CHLOROFORM IN USE 573 



under at i per cent, is not likely to get an overdose (at least, 

 in the first hour of anaesthesia) ; while, if it is necessary to go 

 up to 3 per cent, for induction, the anaesthetist knows that 

 this is a percentage that may easily become dangerous, and is 

 proportionately careful. There is, therefore, no place left for 

 11 accidental " deaths by this method. 



But even with this great advantage it must not be thought 

 that the anaesthetist can ever relax his vigilance. A percentage 

 that is "safe" at one time may very easily cease to be so at a 

 later stage, or in a different patient. The study of individual 

 variations will serve to put the anaesthetist on his guard and 

 give him some idea of what percentage to use, but can at 

 present do little more. 



One thing is, however, very clear. Any haste in the induc- 

 tion of anaesthesia is fraught with especial danger by any 

 method. It is only safe to go as high as 3 per cent, if this is' 

 done very gradually, and this gives anaesthesia in from seven 

 to ten minutes. What, then, can be said about the induction 

 of anaesthesia in five minutes? Obviously a higher percentage 

 must be used, and used rapidly ; and if the patient, under these 

 conditions, escapes with his life, it is more than the anaesthetist 

 has any right to expect. Embley's motto, "Take time to put 

 the patient under," should be painted in letters of gold on the 

 walls of each anaesthetising-room. In short, if there is any 

 reason for haste, chloroform should not be used at all. 



In bringing this paper to a conclusion, I may be perhaps 

 allowed to add a personal note. A research of this kind can 

 only be brought to a successful issue by the kind co-operation 

 of others, and 1 feel that I owe to the help and advice of my 

 colleagues at St. Mary's Hospital more than can be expressed 

 in the usual formal acknowledgment of thanks. 



Literature 



(1) Snow, On Chloroform and other Anaesthetics, London, 1858. 



(2) Cushnv, Ueber Chloroform- und ^thernarkose, Zeitsch.f. Biologie, Bd. xxviii. 



1891, p. 365. See also Lancet, March 14, i89i,p. 593. 



(3) Kionka and Kronig, Mischnarkosen mit genauer Doserning der Dampf- 



concentration, Archiv.f. Klin. Chir. Bd. lxxv. p. 1. 



(4) Vernon-Harcourt, {a) Proc. Roy. Soc. vol. lxx. 1903, p. 504. 



{b) On a Chloroform Regulator, Brit. Med.Journ. July 18, 1903, p. cxliii. 

 (c) CHC1, Committee Report, idem. July 14, 1906, p. 83. 



