237
secondary syncope". It is evidenced by pallor of the face and other symptoms, to which
Mr. Battle and Mr. Hewett referred in their letters to THE LANCET of Feb. 22nd and March
1st, 1890.
5. The Commission discovered gradually ( vide Experiment 148) that it is possible to
give chloroform in such a way that full anæsthesia is produced, with a gradual fall of blood-
pressure, unaccompanied by any irregularity of the heart or circulation. The Commission found
that the way to do this was to ensure natural and regular respiration, without struggling,
holding the breath, or asphyxia, or any interference with the breathing. It became evident
in the course of the experiments that it was difficult, if not impossible, to make any animal
inhale unduly strong chloroform vapour without previously making it hold its breath, asphyx-
-iating it, or making it insensible. When an inhaler saturated with chloroform is held too
close to the mouth and nose an animal holds its breath: and in many animals, especially the
rabbit or the goat, holding the breath stimulates the vagus and at once slows the heart and
retards the circulation.
6. The experiments of the Commission proved that death from chloroform is
i n v a r i - a b l y d u e t o a n o v e r - d o s e ; a n d t h e q u e s t i o n w h i c h n e x ta
r o s e w a s ,
a r e t h e r e a n y
circum-
stances which make chloroform inhalations dangerous, and, as it were, open the door to an
overdose, or make the action of the drug appear capricious?
7. It is fully demonstrated by the experiments of the Commission that struggling
holding the breath, any form of asphyxia, or any kind of interference with the breathing are
dangerous in chloroform administration. Obviously either complete asphyxia or continuous
holding of the breath, if this were possible, would be sure preventives of poisoning by chloro--
form; but the danger in such conditions is due to the fact that they must alternate with
extra vigorous and deep respiration. Struggling makes the inhalation of chloroform dangerous,
because it either partially asphyxiates the patient, or alternately does this and accelerates the
respiration and circulation, so increasing the amount of chloroform inhaled and ha stening
t h e
rapidity with which the chloroform is conveyed to the brain and nerve-centres. Holding the
breath causes asphyxia, and asphyxia produced in this or in any other manner poisons and
stimulates the respiratory centre, and, on the o n e h a n d ,
m a k e s i t e x t r e m e l y o b n o x i o u st
o
paralysis by chloroform; while, on the other, it leads to gasping and deep inspirations, by
which an over-dose is very soon taken in. The rapidity of chloroform poisoning when asphyxia
is produced is much the same as it would be if you threw a man into a pond, and held a chloro-
form inhaler over his head every time h e came to the surface to take a breath. This is exactly
what a timid or badlyt a u g h t
o p e r a t o r o f t e n d o e s . H e m e a s u r e s h i sc
h l o r o f o r m a n d p o u r s
it into a patent inhaler, which he then applies to the patient's face. The patient, holds his
breath and becomes deadly pale, while his vagus slows the heart and circulation. P r e s e n t l y
the patient takes a deep gasp, and as soon as the chest begins to move, the chloroformist
thinks there is no danger and replaces the inhaler on his face, too probably adding another
d o s e o f c h l o r o f o r m a s h e d o e s s o .T
h e p a t i e n t ' s n a t u r a l p r o t e c t i v e m e a n s b e i n ge
x h a u s t e d , h e
very quickly absorbs a fatal dose of chloroform, and we are subsequently told that his heart
failed, that he afterwards gasped two or three times and then died. No care in measuring