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on Indian dogs and monkeys. To help The Lancet in its consideration of the question, how
to save people's lives? I desire to contribute some evidence on the other question, why and
how do some people die under the influence of chloroform?
During the last twenty years in conjunction with my colleague, Dr. Moore, as
one of the medico-legal examiners for the city of Glasgow, I have had exceptionally favour-
able opportunities of acquiring experience of the fatal results following chloroform administra-
tion. In these years there has been a considerable number of deaths of individuals while under
the influence of chloroform. The deaths which were made the subject of post-mortem examin-
ation, took place in the Royal and Western Infirmaries, in the hospital of the Barnhill Poor-
house, in the operating rooms of dentists and consulting-rooms and elsewhere of private practi-
tioners in the city and suburbs of Glasgow, within the county of Lanark. A careful study
of such details as are before me leads me to the conclusion considering the population , its
numbers and character under medical treatment, and subjected to chloroform,
the proportion
of fatal cases is very small, probably not more than from two and a-half to three per annum.
Within the last ten years the deaths under chloroform have b een more numerous than they
had been in the previous decade. There have been. however. at least eight or nine deaths
s i nce J anuar y 1s t , 1888, and of t hes e s even wer e t he s ubj ect of pos t - mor t em exami nat i on,
and in all, so far as I can learn, it was the respiration that was watched and not the pulse.
The respiration gave no signs or warning of approaching danger. It was noted that the fatal
results occurred in the young and middle-aged, not in children or very old men, and in females
as well as males. It was further noted that some forms of surgical procedure had some pecu-
liar influence in predisposing to a fatal result, as operations upon joints, not, however.
involving the use of the knife. Two individuals died whow e r e h a v i n g d i s l o c a t i o n s a tt
h e
shoulders reduced, one a dislocation at the elbow, and three breaking do wn adhe sions within
and about the knee-joint. In no single case was death attributable to nervous shock from
the operation having been begun or completed while the patient was not fully under the
influence of the anæsthetic. Some of the deaths which took place while th e
p a t i e n t s w e r e
under chloroform wwere not directly due to the poisonous effects of the drug itself, b ut to some
other cause. On e d e a t h w a s d u e t o a s p h y x i a f r o m v o m i t e d m a t t e r ( t r i p e ) o b s t r u c t i n g t h e a i r
passages. The help present was neither adequate nor skilled, and the men lost their heads.
Another was caused by the bursting of a small pouch (aneurysmal) in the brain, a third of an
aneurysmal pouch in the first part of the aorta, both deaths taking place in the early period
of the administration and while the patient was struggling. The deaths which are to be
distinctly charged against chloroform are, according to the
post-mortem appearances,
d i v i s i b l e i n t o
t w o d i s t i n c t c l a s s e s . I n
t h e o n e a n d l a r g e r c l a s s t h e a p p e a r a n c e s a r e t h o s eo
f d e a t h b y
asphyxia—death through the lungs. In the other and fortunately smaller class, the appear_
minces are those of death by syncope,—death through failure of the heart. The proportion
is one death from syncope to about twelve from asphyxia. I may
mention here that I think the
deaths from asphyxia ought to be to a large extent preventable. The deaths from syncope
are in most instances beyond the control of the highest, skill and the greatest care. In order
to make these observations somewhat cl ear er I ment i on t he f ol l owi ng:
-
In the deaths from asphyxia the right side of the heart was full of liquid blood, not dark
blood such as is present in asphyxia from drowning, but blood with a pinkish or magenta