281
form five or ten times daily for fifteen years without a casualty, i.e ., a mean of 40,000
anæs-thetics; and other exceptional estimates have been given by Baudens, 1 in 10,000 during the
Crimean War, and Hunter McGuire, 1 in 15,000 during the Secession War. These deaths may
be due to—(1) impure chloroform; (2) careless anæsthetisation; (3) careful but faulty methods
—in any of which events the chloroform is not to blame; (4) the direct effect of the
anæs-thetic, due to its intrinsic properties, and unavoidable by care, skill, or the most approved
methods.
No. 1.—The impurities of chloroform which may produce untoward effects are free
acid, free chlorine. These, however, always give rise to coughing, and assail the nose of the
administrator as well as the patient. Chloroform, when left for long exposed, liberates noxious
fumes, and should in this case not be used; and chloroform, when given in a room heated
strongly by illuminating gas, also decomposes, and most pungent and irritating fumes are given
off, but only the utmost carelessness could fail to detect such a state of things. I think we
may take it that by far the greater number of cases of chloroform deaths occur in public institu-
tions, hospitals, &c., where the drug is in constant use and for several patients. We may fairly
say then that reason No. 1 accounts for but few cases.
No. 2.—Is probably a more common source of danger, and is one which is likely to be
still more prolific of evil if the belief gets abroad, as a daily paper expressed it after the first
authoritative statement, that the heart was unaffected by chloroform, that taking this
a n æ s t h e - t i c p o s s e s s e d n o m o r e d a n g e r t h a n t a k i n g a g l a s s o f w h i s k y - a n d - w a t e r . I f t h e c o n t e n t i o n o f t h o s e
who deny primary cardiac syncope as a possibility in chloroform narcosis be just, any method
which ensured due respiration and a percentage of chloroform below 4 per cent. must be
approved and be safe, unless the personal equation of the administrator coming in changes
the safety to danger by his failing to watch the respiration, &c.
No. 3.—Undoubtedly some methods are open to grave cavil, but by far the most com-
mon methods employed are the open method, riz., the use of lint or a towel, Skinner's mask or
Junker's apparatus, and these are not faulty in principle, although dangerous in that the
administrator may through heedlessness lessen or increase the strength of the anæsthetic to a
dangerous extent.
No. 4.—Chloroform kills, all admit, through respiratory paralysis; while observers are
divided as to whether it also ( α) allows death through reflex shock in a patient partly or wholly
under its influence, or (β )
d e s t r o y s l i f e b y d i r e c t a n d p r i m a r y h e a r t s y n c o p e . A d m i t t i n g o n l y
that extinction ensues through respiratory paralysis, one party affirm, and so far justly if we admit
their premisses, that the duties of the administrator are really free from anxiety; watch the
respiration, say they, and if it fails take your measures promptly—artificial respiration under-
taken before the heart has given out (secondary heart syncope) will lead to resuscitation. On the
other hand, those who contend that chloroform kills directly through the heart teach us a mourn-
ful story. Take the utmost care, use the most perfect method in the most approved and conscien-
tious fashion, watch for the inception of symptoms of danger and grapple promptly with the peril,
and yet in spite of all a certain number of the patients will die. Both will admit the danger
3 6