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THE LOCAL GOVERNMENT BOARD AND THE EARLY DIAGNOSIS OF DIPHTHERIA.
1359
Annotations.
He was A careful was
lying on his back and was rather nervous. preliminary examination of the heart and lungs made, and they were found to be in a satisfactory con-
dition. A drachm of chloroform was poured upon the wire inhaler and given slowly. From time to time half a drachm The man appeared to take the ansesthetic more was added. THE LOCAL GOVERNMENT BOARD AND THE well. The chloroformist noted the respiration, the pupils, EARLY DIAGNOSIS OF DIPHTHERIA. and the pulse, and observed no departure from the normal. Ws have been informed that arrangements have been made When under the ansesthetic the operation was commenced, an in the Medical Department of the Local Government incision being made, and immediately the pupils dilated and the Board which have for their object to assist medical respiration ceased. Instantly the chloroform was stopped, the officers of health in forming a correct diagnosis as to head was lowered, and artificial respiration was commenced by the character of certain forms of "sore-throat" which Silvester’s method. Nitrite of amyl, hot flannels to the preare often associated with the beginnings of diphtheria cordium, hypodermic injections of ether, and galvanism were prevalences. The plan to be adopted is practically that resorted to without avail. The artificial respiration was kept which was followed during the past two autumns with up for twenty minutes as the heart’s action was observed reference to the diffarentiation of cholera and diarrhoea. after complete cessation of breathing. The same chloroform As was the case in regard to cholera, so it is under- had been taken without any bad symptoms by another patient The truthful narration stood that in the case of diphtheria the bacteriological just before this patient took it. investigations, which will be made for the Local Government given cannot but prove sadly interesting. That school of Board by Dr. Klein, F.R.S., are intended to secure the thought which maintains that shock is peculiarly prone to adoption, at as early a date as practicable, of the necessary make itself felt in cases in which the narcotism is not measures of prevention ; and hence when once it has been rendered profound before a skin incision is made will find in ascertained that the disease in question is diphtheria the mode of death described above a likeness to cases no further material from other cases forming part of recorded as instances of cardiac inhibition during imperfect the same prevalence will be submitted to examination. anaesthesia. Upon the other hand, it would appear that The following are the conditions under which the material in the respiratory centre was paralysed before the cardiac question is to be transmitted : It is to be taken by scraping centre-at least, this was the view of the chloroformist: with a clean instrument from the surface of the tonsils or Such paralysis is, as a rule, the result of an overdose of the If mem- ansesthetic, and according to the valuable statistics of the other suspicious-looking surface of the fauces. brane be present a small portion of it should also be Hyderabad Chloroform Commission in most cases was overThe material should be at once placed in come in the Hyderabad experiments by prompt resort to included. a small glass-stoppered bottle, previously washed out artificial respiration. In the present instance primafcccie with clean water. No spirit or other fluid should be no overdose was given and the promptest action was taken added. The bottle, which should then be properly secured to restore breathing. We have, however, in speaking of and so packed in cotton-wool or otherwise as to travel with an "overdose," to carefully discriminae between too safety by post, should be posted without delay to the Medical large a dose being given at one time and the equally Officer of the Local Government Board, Whitehall, London, perilous and far more insidious overdosage which S.W.; and it should be accompanied by a history of the case, occurs if through impediment of the breathing by any means interference takes place with expiration. Sach an or of the outbreak of which it forms a part, signed by the accumulation of chloroform in the blood as happens under medical officer of health for the district concerned. such circumstances probably permanently injures the protoplasm of the medulla before any very marked phenomena, DEATHS UNDER CHLOROFORM. save slight and easily overlooked alteration in the breathing, A DEATH recently took place during an operation performed occur. We must be understood to in no way state any of under chloroform at St. Bartholomew’s Hospital. The these solutions of the difficult problem-Why does a patient patient, a man aged forty, suffering from cancer affecting die under chloroform ?—as applying to this particular case ; the pharynx and structures of the air and food passages, it is, we believe, useful to apply pro and con. reasonings in all was admitted to have tracheotomy performed, an operation instances of chloroform deaths when the phenomena are the nature of which was explained to him, and which sufficiently clearly stated, as in the particular case upon which . was rendered imperative owing to the extensive character of we are commenting. the invasion of the neoplasm. The man was given chloroform according to the method in vogue at this hospital, and FEEBLE-MINDED BOYS. when under its influence the operation was commenced. While the tracheotomy was in progress the man’s breathing THERE are few more striking characteristics of the present stopped. Death is, however, stated to have been due day than the humane efforts which are made on all sides to to heart failure caused by the combined shock of the bring help to those who are unable to help themselves,"the operation and of the chloroform. The necropsy revealed strong bearing the infirmities of the weak," and so tending The operation as to counteract the pitiless tendency in nature for the survival extensive carcinomatous infiltration. not to we is calculated such, presume, produce severe shock, of the fittest only. And although from the selfish point of but doubtless the condition of the man and the probable view of utility the wisdom of this may be doubted by some, narrowing of his respiratory outlet rendered him less able to there is no need nowadays to argue seriously of our duty to bear shock or withstand the depression due to the ansesthetic. help, and even to make some sacrifice for, those who come We are indebted to the chloroformist in the following into the world imperfectly equipped for the race which recase for a lucid account of the fatality. The patient, quires all the energies of a normally constituted individual. a muscular but pale man fifty-five years of age, of From time to time we have in these columns drawn attention abstemious habits, was admitted into the Wallingford to movements which aim at rescuing from distress or preCottage Hospital on Nov. 9th for treatment of extensive serving from slipping into the criminal classes those disease of the carpus on the right side. On the 10th he who from disease or from congenital mental deficiency was put under the influence of chloroform; the anses- are in some danger of such a fate. Only lately we directed thetic was given from a wire mask covered with flannel. attention to the scheme for the colonisation of epileptics "lie
quid nimiB:’
-
Annotations.
He was A careful was
lying on his back and was rather nervous. preliminary examination of the heart and lungs made, and they were found to be in a satisfactory con-
dition. A drachm of chloroform was poured upon the wire inhaler and given slowly. From time to time half a drachm The man appeared to take the ansesthetic more was added. THE LOCAL GOVERNMENT BOARD AND THE well. The chloroformist noted the respiration, the pupils, EARLY DIAGNOSIS OF DIPHTHERIA. and the pulse, and observed no departure from the normal. Ws have been informed that arrangements have been made When under the ansesthetic the operation was commenced, an in the Medical Department of the Local Government incision being made, and immediately the pupils dilated and the Board which have for their object to assist medical respiration ceased. Instantly the chloroform was stopped, the officers of health in forming a correct diagnosis as to head was lowered, and artificial respiration was commenced by the character of certain forms of "sore-throat" which Silvester’s method. Nitrite of amyl, hot flannels to the preare often associated with the beginnings of diphtheria cordium, hypodermic injections of ether, and galvanism were prevalences. The plan to be adopted is practically that resorted to without avail. The artificial respiration was kept which was followed during the past two autumns with up for twenty minutes as the heart’s action was observed reference to the diffarentiation of cholera and diarrhoea. after complete cessation of breathing. The same chloroform As was the case in regard to cholera, so it is under- had been taken without any bad symptoms by another patient The truthful narration stood that in the case of diphtheria the bacteriological just before this patient took it. investigations, which will be made for the Local Government given cannot but prove sadly interesting. That school of Board by Dr. Klein, F.R.S., are intended to secure the thought which maintains that shock is peculiarly prone to adoption, at as early a date as practicable, of the necessary make itself felt in cases in which the narcotism is not measures of prevention ; and hence when once it has been rendered profound before a skin incision is made will find in ascertained that the disease in question is diphtheria the mode of death described above a likeness to cases no further material from other cases forming part of recorded as instances of cardiac inhibition during imperfect the same prevalence will be submitted to examination. anaesthesia. Upon the other hand, it would appear that The following are the conditions under which the material in the respiratory centre was paralysed before the cardiac question is to be transmitted : It is to be taken by scraping centre-at least, this was the view of the chloroformist: with a clean instrument from the surface of the tonsils or Such paralysis is, as a rule, the result of an overdose of the If mem- ansesthetic, and according to the valuable statistics of the other suspicious-looking surface of the fauces. brane be present a small portion of it should also be Hyderabad Chloroform Commission in most cases was overThe material should be at once placed in come in the Hyderabad experiments by prompt resort to included. a small glass-stoppered bottle, previously washed out artificial respiration. In the present instance primafcccie with clean water. No spirit or other fluid should be no overdose was given and the promptest action was taken added. The bottle, which should then be properly secured to restore breathing. We have, however, in speaking of and so packed in cotton-wool or otherwise as to travel with an "overdose," to carefully discriminae between too safety by post, should be posted without delay to the Medical large a dose being given at one time and the equally Officer of the Local Government Board, Whitehall, London, perilous and far more insidious overdosage which S.W.; and it should be accompanied by a history of the case, occurs if through impediment of the breathing by any means interference takes place with expiration. Sach an or of the outbreak of which it forms a part, signed by the accumulation of chloroform in the blood as happens under medical officer of health for the district concerned. such circumstances probably permanently injures the protoplasm of the medulla before any very marked phenomena, DEATHS UNDER CHLOROFORM. save slight and easily overlooked alteration in the breathing, A DEATH recently took place during an operation performed occur. We must be understood to in no way state any of under chloroform at St. Bartholomew’s Hospital. The these solutions of the difficult problem-Why does a patient patient, a man aged forty, suffering from cancer affecting die under chloroform ?—as applying to this particular case ; the pharynx and structures of the air and food passages, it is, we believe, useful to apply pro and con. reasonings in all was admitted to have tracheotomy performed, an operation instances of chloroform deaths when the phenomena are the nature of which was explained to him, and which sufficiently clearly stated, as in the particular case upon which . was rendered imperative owing to the extensive character of we are commenting. the invasion of the neoplasm. The man was given chloroform according to the method in vogue at this hospital, and FEEBLE-MINDED BOYS. when under its influence the operation was commenced. While the tracheotomy was in progress the man’s breathing THERE are few more striking characteristics of the present stopped. Death is, however, stated to have been due day than the humane efforts which are made on all sides to to heart failure caused by the combined shock of the bring help to those who are unable to help themselves,"the operation and of the chloroform. The necropsy revealed strong bearing the infirmities of the weak," and so tending The operation as to counteract the pitiless tendency in nature for the survival extensive carcinomatous infiltration. not to we is calculated such, presume, produce severe shock, of the fittest only. And although from the selfish point of but doubtless the condition of the man and the probable view of utility the wisdom of this may be doubted by some, narrowing of his respiratory outlet rendered him less able to there is no need nowadays to argue seriously of our duty to bear shock or withstand the depression due to the ansesthetic. help, and even to make some sacrifice for, those who come We are indebted to the chloroformist in the following into the world imperfectly equipped for the race which recase for a lucid account of the fatality. The patient, quires all the energies of a normally constituted individual. a muscular but pale man fifty-five years of age, of From time to time we have in these columns drawn attention abstemious habits, was admitted into the Wallingford to movements which aim at rescuing from distress or preCottage Hospital on Nov. 9th for treatment of extensive serving from slipping into the criminal classes those disease of the carpus on the right side. On the 10th he who from disease or from congenital mental deficiency was put under the influence of chloroform; the anses- are in some danger of such a fate. Only lately we directed thetic was given from a wire mask covered with flannel. attention to the scheme for the colonisation of epileptics "lie
quid nimiB:’
-