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the inhalation whenever the breathing is irregular, and directly the patient is fully under the
influence of the anæsthetic. We never have trouble now from overdosing; you rarely see
respiratory embarrassment in my operations, and during the last year, since the Commission
completed its work., we have not had a case in which stoppage of the respiration has occurred.
Professor Wood finds ether is as bad as chloroform in the laboratory. Clinically it does not
kill so many people, because it is not pushed so far. In many cases, partial anæsthesia is con-
sidered sufficient when ether is used. Professor Wood has found out also that atropine, caf-
feine, and alcohol are not beneficial in chloroform administration, and that digitalis is. He has
only to study our report and the vagus experiments to understand why. Anything which in-
creases the rapidity of the pulse increases the rapidity with which chloroform is conveyed to
the nerve centres, and if alcohol, or atropine, or caffeine does this they are bad. But alcohol
does not always increase the rapidity of the pulse. Very often if a patient is frightened a
small dose steadies and slows the pulse, and gives him confidence; and in so far as it does this,
a preliminary close of alcohol does good in operations under chloroform.
Before bringing this lecture to a close, I desire to call your attention to a paper by Dr.
James Dunlop in The Lancet of September 27th, 1890, as it has an important bearing on
Professor Wood's address. Dr. Dunlop's paper consists of observations on the administration
and dangers of anæsthetics, in reply to The Lancet's circular calling upon scientific medical
men throughout the world for information on the subject. Dr. Dunlop states that "the skilful
administration of the anæsthetic includes attention to the pulse, as well as watching the respira-
tion", and he gives numerous instances of death under chloroform from what he calls asphyxia
and syncope. Dr. Dunlop's paper emphasises the truth of what I have already stated with
regard to the worthlessness of Professor Wood's clinical facts, and it affords additional evidence
that if part of the chloroformist's attention is devoted to the pulse in chloroform administration,
deaths occur. It must be clearly understood what is meant by attention to the pulse in chloro-
form administration. Any surgeon who can give chloroform safely can keep his eye on the
pulse. Towards the end of long operations I often ask my students, just as Mr. Syme used to
ask me, "How's the pulse?" This is quite a different matter from watching the pulse for
signs of danger from the anæsthetic—which is both unnecessary and dangerous. It is unne-
cessary because no reliable information as to the effect of chloroform can be obtained from
the pulse, and it is dangerous because if ever the administration of chloroform is pushed
far enough to cause the pulse to show signs of failure of the heart, the limits of safety have
already been so far exceeded that a fatal result must almost inevitably ensue.
It is strange to find a surgeon of Dr. Dunlop's standing writing of deaths under chloro-
form occurring from asphyxia. The Hyderabad, Commission has pointed out that the only
danger of asphyxia, as of holding the breath, in chloroform administration, is that it makes
patients gasp and so take in an overdose with extreme rapidity. Dr. Dunlop asserts that
deaths from syncope occur early in the administration of chloroform. He says : "A small
quantity of concentrated vapour without any air administered to a nervous, timid patient has
proved fatal. A healthy florid-faced young man had chlorofrom administered to him
in private by a surgeon who had gained much experience of chloroforming in the
wards of the Royal Infirmary. The chloroform was administered on a folded towe"