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elimination of urea, epileptiform convulsions may occur and death result. There are always
danger and trouble during the administration of chloroform when albumen is present. To
prevent death from asphyxia chloroform requires skill, experience, undivided attention, prompt
action in time of danger, and a suitable method of administration. Anæsthetics should never
be administered in a close, crowded, small, ill-ventilated apartment, or side room of a ward, or
in the lobby of an operating theatre. Neither should there be a crowd around the patient
witnessing the operation. several deaths had the fatal result induced or hastened by one or
other of these conditions.
Of the apparatus used in the administration of chloroform, based upon the evidence
afforded by the deaths, Allis' s inhaler is the most dangerous. Next in order is the folded
towel arrangement, and the safest of all is the drop method on flannel stretched on wire.
Deaths from syncope or failure of heart are not common. They do, however, occur,
and, as a rule, early in the administration. A small quantity of concentrated vapour without
any air administered to a nervous, timid patient has proved fatal. A. healthy, florid-faced
young man had chloroform administered to him in private by a surgeon who had gained
much experience of chloroforming in the wards of the Royal Infirmary. The chloroform was
administered on a folded towel, three or four drachms having been poured on. While the
patient was counting, and when he had reached the number twenty-five, his face became at once
pale and blanched, the pupils suddenly widely dilated, no pulse was felt at the wrist. The
young man was dead. On post-mortem examination I found his heart an empty flaccid bag.
There was no disease of any organ, and no evidence of death from asphyxia. I have known
a robust-looking ship captain die under precisely similar circumstances, and on post-mortem
examination I found only an empty flaccid heart. Both men had hearts and nervous systems
specially sensitive to chloroform, and the fatal result could not have been provided against.
There is no possibility of discovering beforehand the existence of such a sensitive heart.
Weakly, flabby, thin-walled, yellow hearts, and hearts bound to the pericardium by old adhe-
-sive bands of probably rheumatic origin, are prone to become paralysed very early in the
administration of chloroform.
Indian dogs and monkeys, the subjects of experiments by the Hyderabad Commission,
do not afford the cardiac and pulmonary complications which are often present in man, and con-
- c l u s i o n s b a s e d u p o n s u c h e x p e r i m e n t s , h o w e v e r i n t e r e s t i n g a n d i m p o r t a n t t h e y m a y b e w h e n
viewed from a purely scientific standpoint, are of very little practical importance or value as
guides to us in the safe administration of chloroform to our patients.
Strange as it may seem, disease of valves, hypertrophy of walls, cardiac murmurs of all
kinds, give no trouble during the administration chloroform. I know that from experience
in the operating theatre, and I have never found any valvular disease in any case of death
under chloroform. I have no post-mortem data of deaths from syncope in the last period of
the administration of chloroform. On that point I have nothing to say.
In conclusion, I have to state that after thirty years' experience as a surgeon in hospital
and in private practice, experience both of the living and the dead, I have formed the opinion
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