fmm
mm    ip
I (MP !  1W
', n <).'•'■ I'd-:." ••'.■■i« ','(.  ',..>•:• .
vM: 
NATIONAL lliRARY OF I
■3K

NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE  NA
[  v^k ! P^y   \

1NDI01W JO AHVBII1 IVNOIIVN 1NI3I01W JO A I V II « I 1 IVNOIIVN IN


























NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA
 
 
 
EFFECTS
CHLOROFORM
STEONG  CHLORIC  ETHER,
AS NARCOTIC AGENTS.
   BY JOHN C. WARREN, M.D.
AUTHOR OF " ETHERIZATION, WITH SURGICAL REMARK9," ETC.

         BOSTON:
WILLIAM D. TICKNOR & COMPANY.
           1849. 
              BOSTON:




PRINTED  BY  JOHN  WILSON,



            21, School-street. 
         CHLOROFORM

                  AND

STRONG  CHLORIC  ETHER.
A short time since, I received a letter from a dis-
tinguished person in Canada, in which my opinion
was requested as to the state of the ether practice,
and  the  use of chloroform.   This communication
led me to see the propriety of  publishing some  ob-
servations and results of a practical nature, which
had occasionally presented themselves in the course
of my reading and experience.  I had, in fact, already
promised  to do this at the meeting of the " Ameri-
can Medical Association" in Baltimore, last spring,
as will be explained hereafter.  A natural reluctance
to take up a subject, which, however important, has
already been so hackneyed, had prevented me from
executing this design, until I was repeatedly in-
quired of as to the actual  condition of the ether
practice.  The very unfavorable influence exerted
on  this  practice by the  fatal cases of chloroform
seemed also to add to the necessity of a careful con-
sideration  of  the  phenomena with which they were
attended.   At length I received, among others, the
letter already  alluded to,  from which  the  following
passage is extracted : — 
4
   " The use of chloroform had been just announced
 as your book was going to press;  and you reserved
 your opinion on its merits, till you could speak from
 experience.   In the interim, it  does not seem to me,
 that, in this vicinity,  the medical profession are
 availing themselves generally  and with confidence
 of the aid of the one agent or the other, which I am
 at a loss to  account for;  and  I am surprised that
 more has not been said of this  wonderful discovery,
 than appears  to have been   within  the  last six
 months. ... I  have a curiosity to know whether, as
 you have become more familiar with the use of ether
 and chloroform, your confidence in it has been con-
 firmed  or shaken.   Judging  from the clear and
 succinct summing up at the end  of your treatise,
 which all readers can  understand, I should  expect
 to  hear, that,  unless  something  has occurred  to
 change   your views very  materially,  you  would
 scarcely  think  of leaving a patient to endure the
pain of  a severe operation, without giving him,  at
least, the choice of such relief as you describe.   Arid
yet I am not sure that  this is now the general prac-
tice with you:  it certainly is not with us."
  In the " Remarks on Etherization," which I pub-
lished about a year  since, it was said, that another
year was necessary to give us the means of judging
fully and definitively on the merits of the ether prac-
tice.  Before that publication was  fairly out of the
press, a new agent was proposed, which was  des-
tined to effect a great change in the use of ether.
  The introduction  of chloroform produced an ex- 
•J
citement scarcely less than that  of the discovery of
the  narcotic effect of ether.    The beauty  of  the
article, and the rapidity of its influence, gave it an
immediate and general currency;  for not only was
it employed by physicians, but the community took
the narcotizing drug into their own hands, and, from
the highest to the lowest, indulged themselves in the
chloroform excitement.   This  substance, as pro-
posed and promised in the remarks I had occasion
to make  on  the subject of etherization, was taken
up by me, and fairly tried in  a great number of
instances, and among the first on my own person;
so as to give it a thorough trial in every way.   In
the cases under our direction, it was  used with  all
the precautions  possible.   The  quantity of chloro-
form was limited;  and an inhaling apparatus com-
monly employed, varying in form according  to  the
ingenuity  of the contriver.   The apparatus more
particularly resorted to was arranged to accomplish
inhalation by the nostrils, a sponge or rag being so
placed in the box as  to permit  the mixture  of  air
with the narcotic vapor.
   We  were soon awakened from our dreams  of  the
delightful influence of the new agent,  by  the  occur-
rence of unfortunate and painful consequences, which
had not followed in this country on the practice of
etherization.   The  profession  were led to hesitate,
many of them to suspend the  use  of chloroform, to
watch  its effects with  a jealous  eye; and, finally,
when the lapse of time produced new cases of fatal-
ity in pretty regular succession,  some were induced
         1* 
6
to relinquish it entirely, and employ the safer and
less violent substances, — the sulphuric and chloric
ethers.
   The loss of a single life, from an application used
for the purpose of preventing pain, must make a
strong impression on the mind of any conscientious
physician or  surgeon ;  and when this occurrence
presents itself repeatedly within a short space of
time, — affording, as it must do, reason to apprehend
the same result in cases  otherwise the most  favor-
able, — it becomes the duty of a professional man,
either to relinquish the practice, or to find out some
way of rendering it safe.  Now, it appears that  no
less  than ten  well-authenticated fatal  cases  have
presented themselves to the public eye within little
more than a year.   When we consider that there
are other  cases not well ascertained, and  probably
others which have never become public, we are called
on to  investigate  these  fatal occurrences  with the
greatest care, and to discover, if possible, why these
patients died, while others have escaped, and whe-
ther there are any means of avoiding similar results
in the future practice.
   Some writers have thought that the fatal effects
in these cases did not arise  from chloroform, but
might  be well explained by other causes.  In  in-
stances, where the fatal result has followed the use
of chloroform, with scarcely a longer  intervention
than death from a wound in the  heart  follows the
stroke of  the knife, chloroform has by learned  and
experienced surgeons been pronounced to  be abso- 
7
lutely guiltless of the mortal consequence ; and the
death has been attributed to fainting, or syncope;
to apprehension, or fear; to bleeding at the lungs ;
to diseased heart and enlarged liver ; to asphyxia :
and, finally,  the  well-known  fact, which  we our-
selves have formerly cited,  that deaths  sometimes
take place from a violent constitutional  impression,
has been quoted  as the cause.   In regard to this
last, if such were the true explanation, the crowding
of so many cases of rare occurrence into the com-
pass of a few months must form  an epoch in the his-
tory of this constitutional sympathy.
   In order to present the phenomena of the fatal
cases produced by  the administration of chloroform,
we shall bring them together in  such way, that they
may be  readily compared.   But, before  doing this,
some may be mentioned as precursors of the  formi-
dable train of results which  was  to follow.
   The cases  which first gave  me  uneasiness  as to
the  effect of chloroform were,  among  others, the
following : —
   A lady,  Mrs. H. about forty-five years old, in
good health,  of rather a delicate temperament, had
a tooth  extracted  under the use of ether, in 1847,
with favorable  effect.   In the early part of 1848,
having occasion to undergo the same operation again,
she applied to the same dentist, a gentleman well
practised in the use of ether.   Instead of this article,
he  thought best to employ chloroform, which was
given her on  a handkerchief, to the amount of about
thirty drops.   After five or  six  inspirations, she 
s
 had a partial convulsion, was deadly pale and faint.
 Being laid on the sofa, she recovered in a degree;
 in ten or fifteen  minutes became  very  sick  at  the
 stomach, and continued so all that day.   On the day
 following, the sickness still  remained  ;  she had
 severe  headache,  loss  of appetite,  with nervous
 twitchings of the muscles.  At the end of five days
 she was able to walk out, and came to consult me.
 Her symptoms at this time were an uneasy sensation
 in the stomach, stricture across the  chest, loss of
 appetite, headache, and great prostration of strength.
 The last symptom continued  to the month of De-
 cember ; when she came  into  town again, for the
 purpose of consulting me once more.
  Not long after the occurrence  of  this case,  we
 received by the  " London Medical  Gazette"  for
 Dec. 1847, an account  of an instance of asphyxia
 and convulsions, under the influence of chloroform,
 in Halesworth, England.  The writer, Mr. Beales,
 represents his patient as a young lady, twenty-seven
 years old, who  had labored  under  neuralgia  for
 three years, and from whom he extracted an upper
 molar tooth,  on the left side.   A drachm was  at
 first used; but finding slight effect, from twenty to
 thirty drops more were  poured upon the sponge,
which in two or three seconds produced  rigidity of
the  extremities, slight convulsions  of the  abdominal
muscles, extreme dilatation of the pupils ;  succeeded
by the most alarming state of asphyxia, lasting for
at least a minute.   When re-action  came on, she
fell  apparently into  a calm  sleep, during  which the 
9
 attempt was made to extract the tooth.   But before
 the instrument could be removed, the jaws  became
 so firmly fixed as to hold it for two or three minutes ;
 while  the  arms, legs,  and whole body, underwent
 the most distorted convulsions.   At length, the  in-
 strument and tooth were removed ;  the  convulsions
 continuing  for five  or six minutes longer,  though
 with less violence.   She then became half conscious,
 muttering, " More, more, or I cannot have my tooth
 out."   To this state, which continued half an hour,
 succeeded  a most excruciating pain at  the  top of
 the head,  lasting twenty minutes;  and  it was not
 till the expiration  of  an  hour and a half, that she
 was enabled to return home.
   Within a month  from this date, there appeared
 in the public  newspapers an account of a  case of
 convulsions, lasting sixteen hours, at New Bedford,
 Mass.  in an apothecary, who undertook to  divert
 his friends  by an exhibition of the effects of  chloro-
 form.   There also occurred in Baltimore a  case of
 asphyxia from the same cause,  continuing an hour
 and a half,  and by  which  an unfortunate  medical
 student nearly  lost his life.  In  New York, about
 the same time, a lady, after having a tooth extracted
 under  chloroform, lay fainting for several  hours:
 the recovery of her  mental faculties was attended
 with prostration, paralysis of the tongue, and loss
 of voice.   To  these, many similar instances  might
be added.
  But these occurrences were of trifling importance,
compared with  others which  followed.   A number 
10
of individuals, in the full vigor of youth and health,
were struck dead under the very hands of the sur-
geon  raised for their  relief;  and, in one <or two
instances, the proposed operation was unknowingly
performed on a lifeless body.
  The causes of death from chloroform have  natu-
rally attracted the careful attention of physiologists
and physicians.  They have been anxious to discover,
why this article has produced many more dangerous
effects than ether, and  what organ was  attacked
with so great violence  as to interrupt suddenly its
functions, and  consecutively the  other functions of
animal and organic life.
  Very careful and minute  investigations  and dis-
cussions, intended to  answer these questions, have
been undertaken by learned physiologists and pa-
thologists in various countries.   My intention is not
to follow in the search so ably pursued  elsewhere
by others,  but  to endeavor to throw some light on
these critical  inquiries, by bringing together, in  a
comparative view, the  most remarkable phenomena
these fatal  cases have presented, in order to ascertain
whether they agree in any one or more circumstances
which may offer a  clue to the  peculiar effects of
chloroform, and the  means of obviating  them.  To
attain this object, it  was necessary to present simply
the most remarkable phenomena in each case, and
then to compare them  by constructing a Table. 
11
                  CASE  I.

Name. — Hannah Greener.
Date.—Jan. 25, 1848.
Disease. — Onychia.
Previous  Use. — Sulphuric  ether, two  months
  previous.
Time of Inhalation. — About half a minute.
Quantity Consumed. — About a drachm.
Posture. — Sitting.
Lapse of Time till Death. — Two minutes.
Symptoms.—In half a minute, no change of breath-
  ing or alteration of pulse;  arm rigid;  insensi-
  bility ; after semilunar incision, a twitch ; sudden
  blanching of lips ; spluttering at  the mouth ;  not
  the slightest attempt at a rally ;   death.
Morbid Appearances :
     Brain. — External  and  internal congestion
  more than usual;  rather more than usual quantity
  of serum in ventricles.
     Heart. — Healthy ; dark fluid  in both  cavities,
  less in left.
     Lungs. — Not collapsed ;  one or two  slight
  adhesions; external surface  of both  highly con-
  gested ;  mottled with deep purple,  bluish, or
  scarlet patches ;  crepitant; small emphysematous
  bubbles along outer and interior border of both,
  more on upper lobe of left;  bloody froth in tissue
  and in bronchi; epiglottis reddened ; also mucous 
12
  membrane of larynx reddened and mottled ;  dark
  mucus in the sinuses.*
    Liver, kidneys, and spleen, congested ; digest-
  ive organs healthy.
    Some veins more distinct than usual.
    Rigidity as usual.
Cause  of Death assigned by Jury. — Conges-
  tion of the lungs produced by chloroform.
                 CASE  II.

Name. — Arthur Walker.
Date.— Feb. 5, 1848.
Disease. — None.
Preyious Use. — Frequent.
Time of Inhalation. — Unknown.
Quantity Consumed. — About half an ounce.
Posture. — Leaning forwards.
Lapse of Time till Death. — Uncertain.
Symptoms. — Not known.
Morbid Appearances :
    Brain. — Veins on the upper surface full, not
  turgid;  pia mater  injected ;  puncta vasculosa
  larger than usual;  velum interpositum and cho-
  roid plexus much loaded with dark-colored blood.
    Lungs. — Turgid ; loaded  with dark-colored
  blood, particularly at the upper margin  of the
  lowest lobe of right lung;  lower lobe of left and

             * Query. — Pacculi laryngis?
• 
13
  smaller portion of upper lobe of right engorged,
  of apoplectic character, emphysematous.
    Heart. — Old adhesions of pericardium; right
  side distended with thin and dark  fluid blood;
  walls  of right ventricle unusually thin; cavity
  enlarged.
    Blood. — General mass darker than usual.
Cause of  Death  assigned by Jury. — As-
  phyxia,  consequent on the inhalation of chloro-
  form.


                 CASE  III.

Name. — Mrs. Martha G. Simmons.
Date.— Feb. 23, 1848.
Disease. — Extraction of the stumps  of teeth.
Previous Use. — None.
Time of Inhalation. — About a minute.
Quantity Consumed. — Uncertain.
Posture. — Sitting.
Lapse of  Time till Death. — Estimated by two
  witnesses at about two minutes; by the dentists,
  from five to ten.
Symptoms. — Face pale during inhalation; groans
  during extraction, but no other sign of conscious-
  ness.  In  two minutes from beginning of inhala-
  tion, head turned to one side ; arm slightly rigid;
  body drawn backwards; pulse feeble, and instantly
  stopped, so with respiration;  face, previously
  pale, now livid; lower jaw dropped; tongue pro-
           2 
14
  jected at one corner of the mouth ;  arms perfectly
  relaxed.
Morbid Appearances :
     Brain. — Integuments contained  but  little
  blood ; more than usual in vessels  of dura mater ;
  superficial vessels  moderately  distended;  from
  sinuses of dura mater, two  or three ounces  of
  fluid blood mixed with bubbles of air; aspect,
  character, and color, normal.
     Heart. — Flaccid, cavities  empty, inner sur-
  face of all deeply stained ; six drachms of bloody
  serum in pericardium; aorta and pulmonary artery
  empty ;   cava empty in  chest, containing very
  little in abdomen ; lining membrane of all blood-
  vessels deeply stained.
     Lungs. — Considerable congestion, crepitant,
  no extravasation; congestion of lining membrane
  of bronchi; deeply  stained;  great injection of
  pleura;  six drachms bloody  serum  in right, two
  ounces in left.
     Liver. — Pale.  Kidneys engorged.
     Blood. — Everywhere fluid as water; no coagu-
  lum in any vessel;  examined  by  the  microscope
  some alteration in the form of globules;  some
  irregular; generally more distended and globular
  than normal, also somewhat fragmentary  ; number
  somewhat diminished;  color, dark venous.

  Note. — Professor  Mussey, who  was called upon to
superintend the examination of the dead body of Mrs. Sim-
mons, informs me  that this patient inhaled Ijhrough an
apparatus " in such manner  as  to prevent air  passing 
15
through her nose, so that probably little or no air was
received into her lungs, except through the valve of the
inhaler.  It is impossible to determine how much chloro-
form was consumed.  A piece of sponge, occupying about
two-thirds of the space in the globe of the  inhaler, was
saturated with chloroform, besides not far from half an
ounce of the free liquid remaining in the vessel.  This was
after the experiment made by Mrs. Simmons."
                  CASE  IV.

Name. — Patrick Coyle.
Date. — March, 1848.
Disease. — Fistula.
Previous Use. — Once.
Time of Inhalation. — About one minute.
Quantity Consumed. — About thirty drops.
Posture. —Upon the side.
Lapse of Time till Death.—About one minute.
Symptoms. — Showed signs of pain  by putting
  hand  to the part;  in a moment, his pulse, which
  was full and natural, sunk;  death.
Morbid Appearances :
    Brain. — This,  with the membranes, natural
  and healthy.
    Heart. — Enlarged,  pale, soft;  two or  three
  ounces of serum  in pericardium; blood-vessels
  with dark fluid blood.
    Lungs. — Studded with tubercles;  abscess  in
  in each; lower parts congested;  pleura exten-
  sively adherent. 
16
    Stomach. — Mucous  membrane softened,  its
  veins turgid.
Cause of Death assigned. — Disease  of the
  lungs.


                  CASE V.

Name. — Mile. Stock.
Date.—June, 1848.
Disease. — Opening an abscess in hip.
Previous Use. — None.
Time of Inhalation. — Less than one minute.
Quantity Consumed. — From fifteen to  twenty
  drops.
Posture. — Sitting.
Lapse of Time till Death. —Very brief.
Symptoms. — After  several inspirations, tried to
  withdraw  handkerchief; crying, — "I choke;"
  face suddenly pale; countenance changed; breath-
  ing embarrassed; foam at the mouth.
Morbid Appearances :
    Brain. — Superior longitudinal sinus  empty ;
  veins  on convex surface not engorged, but the
  column of blood broken at intervals with bubbles
  of gas, also air in veins at base of the skull, also
  escaped with the blood  from ophthalmic veins,
  cavernous  sinuses,  and  inferior  cerebral  veins;
  serum  in lateral ventricles  moderate;  substance
  firm.
    Heart. — Serum  in pleura and pericardium ; 
17
  heart excessively flaccid;  right  and left cavities
  empty; not  the smallest clot;  frothy blood in
  the orifice of ascending cava; a little blood mixed
  with air from pulmonary veins; internal mem-
  brane of heart red,  especially of right cavities ;
  tissue pale.
     Lungs. — Especially left,  voluminous, visibly
  engorged in lower lobes ; on incision, a very black
  fluid blood;  remarkable crepitation; pulmonary
  vesicles dilated with air, probably from the arti-
  ficial  respiration;  neither interlobular nor sub-
  pleural emphysema; tracheal mucous membrane
  bright red; no froth in bronchi.
     Liver. — Very large ;  air-bubbles with much
  black and fluid blood escape on incision.  Intestines
  distended with foetid gas.  Spleen softened, gorged
  with blood, bubbles of air escape on pressure.
     Blood. — As black as ink ; air bubbles up from
  a remarkably black and very fluid blood from in-
  ternal saphsena and left crural;  blood-vessels
  near the wound found  to be perfectly entire.
Cause of Death assigned.  — Syncope, caused
  by  sudden suspension of the cerebral  functions
  under chloroform.
2* 
IS
                CASE  VI.

Name. — Daniel Schlyg.
Date. — June 25, 1848.
Disease. — Disarticulation of thigh.
Previous Use. — None.
Time of Inhalation. — Four or five minutes.
Quantity Consumed. — Not stated.
Posture. — Recumbent.
Lapse of Time till Death. — Three quarters of
  an hour.
Symptoms. — Face very pale, lips discolored, pupils
  dilated, eyeballs rolled upwards; respiration in-
  frequent and sighing; pulse no longer percepti-
  ble ; limbs perfectly relaxed.
Morbid Appearances. — No autopsy was made.
Cause of Death assigned by the Surgeon,
  M. Robert. — Syncope.


                CASE  VII.

Name. —Walter S. Badger,  gentleman.
Date. — June 30, 1848.
Disease. — Operation on teeth.
Previous Use. — None.
Time of Inhalation. — One minute.
Quantity Consumed. — A  drachm and a half.
Posture. — Sitting. 
19
Lapse of Time till Death. — One minute.
Symptoms. — Face livid, pupils dilated, tempera-
  ture of the body lower than natural.
Morbid Appearances :
    Brain. —Nothing abnormal; slight congestion
  of corpora striata and optic thalami; membranes
  congested.
    Chest. — Lungs and heart pushed up as far as
  third and fourth ribs; lungs healthy; crepitant
  throughout; some adhesions; on right, little con-
  gestion.
    Heart. — Pale; flaccid;  not hypertrophied or
  dilated; some adipose spots on surface;  walls of
  left ventricle thinner than usual; fatty degenera-
  tion of tissue, especially  at apex;  clots of dark
  grumous blood in both ventricles ;  inner surface
  of aorta rough;  mitral valves unequal at their
  edges ; tissue hard, grating.
    Abdomen. — Omentum fatty ;  stomach not dis-
  tended ; liver very large, reaching up  to third
  and  fourth  ribs;  pale,  brownish,  dirty-white;
  weight, eight pounds.
Cause of Death assigned by Jury. — Obstruc-
  tion  to the heart's action  from an enlarged liver,
  and the influence of chloroform thereupon. 
20
               CASE VIII.

Name. — A young woman of Hyderabad.
Date.— July 11, 1848.
Disease. — Amputation of middle joint of middle
  finger of left hand.
Previous Use. — None.
Time of Inhalation. —Very brief.
Quantity Consumed. — A drachm.
Posture. — Sitting.
Lapse of Time till Death. — Instantaneous.
Symptoms. — Slight cough, with a  few brief con-
  vulsive movements.
Morbid Appearances. — No autopsy was made.


                CASE IX.

Name. — John Griffith.
Date. — Jan. 19, 1849.
Disease. — Chancres and hemorrhoids.
Previous Use. — Chloroform on Dec. 26, 1848.
Time of Inhalation. — None given.
Quantity Consumed. — About three drachms.
Posture. — Lying on one side.
Lapse of  Time till Death.—About ten  min-
  utes.
Symptoms. — Face and neck of a livid, leaden hue;
  the eyes turned upwards ; the pulse imperceptible 
21
  at the wrist;  respiration  laborious;  the whole
  body relaxed ; after two or three gasps, he ceased
  to breathe.
Morbid Appearances :
     Brain. — Healthy ;  no  other appearances than
  in persons dying when  in full health.
     Heart. — Large ; its  ventricles and  auricles
  empty;  its condition  flabby ;  the substance of
  the left ventricle rather softer than natural.
     Lungs. — A good deal congested ; and  dis-
  charged, when cut, a  large quantity of bloody
  serum.
     About half an ounce of a watery fluid was found
  in the pericardium.


                 CASE  X.

Name. — Abby Pennock.
Date. — March 6, 1849.
Disease. — Toothache.
Previous Use. — Frequent.
Time of Inhalation. — Unknown.
Quantity Consumed. — Three drachms in two
  applications.
Posture. — Recumbent.
Lapse  of Time till Death. — Probably instan-
  tanedus.
Symptoms. — Unknown.
Morbid Appearances :
     Externally, the body livid over  the whole left 
oo
side ;  face and  neck swelled ;  pupils slightly
dilated ; thyroid gland enlarged.
   Brain. — Free from congestion,  or any other
morbid aspect.
   Heart. — Flaccid ; empty of blood; only a very
small coagulum in its cavity.
   Lungs. — Not much collapsed ; both congest-
ed ;  the left  throughout,  the  right of a bright
vermilion color ; entrance to the larynx inflamed,
and covered with small ulcerations.
  Abdomen. — Semi-digested food in  stomach;
lacteals full of chyle ;  intestines in a remarkably
decomposing  condition.    Liver  not  altered.
Spleen rather large, and contained great numbers
of distinct whitish bodies smaller than the head of
a small pin, not tubercles. Left kidney congested.
Uterus with catamenia. 
23
  By the above Tables, we learn the

Time of Inhalation to have been -
    Less than a minute in
    About a minute .
    Four or five minutes
    Uncertain  ....

Quantity.
    Half a drachm and under     .    .     .2
    A drachm, but  less than two      .     .    3
    Between two and three  .         .     -1
    Uncertain  ......    4

Posture.
    Sitting.......5
    Leaning forwards     ....    1
    Recumbent   ......  4

Lapse till Death.
    Within one minute   ....    4
    Within two minutes    .     .    .     .2
    In ten minutes   .....    1
    In three quarters of an hour    .    .     .1
    Uncertain  ......    2

Morbid Appearances.
    Not given     ......  2
 Brain —
    Congestion moderate  ....    4
         „     none.....4
.   3
   3
.   1
   3 
21
   Heart—                                  Catu
     Healthy    ......     1
     Enlarged and soft.....2
     Disordered  ......     1
     Excessively flaccid  .     .     .     .     .2
     Flaccid     ......     i
     Flaccid, compressed by liver   .     .     .1
             Mostly free  of blood in all.
   Lungs —
     Congestion great .....     4
          „     considerable  .     .     .     .   3
          „     little .....     1
   Blood — In each instance black and fluid.
     Dark and fluid.....1
     Darker  than usual    ....     2
     Dark, venous, fluid  as water   .     .     .1
     Black as ink    .....     1
     Not stated......3
 Air in the Veins mentioned in      .    .    2
 Mode of Inhalation.
     From an apparatus.....2
       „  a  sponge.....1
       „  a  towel ......  3
       „  a  handkerchief  ....     4

   It has been stated,  that  the greater part  of the
victims of chloroform  were  females.  An examina-
tion of the cases recorded shows, that the numbers
are exactly equal, five  males and  five females.   The
questionable cases hereafter cited are two males and
one female. 
25
   In a Review in the "London Medical Gazette"
for  Sept. 1848,  page 424,  a quotation  is  made
from " Remarks on the Employment of Anaesthetic
Agents in Midwifery," by G. T. Gream, in which
he says : — " For they should know that fatal con-
sequences have ensued from the use of chloroform
during parturition."
   We have thought it right to mention this  allu-
sion ; but, as there is uncertainty about it, it should
not be considered, in the present state of our infor-
mation, as a well-authenticated statement of  death
from chloroform.   It seems a little remarkable, that
in these  cases, and also  in some others mentioned
above, in which it could scarcely  be doubted that
chloroform was the cause of death, no examina-
tion of the dead  body was made, or at least none
reported.

   M. Malgaigne, in the " Proceedings of the French
Academy of Medicine " for October 31, 1848 {vide
"Gaz. Med. de Paris" Nov. 18), reports a  case  as
follows: —
  "  A man,  wounded in June, had the  neck  of
the humerus broken by a ball, which was lost in the
flesh.   Two abscesses formed, and were  opened
without discovery  of the  ball.   Finally, gangrene
appeared in the wound, and the patient was  sinking
under secondary hemorrhage.   Having at length
decided to attempt the scapulo-humeral disarticula-
tion, with scarcely any  hope of saving him, but
rather to prevent him from dying of hemorrhage,
         3 
26
the patient was put  to  sleep  by chloroform.   He
aroused after the operation;  but the search for the
ball, which had been split in two against the scapula,
and buried in the walls of the thorax, requiring
another incision, chloroform was again applied to
the nostrils; and the incision,  commenced upon the
living, was finished upon the dead body.  His condi-
tion was so desperate, that I could not for an instant
attribute his death to chloroform; and there  is no
surgeon who, in similar circumstances, has not had
the grief to see patients die under his  hands."

   M. Roux, at the sitting of the Academy of Medi-
cine for Jan. 16, 1849 (" Gaz.  Med. de Paris," Jan.
20), related the following interesting case, in which
he attributed the death to syncope : —
   " Some months  since, I was called on to operate
upon a female, fifty years of age, with a cancer of
the breast.   She was  much debilitated.   Besides
the tumor of the breast, the  glands of the axilla
were also  much  diseased,  and their  extirpation
judged necessary.   I did not hesitate  to put her
under the influence of chloroform : during the sleep,
which was sound, I removed the tumor.  The first
operation was hardly ended, when the patient awoke.
4t then remained for me to extirpate the glands in
the axilla: this I begged her to  permit me to do with-
out resorting to chloroform.   She consented.   The
operation was long and laborious.  The dressing was
applied;  then,  according  to my usual custom, a
bandage rolled  around  the  body.   To apply this 
27
 bandage,- she was made to sit up;  syncope at once
 took place; all efforts to re-animate were vain ; the
 patient was dead."

   In the "Paris Medical Gazette" of Jan. 20, 1849,
 a case  is related, in which chloroform produced very
 alarming appearances.  The patient was a lady, who
 had passed the middle period of life,  affected with
 a  tumor in the groin, of very large size.   Chloro-
 form, being previously administered, produced some
 ridigity of the muscles ; but the patient, ultimately
 coming under its full influence, went  to sleep, and
 the operation was performed without pain. After the
 operation was over,  she awoke; and, the dressing
 requiring a painful application of sutures, chloroform
 was again administered, and the dressing was com-
 pleted   under its influence.    Immediately  after,
 alarming  symptoms  presented  themselves.   The
 patient was taken with a chattering  of the  teeth,
 extreme paleness of  the face, almost complete dis-
 coloration of the  lips, dilatation  of the pupils, rapid
 depression of the pulse, which became imperceptible
 for some time, convulsive movements  of the face,
 and contractions of the flexor muscles of the hands,
rigidity of all the extremities, stertor, a little rattling,
 slight  delirium,  muttering.  This condition lasted
for about  seven  or eight  minutes.   Fresh  air was
thrown upon the  face, and she was stimulated by the
vapor of ammonia; by which applications  she was
gradually brought to herself, though  not without
great anxiety on the part of her  medical attendants. 
28
  The following case is one of so recent occurrence,
that I am induced to give it at length : —
  " John Griffith,  an  Irishman,  aged  thirty-one
years, a seaman in the navy, who was admitted into
the New York  Hospital early  in December, on his
return from Mexico, suffering  with diarrhoea, chan-
cres, and hemorrhoids, died from the administration
of chloroform on Saturday, while undergoing  an
operation.   A  coroner's  jury so  declared, adding
that the use of it was proper and justifiable in the
case.    The affidavit of Dr. Buck tells the whole
story :
   " Gurdon  Buck, jun.  attending surgeon to the
New York Hospital,  being sworn, says, ' That, on
or  about the 26th December, I advised that chloro-
form should be administered to the deceased, for the
purpose of examining the condition of the rectum;
the parts being in a state of  such excessive irrita-
bility as scarcely to admit of a  separation of the
nates.  The patient recovered from the effects of the
chloroform, and remained in all respects in the same
condition as before its use.   On  the 19th  of Jan-
uary, the  deceased being  in a  sound condition,
except the local ailments  spoken of, and he having
never complained of either his head or his chest,
and not having suffered from the first administration
of  chloroform,  I directed it to be administered  to
him for the purpose of performing an operation upon
the rectum, and the  operation of circumcision,  to
remove  a phymosis caused  by the chancres.   The
patient soon became excited by the chloroform,  as 
29
 is usually the case, but not beyond a degree which
 I  have often observed.   Shortly  after, he  became
 more tranquil.   The deceased was placed upon his
 side, and the operation performed,  which  consisted
 in the removal of two external tumors, and the tying
 of one internal tumor.
   'At this moment m)T attention was arrested by my
 assistant calling for a wet cloth.  On examining the
 patient, I found his face and neck of a livid, leaden
 hue or color, the eyes turned upward, the pulse
 imperceptible at the  wrist, and  the  whole body
 relaxed;  after two  or three  gasps,  he ceased to
 breathe.  Every means was promptly used  to  res-
 tore the deceased, but without effect. The chloroform
 was obtained at Kent's,  91, John-street, and  not
 exceeding three drachms  was  administered  from a
 napkin:  a  portion of chloroform  from the same
 phial had  been administered  the  day before to  a
 patient,  without any unfavorable  effects.    About
 ten minutes elapsed from the commencement of its
 administration before death took place.   On making
 a post-mortem examination twenty-four  hours after
 death, I found the face less livid than before death :
 on examining the head, the brain and its membranes
 presented no  other appearances  than are seen in
 persons dying when in  full health ; the  lungs were
 a good deal  congested, and discharged, when cut,  a
large quantity of bloody serum ; the heart was large,
its ventricles and auricles were empty, its condition
flabby, the  substance  of the  left ventricle rather
softer than natural; about half an ounce of a watery
         3* 
30
fluid was found in the pericardium; the viscera of
the abdomen were healthy.
                      'Gurdon  Buck, M.D.
                ' Surgeon to New York Hospital.'
  "  Drs.  Kearney  Rodgers, Buel, and  Bathgate
testified to the proper use of the  chloroform.  Dr.
R. has seen  it used  a  hundred times  without any
bad effects."
  Dr. Parker, Professor of Surgery in New York, to
whom I had written on the subject, gave me a state-
ment confirmatory of the deposition of Dr. Buck.

  Another fatal case of chloroform has this moment
occurred, March 6, in Boston.  The following were
the circumstances : — A young woman, Abby Pen-
nock, 17 years old,  finely constituted,  came a few
weeks  previous to  live  as  domestic  in  a highly
respectable family.   Being troubled with toothache,
and occasionally with pain in the side, she applied
for medical advice.   On a visit to  her physician, she
asked him for chloroform, and  he gave her a few
drops.   She then took the phial, poured the liquid
freely on her handkerchief, and inhaled it until fair-
ly under its influence.
  On the evening of March 6,  she went out, and,
having had  the toothache, used chloroform.   After
her return home, she ate a good  supper, and soon
went to bed.  In half an hour, a young woman who
lodged in the same chamber went  to her room, and,
on entering it, spoke to her, but, receiving no answer,
presumed she was asleep, said no more, and went 
31
to bed herself.  She  noticed that the window  of
the chamber had been opened, as she has  since
thought,  to  take  off the smell of the chloroform;
and, having  no objection herself to its  being so, she
allowed it to remain open, although the temperature
was below freezing.
  The next  morning, when she arose, finding that
Abby  was  not stirring, she did  not attempt  to
rouse her, but dressed and went about her business.
As the latter did not appear, her room was visited
about  half-past 6, a.m.  and  she was discovered  in
bed lifeless and cold.   She lay on her  left side with
the knees drawn  up,  and all the  limbs in a rigid
state.  Dr.  Jeffries  was immediately  sent for, and
very soon arrived.  On viewing the appearance of the
body,  he perceived the left  hand clenched over
the mouth, and the  right arm crossing the left.  An
examination of the left hand  detected a handker-
chief crowded in  its hollow, which being removed,
the  foetid odor of  stale chloroform was perceived.
Suspicion being excited, search was  made around
the room and in the drawers for a bottle contain-
ing the suspected liquid ; but none was discovered.
Afterwards, when the body was moved, a bottle of
chloroform fell out of the bed.  It was a two-ounce
phial, and  three fluid drachms  of  it had  disap-
peared.
   Dr. Jeffries proposed an examination of the body;
and, this being consented to, he called on Dr. J. B.
S. Jackson, who performed it.
   External Appearance. — The body was livid 
32
over the  whole of the left side on which she had
lain.  The face and neck were swelled,  so  that the
string of her night-cap produced a distinct  inden-
tation.  The pupils of the eyes were slightly dilated.
The thyroid gland was much enlarged.
   Thorax. — The lungs were not  much collapsed;
both of them were congested, but  the congestion in
the right was bright-colored, while that on the left
was purple.  As the lungs  were  much collapsed,
the congestion could not be  excessive.   The heart
was flaccid, and empty  of blood.   Nothing  was
found in its cavities, but a  very small coagulum.
   Head. — The brain was entirely free from con-
gestion.   There was a little water in the ventricles,
but no other remarkable appearance.
   Abdomen. — The stomach contained a considera-
ble quantity of food in a semi-digested state, and the
lacteals were full of chyle.   No morbid change in
the mucous coat.  There was no appearance of poi-
sonous substance.  The intestines  were  in a decom-
posing  condition,  quite  remarkable,  considering
that she  had been alive and on her feet the evening
before.   The liver was not altered.   The  spleen
rather large, and contained great  numbers of dis-
tinct whitish  bodies, smaller than the head of a
small pin,  not  tubercles.    The  left  kidney  was
congested.  The uterus exhibited a catamenial ap-
pearance.
  Remarks.—To what has been stated above may be
added, that there was reason to believe the chloroform
was purchased on the evening it was taken; that  it 
33
had been used during that evening, at least once be-
fore the fatal application ; and that the three drachms
which  had disappeared must  therefore be divided
between the two applications; that there is no reason
to believe, that any  other article of  a,poisonous
nature was employed; that there can be no reason-
able doubt of the patient's having died the evening
before, and died instantaneously;  that she did not
die from suffocation, but of the effects of chloroform.
She must have died instantaneously ; because, if the
dying  state had been prolonged, the  hands  would
have been removed from the mouth in all probability
by spasmodic movements of the muscles;  and she
probably did not die of asphyxia, as  the lungs were
not so much congested as they generally are in cases
of suffocation.   And, on the whole, the phenomena
in this case agree with those presented in the other
fatal cases  of chloroform.
  In considering what organ might be principally
affected by the deleterious agent in producing the
fatal symptoms, my first impression was, that the
lungs were primarily  disordered, and  that death
arose  from  non-oxygenation of  the blood.   The
suspended or struggling respiration, purple color  of
the skin, irregularity of the pulse, muscular spasms,
&c. led  to  this opinion.   If it  were the fact, we 
34
should find a great engorgement of the lungs, of
the right side of the heart, and probably also of the
brain.   Now as to the lungs, we find them engorged
more or less in every case, but excessively engorged
in four.  And, on the  whole, they  do not present
the degree of engorgement which  accompanies as-
phyxia.  The same may be said of  the  heart.  As
to the brain, the  accumulation in its  vascular sys-
tem has  been found to be for  the  most part very
slight.  The blood, in every case where it  is men-
tioned at all, was found  in  a  fluid state.  There
does not,  then,  appear to be any  morbid change
uniformly exhibited in either of these organs, which
authorizes  us to consider the disturbance  of  such
organ to be the immediate cause of death.
   The facts which we have collected and compared,
while they do not  support the  doctrine that  death
occurs from a visible alteration in any of these great
organs, seem to  leave  us only the  nervous system,
independent of vascular action or congestion, as the
seat of the sudden change produced  by the  rapid
passage of the narcotic principle to the great ner-
vous centres. This is, indeed, to be considered a
mere hypothesis  at present;  but, as the object of
these remarks is altogether of a practical nature, I
shall not undertake to  examine the subject physio-
logically, in order to prove the truth of this hypothe-
sis.  The fluidity of the blood,  in every case where
the blood is mentioned at all, goes to show, that its
vitality had been suddenly destroyed by the action
of a deleterious principle.   The flaccid state of the 
35
heart, which appears in every case examined, affords
another fact in favor of the same opinion.
  In a large part of the fatal cases, one fact at least
is conspicuous;  and that is the suddenness with
which the fatal phenomena occurred.  In four cases
death took place within a minute;  in two, in two
minutes ;  and in my patient, Mrs. H. five inspira-
tions, requiring a few seconds only, produced symp-
toms which lasted a long time.   When we compare
these sudden effects of chloroform with those from
its continued use in many cases of prolonged opera-
tions, it seems quite clear, that the fatal issue is not
a consequence of  the quantity inhaled, nor  yet  of
the time, but rather of the instantaneous violence
of the  impression.
   An important  objection  to  chloroform  is the
facility with which it may be abused.  The  highly
concentrated state of the toxic principle, the con-
venience with which the substance  may be  trans-
ported, the absence of the penetrating and diffusible
property of ether, favor its use in an undiscoverable
manner.  Hence  it has happened, that many per-
sons of both sexes, and of all ages, have resorted to
it for  the purpose of obtaining the pleasure of a
temporary delirium.   The number  of individuals
whom I have  known to use it in  this way is  so
considerable as to lead me to  believe,  that those
who employ it in  secrecy must be very great.  Per-
sons, therefore,  who recommend chloroform, for the
purpose of preventing pain or procuring a transient
pleasure, must  take into view the probability that 
36
the patient will resort to it afterwards without medi-
cal advice;  that the habit of taking it may be thus
formed,  and origin given to the  most pernicious
consequences.*
   An  English gentleman, Mr.  Carruthers, was in
the habit of using chloroform  for  relief  from the
asthma.   He was an expert angler, and sometimes
sat till a late hour arranging his hooks, and making
artificial flies.  In this  position, he was found one
morning by his  servant,  apparently pursuing the
occupation  of the evening  previous ;  but he  was
soon ascertained to be dead, while upon the table
lay the handkerchief and chloroform.  We have not
heard  of a post-mortem  examination in this case.
   A physician in New York, who had attained some
distinction, and who suffered from mental trouble,
resorted to  the use of chloroform so frequently as
ultimately to  produce a delirium; during which he
committed some  extraordinary acts, and finally de-
stroyed himself.
   It is true, that an objection may be raised against
ether on the same grounds.   This has been replied
to in the " Remarks on Etherization " by the fact,
that the volatility of  ether is so great as  to reveal
its use.  The  quantity required is also  such as to
make it  much  more difficult to conceal the employ-
ment.

   * This remark has been verified, at the  moment these sheets were
correcting, by the case of a young woman in this city, who took chloro-
form for the relief of toothache, and fell a victim to its effects. — Vide
Case X. 
37
   A practical conclusion, then, from these  cases,
 which seems to me  unquestionable, is, that chloro-
 form, containing the narcotic principle in a highly
 concentrated state, like many other powerful agents
 in Materia Medica, although it may be employed in
 this state in some instances, yet in common practice
 should be used, if at all, in a diluted form.  If this
 fact is admitted, we are naturally led to ask whether
 we shall use it thus diluted, return to sulphuric ether,
 or whether  there are any other narcotic, or, as they
 have been called, anaesthetic  agents, which may ad-
 vantageously  be substituted.
   Various  such substitutes  have  been  proposed;
 among them are the nitrous oxide gas, as  employed
 by Dr. Wells,  and different  articles  experimented
 on by a number of physiologists.   None of these
 seem well calculated to be substitutes for chloroform
 and sulphuric ether.
   On hearing of the first fatal cases of chloroform,
 the thought occurred to me of giving  a more thor-
 ough trial to the chloric ether of commerce. This, as
 is well known, is the product of the distillation of
 alcohol and  chloride of lime.  I had tried it formerly,
 as stated in my first publication,  and now tried it a
 second time with  great care, but without any nar-
 cotic effects.
  After the preceding experiment, I tried the first
portion  of the  product of the distillation without
purification, and without mixture with the residuum,
or any additional preparation.  The first person to
whom this was  administered was a patient of Dr.
            4 
38
J.  Mason Warren, suspected to have a stone in  the
bladder, who had been so very irritable, that it was
impossible to sound him satisfactorily.  He inhaled
freely from a sponge ;  in about four minutes, went to
sleep; the  sound was  at  once  introduced without
any  trouble, and a  stone detected.   Under  the
influence  of the same  preparation,  the  lithotritic
operation was performed;  and, after two or three
applications, the stone was removed.  In four  or
five other cases of stone, — one of them an oxalate
of lime case, in which the calculus was very refrac-
tory, — the patients were conducted safely and
successfully through the lithotritic treatment, under
the influence of chloric ether, by the same opera-
tor.
   Among the subsequent cases in which  this ether
has  been employed,  I  will mention only a single
class, with a couple of interesting illustrations.  The
admirable effect of sulphuric ether, in  enabling  us
to break down  the adhesions in joints  stiffened  by
inflammation from fractures and other causes,  has
been stated in the   " Remarks  on  Etherization."
Chloric ether has been used a great number of times
for the  same  purpose, and  with results equally
favorable: —
   About the beginning of February, 1849, a young
lady, who had fallen  on the ice three weeks before,
and  broken the  olecranon process of the  ulna, was
brought to  me, with  a  stiff elbow, by her  parents.
Various efforts were made to move the  fore on  the
upper arm ;  but the patient expressed so much pain, 
39
it seemed necessary to desist.  As she had not been
allowed to move the arm at all, I recommended to
her to go home and bend the arm, or have  it bent,
every day, and thus to increase the motion as much
as possible;  and, if she  found  that nothing  was
gained, to come to me again in five days.  At the
end  of the time indicated, she was brought,  and I
found that nothing had been accomplished in moving
the joint.  She  was then etherized  by Dr. Mason
Warren to  the  point of physical  insensibility, and
I attempted to  restore  the natural  motions of the
arm  by force.   It  was, however, impossible for me
to accomplish it in  this case.  She was  therefore
etherized with the chloric ether two minutes longer,
fell asleep; and then, renewing my efforts, the ad-
hesions  and muscular contractions  gave way with
an audible crack.   Two other etherizations  were
required to effect  the  restoration  of  the  perfect
movements of the limb.
  A patient of mine, who had apparently undergone
inflammation of the spinal marrow, with phenomena
very curious, but  which cannot  properly be  men-
tioned here, on recovering was found to have a false
anchylosis in the right hip, a true anchylosis with
dislocation in the left.   Under the  use of chloric
ether, the anchylosis in the  right hip was broken
with a very loud crack.   The  left could not be at
all moved.  It was  therefore  resolved, in order to
give him a fair chance, to employ pulleys for breaking
down the anchylosis, and reducing  the dislocation.
He was bled nearly a pint; then, having used chloric 
40
ether many times before with excellent effect, it was
employed; but the state  of susceptibility was  so
altered, that  both this, sulphuric ether and  chlo-
roform were  tried  ;  the  administration  requiring
nearly three quarters of an hour before he was nar-
cotized.  The pulleys were applied for fifteen min-
utes ; during which one of the cords was snapped,
and replaced.   Efforts to move the limb were then
made,  but without accomplishing any motion of the
os  femoris on the os innominatum.  The patient
was then roused  from his state of etherization, and
recovered almost immediately.   On the day follow-
ing, he experienced some pain  in  the right  hip,
which I had  moved during etherization; but the
force applied to the left had not produced any pain
or soreness.   This happy immunity is to be attribu-
ted, I think,  to the precursory bleeding.
   As the dislocated left limb was inverted to such
a  degree, that  the  left  knee constantly impinged
upon the back and inner part of the right, thus
interfering in an embarrassing and painful way with
its motions,  and in  fact  disqualifying  the patient
from any active occupation, it was determined to saw
through  the upper part of  the thigh-bone, in order
to admit of rotation of the  limb outwards.  This
was happily  accomplished on March 17.   Chloric
ether, used at this time, narcotized the patient in five
minutes; and he continued, with occasional appli-
cations of the sponge, in a state of total insensibility
for ten minutes longer, during which time the opera-
tion lasted. 
41
   The first  of  these trials of chloric ether was  in
 March, 1848 ;  between that time and the month  of
 May (when I mentioned the subject to the American
 Medical Association), the strong chloric  ether was
 used in fifty cases with  perfect success,  so  far  as
 regards the narcotic influence, and without any un-
 pleasant occurrence at the time or afterwards.   The
 experience of that term has been confirmed by the
 observations of ten additional months, so that I now
 employ it almost exclusively.
   It may be objected to  the strong chloric  ether,
first, that it irritates the skin, as chloroform does ; —
 second, that  it causes nausea; — third, that it is, in
 fact, chloroform diluted with alcohol;—fourth, that,
 when chloric ether is administered by a wet sponge,
 the  alcohol combines with the water in the sponge,
 and leaves chloroform to be inhaled.
   In answer to the first objection, we  should say
 that it is not necessary to use this ether in such way
 as to irritate the skin ;  also, that the skin is  easily
 protected by a  cloth, and by various contrivances,
 particularly by rubbing the  face with an  unctuous
 substance previously.  Second, That the subsequent
 sickness, so far from being an objection, is an ad-
 vantage ;  for, in patients who  have experienced it,
 the lungs are relieved from congestion, and therefore
 recover from narcotism more rapidly.  Third,  The
 fact  that it is chloroform diluted with alcohol does
 not form any objection to its use, since the chloro-
form is sufficiently diluted  to render its  inhalation
safe.  . Fourth, The supposed decomposition of the
         4* 
42
strong chloric ether, in consequence of the combina-
tion of its  alcohol with the water  in  the  moist
sponge, may be obviated,  by those who  believe in
such  a  combination,  by administering  the  chloric
ether on a  handkerchief, towel, or other cloth not
moistened.   It is, however, probable that any por-
tion of  alcohol, which combines with the water of
the  moist  sponge, being  reduced to the state of
rum, the exhalations would enter the  lungs with
the  chloroform, and  help to  dilute  its  narcotic
property.
   It may be asked, whether chloric  ether has  any
advantage over sulphuric.  In my opinion,  it has.
It irritates  the  lungs less;  its inhalation is more
agreeable;  and it never  has  produced  headache
in the operator and  by-standers,  as  is the case in
regard  to many individuals  from sulphuric ether.
As to the narcotic  power of the two  articles, there
seems to be but little difference.

   The distinguished Mr. Lawrence is said to have
used chloric ether in  the summer  of  1847,  but
whether that of commerce or  the concentrated I am
ignorant.   The idea  of using this agent Avas sug-
gested to me by seeing the process of preparing the
chloric  ether of commerce and the  chloroform  by
Mr. W. B.  Little.   Alcohol  and chloride of lime
being distilled together, the product of the distilla-
tion is the chloric ether of commerce; but a small
quantity of the first product of distillation is much
stronger than the aggregate.  Taking therefore this 
43
first product, I made trial of it, as before mentioned,
and found it produced a satisfactory narcotic  effect.
Mr. Little has since improved  the process, and pre-
pares his chloric ether in the  following  manner, as
he has kindly informed me by  letter: —
  " Take the first run (that is, what passes first in
distillation) when distilling chloroform, and re-distil
from water containing an excess of lime, which gives
a perfectly pure ' chloric ether,'  free from chlorine
or any other  impurity.   We furnished Dr. Warren
with different samples, until he was satisfied with
the strength, and since then have uniformly made it
of  the  same quality.   Our  ' concentrated  chloric
ether' contains 33£ per cent  pure chloroform, the
remainder being nearly absolute alcohol (containing
but about 4 or 5 per cent of water)."*
  After this  article had been employed in  a con-
siderable number of cases,  the subject was brought
forward (not by me), as already stated, at the meet-
ing of the American  Medical  Association, at Balti-
more, in 1848.  Having used  it myself, I felt bound
to give to the Association some account of its intro-
duction, and of my reasons for using it.   The Presi-
dent of the Association, Dr.  A. H. Stevens, called
on me to furnish a copy of the remarks  I made, for
   * I have been informed, that a chloric ether made in Philadelphia
does not, when water is added, undergo the separation of chloroform,
while that made here does.  I have tried the experiment myself, and it
has been tried by two of my friends,  one a  physician, the other a
chemist; and we have all found that chloroform does separate in both,
on the admixture of water.  The  fact is, however, of no practical
importance, since the chloric ether prepared  as above answers  the
purpose. 
44
publication  in  their proceedings.   This I did not
wish to do at that time, because a longer experience
seemed necessary ;  and because the dangers of chlo-
roform were not so fully established as to exclude
the suspicion, that they might have arisen from a
careless use of the article.
  Since that time, May, 1848, the fatal cases  have
more than doubled.  The  apprehensions, grounded
on these occurrences, have led me to use, in prefer-
ence to chloroform, the ethers, — either  sulphuric
or chloric, — and five times out of  six the chloric,
employing the former only for the purpose of com-
parison with the latter.  I have never seen or heard
of any accident from the use of chloric ether, which
gave me reason for discontinuing it; and I think I
can confidently recommend it to the profession, as
more safe than chloroform, and more agreeable than
sulphuric ether.  Should any one, preferring chloro-
form  to the ethers, feel  disposed  to  employ  this
article in a diluted state, he  might very  properly
add a certain portion of alcohol.  I  have used  two
parts of the purest alcohol with one part of chloro-
form ;   but  have not sufficient experience  of its
effects to  enable me to say, that these  are  the  best
proportions.
   There are cases in which chloroform will have an
advantage.   We occasionally  find instances of a
want  of susceptibility to  the narcotic  action.   In
such, after trying in vain the use of ether, the more
powerful  impressions of chloroform have been re-
sorted  to with good effect.   I cannot say, however, 
4-j
that this has occurred in my practice more than two
or three times out of a great number of cases.
   Chloroform,  used externally, does  not  produce
an anodyne  effect, when employed  on a surface of
moderate extent, as for example a leg.  It causes a
slight cutaneous irritation, which sometimes relieves
pain, and sometimes  aggravates it.  Taken inter-
nally, a fluid drachm of chloroform, diluted  in two
ounces of water,  seems to  have an anodyne influ-
ence.  This dose may be repeated at intervals of
an hour or less, two or three times.
   Strong  chloric  ether, employed  in very small
doses, has much the same effect as spirits of nitrous
and  sulphuric ether.  So far as regards its anodyne
property,  it  does  not  answer for  internal  use,
through  the medium  of the  stomach, as well as
chloroform.

   To the questions  contained in the letter at the be-
ginning of this article, and to those  which have been
addressed to  me  from  other quarters, I now reply
in a few  words by stating: — 1st, That my confi-
dence in the beneficial effects  of ether, in surgical
operations, is undiminished ; but if I were compelled
to substitute chloroform, I should do so with  much
anxiety.   2d, Etherization is not, I  think, employed
so extensively as  it was during the period of enthu-
siasm following the first inhalations of ether.   The
occurrence of fatal cases of  chloroform has done
much to cause a diminution of the use of ether, and
the latter article has not been free from the charge 
46
of pernicious consequences.   No fatal case from  its
use has transpired, however, in this country, nor in
Great Britain, so far as we know.  One well-authen-
ticated instance only has occurred in France.*  The
details of this case  I  am  not able  to give, further
than to say, that the patient was a male, resident in
Auxerre, about  forty  years of age, who  underwent
an operation for  cancer of the breast, and  died  in
ten minutes.   3d,  Chloroform or ether  is used  in
this  part  of the  country  in  all  capital  operations,
and I believe pretty generally in such operations  in
other parts.  In  parturition,  also, the former is ex-
tensively employed here ;  but a considerable number
of practitioners  use it rarely, and only in cases  of
extreme suffering.  The relief from pain is uniformly
said to be great;  but whether the patient  does as well
on the whole after this narcotism is a doubtful point
with me, confiding as I do in  the power of nature
to render this process generally perfect without the
aid  of art.   In  surgical  operations, there  is  every
   * Dr. Snow, of London, one of the best writers on ether and chloro-
form, and a strong advocate fof the latter, gives the following  opinion
on the supposed bad cases of ether in the " London Medical Gazette "
for November, 1848, p. 841, note : — "lam aware that ether was thought
by some to have caused death in two or  three instances, in which  the
patient did not recover from the operation, but died two or three days
afterwards; and, in one of these instances, a coroner's  jury returned a
verdict to that effect.   But I believe the only instance on record in
which the inhalation of ether was fatal was one that occurred in France
(see " Gazette  Medicale, 4 Mars," and " Med. Oaz." p. 432, last vol.) j
and, in that case, the  inhalation was continued without intermission
for ten minutes, although alarming symptoms were present nearly all
the time; and it is probable that the result was owing as much  to some
defect in the inhaler, which limited the supply of air, as to the effect of
ether." 
47
possible evidence, that the chance of success  is not
diminished by etherization.
  An attempt has been made to parallelize the un-
favorable  cases of ether with those of chloroform,
with a view to determine the proper application  of
each of these to different cases.  No such parallelism
can be legitimately established.  The fatal instances
of chloroform, to whatever  cause  they may be im-
puted, are sudden, and are  unequivocal sequels  of
chloroformization.  Those of ether, on the contrary,
are, with  a single exception, lingering cases,  sub-
sequent indeed to the application  of ether, but not
immediately connected with it in time.  The former
mostly occurred  within a few  minutes of  the  ad-
ministration, and none are considered as unquestion-
able  poisonings  by  chloroform which  have been
prolonged an hour or more ; while those alleged to
be from ether, — varying in number from five to ten,
according to the varying judgment of different per-
sons, — have been prolonged to a number of days,
during which, time  enough elapsed  to admit the
intervention of various causes.  There is therefore
no  good  ground for the effort to  specialize cases
to which  the application of  chloroform and  ether  is
relatively proper ; ether  is  generally  safe;  chloro-
form cannot be said to be safe in any  case.   It has
destroyed the feeble and the strong, the sick and the
well, the  young and the middle-aged;  and no prac-
titioner can be reasonably assured in his own mind,
that  it will  not  prove fatal the next time  he  em-
ploys it. 
48
 Means of preventing and remedying the  bad Effects
         incident to the  Chloroform Practice.
    First, To use chloric or sulphuric ether, for the
 purpose of  producing narcotism in  surgical opera-
 tions,  in  preference  to any other  agent.   Second,
 Not to use narcotism for trifling operations.   Third,
 Where the operation  is not very  severe and pro-
 longed, to  produce  only that  degree of  narcotic
 influence,  which  destroys  the  susceptibility  to
 pain, without abolishing the intellectual  functions.
 Fourth, To be careful that the patient does not get
 an  exclusive  inhalation of the narcotic  vapor, but
 obtains with it a sufficient  quantity of atmospheric
 air to carry on the oxygenation of the blood;  and,
 when he is unpleasantly affected by the first  impulse
 of this vapor,  not to press it too harshly upon  him.
 Fifth, When a powerful application  is required, as
 in cases of the  reduction  of  hip-dislocation, the
 patient  should always  be bled before etherization.
 It is very  desirable,  that  a  powerful  narcotism
 should never be produced, without previous abstrac-
 tion  of  blood, except  in cases  of great debility.
 Sixth, The respiration and pulse should be carefully
 watched, during  the whole  operation, by  one in
 whom the operator can confide.  Seventh, When the
 pulse intermits, and  respiration is  suspended, in-
 halation should not be continued.    Eighth, The
position of the  body does not appear to exert a par-
ticularly unfavorable influence;  of the fatal cases, 
49
five  occurred  in the sitting posture, four in  the
horizontal, and  one  in  a state of flexion  forwards
on a table.  Ninth, Whenever etherization is to be
accomplished,  there should be a  sufficient number
of assistants present, to guard  the  patient  if he
should become violent.   Tenth, To protect the face,
a small towel  is folded in a funnel-like shape, in the
apex of which is placed a sponge, double the size of
an  egg, charged with  an ounce of  chloric  ether;
or the liquid may be poured directly on the interior
of the cloth.   Eleventh, Chloroform or ether should
not  be administered upon a full stomach, nor in
cases of epilepsy, of active organic  disease of the
heart,  of acute  affection  of the lungs, or in a hem-
orrhagic tendency of these organs.  Twelfth, The
fatal effects of chloroform, in almost every instance,
have been produced by  small quantities.
   Some very judicious  physicians and surgeons are
of opinion, that the dose of chloroform should be
exactly measured ; and that, if this were rigidly and
uniformly  attended to,  any calamitous  consequence
would be  avoided.  Should the use of chloroform
be continued, this might be desirable ; and the most
exact apparatus for  accomplishing this object is  a
small box, intended  to  receive the chloroform  and
the sponge or cloth containing it.  To this box are
appended two tubes, five or six inches in length,
and  fitted  to  the nostrils, through which alone in-
halation should  take place.  In this way, the utmost
precision may be attained.
  The ethers, however, have the  great advantage of
         5 
50
not requiring this extreme exactness  of administra-
tion.   A large  sponge,  imbued  ad  libitum  with
ether, we have seen employed in a great number
of instances, and know that it has been employed
by  distinguished surgeons  in  whose judgment we
have very great confidence.   This profuse admini-
stration is not what we have recommended.  A more
sparing and precise exhibition seems better adapted
to the power of the substance and the importance of
the object, for the attainment of which it is given.


On the means of restoring the vital actions, when sus-
         pended by  Chloroform or Ether.

   First, When  the  pulse  and respiration  are  sus-
pended, the face  should be dashed with cold water
from a sponge.   Second, A free passage of air to be
directed to the patient's nostrils and mouth.  Third,
Inflation through one of the nostrils by an inflating
tube, or, if this is  not at  hand,  by the  bellows;
the opposite nostril and  the mouth being closed,
and the larynx pressed backwards  to prevent the air
from going into the stomach.  Fourth, Forced move-
ments  of the  chest, in  imitation  of  respiration.
Fifth,  Friction  of the chest, abdomen, and  extremi-
ties. Sixth, Heat applied to the same parts.  Seventh,
The nostrils to  be stimulated with  the vapor of aqua
ammoniae.    Eighth, The fauces  irritated with a
brush  or quill-feather dipped in  aqua  ammoniae.
Ninth, The introduction of  stimulating  liquids into 
51
the stomach by a gum-elastic tube.   Tenth, The use
of galvanism, if an apparatus can be immediately
obtained.   Eleventh, Inflation with oxygen  gas of
the nostrils and lungs.   Twelfth,  Inflation  of the
lungs through an aperture between the thyroid  and
cricoid cartilages.   Thirteenth, A  limited applica-
tion of caustic ammonia to the region  of the heart.
Fourteenth, Convulsions to be  treated by bleeding,
vapor of ammonia, cold to the head : for the sudden
production of the latter, evaporation  of sulphuric
ether  answers well.
              CONCLUSION.

  I  hope it will  not be thought presumptuous in
me to propose the substitution of the  ethers for an
article which, although so deleterious to some indi-
viduals, has been and is still  extensively used with
safety  on others.   My apology  must be found in
the reflection, that, for  more than a year before  the
introduction  of chloroform, the  ether-practice  was
carried  on without  any fatal  result; that several
fatal cases from  chloroform  occurred in a  much
shorter space  of time  than that above mentioned;
and that a number of practitioners will feel absolu-
tely  compelled to abandon the employment of these
anaesthetic agents, if chloroform be looked to as the
principal.  Moreover,  the suggestion of a judicious
friend will have its weight in forming this apology. 
r>2
" Nor  would  it," he writes, " alter my  opinion  of
the wisdom of strongly urging the objections at this
time, should longer experience show, that the dis-
asters in the use of chloroform, during the year past,
arose from peculiar coincidences;  and  that  it is,  in
reality, as safe as the sulphuric ether.  In so grave
a matter, we should be willing  to be proved over-
cautious, rather than the contrary." 
53
POSTSCRIPT.
   While  the  preceding pages were in process of
printing,  new  instances of the fatal  consequences
of the inhalation of chloroform presented themselves.
Some of these cases are detailed with a minuteness
which leaves us little to desire; others, on the con-
trary, are reported in so meagre a style as to  allow
us  to remain  in  great obscurity.   On the  whole,
however,  though  three  of them are scarcely more
than mentioned, yet, as we really believe  that they
are of the same character, and have equal import-
ance with the  others,  we cannot pass over them in
silence.
   We shall present here five additional  instances.
The first,  which we quote from the  " Gaz. Med. de
Paris" of January, 1849, is  that  of a patient who
underwent the extraction of a tumor, not remarkable
for its size,  or  for the  danger  of its  situation.  The
patient never seemed to recover perfectly from the
effects of the chloroform.
  The second  case occurred in the  Hotel Dieu of
Lyons, a medical establishment highly distinguished
for its scientific character, and for  the reputation of
         5* 
54
 the  illustrious  savans who actually discharge its
 duties.  The details of  this case are wanting; but
 they are spoken of by the editor of the " Gaz. Med.
 de Paris " as having been already published, and as
 of unquestionable authenticity.
   The third  case  is  said to have  occurred at the
 Bicetre, in September,  1848;  but  the  details are
 not at hand.
   The fourth case  we take from the  " London Lan-
 cet."   The  description was  no  doubt  published
 before the details could  be obtained :  these we shall
 probably see hereafter.
   The fifth case occurred  at  the  Hotel Dieu, at
 Lyons, and is described with much care and minute-
 ness.


 I. — Case  of Death  attributed to  Chloroform, by
                    M.  Vanini.
 Copied into "Paris Med. Gazette," Feb. 17,1849, from the "Gazzttta
                  Medica Lombarda."
   On Jan. 25, 1848, at  the Hospital at Como, was
 made  the first trial  of  chloroform.   Petronille F.
 a peasant woman of Alzate, aged thirty-six, having
 the aspect of  fine health and flourishing nutrition,
 was put under the influence of chloroform, in order
 to undergo the removal of a sarcomatous  tumor.
 The  operation, very trifling in itself, was  promptly
performed,  unattended with accident; nor  was it
indeed capable, under the circumstances, of compro-
mising the  life of a  woman so  healthy.  She was 
55
put to sleep by pouring about a drachm of chloro-
form on a sponge, which was  applied to the nostrils.
The effect, although tardy, was complete;  but the
consecutive phenomena were  such as led the author
to think that chloroform developed an action much
more powerful, if not more  rapid, than ether.  In
effect, the pain in  the head, the dulness and stu-
pidity of the mind, somnolency, giddiness, slowness
and embarrassment of her pronunciation;  in fine,
all the symptoms which announce the state of cere-
bral congestion were  prolonged for more than eight
hours after the operation.  Nor can we reasonably
affirm, that, at  the end of this time,  all the phe-
nomena were  entirely dissipated ;  for the next day
the pains in  the  head continued, with a feeling of
fulness and of dulness, accompanied with a burning
fever.
   The  thorax and abdomen, being slowly and at-
tentively  examined,  manifested no symptoms  of
pain,  or signs  of  lesion,  with the  exception of a
 slight cough,  which the patient said  she had already
 had  habitually.   The wound resulting from  the
 operation had a pale and greasy appearance.
    The chief surgeon  of the  Hospital, suspecting a
 latent inflammation of some of the viscera, prescribed
 bleeding, which diminished  the fever and the pain
 in the head.
   At the visit on the  morning of the 27th, the patient
 was tranquil.  Four hours  after mid-day, she was
 seized with irregular and prolonged chills.   At nine
 in the evening,* she died suddenly. 
56
   Autopsy. — The  membranes of the brain were
 in a  state of abnormal  turgescence.  The cerebral
 hemispheres exhibited their  ordinary consistence.
 All  the vessels of the  interior  of the  encephalon
 were gorged with blood.  The cutting of the cere-
 bral pulp exhibited numerous bloody points.  The
 marrow was softer in the lumbar region than else-
 where.   Its coverings were  slightly injected.
   The  lungs were  filled with blood, and softened.
 There was some bloody serum in the pleura.  The
 heart was normal as to size, but flaccid, and without
 blood in its cavities.
   No morbid appearance was exhibited  in  the ab-
 domen, if we except a bloody suffusion of the spleen,
 which was softened, like  a bladder full of a blackish,
 fluid pulp.
   The kidneys were softened, and natural as to form
 and size.
   Remarks. — This case, attributed to  chloroform
 by M. Vanini, does not  come in exactly the same
 class  with those we have considered as normal cases
 of poisoning by chloroform, because  the death did
 not take place under the  immediate influence of this
 agent.  That the patient did actually die from the
 effects  of chloroform, there seems  little reason to
 doubt,  since she never revived  fully from its first
 effect, and did not experience any other symptom
 sufficient to explain the cause of death.  The morbid
 appearances correspond nearly with those of other
 chloroform cases: — the  same  dark color  of the
blood, congestion of the lungs, flaccidity of the heart, 
57
but  a  greater  degree  of congestion of the brain.
The last-named circumstance is attributable to the
comparative slowness  of  death in this case.   The
lungs, so far as we can judge from  the  statement,
were more congested than usual;  and the gradual
accumulation of blood, constituting this congestion,
would also be a natural consequence  of the slowness
of the  morbid changes.

   II.  —  At  the  Hotel  Dieu of Lyons, Charles
Desnoyers, aged twenty-two; of  scrofulous  habit,
affected with white swelling of the left wrist.  Chlo-
roformization with an apparatus during five minutes.
Transcurrent cauterization of the joint.   Death at
the commencement of the operation.

  III. — An  instance reported  by J.  Guerin as
having taken  place at the Bicetre,  in Sept. 1848.
A man suffering from a lesion of the thigh. Chloro-
formization; coxo-femoral disarticulation.   Death
before the end of the operation.

  IV.  — A death from  chloroform  is reported in
the "London Lancet," Jan. 6, 1849,  page 25, as
follows: —
  " The ' Glasgow Herald'  states, that  recently a
young gentleman  returned from Australia, to visit
his relatives in the neighborhood of Govan (a town
about  four miles from Glasgow).    Before leaving
the colony, he met  with a slight accident in the
foot, which, being perhaps neglected during the pas- 
                       5$

sage home, caused the  great  toe-nail to grow into
the flesh.   To remove the pain and  inconvenience,
the gentleman resolved to submit  to  an operation,
which a respectable surgeon in Govan was employed
to perform on Tuesday last.   Preparatory to doing
so, the surgeon resolved to make use of chloroform ;
but  the patient,  after inhaling the gas, almost in-
stantly expired."


V. — Case of Death from Chloroform at the Hotel
                  Dieu of Lyons.
Reported by M. le Doct. Barrier.  " Paris Gaz. Med." No.7, Feb. 17,1849,
                      page 115.
         To the Editor of the " Union Medicate."
   Mr. Editor, — Whilst  the  discussion  of chloro-
form is  still  pending at the  National Academy of
Medicine, I believe it my duty to  publish, without
delay, a case of  chloroform-inhalation followed by
death, which I have just had the pain of witnessing
at the Hotel Dieu of  Lyons.   Hitherto an avowed
partisan of chloroform,  I do not now know whether
I shall decide to continue or abandon the use of it.

   J. Verrier, aged seventeen, of lymphatic tempera-
ment and good constitution, entered the Hotel Dieu
of Lyons, Jan. 24, 1849.  He bears  on his limbs
the scars of scrofulous ulcers,  which he attributes to
the labors of his trade,  that of a miner.   He  comes
to the Hospital for a disease  of the middle finger of
the  right  hand,  consisting of a complete  necrosis 
59
of the first  phalanx, with suppuration, fistulae, and
fungosities of the two  joints,  of which this bone
makes a part.  The affection not being curable with-
out an operation,  the 31st of January is appointed
for it.   The intention is  to amputate the  finger,
and to cut out as much  as is necessary of the meta-
carpal bone.
   The day having arrived,  after being assured  that
the patient  otherwise enjoys good health, and has
taken no aliment, he is placed upon a bed,  and put
under  the influence of chloroform, which he  had
desired, and which inspired him with no apprehen-
sions.  The phial  containing the anaesthetic agent is
the same that has been used, but a moment previous,
to put a  young girl to sleep, in whose case all had
passed off regularly.   As usual,  a compress of very
thin texture is drawn  over the  face, leaving free
passage for the air; and chloroform is dropped,  with
many  intervals, on  the part corresponding  to the
nasal aperture.  Two  assistants,  very familiar  with
the administration of chloroform,  are entrusted with
this, and, at the same time, with  the exploration of
the pulse at the  wrist.  The  operator overlooked
and directed the labor of his assistants.   After four
or five minutes, the patient still  feels and speaks.
Hardly another minute has elapsed when the pa-
tient  pronounces some  words,  and manifests slight
agitation.   In all, about six or  eight grammes (from
one to two  drachms) of chloroform are absorbed;
or, rather, this is the quantity  dropped on  the  com-
press,  and evaporation has necessarily exhausted the 
60
greater part of it.  The pulse continues with perfect
regularity, as it regards the rhythm and force  of its
motions.   All at once, the patient hastily raises his
body, and moves his limbs, which escape from the
assistants ; but they promptly seize them again, and
replace the sick man in his position.   This move-
ment has lasted certainly not  more than  a  quarter
of a minute, yet one of the assistants immediately
announces that the pulse at the wrist has  ceased to
beat.  The handkerchief is taken  away.  The face
has  surprisingly altered.   The action of  the  heart
has altogether ceased.   There is no longer any pulse
or any sound in the region of the heart.  Respiration
still continues; but  it becomes  irregular, feeble,
slow, and at last stops entirely in the space of about
half a minute.
  At the first signal given, energetic measures are
directed against the accidents, the gravity of which
is immediately perceived.  A little ammonia  upon
a cloth is immediately applied to the nasal aperture.
A large quantity is poured  upon the thorax and
abdomen,  which  are  forcibly rubbed.   The  same
substance is  employed to irritate, if possible, the
most sensitive parts of the integuments, as the lips
and  the genital mucous membrane.    Mustard is
applied.   His head is  inclined over the edge of the
bed.   Finally, an  attempt  was  made to  restore
respiration by pressing alternately upon the abdomen
and the chest.   After two or three minutes, respira-
tion  returns, and  even has a  certain  fulness; but
the pulse is not again  aroused.   The  frictions are 
61
persisted in.   Respiration is again  slackened, and
ceases  a second time.   The hopes  that  had been
raised vanished.  Air is blown into the mouth, and
even into  the  larynx,  a probe  being introduced
through the aperture of the glottis ;  because, while
blowing  into the mouth, it was perceived that  the
air passed into the stomach.   The cauterizing irons
having been put into the fire at the  commencement
of the  accidents, the surgeon cauterized powerfully
the precordial,  epigastric, and prelaryngeal regions.
The pulse does not revive.  Still every conceivable
effort to restore the patient to life is continued for
over half an hour.  These efforts are useless.
  The Autopsy could not be made  till seventy-two
hours after death.   The weather  being sufficiently
cold, the body does not exhibit any marks of decom-
position.   There is  still  a  decided  rigidity of the
limbs.   The features show no particular alteration.
A careful examination is made of all the organs.
  The stomach contains about forty-five  grammes
of a thick fluid; the  color of lees of wine, but not
at all resembling any alimentary liquid.  It is  dis-
tended with gasses, and also the rest of the digestive
canal.   With  this exception,  it is  healthy.  The
liver and spleen are a little congested.
  The heart. — Size normal, flaccid, empty of air
and blood.  The walls of the ventricles are moistened
by a thin froth, very red, giving one the  idea of a
little blood that has been beaten by the fleshy pillars
of the  heart.   The venae cavae and  vena  porta are
distended with black fluid blood,  very copious.
            6 
62
Over the Eustachian valve is found a fibrinous clot
of blood, of little consistency, weighing four or five
grammes, being all that is met with in the cavities
of the heart and  great  vessels.   Moreover, these
cavities are opened with sufficient attention to render
it certain that there was no accumulation,  in any
observable quantity, of any aeriform fluid.
  The lungs are very much contracted on the open-
ing of the thorax.  They exhibit a very decided dark
slate-colored appearance.  A section of the lungs
exhibits the  same tint.   With  this  exception, the
tissue is healthy.  The larynx and trachea show no
lesion.  The brain is unaltered.   The sinuses and
the dura mater  contain a considerable quantity of
black uncoagulated blood.

  Remarks. — The phenomena in this case accord
with those of the other fatal cases.   The lungs were
dark-colored, and their contraction showed that there
was no great accumulation of blood, as there is in most
cases of asphyxia.  The  heart was, as in every case
we  have noted, empty and very flaccid, as  if it had
been suddenly deprived of its vis insita,  or organic
power, by a deleterious agent.  No air was detected
in its cavities or in the  blood-vessels.  The brain
was unchanged, exhibiting of course nothing which
would lead us to believe, that death had been pro-
duced by an organic lesion of this viscus.  The blood,
so far as it is mentioned, — and this  has  only been
done incidentally, — was found in a fluid and dark-
colored state, such as would result  from the action 
63
of a poison.   The morbid  appearances in  other
organs are not of a character to lead us  to  believe,
that they had  any material influence in  causing
death.
  We are therefore led to the conclusion, that the
fatal result  is  not to be attributed  to  simple as-
phyxia, to accumulation in the heart or in the brain;
but that  it  may  be ascribed to  an undiscoverable
toxic action  received by the lungs, and thence con-
veyed to the nervous centres.
  The administration of chloroform seems  to  have
been judiciously  conducted,  admitting,  in its full
extent, the fact that the cloth or compress, by which
the chloroform  was applied, was, as stated, of a thin
and open texture.  No case  can  more clearly show
the dangers  of chloroform. 
64
           Summary of Case I., p. 54.

Name. — Petronille F. aged thirty-six years.
Date.— Jan. 25, 1848.
Disease. — Sarcomatous tumor.
Previous Use. — None.
Time of Inhalation. — Between five and six
  minutes.
Mode. — From a sponge.
Quantity Consumed. — About a drachm.
Posture. — Recumbent.
Lapse of Time till Death. — About fifty hours.
Symptoms. — Pain in head; dulness and stupidity
  of mind ; somnolency ;  giddiness ; slowness and
  embarrassment  of pronunciation;  all  symptoms
  of cerebral congestion,  lasting more than  eight
  hours; not then entirely disappearing, but  some
  fever present; death in about fifty hours, sudden.
Morbid Appearances :
     Brain. — Membranes turgid;  cerebral hemi-
  spheres of ordinary consistence ; all internal ves-
  sels greatly gorged ;  puncta  vasculosa  many ;
  spinal marrow softer than natural in lumbar re-
  gion ;  its coverings slightly injected.
     Heart. — Normal  in size ;  flaccid ;  no blood
  in cavities.
     Lungs. — Filled  with  blood  and  softened ;
  bloody serum in pleura. 
65
  Spleen. — Softened, like  a bladder full of a
blackish fluid pulp.
  Kidneys. — Softened ;  natural in form  and
size.
           Summary of Case V., p. 58.

Name. — J. Verrier, aged seventeen years.
Date. —Jan. 31, 1849.
Disea.se. — Necrosis of first phalanx of right hand,
  with fistulae, fungosities, &c. of the two joints.
Previous  Use. — None.
Time  of Inhalation. —  Between five  and six
  minutes.
Mode. — From a  thin compress  drawn over the
  face, and chloroform dropped at nasal apertures,
  with many intervals.
Quantity  Consumed. — Between one and two
   drachms.
 Posture. — Recumbent.
 Lapse of Time till Death. — Between five and
   six minutes.
 Symptoms. — In four minutes, feels and  speaks;
   in five, slight agitation, and speaks; pulse per-
   fectly regular ; at once, he hastily raises his body,
   and moves his  limbs;  pulse  at  wrist  ceases;
   heart  ceased  its  action;  no pulse,  or sound  in
   region of heart;  respiration  irregular,  feeble,
   slow,  then stops  in about a minute. 
66
Morbid Appearances :
     Brain. — Unaltered;  sinuses and dura mater
  contain a quantity of black uncoagulated blood.
     Heart. — Size normal;  flaccid ; empty of air
  and blood ;  walls of ventricles moistened by thin
  froth, very  red;  vena cava and porta distended
  with black fluid blood, very copious ;  small fibri-
  nous  clot over  Eustachian valve ;  no  other  in
  cavities of heart or great vessels.
     Lungs. — Much contracted on opening of tho-
  rax ;  dark slate-colored appearance ; same tint on
  section; otherwise healthy.
     Stomach.  — About a couple of ounces of thick
  fluid,  like  lees  of  wine ; not like  alimentary
  liquid;  distended with  gasses, like rest of the
  canal;  otherwise healthy.
     Liver and spleen a little congested. 
 

V
n ivnoiivn  iNOiaiw jo Aavaan ivnoiivn ikdioin jo Aavaan 1



              »«»•» OF MEDICINE NATIONAL LIBRARY OF M

*y( W\  *   /ViV
>F MEDICINE  NATIONAL LIBRARY OF MEDICINE  NATIONAL LIBRARY OF M
i ivnoiivn  iNoioiw jo Aavaan ivnoiivn  inoioiw jo Aavaan iv
IV
£b, J c
* MEDICINE  NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF M]
&.
/v ^ * ^ yv
/VfVT 
aw jo Aavaan ivnoiivn   jnoiojw jo Aavaan ivnoiivn ihijioiw
NAL LIBRARY OF MEDICINE  NATIONAL LIBRARY OF MEDICINE  NATIONAL
ARY OF MEDICI
aiw jo Aavaan ivnoiivn   inoioiw jo Aavaan ivnoiivn  ikijioiw
                                         3b.  5
1   \/\ f  y^S/   1
5NAL LIBRARY OF MEDICINE  NATIONAL LIBRARY OF MEDICINE NATIONAL
ONAl LIBRARY OF MEDICINE  NATIONAL LIBRARY OF MEDICINE  NATIONAL
        s  ^y^     j    /w  g w\    a__xv 
NLM041402033