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judged by the eye and the plan above mentioned, shows no alteration; that not only is
there evidence of general feebleness of circulation, which might be attributed to the fall of
blood-pressure, regarded by the Hyderabad Commission as protective, but that distinct and
unmistakable cardiac enfeeblement occurs. Further, this is progressive, and likely, it has
appeared to me in more than one case, to end in cardiac syncope unless prompt and vigorous
measures were used. Inversion, which undoubtedly would be highly prejudicial in chloroform,
danger due to respiratory paralysis or asphyxial conditions, proves highly efficacious in such
cases of cardiac and circulatory enfeeblement. In contending that a fall of blood-pressure is
protective, I think a most important factor has been left out of consideration. For granted
that such a fall leads to lessened intake of the narcotic vapour, it also determines a lessened
output of that which still circulates in the blood. Things being equal, I believe that chloroform
acts more harmfully upon poorly oxygenated blood and tissues, e.g., the anæmic, the cyanotic
those whose circulation is depreciated by fatty changes in their heart and other viscera, than upon
those better supplied with oxygen. On the other hand, cases present themselves when, from
the nature of the operation, the chloroforming is complicated by partial asphyxia! and these
offer a contrast in that their danger reveals itself in respiratory difficulty leading even to cessa-
-tion of breathing. I have found, however, that such cases responded readily to artificial res--
piration, and danger was over. Words give a poor idea of the contrast presented between
these two categories of cases, but one has only to be brought face to face with them to be con-
vinced that their difference is one of kind and not one of degree. Again, having once seen the
heart relax and dilate under chloroform, as in Professor Mac William's experiments, one recog-
nises the anatomical counterpart of the procession of events which one had encountered again
and again in the operating theatre. It would subserve no useful purpose to attempt to explain
the discrepancies which appear between the experiments undertaken by the Hyderabad Com-
mission and those of other observers, or to reconcile these results with those arrived at by the
daily observations—now hundreds of thousands in number—made by medical practitioners in
surgical cases, but it may be mentioned that it has been amply shown, by experience with the
lower animals and man, that the more highly organised and differentiated nervous systems are
more easily affected by reflex shock. Fainting caused by emotion, common in man, is not a
daily occurrence amnia dogs or monkeys.
It may be remarked that it is singular that Professor Mac William's dilatation was not
discovered by the Hyderabad Commission. The conditions, however, were wanting, for
their animals were permitted to die or get in extremis through respiratory difficulties so that
stress of the anæsthetic was made more evident in most cases quâ the respiration than quâ the
heart, although some of the cases must undoubtedly have revealed the condition had it been
sought. A further point noticeable about dogs is that they are peculiarly susceptible to respira-
tory failure under chloroform, and in performing physiological experiments upon them the
utmost care has to be used unless artificial respiration be employ e d to prevent death from
cessation of natural breathing.
Under the last heading I inquired what conclusions practical men must arrive at when
comparing chloroform with other anæsthetics, and here I will not press the point beyond