1898 BMJ (Clinical Research Edition)  
A., M.B., B.Ch. Oxon, M.R.C.S., L.R.C.P.] T. C., a man, aged 39, was admitted on September 21st, 1897, with fracture of the right femur. The fracture -at the junction of upper and middle third was slightly oblique. Splints and extension were applied as usual. Six weeks later when the splints were taken down no good union had occurred; consequently they were replaced for another three weeks; at the expiration of this period very fair union had occurred. During this time the patient was placed on
more » ... tient was placed on a agenerous diet, which included Bass's ale Oi a day, and he was also taking 3 ij cod-liver oil three times a day. Consequent on the prolonged use of the splints the knee was found to be stiff and almost quite useless, owing to adhesions about the joint. All efforts to break these downwere accompaniedwith such pain that it was thought best to place the patient under an anaesthetic for this purpose. On the afternoon of December 8th, 1897, the patient, who -had previously been prepared by a good purge and by abstin--pnce from food, was brought into the operating theatre. The Fheart was examined, and the sounds though not loud were -determined to be regular and those of heslth. Ether was then administered by a Clover's inhaler. The patient was tlightly longer going under than usual and tolerated the indi. -e4tor turned to I for some time; then followed a short spell of incoherence and struggling and complete ansesthesia was obtained. No difficulty with the breathing occurred. The -slight operation of breaking down the adhesion was now completed, and the administration of ether was stopped. The (patient was now breathing stertorously and well, like one recovering from ether. Ten minutes later one of us helped the porter to carry him back to bed on the stretcher. Before leaving him in the ward the corneal reflex was tried and found to be present, indeed the patient moved his head as resenting 4uch treatment. Later on it is reported that he opened his eyes, and seemed -to recognise an onlooker; consequently no special superwvision wAs maintained, beyond that a nurse and the porter were constantly moving about the ward. About twenty wminutes later (half an hour in all since the administration of ,Any ether), the porter noticed the breathing to be in gasps, and that the patient was blue in the face. He fetched one of us from the theatre where another operation had by now been just completed. Before we could get to the ward the patient was dead, and beyond all chances of resuscitation. He was 4ying with the head thrown back, so that no possible diffi-.-elty of breathing could have arisen due to his position. The eyes were open and the lips slightly parted, and there was no sign of any struggle for breath. There had been no .sickness. The ether used has been submitted to two independent ,analyses, and foundl to be pure anaesthetic ether of the B.P. IRather less than zj was used (it was impossible to measure -exactly afterwards, and no observation was made at the time). At the po8t-mortem examination the body was found to be fairly well nourished. The heart and pericardium were healthy. There was a slight excess of fat over the right side -of the heart, specially tilling up the auriculo-ventricular egreeve. The coronary veins were much distended. The right side was distended with fluid venous blood; the walls of ,the right side seemed rather thin, though the muscular tissue owas healthy and not invaded by the overlying fat. The left .side was healthby, all the valves seemed competent and the flaps healthy. No obstruction to the circulation could be tfound in the pulmonary arteries.
doi:10.1136/bmj.1.1932.87-a fatcat:e5zn3lsk3ra3pj3qj3ttnndwcy