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(3) The comparative disadvantages between the two agents, and the best method
of securing the desired results.
(4) The treatment of accidents occurring during ether or chloroform anæsthesia.
In regard to the method in which anæstheties kill, my own teaching hitherto has been:
first, that although ether in moderate doses acts as a stimulant to the circulation, yet in over--
whelming amount, it is capable of depressing the heart, but that such depression of the heart
is always less than the depression of the respiration, and therefore ether kills always through
the respiration; secondly, that chloroform may produce death by paralysis of the respiratory
c e n t r e , o r b y a s i m u l t a n e o u s a r r e s t o f r e s p i r a t i o n a n d c i r c u l a t i o n , b u t t h a t p r i m a r y p a r a l y s i s o f
t he he a r t ma y oc c ur , a nd i s e s pe c i a l l y pr one t o do s o whe n t he c hl or of or m va pour ha s be e n
given in concentrated form.
I think that these views are in accord with general professional belief, but it has recent
-ly been alleged that they are at variance with experimental evidences, so that a re-examina--
tion is necessary. What then are the clinical facts?
If any credence is to be attached to the statements of competent witnesses, who have
recorded human deaths during anæsthesia it is certain that in some cases, under the influen
ce of chloroform, the pulse and respiration have ceased simultaneously: whilst in other instances
the respiration has failed before the pulse: and in still other cases the pulse has ceased its
beat before the respiratory movements were arrested.
Usually ether arrests respiration in men before it paralyses the heart, but the collec--
tion of records made by Dr.
J. Reeves certainly show that the fatal result may be produced
by syncope. Thus Dr. Ernest H. Jacobs, in a report of a fatal positively
pulse ceased, the breathing continued". It would seem that we must allow that ether in the
human subject may cause death in the same methods as does chloroform.
Such then are the clinical facts; or, in other words, such are the results of observations
made upon the human subject. What are the results of observations made upon animals
?
The general teaching in regard to chloroform has been recently challenged by
Dr. Lauder Brunton, who, as the result of 450 experiments made by himself upon the pariah
dogs of India, has reached the conclusion, as published in the London Lancet,
that however concentrated the chloroform may be, it never causes that death from sudden stoppa
ge of the heart. In the physiological laboratories of the University of Pennsylvania, for
some years, several hundred dogs have been used annually, and a very large proportion of
these dogs have been, at the end of an experiment, killed by chloroform. The observations of
Dr. Reichert, professor of Physiology in the University. Dr . Hobart Hare, Demonstrator o
f Therapeutics, and myself, have been concordant in showing that chloroform is a cardiac para--
lysant, and often does kill dogs by a direct action upon the heart or its contained ganglia. The
statements made concerning the Hyderabad Commission, however, led Dr. Hare and myself