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three or four drachms having been poured on. While the patient was counting, and
when he had reached the number twenty-five, his face became at once pale and
blanched, the pupils suddenly widely dilated, and no pulse was felt at the wrist. The young
man was dead." In order to understand the cause of the young man's death, you
must consider Dr. Dunlop's account of it carefully, and remember that it is impossible to
make any patient (or animal) inhale concentrated chloroform vapour without any air, unless
you either cause him to gasp, by making him hold his breath or by asphyxiating him, or first
render him insensible. From Dr. Dunlop's statement it is clear that the young man was made
to count while the chloroform was held over his face on a towel. No surer method of making
him gasp could possibly have been devised. Try it yourselves without chloroform, and tell
me if counting and regular natural breathing are compatible. But with chloroform close to
the face, it is certain that if you try to count you must gasp after every number, or after every
few numbers. In fact, counting must lead to gasping much more quickly than holding the
breath, because the lungs are emptied by the process. You r emember a case which occurred
here the other day. When a patient was nearly under chloroform he suddenly began to try
to speak, and went on muttering "er—er—er—er—er" for a long time without taking a
breath. I told the student to remove the chloroform cap from his face, as the patient was
sure to gasp, and after a few seconds more the gasp came. Fresh air entered the lungs, and the
patient recommenced breathing regularly, and very soon went over; but if the cap had been
kept near this face, he would have inhaled a large dose of chloroform, and might have been
at once poisoned. Substitute counting for the noise our patient made, and you have the true
explanation of the cause of overdosing and death in Dr. Dunlop's case. Dr. Dunlop says no
disease was found in any of the young man's or g ans on post-mortem examination, and adds:
"Strange as it may seem, disease of valves, hypertrophy of walls, cardiac murmurs of all kinds
give no trouble during the administration of chloroform." According to this teaching, the
more healthy a man's heart is the more certain he is to be liable to sudden death from syncope
under chloroform; and if this is to become part of our belief, we shall soon have to refuse
chloroform to anybody who has not a diseased heart. This is on all fours with the text-book
teaching with reference to shock under chloroform. It is not the capital operations like
amputations which are said to be dangerous from shock under chloroform, but only the trivial
ones, like the operation for squint or for ingrowing toe-nail. In order, therefore, to make the
operation for squint safe under chloroform, the patient ought first to have his leg off! You
may believe me that there is no such thing as chloroform syncope, and that all deaths f r o m
chloroform are due without exception to over-dose. You never hear of syncope except in the
practice of those who do not know how to give chloroform with safety; and when once the
truth is accepted, as it must be eventually by the whole profession, chloroform syncope will
disappear into the region whence it came.
It is now time to ask what are the results of The Lancet's call for clinical experience.
I t s e e m s t o m e t h a t s u f f i c i e n t e v i d e n c e o f t h e m o s t c r u s h i n g k i n d h a s b e e n a c c u m u l a t e d i n
The Lancet for 1890 to show that if the chloroformist's whole attention is not directed to the
respiration, so as to keep it regular, deaths are inevitable. First, we have had the statistics of
Mr. Roger Williams (vide The Lancet, Feb. 8th, 1890), to show that one patient dies in