Second report of the Departmental Committee appointed to inquire into the law relating to coroners and coroners' inquests, and into the practice in coroners' courts.

  • Great Britain. Committee on Coroners.
Date:
1909
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Licence: Public Domain Mark

Credit: Second report of the Departmental Committee appointed to inquire into the law relating to coroners and coroners' inquests, and into the practice in coroners' courts. Source: Wellcome Collection.

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    1 July 1909.] [ Continued. 7452. Can it only be done in a hospital, or can it be done in field work P—Practically it can be carried out under all conditions. It can be carried out with measuring apparatus. An experienced person can carry it out, knowingly or unknowingly, by following the ordinary open method of administration. As a matter of fact, when one comes to examine the empirical recommendations made by practical anesthetists one finds it amounts to this: that the chloroform offered to respiration will be at 2 per cent. or thereabouts. I have measured the amount of chloroform vapour under these conditions and find it rarely exceeds 2 per cent. 7453. When a skilled man is giving chloroform on a small shield ?—I will take the most dangerous, a wad of lint. 7454. With a shield P—No, without a shield. That in the hands of a skilled administrator who knows what he is doing, who knows the weight of chloroform vapour, may be safe, can be safe ; whereas as ordinarily used in ordinary hands it is the most dangerous possible proceeding. Onthe other handif it is held ata distance from the face, so that the heavy chloroform vapour is ina comparatively large mass with a great dilution of air, and the heavy mixture falls past the face of the patient it is a comparatively safe method. ; 7455. The mixture falls?—Yes, and the patient breathes in an atmosphere in immediate contact with his mouth, which is approximately at the percentage I named. 7456. 2 per cent. >—Yes, or below. 7457. Would that hold good in a hot as wellas a cold climate P—Yes. 7458. Suppose the temperature is about 90 degrees ; T am thinking of an ordinary tropical climate ?—I have no experience, so that I ought not to answer. 7459, What effect has the rising of the tempera- ture >—It increases the amount of chloroform that the air is able to take up, so that theoretically the per- centage of chloroform given off from a fabric in a hot climate will be greater than in a cold climate. But you cannot make that responsible for the greater number of accidents. There is not a greater number of accidents in hot climates than in cold. And as a matter of fact you can make the percentage of chloro- form anything you wish in any climate. 7460. In certain cases you seem to be able to give chloroform with impunity ?—So it is said; there are many things said. I was in Johannesburg and they asked me whether the barometric pressure could account for the greater mortality. Iwas in Montreal and they asked me whether the low temperature of winter could account for the greater mortality; every- thing except the right cause is appealed to. 7461. You think the right cause is the question of quantity ?—Yes, and quantity always, and after quantity I will talk about details. But I will not talk about idiosyncrasy in the case of chloroform until I have some idea how much chloroform may have been absorbed any more than I should talk about idiosyncrasy in a case of intoxication until I know whether a man has drunk a glass of claret or a bottle of whisky. 7462. You agree that idiosyncerasy plays a very important part P—-Yes, but I will not talk about that unless I know how much poison a man has had offered to him for absorption. 7463. Does this question enter into it at all? Suppose a man takes chloroform badly and struggles ; is not he likely to inhale a larger amount ?—Certainly. The machinery of it would be this, that the administrator presses the chloroform, be it in a towel or skinner’s mask, close to the face, crams it over the patient’s mouth, and, instead of 2 per cent. you may have 10 per cent, of chloroform vapour. You have offered to inspiration, under those circumstances, by the person who is not fully persuaded of the nature and physiological properties of chloroform 10 per cent. of vapour’ As ordinarily admini- stered, it is quite possible that a patient should take into the lungs in one minute 10 litres of air, containing 4 per cent. of chloroform vapour, 7.e., 400 ¢.c., of which one- half may be at once absorbed by the pulmonary blood and carried to the heart, z.e. 200 ¢.c., or one gramme, or one-half the quantity reputed to be lethal. Merely by a single deep gasp after the breath has been held, it would be quite possible for a patient to take suddenly into his lungs perhaps 100 ¢.c. of vapour, or half a gramme of liquid chloroform. Taking the lethal quan- tity in five litres of blood at 2°5 grammes or 500 c.c. of vapour, the extreme danger of allowing gasping respiration with a towel or piece of lint, closed over the mouth and nostrils, is obvious. The percentage inspired might under such circumstances reach to 10 per cent. By asingle gasp the patient might inspire 2,000 c.c. of such a mixture, and through the pul- monary sheet of blood ;3,th mm. thick by 150 square metres in extent, an overpowering amount of chloroform sufficient to arrest the heart instantly, might be at once absorbed; a heart thus arrested would remain under the influence of stagnant blood and eould hardly be expected to contract again. 7464. Does the depth of the respiration make a difference >— Yes. Whereas the difference in the amount according to the activity of respiration, is a difference of 100 per cent., the other is a difference of 1,000 per cent., that is the difference between life and death. You may have ventilation of the lungs at 5 litres per minute, so much of chloroform inspired; at 10 litres per minute, double the amount. 7465. Have you any figures to give us of deaths P— I can only quote. I have the statistics of the Registrar- General, and I have the originals, because even in so simple a matter as the quotation of statistics accuracy seems to be difficult. 7466. Particularly in the quotation of statistics P— Yes; but simply in the quotation of naked figures. I will put in evidence the curve I constructed from the Registrar-General’s returns, copied by a clerk, Mr. Gladstone in the House returned also the figures from the Registrar-General’s returns, presumably again copied by a clerk, but the figures differ. 7467. Have you the figures P—I have the original return of the Registrar-General. I do not know whether Mr. Gladstone had been provided with a different lot of figures. 7468. Let us have the Registrar-General’s return for what it is worth P—You do not want the whole ? 7469. I wanted to compare it with Dr. Hewitt’s—I will read backwards then: 1907, 199. That is the net total number of cases of anesthetics. As a matter of fact, they are 80 per cent. chloroform, or more. 7470. Or chloroform and ether mixed ?—Yes; but there are comparatively few of those. 7471. (Sir Malcolm Morris.) Does it work out at 80 per cent. really P—I have not worked it out. In 1907 there were 199 deaths ; in 1906, 193 deaths. 7472. (Sir Horatio Shephard.) In your paper it is 183 P—May I consult the original curve I sent in? My clerk may have copied it wrong in that case, or I may have added my numbers wrong. May I add them again P 7473. 1907 is blank P—In 1907 I have 199; in 1906 Ihave 193. I will go on dictating from my curve. In 1905 my number is 168; the Home Office number is 155. In 1904 my number is 166, and the Home Office number is 156—my arithmetic wants checking, perhaps. Then in 1903 my number is 153, and 146 is the Home Office number. In 1902 164 is my number, and 148 is the Home Office number. In 1901 my number is 107, and the Home Office number is 133. 7474. (Chairman.) What are the features in different bases of calculation ?—I will take one more year because that will include the whole series given in the House. In 1900 my number is 123, and it seems to be the same as the Home Office number. 7475. These Home Office figures relate only to England and Wales. You may have got the United Kingdom, or included Scotland; that may have made the difference P—Mine are England and Wales also. 7476. Then Mr. Gladstone’s figures include all anesthetics—nitrous oxide ?—Yes, so do mine. That is a negligible quantity. It is not a matter of impor- tance. It only shows that in such a simple matter it is difficult to get the exact figures. 7477. The Registrar-General is entirely dependent on information supplied to him ?—Yes, and there much doubt has been cast. If one goes behind statistics one knows what is the basis of statistics,