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instituting a rough-and-ready comparison between chloroform and ether, when both are
administered by skilled persons employing good methods; and I am bound to say that ether,
whatever may be urged against it, has fewer deaths to account for than chloroform. It has
been said that chloroform kills at or during the operation, whereas ether kills afterwards. This
is not my experience. One's kind surgical friends usually keep one well informed of un-
toward results following or traceable to the anæsthetic, and yet I have not found ether after-
effects more severe or dangerous than those arising from chloroform. The subject of this
communication is the administration of chloroform, so that I will dismiss this ether digression,
and conclude by inquiring, Where does the above reasoning concerning chloroform leave us
? I s u b m i t t h e r e e x i s t s a c o n s i d e r a b l e b u l k o f d i r e c t e v i d e n c e p o i n t i n g t o t h e t r u t h o f t h e
existence of primary heart failure under chloroform, due to a distinct anatomical result of the
anæsthetic, and that disregard of the pulse must tend to induce the anæsthetist to overlook the
impending danger, while a careful watch over the colour and pulse, on the other hand, would
give timely warning for measures to be adopted which would stave off the peril. Respiration
must, of course, also be noted, as death may arrive through that channel. Skill and a lively
sense of responsibility, which is not fear of chloroform, will do much to lessen deaths from that
anæsthetic, but I submit the courage or recklessness begotten of a false sense of security must
only end in still further increasing the death-rate from chloroform, already unnecessarily high.
While thus contending that chloroform kills through the heart as well as the respiration,
I would not be understood in any way to deprecate its use and value in suitable cases. Because
we recognise its dangers it does not follow that those dangers assume an exaggerated appearance
indeed, the reverse effect is likely to obtain, especially if we at the same time learn how to
recognise and guard against them.
Mortimer-street, W.
ANNOTATION.
From "The Lancet," Dec. 27, 1890.
IN the course of his presidential address, delivered at the annual meeting of the South-
Western State Medical Society of Ohio, Dr. J. C. Reeve reviews with some care the expe-
rience of American surgeons concerning deaths under chloroform. Reports of such casualties
occurring in the States lead him to tabulate the following as causes of death:—(1) Sudden
death during the stage of struggling or excitement, and this form he finds to occur with alarm--
ing frequency. (2) Death from respiratory failure. (3) Death from cardiac paralysis, the heart
ceasing to beat while respiration goes on. (4) Death when respiration and circulation appear
to stop simultaneously. As to frequency, deaths from cardiac failure are said to he largely in
excess of those due to respiratory paralysis. Dr. Reeve criticises the results arrived at by the
Hyderabad Commission on the grounds that the number of their experiments was too small
when as good a record is extant as 1 death in 28,000 administrations, Confederate Army; 1 in
15,000 (Hunter McGuire). He adds that such records do not represent the true mortality, as
some hospitals show as high a rate as 1 death in 200 administrations. Dr. Reeve questions the
validity of arguments based upon experiments made upon the lower animals, pointing out that