On the other hand, the fear that un toward results will follow the use of an anmsthetic in patients of advanced age is equally exaggerated, as shown by a large series of cases reported in which no unusual effect was witnessed. Heath, for instance, administered chloroform to a woman 94 years old, to reduce a dis location. The patient bore the anws thetic calmly and easily. Indeed, acute suffering is a prolific source of fatal shock in old people, and amesthesia thus becomes a life-saving agent in them.
As regards the increased liability to untoward effects through disease, Rey nier recently showed that, according to the more or less great resisting power of the various cells affected during the anmsthetization, are fatal accidents lia ble to occur. While in alcoholics, whose cerebral cells are in a continual state of hypersthesia, delirium is observed, which may reach the stage of delirium tremens; but in these, also, heart-wall degeneration is probable, and early syn cope is likely in proportion. In hyster ical subjects all varieties of hysterical at tacks may occur, even paralysis and syn cope. The same is the case in epileptics. In morphinomaniacs only slightly in toxicated chloroformization is easily and rapidly accomplished; in others, on the contrary, it is more dangerous. In ataxic subjects the period of medullary excitement nearly always gives rise to reflexes which may arrest the respiration and heart-movements.
To these morbid conditions must be added those enumerated and involving the circulatory, respiratory, and urinary systems, and prolonged abdominal op erations, strangulated hernia in old and exhausted subjects, colotomy and colec tomy, etc.
Extra watchfulness should be observed in all such cases, and shock anticipated by preliminary measures: stimulants, strychnine, etc.
Shock.. — Murray-Aynsley emphasized the fact that many deaths under chloro form occurred within a very short time after the commencement of inhalation, or when comparatively trifling, although painful, operations were to be performed (extraction of teeth, etc.) were due to shock during imperfect anesthesia. He denies that the experiments performed by the second Hyderabad Commission prove that shock under chloroform was not competent to produce syncope, as in them painful operations were per formed on animals coining out of chlo roform, and in a condition where, as he contends, analgesia persisted, although ansthesia was imperfect.
Closely connected with the production of shock is fear, which tends greatly to increase the chances of cardiac syncope, through the exaggerated. functional ten
sion induced. White has shown that even a small amount of chloroform is capable of inducing a fatal issue under these circumstances. There is a marked difference in this particular between Europeans and Hindoos: a fact which has served to markedly decrease the mor tality of amesthesia in India.
The letters which are constantly ap pearing in current medical journals in nicate very plainly the views which are held in this country on the vexed sub ject of chloroform rersuN ether as an anmsthetic, but less is generally known of the opinions of the profession _America on this matter. It might per haps be hastily assumed that in the United States, the home of anmsthesia by ether, no other drug, and least of all chloroform. would be habitually used. To those who are of this opinion the statements made by Dr. J. A. 13odine. Adjunct Professor of Surgery at the New York Polyclinic, will come as a surprise. In a recent lecture he admits freely that chloroform possesses many advantages over ether, but points out that the administration of the former has been followed by a considerably larger proportion of deaths from the amestlietic than when the latter was employed. he thinks, however, that this unfortunate fatality might be offset to some extent by the deaths which take place some time afterward, from kidney irritation and lung involvement after ether.
Be contends that most chloroform deaths are dile to vasomotor paralysis, and that deaths from fright occur just in the same way. Two instructive and suggestive cases are cited. In the first, the patient, a very nervous individual. became .so frightened before the opera tion that the rhythm of his breathing Wa S .seriously disturbed: the amesthetist, consequenee of this, gave him some preliminary training. in deep breathing, before the administration of the chloro form; the cone was placed over his face. and lie was told to breathe deeply; after a few gasps Ile ceased to breathe and could not lie resuscitated. Not a single (Irop of chloroform had been adminis tered. In the second case, the patient, who Wa S also a very nervous man and very fearful of the result of the opera tion (for lnemorrhoids), was given an enema before any amesthetic was ad ministered; he thought this was the first step of the operation, ceased breathing., and (lied. In both these eases the necropsy revealed no morbid state except the tense abdominal yeims, in which nearly all the blood of the body had collected as a result of the vaso motor paralysis consequent upon the fright.