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dose is at once conveyed to the nerve centres". This ingenious view has much to support
it, and we think that much credit is due to the Hyderabad Commission for its sugges-
tion, as it undoubtedly explains the beneficial action of atropine as an adjunct to chloroform
administration. We would remark, however, that in our opinion the Hyderabad Commis-
sion attach too much importance to it, and that it does not account for the facts in each case.
For example, we observed in one case, after stoppage of respiration, while the heart continued
beating, that respiration was spontaneously resumed; and we suppose that by the cessation
of respiration, less chloroform was taken into the blood, so that in a short time the respiratory
centre recovered. In this case the heart was pulsating vigorously after stoppage of respiration,
but as the chloroform in the air-passages was taken up and quickly eliminated and decomposed
in the blood, the respiratory centres recovered. When, however, they recovered, breathing
recommenced, more chloroform was introduced, and again there was danger to the respiratory
centres and to the h e a r t . C h l o r o f o r m , n o d o u b t , i s t a k e n f r o m t h e p u l m o n a r y a i r - c e l l s b y
diffusion, and this will be facilitated by inspiration. possibly by expiration; at all events, the
rapidity of absorption will not be the same when the pulmonary aircells are quiescent as
when they are expanding and contracting in inspiration and expiration. Thus the movements
of respiration will affect the amount of chloroform absorbed, and if, respiration becomes
feeble, or even ceases, less chloroform will be taken up and time may be allowed for both the
respiratory centres and the heart to recover. Thus the number and volume of the respiratory
movements affect the quantity of chloroform absorbed and the number and volume of the
heart beats affect the quantity of chloroform sent to the nerve centres. It is clear, therefore,
that the problem is more complicated than as stated by the Hyderabad Commission, and that
the physiological action will depend on so many factors as to make it extremely unlikely that
the course of events will be the same in each case. Thus we have (1) the condition of greater
or less asphyxia, as effected by the quantity of air mixed with the chloroform vapour; (2) the
occurrence of any inhibition of the vagus, as affecting the number and volume of the heart
beats, and thus the amount of chloroform reaching the nervous centres; the number and
amplitude of the respiratory movements, as affecting the amount of chloroform absorbed into
the blood; (4) as we hold, the specific action of chloroform on the muscular structure and
intrinsic nervous mechanism in the heart: and (5) the influence on the vaso-motor centre, as a
factor in producing the great fall in blood-pressure. We think the Hyderabad Commission
attach too much importance to one common mode of death, failure of the respiratory centres;
and while we agree generally with their conclusions, which in many respects are similar to
our own.
we consider it unwise and unsafe in practice to pay no attention to the state of the
circulation, and to observe respiration alone. We also consider it unwise to convey to the
public, even through the profession, the notion that the administration of chloroform is a pro-
-ceeding in which there is practically no danger. At the same time, we thankfully admit that
the number of deaths following the use of so potent an agent has been remarkably small, even
in the hands of those who pay little or no attention to the condition of circulation. As a
matter of common prudence, and especially seeing that when respiration fails we can employ
artificial means for its restoration, while if the heart fails, little or nothing can be done to
avert a fatal issue, it is incumbent on every one giving chloroform to watch both the pulse
and the breathing.