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muscle relaxed, and dilatation took place, leading, of course, to gradual failure of circulation.
Up to a certain point this "give" of the heart muscle was recoverable, and upon chloroform
being stopped the heart regained its normal tone and contraction. Other phenomena asso--
ciated with the action of chloroform upon the heart are summed up under the term "delirium
cordis," or a rhythm of the heart muscle leading to futile contraction of portions of the
myo-cardium without assisting the viscus to effectually contract and expel its contents. In some cases
the dilatation was sudden, and all efforts at resuscitation failed. These results are important,
in so far as they are positive, not negative, and because they are demonstrable; the heart is
seen to undergo dilatation and to contract up to its usual capacity, or to give out altogether, as
the case may be. We have, then, to a certain extent, a conflict of opinion—the one based
upon negative, the other upon positive evidence, at least in the field of experimentation; but
I submit neither view can be allowed to go wholly unquestioned when we pass from dogs and
monkeys to men. It seems consistent to examine how far the one or the other opinion is borne
out in our experience in hospital and in private practice. I find that in most hospitals the
directions are carried out which the Committee of the Royal Medico-Chirurgical Society pro-
mulgated in 1864, and which are practically those re-asserted in 1889 by the Hyderabad Com-
mi s s i o n , v i z . , r e c u mb e n t p o s t u r e , l o o s e n e d d r e s s , &c . , a n d t h a t t h e p u l s e i s wa t c h e d , —a n i n j u n c t i o n
which the more recent Commission strongly repudiates. And yet I find deaths constantly
occur, and these deaths arise, we are told by the chloroformists, from primary heart failure.
Respiration, it is asserted, does not fail first. It is competent for a dispassionate commentator
to say that the hurry and excitement, of a chloroform death are such that mistakes are easily
made, and that it is a well-known fact that the thorax works as if in respiration even when no
air can enter the lungs; but, granting this, we have to remember two facts, The "first aid"
to those in danger from chloroform is now widely known: the tongue is dragged out, and
artificial respiration is started as soon as danger threatens. The other fact is that when the
danger is due to primary respiratory failure these measures restore life; when due to primary
cardiac failure, they fail. Do most of the cases of peril under chloroform recover or succumb?
Sir Joseph Lister, in his classical article on chloroform in "Holmes' System of Surgery"
tells us that he has saved more than one life by directing attention to respiratory difficulties
under chloroform. But chloroformists are not so careless as to neglect the elementary law of
the anæsthetist, riz., to permit nothing to distract his attentionf r o m
h i s
p a t i e n t .
A g a i n , t h e
fact that Snow and Clover each met with deaths proves that such events,h o w e v e r
t h e y
m a y
be lessened in number by skill and care, cannot be reduced to a vanishing point. A further
consideration which I am able to adduce from my personal experiences is this,t h a t
o f t h e v e r y
large number of patients to whom it has been my duty to give chloroform, or the substance
called methylene, a certain percentage have given me anxiety. My plan is to use Lister's open
method or Krohne and Sesemann's recent and useful modification of Junker's inhaler, the
flannel cap face-piece of which permits a free current of air to pass through it. I also make it
a rule to test the vigour of respiration by placing my hand over the mouth, to watch the colour
of the patient' s face and ears, and to keep a finger upon an artery, always testing the initial
rate and force of the pulse in that artery at the commencement of the operation. Pro-
-ceeding in this way I have sometimes found that the heart flags even when respiration,