CHLOROFORM A POISON 13 



than anything else to diminish the dangers of overdosage. Yet 

 it must always be remembered that no apparatus, however 

 accurate, can ever do away with the necessity of constantly 

 observing the condition of the patient. All that an apparatus 

 can accomplish is to remove one of the dangers of chloroform 

 anaesthesia. If the alternatives were either to watch the patient 

 or to use an apparatus, there can be no question but that the 

 former would be by far the safer course. Fortunately no such 

 alternatives exist, and it is possible to combine the use of an 

 apparatus with the most careful observation of the patient. 

 Nevertheless, from lack of such a warning as this it might well 

 happen that the use of an apparatus might become a source of 

 added danger rather than of increased safety. 



One may adopt the view that the same percentage of 

 chloroform in the lymph produces the same effect on all 

 patients, thus reducing idiosyncrasy to conditions which alter 

 the rate of absorption. Yet such an opinion, although receiving 

 considerable support from experiments on isolated nerves, is 

 of little practical value, for an apparatus can only tell us the 

 percentage of chloroform in the air inspired — no information is 

 given as to the percentage in the lymph. The varying relation- 

 ship between these two percentages thus becomes a matter of 

 great importance to the anaesthetist, and it is for this reason that 

 a study of the absorption of chloroform is of considerable value 

 as throwing light on all questions concerned with its admini- 

 stration. It is one of the objects of this paper to attempt to 

 investigate this subject in detail. 



During the actual administration of chloroform the percentage 

 in the lymph can only be gauged by the condition of the patient. 

 How, then, it may be asked, does an apparatus afford any 

 assistance to the anaesthetist? The answer to this question is 

 contained in the statement that if the percentage of chloroform 

 inhaled be known and kept at a value that experience has shown 

 to be legitimate, the condition of the patient can scarcely become 

 serious without ample signs of warning, whereas if the per- 

 centage of chloroform inhaled be unknown, the patient's condition 

 may suddenly become one of grave danger from overdosage of 

 the drug. In other words, the use of a graduated apparatus 

 renders sudden changes of a dangerous character in the patient 

 almost impossible. It is not the slow, but the sudden changes 

 that the anaesthetist has learnt to dread in chloroform anaesthesia. 



