Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS. 235
But there are those cases which have the operation the anaesthetizer remarked upon
power of binocular vision and whicli will the large amount of chloroform necessary
require the fusion training of the defective to keep the patient asleep. Patient was reej'e.
turned to the ward in excellent condition
A number of methods are used for this — and reacted nicely from the operation,
example: At 4.30 p. m. he became nauseated and
1; Worth's amblyoscope. vomited a small amount of a brown fluid,
2: Stereoscopic charts, etc. again at 7.30 p. m. he vomited a similar
31 Also by atropizing the fixing eye and fluid, also at 8 p. m. After each attack of
forcing the use of the squinting eye, the emesis he complained of great burning in
vision is developed and binocular vision his stomach and throat. At 8.30 p. m. he
can be cultivated after the fusion sense has was given hypodermically morphia, gr. }(,
been developed. and atropine gr. 1-150, as a result he rested
Unless these amblyopic eyes are trained, well until 4 a. m. when his nausea returned
we will have a complete, or almost com- and vomiting of acid fluid every half hour
plete, amblyopia exanopsia. or so during the day, otherwise his coudition
was excellent, abdomen flat, no signs
Acidosis Following Chloroform Narcosis: of any surgical complications whatever.
—Report of a Fatal Case. During the day his pulse varied from 88 to
. „ ,. ^ ,. , ,. ^ 110, temperature remained around 100° F.
By J. P. Patterson, M. D.. New Bern, N. C.
An attempt was made to give powders of cal-
By reporting this case of Acidosis follow- cined magnesia, grs. 10, and charcoal grs.
ing chloroform anresthesia I hope to im- 20 every two hours, none were retained, in
press upon the Medical Profession one of the fact water was regurgitated as soon as swaldangers
of chloroform as an anesthetic, a lowed.
danger which is often overlooked and dis- August 6th. Condition practically the
regarded, for many cases of post-operative same as that of day before— incessant naudealhs
are due to this condition and not to sea, vomitus however contained coffeeother
causes as supposed. ground particles. Abdomen flat, no signs
History— L. L., a strong sturdy lad of of peritonitis nor obstruction. Wound was
nineteen years, was seen upon the morning examined and found to be healthy, draiuof
July 3Ist, with the history of having been age was removed. Pulse and temperature
taken sick the night before with abdominal about the same as the day before. Conpain
followed shortly by nausea and vomit- junctiva slightly yellow—calomel, gr. 10,
ing. When seen he presented all the symp- was given and retained by being preceded
toms of catarrhal appendicitis, temperature by a hypodermic of morphia, gr: )i, and
100° I'., pulse 90. He was placed upon the atropine, gr. 1-150; at 7 p. m. a low soap-
Ochsner treatment—by night all the symp- sud enema was given and followed by extoms
were milder and the attack appeared cellent result.
to be resolving. The following morning, August 7th. Patient markedly jaundiced
August 1st, unknown to any one, he arose and restless; at times delirious; regurgitafrom
l)ed, walked to a restaurant and ate a tion every few minutes of a blackish fluid
plate of broth. In a few hours he was again which seemed to contain blood. Petechiae
taken sick with abdcmiinal pain followed by noticed upon his back— pulse in the mornnausea
and vomiting; when seen the local ing varied from 118 to 130. At 11 a. m.
symptoms of appendicitis were marked, stomach was washed out with a bicarbontemperalure
101° 1'., pulse 94. Me was re- ate of soda solution. A soapsud enema was
moved to the Hospital for a section but this followed in a few minutes by a large evacuawas
postponed for the reason that his symp- tion. Inhalations of oxygen were given
toms ameliorated markedly in a few hours for fifteen minutes of every hour. Abdoand
an interval operation was decided upon, men flat and no local abdominal symptoms.
The Ochsner treatment was continued. During the day his pulse increased in fre-
From this date until August 3rd he was quency, coma became more marked until 2
free from temperature and pain—but on the p. m. when he commenced to have tonic
morning of the ,3rd a mass about 6 C. M. convulsions every few minutes. At 4 p. m.
in diameter was detected in the region of seven hundred C. C. of blood were removed
the appendix. Prejiarations were made for from the left median basilic vein, while an
operation the following morning. infusion of a sodium bicarbonate solution,
Operation performed at 1 1 a. m. August 1 dram to 500 CC of normal salt solution
4th, Chloroform Anesthesia. Appendix was made into the right median basilic vein,
was found greatly thickened and bound For a time his convulsions were controlled,
down by stnnig adhesiinis, however it was however his pulse increased in frequency,
removed with little difficulty. Wound was temperature rose until just before death,
drained with gauze. Several times during the which occurred at 6.30 p. m., when his