Upon the results of the Hyderabad Chloroform Commission / a communication by Surgeon-Lieutenant-Colonel Lawrie ; discussion by Dr. Gaskell [and others].

  • Lawrie, Edward.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Upon the results of the Hyderabad Chloroform Commission / a communication by Surgeon-Lieutenant-Colonel Lawrie ; discussion by Dr. Gaskell [and others]. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the respiratory centre and not of asphyxia. This is precisely what Mr. Horsley states with regard to death from bullet wounds of the head. (4) In death from chloroform the respiratory centre is narcotised or paralysed from the commencement, and is never stimulated at first as it is in asphyxia. This remark applies equally to bullet wounds, except that the narcosis of the respiratory centre is gradual in chloroform poisoning, and paralysis of that centre is sudden in bullet wounds of the brain. (5) The proper thing to do in chlo- roform poisoning is to employ artificial respiration rather than the giving of stimulants. These, again, are Mr. Horsley^s own words with regard to bullet wounds of the brain. (6) In chloroform poisoning the narcosis may be complicated by vagus stimulation, which produces marked slowing of the heart. The same thing occurs in bullet wounds of the brain; haemorrhage may be produced, which stimulates the vagus centre by pressure on the medulla and causes marked slowing of the heart. In chloroform poisoning we regard this slowing of the heart as a safeguard, in that it tends to diminish the blood supply which is conveying the poison to the brain and producing the fatal narcosis. In bullet wounds of the brain the slowing of the heart may also be a safeguard, in that it tends to arrest the haemorrhage which is pro- ducing the fatal compression. Lastly, from the year 1879 the opinion has gained ground that death from chloroform is due to primary arrest of the heart and syncope. This belief corresponds closely with the opinion hitherto, however, held universally, that bullet wounds of the brain cause death by arrest of the heart and syncope. No doubt in death from chloroform the process may be complicated by asphyxia, but it is important to bear in mind that the only danger of asphyxia under chloroform is to cause an increased in-take of the anaesthetic and rapid narcosis of the respiratory centre, a narcosis which may be so rapid and permanent as to appear like sudden death. It has been stated that when the respiration stops in chloroform poisoning the heart may stop suddenly. I have frequently seen reflex stoppage of the heart mistaken for heart failure in the laboratory— dogs removed as dead, because the needle in the heart had stopped moving, which afterwards revived spontaneously. I have recorded one case in the operating theatre, where a child was left for dead be- cause no heart-sounds could be detected after its respiration had
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