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very rare for the blood-pressure to remain near the normal, and I have seen the blood-pressure
begin to fall in the very first stages of ether anæsthesia; moreover, in at least two experiments,
death occurred from syncope, the respiration continuing for one or two minutes after the com-
plete cessation of the circulation. In experiment in which the fall of blood-pressure was
most pronounced, and the arrest of the heart most complete, the dog was sick from the mange,
and it is possible that the weakened heart was more susceptible than is the normal heart to the
depressing influence of ether.
So far, then, as concerns the method in which ether and chloroform kill, I claim most
urgently that there is no contradiction between the results as obtained by the bedside and in
th e physiological laboratories, and that a complete broad study of the clinical and experimental
evidence leads to one conclusion, namely, that chloroform and ether are capable of paralysing
the respiration and the circulation; that in some cases one f u n c t i o n , i n o t h e r c a s e s t h e o t h e r
function, is primarily arrested, but that ether is less prone to produce a primary arrest of the
heart than is chloroform.
In the discussion of the second point which I have raised, namely, as to the comparative
fatality attending the use of ether and chloroform, I shall not occupy time with any elaborate
setting forth of the clinical evidence. In regard to the number of recorded deaths, I shall
content myself with accepting the latest statistics at hand, n
amely, those collected by Dr.
Lawrence Turnbull, who has found 375 deaths reported from chloroform, and 52 from ether.
I do not believe that these figures nearly represent the total mortality; I doubt very much
whether one-third of the deaths from anæsthesia are reported: certainly not one-third of the
cases I have had personal knowledge of having been publicly recorded. Moreover, the
pressure to conceal deaths from chloroform is greater than when the lethal result is due to
ether. The surgeon who uses ether feels that he has employed the safest anæsthetic, and
that he will receive no blame if a dea th occurs from it, and feels also that he has a rare case to
put on record
, which will give his own name permanent place in anæsthetic literature; where-
as the surgeon who uses chloroform knows that if d
eath occur from the
anæsthetic, a very large
proportion of the profession, at least in the united States, will condemn him either in public
or in secret for the use of this drug, and that he will be fortunate if he escape being publicly condemned by a coronor's jury. Moreover deaths from chloroform are only too common, so
that the surgeon has nothing to gain much to lose by publication of a chloroform death, and, if
possessed of the average human nature holds his peace.
It seems to me impossible to get at the
exact number of anæsthetic deaths or the proper-
tionate fatality of ether and chloroform. Byman considers that in regard to chloroform, the
ratio of deaths to inhalations is 1 in 5,860; Richardson affirms that it is 1 in 2,500 to 3,000;
Andrews puts it for ether at 1 in 23,204; and Lyman at 1 in 16,542.
Without claiming strict accuracy for any of these figures, I think that it can be assert-
ed that the probable ratio of deaths from chloroform is three to f ive times that of deaths from
ether.
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