2o6 Transactions of the Canadian Institlte. [Vol. VII. 



when the pressure is low than when it is not so, why should it be that 

 all anaesthetists are agreed upon the danger of giving anaesthetics when 

 the patient is sitting up ? The answer I believe lies in the fact that most 

 deaths which occur in practice in the administration of chloroform are 

 not cases of poisoning from the drug but ar'e due to syncope resulting 

 either from the pain of an operation commenced too soon or from fear. A 

 close perusal of the Clinical Report of the Lancet leads one to the same 

 conclusion. Very many of the deaths which have occurred during the 

 administration of chloroform were not cases of poisoning at all, as the 

 dose was too small. The following cases summarised from this report 

 are probably examples of these. 



Series A, Case 3. — Fistula in ano, dose ^ dram on towel, anaes- 

 thesia incomplete, felt pain ; in one minute pulse failed. 



Case 28. — Extraction of tooth, sitting posture, 25 drops on sponge, 

 only 4 or 5 respirations, operation not begun, on being asked a question 

 answered in thick and trembling voice and stretched out her arms, face 

 became bluish, eyes haggard, head and arms fell, she was dead. 



Case 73. — For delirium tremens following a fracture, ^ dram on lint, 

 after 2 or 3 inspirations the man writhed and fell back dead, not under 

 influence. 



Series B, Case 56. — For removal of finger, 30 drops on lint, syncope. 



Case 105. — Castration, 15 to 20 drops on lint, pulse ceased. 



Case 285. — Reduction of dislocation, ^ dram, pupils dilated and 

 heart's action failed. 



Case 426. — Dressing sprain of ankle, a few drops, syncope. 



Sir J. Y. Simpson well remarked in this connection^ that, " All the 

 patients that die under the hand of the operator when chloroform is 

 used do not necessarily die from the effects of the chloroform upon the 

 constitution. In several of the recorded cases the dose given was too 

 small to have had any such fatal effect. Before the time that 

 anaesthetics came to be used deaths on the operating table often 

 occurred. Such cases have been recorded by Brodie, Cooper, Home, 

 Travers, etc., etc., but they excited no marked share of professional 



I Works of Sir J. Y. Simpson, p. 148. 



