215
quence of failure of the pulse having been taken to mean that the heart has "suddenly ceased."
I am here only referring to those cases in which chloroform would seem to have been the
cause of death ; and in such cases, which are usually rapid in their course, I do not think the
c l i n c i a l e v i d e n c e w e p o s s e s s i s s u f f i c i e n t t o d i s p r o v e t h e c o n t e n t i o n s o f t h e C o m m i s s i o n . B u t
this, I submit, is the least important part of the subject. Even though we admit the fact that,
when chloroform itself is the direct cause of death. respiration ceases before the action of the
heart, we are confronted by question which seems to me far more important than that upon
which the Commission has laid so much stress. When fatalities occur during the administra
-
tion of chloroform, are those fatalities invariably caused by the direct toxic effects of the drug?
In other words, have we not conclusive evidence to show that, in man, deaths under chloro-
form sometimes arise by reflex cardiac failure which is only indirectly due to the anæsthetic ?
I cannot regard the experiments of the Commission in this direction as rendering such a posi
-
tion untenable ; for cases have come under my own observation in which symptoms of cardiac
depression obviously of reflex origin have arisen. Whether it be the low vascular tension of
chloroform narcosis or other conditions I know not : but I feel sure that there is something
that renders the human heart under chloroform susceptible to impulses which are utterly inopera-
tive under ether. I am inclined to the belief .that that the performance of
m a n y o p e r a t i o n s u n d e r
c h l o r o f o r m i s a t t e n d e d b y c o n s i d e r a b l e r i s k f r o m t h i s q u a r t e r : a n d I a m b y n o m e a n s s a t i s f i e d
that cardiac inhibition is less likely to be produeed during profound than during imperfect
a n æ s t h e s i a u n d e r c h l o r o f o r m . N o t l o n g a g o I a d m i n i s t e r e d c h l o r o f o r m s , b y m e a n s o f J u n k e r ' s
apparatus, to a patient of about thirty-live years of age, whose general health was good. Amæs-
thesia was produced in from eight to ten minutes, and was characterised by muscular flaccidity
abolition of lid-reflex, and slight stertor. Thew were two stages in the operation about to
b
performed. the first of which consisted ill plaeing a temporary ligature round the carotid artery
in the neck. Whilst the artery was being exposed for this purpose the pulse became extremely
feeble, the face pale, and respiration shallow, and the operator had some difficulty in recognis
-
ing the carotid artery by reason of its extraordinary diminution in size. The head was lowered.
After three or four compressions of the chest the pulse improved, and, as rigidity and lid-reflex
soon reappeared, I was obliged to continue the administration, having recourse to e t h e r f o r t h e
remainder of the operation, which was successfully performed. The day after the operation,
whilst the wound over the carotid was being examined, the patient's face suddenly bec
a m e
p a l e , t h e a r t e r y c o n t r a c t e d a s o n t h e p r e v i o u s o c c a s i n , t h e e y e s w e r e o b s e r v e d t o t u r n u p w a r d s
and the museles of the jaw to twitch , and for a few seconds unconsciousness was present. Now
in this case, when the first attack of syncope occurred, the patient was thoroughly anæsthetised
by chloroform ; whilst the quick return of muscular rigidity and of lid-reflex proves that the
anæsthetie was in no way to blame aa ad i r e c t
c a u s e o f t h e s y m p t o m s . C a s e s o f t h i s k i n d
a r e , I
believe, by no means uncommon, and they would seem to point to the conclusion that reflex s
y n -
cope may undoubtedly arise under chloroform even when the anæthesia is profound. Apart
from anæthetics, some persons are, as is well known, more prone to syncope than others, an
d
this would seem to be so with regard to patients under chloroform. How can we compare the
patient above referred to, to the pariah dog ? Would t h e
l a t t e r
be likely to be attacked with
syncope by manipulating its carotid ? I gather from the report of the Commission that
syncope, should it arise, is a safeguard against chloroform poisoning rather than a condition