If pieces of kidneys taken from an animal that died from chloroform are hardened and fixed by proper reagents, the border of the epithelial cells in the convoluted tubes is destroyed. This is of extreme importance, as the border of the epithelial cells is to the kidney what the rods and cones are to the eye, which being destroyed will render the eye blind. The kidney therefore losing that border can no more serve as a filter. The in tegrity of the epithelial cells is abso lutely indispensable for a good function of the kidneys. Twenty-five years ago Heidenhain attributed to those cells the property of eliminating urea. We know now that the function of the cells with their intact border is secretion. They extract from the blood certain products. The renal secretion will therefore de pend upon the integrity of the cells of the tubules. This important function is impaired by chloroform, when adminis tered as an antesthetic, but the cell is capable of recuperating. Henaut (Jour. des Praticiens, No. 15, 1902).
The inhibiting influence of chloroform narcosis upon general metabolism has been considered as a prominent factor in the etiology of untoward phenomena, and Guthrie and Kiefer have ascribed some deaths occurring some days after the administration of the anwsthetic to defective elimination of excretory prod ucts. Casper, l3ehrend, Langenbeck, and. other authorities have shown that chronic chloroform poisoning does act ually occur; and Guthrie ascribed to autointoxication: either a fatty condi tion of the liver (and, therefore, func tional disturbance of the organ) exist ing before the anwsthetic was given, or to chloroform and operation-shock com bined, which aggravated the condition already present. It is supposed that lessened oxidation, such as some believe ether and chloroform can cause, leads to deposition of fat in the liver and where, and so would prevent fat being oxidized on its way from the liver into the general circulation.
Chloroform decomposes blood in pres ence of an alkali and liberates carbonic monoxide; also in the body in alkaline blood. This may account for some deaths from chloroform. Desgr6s and Nieloux (Jour. of Amer. 3Ied. Assoc.. Jan. 29, '98).
Chloroform may cause death several days after administration, from causes which are at present unknown. The changes found in such cases after death chiefly consist in fatty degeneration of the heart-muscle, of the liver, and of the kidneys. The degeneration, although usually present in several of these organs, is more often specially localized in one or other; the resulting clinical features vary accordingly. The degeneration in question is analogous to that observed in animals dying from long-eontinued chloroform amesthesia. Salen and Wallis
(Centralb. f. Chir., Ang. 19, '99).
Ungar, Strassmann, and other observ ers have also found that fatty changes could be induced in the liver through the influence of chloroform upon the blood-vessels and tissue-cells. As a re sult, the urine becomes loaded with alkaloidal bodies which the kidneys can not eliminate with sufficient rapidity.
Hence the autointoxication.
As result ehloroform narcosis there are present fatty degeneration of organs, especially fatty infiltration of the liver and fatty changes in the cardiac and skeletal muscles. kidneys, and stomach; these fatty changes arise from the action of chloroform upon the blood-eorpuseles and iissue-eells. Some subjects show a greater susceptibility to these effects of chloroform than others. Chloroform is eontra-indieated in all eases of fatty liver: whenever this condition is not discoverable by clinical evidence. the faut that the liver-function is hampered —as shown, for example, by alkaloidal bodies in the urine—should be taken as contra-indicative to chloroform. Ungar and Strassmann, Thiem, and Fischer (Deutsche med. Zeitung, p. 4, '89) ; Os tertag (Virchow's Archly, vol. exviii, p. 2).
After death from chloroform there is a decided acid reaction of the fluids and tissues, and the lessening in alkalinity actually occurs during. chloroform in halation. Taken in connection with the researches of Kast and Mester, showing. that fatty degeneration follows pro longed inhalation, this possibly explains the lethal effects that chloroform exerts on the cells. The urine, further, has its acidity increased after chloroform. It would appear as if the acid excretions of the working-muscics, ete., usually readily neutralized by the cells (Langendorff), are left unaltered, or are imperfectly neu tralized during chloroform inhalation. Mansfelde (Omaha Clinic, Sept., '92).
Method of Administration.—Position. —The position of the patient bears an important influence upon the results. -When the splanchnic vasoconstrictors are paralyzed by injuries or poisons, such as chloroform, the influence of gravity becomes manifest, as shown by Leonard Hill, owing to dilatation of the abdomi nal veins with corresponding emptying of the heart and cessation of cerebral circulation; hence the numerous acci dents reported witnessed in the dental position; that is to say, that employed by dentists for the removal of teeth. Death in sitting posture occurs from sudden cessation of the heart's action, through abdominal engorgement and de pletion of cerebral vessels.