The principles and practice of obstetric medicine and surgery : in reference to the process of parturition : illustrated by one hundred and forty-eight figures / by Francis H. Ramsbotham.

Francis Henry Ramsbotham

Date:: 1851

Credit: The principles and practice of obstetric medicine and surgery : in reference to the process of parturition : illustrated by one hundred and forty-eight figures / by Francis H. Ramsbotham. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

665/682 page 549

$The appearance of the internal organs of animals killed by chloroform has been found to differ very considerably, in different instances; and this may in a great measure depend on the length of time the individual was subjected to the influence of the vapour.* Some ob- servers have always met with the lungs highly congested;! others slightly so ;J while others report them as perfectly sound.\ In some cases considerable cerebral congestion has existed; in some the membranes only exhibited that condition;—sometimes serous effusion has taken place into the ventricles, and at the base of the brain ;|| occasionally air-bubbles have been seen in the sinuses of the dura mater, as well as in other bloodvessels of the body;^[ and in other cases no part of the cranial contents showed any deviation from the healthy standard.** This class of remedies seems to possess the power, in common with some narcotics, of pro- ducing congestion of the capillary vessels throughout the whole body;ff and we may safely assert, that in the great majority of instances the lungs have been more or less turgid; that the right side of the heart has been filled with dark, fluid blood; and that the heart itself has been softer than is usual, having partaken, no doubt, of the baneful impression made upon the muscular structures in general. We may therefore fairly infer, that when death has followed the inhalation, the fatal event has happened either from congestion of the lungs, and suffocation of the right side of the heart, or in consequence of direct paralysis communicated to that important muscular organ, in common with the muscles of the extremities. That the local application of chloroform to the extremities will occasion numbness, insensibility, and paralysis, is a fact confirmed by many ;JJ and that it will put a stop to its pulsations, when applied directly to the denuded heart of the rabbit and the frog, the experiments conducted by Dr. Snow distinctly prove.\\ When the blood, then, is charged with a proportion of vapour beyond what the life-force of the organ can resist, the same effects are developed, by the poison acting from within, as would show themselves were it applied to the external surface; and to a degree indeed intensely greater; because the coronary arteries being filled with the poisoned fluid, would carry its deadly freight throughout the whole muscular tissue of the lable property of the blood. (See Brighton Gaz., June 3,1847.) M. Gruby, in a communication to the Academy of Sciences, says, that arterial blood remains red under the influence of chloroform, but becomes black under the action of ether. (Med. Gaz., vol. v. 1847, p. 1123.) * I have made no distinction between chloroform and sulphuric ether in respect to their effects upon the animal economy, for their action seems to be precisely similar. The action of chloroform and ether is essentially the same. (Snow, Med. Gaz., vol. vi. 1S48, p. 74.) Judging from analogy, the effects of ether and chloroform in pro- ducing insensibility appear to me to be precisely similar. (Robinson, Idem, p. 212.) t Dr. Glover, after injecting chloroform into the veins, found the heart gorged with clotted blood, and its irrita- bility destroyed. The lungs were congested to a surprising degree. These experiments were performed so long back as 1842. (See Edinb. Med. and Surg. Journ., vol. lviii. p. 335, Oct. 1842.) Mr. Thomas Wakley (Lancet, vol. i. 1848, p. 25) says: The examinations [of the animals that were destroyed by chloroform in his experiments] prove that blood almost black had collected in the heart and lungs, and the great vessels connected with those organs, to a degree of intensity which was probably never surpassed. Anything of the kind more striking, was probably never witnessed in post-mortem examinations. M. Amussat found, in animals killed by ether, the arterial blood almost black and liquid; the right cavities of the heart containing a large quantity of fluid black blood; the lungs throughout of a deep red colour; the liver and kidneys gorged with blood; the vessels of the dura mater loaded, and those of the pia mater greatly injected. (Med. Gaz., vol. iv. 1847, p. 879.) In Mad. Labruin's case (Gaz. Med., Oct. 20,1849) the membranes of the brain, and especially the veins at the base, together with the sinuses of the dura mater, were gorged with black fluid blood. The substance of the brain was healthy, but when cut presented numerous dark bloody points; a large quantity of serum filled the base of the cranium and vertebral canal: the lungs were crepitant throughout, and of a grayish slate colour. In the case of Hannah Greener and others, the lungs were highly congested. (See Med. Gaz., vol. vii. 1848, p. 108.) 1 In the case of Mr. Badger, the lungs presented little sign of congestion. (Med. Gaz., vol. vii. 1848, p. 79, Note.) i The lungs seemed quite healthy. (Glover, loc. supra cit.) I In the case of Hannah Greener, the brain externally and internally was more congested than usual, and the ventricles contained rather more than the usual quantity of serum. (Sir John Fife's account of the dissection, Med. Gaz., vol. vi. 1848, p. 253.) In the case of Mr. Badger, the membranes presented a congested appearance all over the cerebral mass; there was nothing abnormal in the cerebrum, nor any effusion into either ventricle. (Dr. Waters's account of dissection, Med. Gaz., vol. vii. 1848, p. 79.) In some of Dr. Glover's experiments there was con- gestion of the membranes of the brain, as well as bloody spots on the substance of the brain itself, with much serum in the ventricles, and at the base. (See Exp. 63, same vol. p. 41.) 1[ In M. Gorre's case at Boulogne (Mdle. Stock), bubbles of air were found in the veins on the surface of the brain, in the ophthalmic veins, at the base of the brain, as well as in other parts of the body. (Med. Gaz., vol. vii. 1S4S, p. 212.) Bubbles of air were also discovered in the sinuses of the dura mater, which vessels contained more blood than natural, in the case of death from chloroform at Cincinnati. (Med. Gaz., vol. vii. 1848, p. 81.) But as in both these cases artificial respiration had been practised, the air might have been forced into the vessels by the strenuous efforts made by the medical men to arrest the fatal termination. This hypothesis, nevertheless, will admit of a doubt: for Langenbeck, after amputating a leg, whilst tying the arteries observed black blood and gas bubbles issuing from the wound. The man died of the effects of chloroform, as it is reported, in half an hour after the operation. The same occurrence took place lately at La Charite, during the operation for excision of the lower jaw. On examination, much black and frothy blood was found in the right heart. (Med. Gaz., vol. x. 1850, p. 23.) In a case of death also at Berlin, where no attempt at restoration by inflation appears to have been made, the membranes of the brain were slightly congested; the larger veins contained some air. (Med. Gaz., vol. x. 1850, p. 484.) ** In the case of a dog killed by chloroform, detailed to the Parisian Academy of Sciences, by Dr. Plouvier, of Lisle, on dissection there was nothing to indicate the cause of death. (Med. Gaz., vol. vi. 1848, p. 214.) ff One of the distinguishing characteristics of these substances (chloroform, &c.) is the remarkable power they possess of obstructing the pulmonic circulation. (Glover, Med. Gaz., vol. vii. 1848, p. 42.) Turgidity of the capillaries is an effect of the narcotic poisons. The experiments of Mr. Wakley show that ether and chloroform cause distension of the capillaries of the lungs and other internal organs. (Sibson, Med. Gaz., vol. vi. 1848, p. 267.) ££ See Simpson's Experiments on Animals as well as the Human Subject. (Med. Gaz., vol. vii. 1848, pp. 63, et seq., and Nunneley, Remarks, same vol. p. 1094. §g Med. Gaz., vol. vii. 1848, pp. 414 and 614, &e.$