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THE CASE OF DR. A. D. GRIFFITHS.
178 is thrown from his cycle and falls heavily on his shoulder, striking the side of his head. On recovering from the shock, and before swelling begins, he finds that he can see. As the ecchymosis of the lids proceeds he is unable to open the lids and has temporarily complete loss of vision. When the swelling has subsided vision is again recovered to some extent and may then in course of years again slowly deteriorate with supervention of white atrophy, or it may remain stationary with much impairment, or it may undergo some improvement ; in the latter case probably haemorrhage in the orbital canal took place at the time of the accident and the effused blood has undergone partial absorption. Only a necropsy can determine whether the nerve is actually divided. It is only surprising that amongst the innumerable falls which cyclists have suffered more instances of this kind have not been recorded. Probably many cases have occurred but the visual trouble is lost sight of or disregarded in view of the cerebral and often fatal lesion.
THE CASE OF DR. A. D. GRIFFITHS.
chloroform vapour enters a stomach full of fluid instead of an empty one. Fluids are withheld before the administration of chloroform from fear of vomiting and the passage of the vomited matter into the air passages. But it is well known that most troublesome vomiting may occur with an empty stomach and the vomiting of a small quantity of water would not be attended with much danger. Moreover, as suggested, the presence of chloroform in an empty stomach is probably the most frequent cause of the vomiting. In attempting to prevent this result by insuring the presence of fluid in the stomach it must be remembered that liquids may be quickly absorbed from the stomach or pass into the intestine. After several trials Professor Denucé adopted the following method. One and a half hours before the operation the patient is given a "large glass" of water and the dose is repeated every half hour until the time of operation when the last one is taken. Thus in all four " glasses " are taken amounting to about 800 grammes of water. The results In 20 cases exceeded Professor Denuce’s expectations. there was not the slightest vomiting or even nausea during or after the operation. Many of the operations, which included laparotomy for double ovariotomy, radical cure of inguinal hernia, and operation ’for hydatid cyst of the liver, were long and complicated. That 20 cases are insufficient to decide the merit of any method all will admit but independently of the small number of cases recorded there seems reason to doubt Professor Deiiuc6’s premisses. The probable cause of sickness after chloroform inhalation is not so much the swallowing of the vapour of chloroform as the ingestion of saliva and mucus impregnated with the vapour in the mouth. Salivation is provoked by most of the anaesthetics in use and when it is excessive vomiting is severe but the nausea and emesis are reduced or prevented when care is taken to prevent the patient swallowing. The lateral posture of the head will usually effect this. In patients who have gastric trouble tenacious mucus is liable to collect in the viscus and if this is brought in contact with swallowed chloroform which has become condensed the vomiting may persist for days. It is in such cases that lavage, whether complete or only practised as Professor Denuce recommends, proves most useful. It washes away this thick glairy mucus and prevents the chloroform remaining as an irritant to the mucous membrane of the alimentary tract.
As will be seen by a letter which appears in another column, Dr. A. D. Griffiths’s local professional brethren have not confined themselves merely to passing resolutions of sympathy with him in the terrible anxiety which he has recently undergone. The facts of the case were duly set forth in an annotation published in our issue of Dec. 17th, 1904, p. 1733, under the heading "A Vile Conspiracy." Shortly to recapitulate them they were as follows. A woman named Faithfull asked Dr. Griffiths to attend her for some gynæcological trouble. At the second attendance the husband assaulted Dr. Griffiths, at the same time heaping accusa. tions upon him. The wife also swore in court to acts of immorality with Dr. Griffiths but as the result of an action brought by him for slander the jury awarded to Dr. Griffiths ;E500 damages. The judge pointed out that in his opinion Faithfull’s charges were absolutely groundless. The defendant did not appear and of course the £500 will never be paid. Dr. Griffiths ha been saddled with to the amount of some J2.205 and the medical men expenses of Cardiff and the neighbourhood have accordingly determined to raise a fund whereby to reimburse him. We have the greatest pleasure in giving voice to their appeal for funds and we trust that not only the medical men of South Wales will subscribe but also many of those in other parts of the kingdom. Such,an experience as Dr. Griffiths AN UNJUST RIDER. has recently undergone may be equally the lot of any titioner in the kingdom andthe courage with which Dr.’ AT Lewisham last week Dr. H. R. Oswald, the coroner Griffiths faced a very painful situation not only has worked for the South-East district of London, held an inquest for his own good but for,that of every one,of his professional upon a commercial traveller who had died two days brethren. previously from small-pox. The coroner stated that the deceased was sent to the Metropolitan Asylums Board ADMINISTRATION OF WATER BEFORE GIVING receiving station at Rotherhithe, it being thought by three CHLOROFORM TO PREVENT VOMITING. local medical men that he was suffering from small-pox, and IN the Gazette Hebdoraadaire des Science Médicales de that when he arrived at Rotherhithe he was seen by the Bordeaux of Dec. 25th, 1904, Professor Denucé has described superintendent who decided that the case was not one of a simple method of preventing vomiting after administration small-pox and sent him home again, where he died. Eviof chloroform which he has found very successful-the dence was given in support of this statement and Dr. T. F. administration of water before the anæsthetic is given. The Ricketts, medical superintendent of the small-pox hosrationale of the method is as follows. During the induction pitals of the Metropolitan Asylums Board, owned frankly of anaesthesia acts of deglutition may be observed. These that death had probably been due to hæmorrhagic result .in the swallowing of air charged with chloroform. small-pox. Whereupon the coroner’s jury having brought The chloroform irritates the mucous membrane of the in a verdict in accordance with the medical evidence, added an unjustifiable and ill-informed rider. This stomach, which according to the usual practice and the causes Hence empty, vomiting. efficacy of was to the effect that when a case was sent to the lavage of the stomach which has been employed in Rotherhithe receiving station a certificate should be forthe treatment of the vomiting. Professor Denuce there- warded, signed by two medical men, stating that they were fore asks, Why not prevent the vomiting by not allowing of opinion that the person was suffering from small-pox, and the chloroform vapour to come in contact with the mucous also that the case should not be rejected unless it was seen membrane of the stomach ? This can be accomplished if the by another medical man in addition to the superintendent.
prac-
___
,
is
THE CASE OF DR. A. D. GRIFFITHS.
chloroform vapour enters a stomach full of fluid instead of an empty one. Fluids are withheld before the administration of chloroform from fear of vomiting and the passage of the vomited matter into the air passages. But it is well known that most troublesome vomiting may occur with an empty stomach and the vomiting of a small quantity of water would not be attended with much danger. Moreover, as suggested, the presence of chloroform in an empty stomach is probably the most frequent cause of the vomiting. In attempting to prevent this result by insuring the presence of fluid in the stomach it must be remembered that liquids may be quickly absorbed from the stomach or pass into the intestine. After several trials Professor Denucé adopted the following method. One and a half hours before the operation the patient is given a "large glass" of water and the dose is repeated every half hour until the time of operation when the last one is taken. Thus in all four " glasses " are taken amounting to about 800 grammes of water. The results In 20 cases exceeded Professor Denuce’s expectations. there was not the slightest vomiting or even nausea during or after the operation. Many of the operations, which included laparotomy for double ovariotomy, radical cure of inguinal hernia, and operation ’for hydatid cyst of the liver, were long and complicated. That 20 cases are insufficient to decide the merit of any method all will admit but independently of the small number of cases recorded there seems reason to doubt Professor Deiiuc6’s premisses. The probable cause of sickness after chloroform inhalation is not so much the swallowing of the vapour of chloroform as the ingestion of saliva and mucus impregnated with the vapour in the mouth. Salivation is provoked by most of the anaesthetics in use and when it is excessive vomiting is severe but the nausea and emesis are reduced or prevented when care is taken to prevent the patient swallowing. The lateral posture of the head will usually effect this. In patients who have gastric trouble tenacious mucus is liable to collect in the viscus and if this is brought in contact with swallowed chloroform which has become condensed the vomiting may persist for days. It is in such cases that lavage, whether complete or only practised as Professor Denuce recommends, proves most useful. It washes away this thick glairy mucus and prevents the chloroform remaining as an irritant to the mucous membrane of the alimentary tract.
As will be seen by a letter which appears in another column, Dr. A. D. Griffiths’s local professional brethren have not confined themselves merely to passing resolutions of sympathy with him in the terrible anxiety which he has recently undergone. The facts of the case were duly set forth in an annotation published in our issue of Dec. 17th, 1904, p. 1733, under the heading "A Vile Conspiracy." Shortly to recapitulate them they were as follows. A woman named Faithfull asked Dr. Griffiths to attend her for some gynæcological trouble. At the second attendance the husband assaulted Dr. Griffiths, at the same time heaping accusa. tions upon him. The wife also swore in court to acts of immorality with Dr. Griffiths but as the result of an action brought by him for slander the jury awarded to Dr. Griffiths ;E500 damages. The judge pointed out that in his opinion Faithfull’s charges were absolutely groundless. The defendant did not appear and of course the £500 will never be paid. Dr. Griffiths ha been saddled with to the amount of some J2.205 and the medical men expenses of Cardiff and the neighbourhood have accordingly determined to raise a fund whereby to reimburse him. We have the greatest pleasure in giving voice to their appeal for funds and we trust that not only the medical men of South Wales will subscribe but also many of those in other parts of the kingdom. Such,an experience as Dr. Griffiths AN UNJUST RIDER. has recently undergone may be equally the lot of any titioner in the kingdom andthe courage with which Dr.’ AT Lewisham last week Dr. H. R. Oswald, the coroner Griffiths faced a very painful situation not only has worked for the South-East district of London, held an inquest for his own good but for,that of every one,of his professional upon a commercial traveller who had died two days brethren. previously from small-pox. The coroner stated that the deceased was sent to the Metropolitan Asylums Board ADMINISTRATION OF WATER BEFORE GIVING receiving station at Rotherhithe, it being thought by three CHLOROFORM TO PREVENT VOMITING. local medical men that he was suffering from small-pox, and IN the Gazette Hebdoraadaire des Science Médicales de that when he arrived at Rotherhithe he was seen by the Bordeaux of Dec. 25th, 1904, Professor Denucé has described superintendent who decided that the case was not one of a simple method of preventing vomiting after administration small-pox and sent him home again, where he died. Eviof chloroform which he has found very successful-the dence was given in support of this statement and Dr. T. F. administration of water before the anæsthetic is given. The Ricketts, medical superintendent of the small-pox hosrationale of the method is as follows. During the induction pitals of the Metropolitan Asylums Board, owned frankly of anaesthesia acts of deglutition may be observed. These that death had probably been due to hæmorrhagic result .in the swallowing of air charged with chloroform. small-pox. Whereupon the coroner’s jury having brought The chloroform irritates the mucous membrane of the in a verdict in accordance with the medical evidence, added an unjustifiable and ill-informed rider. This stomach, which according to the usual practice and the causes Hence empty, vomiting. efficacy of was to the effect that when a case was sent to the lavage of the stomach which has been employed in Rotherhithe receiving station a certificate should be forthe treatment of the vomiting. Professor Denuce there- warded, signed by two medical men, stating that they were fore asks, Why not prevent the vomiting by not allowing of opinion that the person was suffering from small-pox, and the chloroform vapour to come in contact with the mucous also that the case should not be rejected unless it was seen membrane of the stomach ? This can be accomplished if the by another medical man in addition to the superintendent.
prac-
___
,
is