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it was proved that the respiration alone was attended to throughout the inhalation." This is
surely a mistake; there are several fatal cases where the respiration only was attended to, one
of which is quoted here, and there are many more in which respiration was attended to as fully
as possible.
Then reference is made to the teaching of what are termed antagonistic schools: Syme
taught—"We are guided as to the effect of the chloroform not by the circulation, but entirely
by the respiration." Erichsen teaches: "When fully anæsthetised the patient requires the
most careful watching by the person who administers the chloroform; his finger should never
be off the pulse, nor his eye taken away from the countenance of the patient."
Surgeon Lawrie considers these opinions "absolutely irreconcilable". They are
nothing of the kind. Erichsen's directions are only a little fuller and more complete than
Syme's, and not incompatible with his.
I do not know the wording of the earlier editions of Erichsen, but in recent ones
(edition of 1884, Vol. I., p. 24), in addition to the words quoted, it is stated, "The breathing
must be carefully observed." It is unlikely that it is not mentioned in some part of the
earlier editions, especially as Dr. Snow, with whose works Mr. Erichsen would no doubt be
familiar when writing the above, constantly emphasises the necessity for observing the state of
the respiration and in reference to this point says:—"The importance of attending to the res-
- p i r a t i o n o f t h e p a t i e n t h a s p r e v i o u s l y b e e n n o t i c e d , a n d i t i s s o o b v i o u s a s y m p t o m t h a t i t c a n
hardly be disregarded if any one is watching the patient; it speaks, moreover, almost to one's
instincts, as well as to one's medical knowledge." ("Snow on Anæsthetics," p. 258, 1888).
Apart from any action which chloroform may have on the heart itself, the experiments
made supply abundant reason for a careful observance of the pulse during the administration
of the drug, and it is surprising that this point has not been referred to in the Practical Con-
- c l u s i o n s . I t s o m i s s i o n l o o k s s u s p i c i o u s l y l i k e t h e r e s u l t o f p r e j u d i c e a g a i n s t i t .
In the report it is shown that the amount, of chloroform inhaled (the "intake") depends
upon the respiration, but that the effect of this ''intake," the way in which it is utilised, lies
with the circulation, with the force and rapidity of the pulse or the reverse.
It is shown that, with a slow pulse, concentrated chloroform vapour can be exhibited with
impunity, but with a full, bounding pulse, dilute chloroform vapour may be dangerous. These
variations occur in practice, from the quick full pulse of a patient with a high temperature to
the slow pulse of a patient with jaundice.
There have been fatal cases in man distinctly due to a non-consideration of these points.
[Case reported in British Medical Journal , 1887, Vol. II., p. 951, where ether was given first,
and then a small dose of chloroform proved fatal.] This is again illustrated in Experiment 177,
Section 34, where sudden quickening of the pulse, from cessation of vagus inhibition, suddenly
placed the animal in a condition of "extreme and unexpected jeopardy". Yet from some rea--
son, though stress is laid upon these points in the Report, they are omitted from the Practical