MEMORANDAI the Duodenum
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June 21,1890.] THE BRITISH MEDICAL TOURNAL. 1425 administered out of a drop bottle on the corner of a towel, spread over the child's mouth and nose and held at a little distance from the skin, so as to allow of the free admixture of air. The quantity used was la drachm. The child took the chloroform well at first, keeping a good colour and no alarming signs appeared whilst the abdomen was thoroughly explored, both externally with the hands and also by passing a soft flexible catheter into the bowel. About half a pint of soap and water was next gently injected into the bowel, the body of the child being raised. It was at this stage that the face was noticed to become blue and the breathing stopped. The chloroform was put on one side and artifioial respira- tion, inversion, flicking the chest with a wet towel, were tried without success for 35 minutes. The heart stopped abotut the same time as the respiration. Po8t-mortem Examination 48 Hours after Death.-Body well nourished, rigor mortis passing off. There was marked discolora- was greatly distended. On opening Fig. 3.-Section through the harder part of the tumour showing a tion of the abdomen, which fibrouis stroma with rounded loculi lined with columnar epithelial cells the abdomen the coils of bowel were distended. No peritonitis. and filled with other more irregularly shaped cells. The large bowel contained much fluid feacal matter, and many large cones of faecal origin were found in the descending colon. On tracing the bowel upwards no cause of obstruction was noted until the duodenum was reached. Here a band was seen passing from within outwards, over and compressing (but not occluding) MEMORANDAI the duodenum. On cutting through the band there was no sign of MEDICAL, SURGICAL, OBSTETRICAL, THERA- inflammation in the bowel. The lungs were congested, contained air. Heart walls and valves healthy. Both sides empty and con- PEUTICAL, PATHOLOGICAL, ETC. tracted. The other organs were healthy, and nothing further ab- normal was noted. Death does not seem to have been due to THE PULSE DURING CHLOROFORM ANAESTHESIA: A CASE asphyxia alone, but rather to reflex shock producing paralysis of IN POINT. the respiratory and cardiac centres. JUST at the present time it is important to compare the induc- C. F. M. ALTHOBP, M.R.C.S.Eng., M.R.C.P.Lond., tions of pharmacologists with the clinical experience of anDesthe- House-Surgeon, Bradford Infirmary. ists in regard to chloroform, and hence the following case may be of interest. NOTE ON SOME PROPERTIES OF SODIUM SILICO- On May 5th last I was administering chloroform to a boy, aged FLUORIDE. 10 years, for tooth extraction, giving it on a piece of lint in the IT is about two years since sodium silicofluoride was introduced usual way. After a few minutes, and before the operation was as an antiseptic agent, during which time it has been more or less begun, I noticed that the pulse had become very weak, and was extensively used, and yet there is little new evidence forthcoming hardly perceptible. On suspending the administration the pulse in regard to its chemical properties and physiological action. rapidly improved, and in three minutes was fairly strong; on re- Some months ago I was engaged in making a series of sterile commencing the anesthetic the phenomena were repeated. The pancreatic digestions, and after employing many of the current pulse, on which I kept my finger, quickly became slower and germicides, I determined to employ a sample of " salufer." Upon weaker, and tbere was distinct pallor on the face. Again I dis- doing so it was surprising to find that at the end of a few days the continued chloroform, and again the pulse recovered. No distinct digestions were some of-them absolutely putrid. failure of the respiration was noted. Certainly there was none The digestions were made in two ways-either a 2 per cent. corresponding in any degree to that of the heart. I now sent for solution of sodium bicarbonate was taken, and the silicofluoride ether, and in about ten minutes began to administer this with a subsequently added to saturation; or a known volume of the Clover's inhaler. The pulse immediately rose from 68 to 85, and saturated solution of sodium silicofloride was taken, and suffi- continued full and strong. Extraction was now commenced, and cient sodium carbonate added as would produce a 2 per cent. accomplished without further trouble. I am sorry I have no more solution. exact records of the pulse and respiration rates, but I can vouch for In the first case the digestion remained aseptic; in the second the main facts, and my observations are confirmed by Mr. George there was effervescence as the sodium carbonate was added, and Brunton, the dentist in this case-a gentleman of great experience the digestion became offensive at the end of a few days. In the and accuracy. I do not at all consider that there is anything first case the total fluorine was much greater, I believe, than in unique in this case; on the contrary, I believe it to be an illustra- the second, existing probably in part as fluoride of sodium, and in tion of what is familiar to those who have given a good deal of part as unaltered silicofluoride. In the second case the silico- chloroform. When I was a student I was told to watch the pulse fluoride became converted, on the addition of the sodium bicarbo- during chloroform anmsthesia, and to believe that chloroform nate, into the silicate and fluoride of sodium, and so little silico- depresses the heart more than ether, and experience does not lead fluoride remained that it was not sufficient in amount to act as a me to change my practice or belief in these particulars. germicide. J. BBNJN. HELLIBR, M.D.Lond., Lecturer on Gyna3cology It was suggested by Thomson,' who discovered the antiseptic in the Yorkshire College, Surgeon to the Leeds action of the fluorides, that surgeons who placed their knives in Hospital for Women and Children. solutions of sodium silicofluoride should add a little carbonate of soda in order to prevent corrosion of the steel. Such a procedure DEATH OF A CHILD DURING THE ADMINISTRATION OF appears, in the light of the above facts, to be more than question- CHLOROFORM. able. ON a 5 was admitted With regard to the mode in which the salt acts as an antiseptic, June 5th child, aged months, into the Brad- the following facts may prove of interest. ford Infirmary, under the care of Mr. Roberts, suffering from in- in testinal obstruction of three weeks' duration. The history was In order to preserve a 5 per cent. solution of serum albumen that there had been trouble with the bowels since birth. On a saline solution, an unmeasured quantity of sidicofluoride was previous occasion the bowels had not been moved for 14 days. added. After a few days the solution was clearer and free from 4 the child did not to in a hazy turbidity previously noticed, but no trace of proteid was On admission (June 5th, P.M.) appear be detected in the supernatant liquid. This effect I have never been pain, there was no vomiting and no sign of an acute character. solu- The abdomen was greatly distended, note on percussion was re able to reproduce in the same degree, although a saturated sonant all over, and no definite tumour was detected. tion of the salt slowly and partially precipitates serum albumen, egg albumen, and paraglobulin from their solutions. In fact, a At 7.45 P M. the same evening the child was seen by Mr. Roberts, these who had chloroform given (by the bouse surgeon) in order to saturated solution proves an exceedingly delicate test for examine the abdomen more satisfactorily. The chloroform was 1 Thomson, Brit. Assoc. Reps., 1887; Robson, JOURNAL, May 19th, 1888. 1426 THE BRITISH MBDICAL JOURNAL. lJune 21, 1890. proteids. With a saturated solution of the salt, albumen was de- tected in a sample of urine containing casts, which only gave a REPORTS reaction with trichloracetic acid on mixing, and with picric acid by ON the contact method, and which gave none on boiling with the ad- MEDICAL & SURGICAL PRACTICE IN THE HOSPITALS dition of a drop of acetic acid, nor with an equal volume of picric IRELAND, acid, nor with acid brine, nor with the cold nitric acid test. The AND ASYLUMS OF GREAT BRITAIN, worst objection to its ufse as a test is that it must be used by the AND THE COLONIES. contact method, and that the drug varies a good deal in com- position. Some specimens were acid, others neutral, and the ma- EYE, EAR AND THROAT INFIRMARY, EDINBURGII. jority alkaline. OF THB TONSIL. While the saturated aqueous solution precipitates some proteids, CASB OF SARCOMA there is yet another effect of the solid salt akin to that of certain (Under the care of G. HUNTER MACKBNZIE, M.D.) other inert powders. M. Boymond2 pointed out that the filtration R. C., aged 23 years, a shoemaker, applied at the Eye, Ear and of a solution of serum albumen through bismuth trisnitrate Throat Infirmary of Edinburgh on January 7th, 1890, on account sufficed to removed the proteid from its solution, and I find that of pain and swelling on the right side of the tbroat. lie had first upon leaving a solution of serum albumen in contact with an experienced the sensations complained of about six weeks pre- underlying fayer of fine sulphur a jelly-like layer of proteid viously.