Medico-Legal and Medico-Ethical

1889 BMJ (Clinical Research Edition)  
July 20, 1889.] THB BRITISE MEDICAL JOURNAL. 156 counteracts any dangerous tendencies of chloroform inhalation, I am strongly of opinion that it does so. The following case, which seems to me worthy of record, impressed me with the belief. A boy was admitted a few years ago into the St. Marylebone Infirmary, with periostitis of nearly the whole of the shaft of one femur, and an enormous abscess in connection therewith formed a large swelling, occupying nearly all the length of the thigh. The
more » ... was very ill, pale, and emaciated, but the abscess was speedily opened, under chloroform, without any ill effects. A few days afterwards, the patient being already better, another slight operation was required under an ancesthetic. Chloroform was again used; but before he was fully under, and before the operation had been begun, respiration stopped, he became collapsed, and only came to after performance of artificial respiration for many minutes. The operation was abandoned on this occasion. In the further course of the case, amputation of the thigh became necessary, and was performed under chloroform without any accident. Some time later, chloroform was again given in order to open a small sinus; but he became collapsed and appeared moribund just as on the second occasion, and was again revived with difficulty. Being puzzled why the same anaesthetic should behave so differently on different occasions in the same patient, I made inquiries as to his condition at the various times. It certainly did not depend on his general health; but I ascertained that on the first and third occasions, a dose of brandy-and-water had been administered shortly before the operation; on the second and fourth, this had been omitted. A slight subsequent operation being necessary in the stump shortly afterwards, the precaution of giving brandy beforehand was duly taken, and this time no evil consequences happened. Before this case, I had not attached much importance to the matter, but since then I have always, either from reason or superstition, taken care to give brandy before administering chloroform; the anmsthetic I usually prefer. I cannot call to mind any untoward effects at any time in -which I know alcohol and chloroform have been given together, and should like to know if other men can cite cases bearing on the point. It harmonises with the fact (if the common belief be true), that bichloride of methylene (which is supposed to be a mixture of alcohol and chloroform) and the A.C.E. mixture are safer than chloroform alone; but it seems to me that giving liquid alcohol ly the mouth, shortly beforehand, in the form of an ounce or two of brandy with water, is the readiest and most satisfactory method of mixing the two substances.-I am, etc.,
doi:10.1136/bmj.2.1490.155-c fatcat:4cnqzy7dz5dcpcoe7an5azfwiu