produce their peculiar dangerous conseconsequence of which the blood becomes arterial from quences, until about sixteen, twenty-four, or forty-eight venous. In looking at this more closely, we have seen that this effect, hours. It would seem in these cases that the injury done to called by us, improperly, perhaps, " cyanosis of the blood," was the vital forces by the chloroform has been so profound that it is true, observed, at its highest degree during the period of collapse, to the patient could not recover from it. He recovers, in such a state of from the he remains but anaesthesia; primitive diminish afterwards in proportion as the respiration resumed he in the and succumbs short that half-stupor prostration, its normal type. If, from motives that wehave previously that we have just mentioned, without our being able periods have the we not considered state of deduced, might already account for it by the fact of hsemorrhage or of penetration collapse as a serious condition during anaesthesia, this circum- to of air into the venous system; nothing, in a word, can stance of the cyanosis of the blood attaining its maximum the cause of death if one does not attribute the fatal tergive during the period of collapse would have been sufficient to mination to a certain extent to chloroform. The only circumfix our opinion on this subject. But that is not the point in the cases of which we have just spoken, could stance which, which we insist at this moment. That which we upon be as the cause of death, except chloroform, would mentioned wish to prove is, that the inhalation of chloroform, at the time be that exhaustion of the nervous power noticed in his time even when we practise it in a manner the most discreet and by Dupuytren, but which will remain always something very well managed, is accompanied always with a certain degree of very mysterious, and very contestable. vague, in incomplete asphyxia, attested by a change the colour of the The cases in which we have observed what we should call arterial blood, the alteration being much more pronounced consecutive deaths-a species of slow poisoning by chloroform, during the collapse. refer to operations performed upon old persons or upon subjects There is an experiment that we have never made, but it debilitated. It was also at the end of those operaextremely would not be difficult to try it in certain operations. The extions that we call 11 sidirantes," to show to what degree they consist suffiin in would periment receiving, graduated tubes, cient quantities of blood thrown out by the arteries, and col- act upon the general state of the powers and upon the entire lected at different periods of the anæthesia. Unless we are economy; for example, operations for strangulated hernia, for of large tumours from old and debilitated permuch deceived we should find remarkable differences in the the removal
sons, and upon persons wounded with fire-arms. The number colour of the blood in different tubes. of these facts (still inconsiderable)-their doubtful interpretaHitherto this question has been too little studied for us to coincidence of the employment of chloroform with tion-the treat it more at length. We propose to ourselves to exan operation in itself very grave, impose upon us a great reamine it more completely, but, provisionally, it has seemed and do not permit us to form conclusions. These are to us that this circumstance of the cyanosis of the blood, even serve, in slightly-established degrees of anaesthesia, deserved to be suggestions which we submit to the consideration of practi; because we believe it our duty to do so at present, pointed out to medical practitioners; and still more so the sen- tioners order to awaken their attention to a cause of death so much ; in sible increase of this cyanosis during collapse. more formidable that it remained unperceived. Until more the On Anæsthetic Shivering.-There are a certain number of fully informed, we will admit the possibility of a slow or consubjects who, after the employment of chloroform, are seized secutive poisoning by chloroform. No. 1747