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THE INFLUENCE OF DRUGS AND CHEMICAL AGENTS ON THE LIVER NECROSIS OF CHLOROFORM ANESTHESIA:  PAPER II

N. C. DAVIS; G. H. WHIPPLE, M.D.
Arch Intern Med (Chic). 1919;23(5):636-654. doi:10.1001/archinte.1919.00090220104007.
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Among the various explanations offered for the well known chloroform livery injury, the theory of Graham1 is, perhaps, the most attractive. This author believes that in the presence of water and oxygen in the body, chloroform is split and hydrochloric acid and carbon dioxid are formed; the hydrochloric acid then kills a certain amount of liver parenchyma, either by direct action or by secondary asphyxia. We must admit that we are unable to follow the chemical reactions as outlined by Graham. Furthermore, it is just as difficult to explain chloroform necrosis as to explain why chloroform passes by all body tissues until it reaches the liver, where the hypothetical chemical reaction takes place with release of hydrochloric acid. The specific susceptibility of the liver cell for chloroform is the riddle which has so far defied solution. Graham produced liver necrosis in dogs by injecting hydrochloric acid into the portal vein;

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