Delayed chloroform poisoning

The study and investigation of the conditions enumerated above has led to a better understanding of the subject, but still there remains a great deal to be done. The mechanism by which these exaggerations of protein metabolism are carried out in the various conditions requires further exploration.In discussing the subject of delayed chloroform poisoning, no paper would be complete which did not deal with its historical aspect.I will deal first of all with this aspect of the subject, from the year 1850, when Caspar reported the first fatal case of delayed chloroform poisoning, up to the present time. The different papers and cases will be mentioned in chronological order, as nearly as possible, with the dates of each. It will help us greatly in the better understanding of the subject, if the action of chloroform upon the various tissues and organs of the body is included in this sketch.I will next deal in detail with practically all the reported cases of delayed chloroform poisoning. I will give an exhaustive analysis of the symptomatology of the condition, and describe the symptoms in two cases which occurred in patients under my care and which have so far not been published. I will follow this up by a minute description of the findings in the urine of patients suffering from delayed chloroform poisoning, and give the results of my examination of thirty urines after chloroform anaesthesia, both by qualitative and quantitative estimation.I will deal next with the pathology of the condition; both the naked eye appearances and microscopic changes will be described in detail. Many causes, other than the toxic after effects of the chloroform, have been ascribed as producing the characteristic symptoms of delayed chloroform poisoning. I will criticise each cause separately, and show that chloroform anaesthesia of itself is responsible for many of the disastrous results, preceded by a characteristic set of symptoms, which may follow even the simplest operation.I will next go carefully into the chemistry of the acetone bodies.The following chapter will be taken up with a consideration of other conditions in which acetonuria occurs. I will here refer to other general anaesthetics, and show that these also may be followed by toxic after effects, and even death.The treatment of delayed chloroform poisoning will next be dealt with in detail, along with a suggestion of my own.Finally, a summary of the whole subject, embodying all the important points of the thesis, will be followed by the bibliography