igoo-i.] Observations on Blood Pressure. 207 



attention, as they were generally supposed to be accidents against which 

 no action could be of an\' use. Of late years and since chloroform has 

 been employed they have usually been directly and at once ascribed to 

 the deleterious action of chloroform." He then gives details of a num- 

 ber of cases of fatal syncope immediately before or during operations in 

 which chloroform had not been used. Here is one example, " A few 

 days after the discovery of chloroform, a case of hernia which had been 

 strangulated for a (ew hours was brought into the Infirmary, and Pro- 

 fessor Miller thought it a case demanding operative interfierence and one 

 in which chloroform should be tried ; but I could not be found in time 

 to give it, and the patient was operated on without an anaesthetic. Pro- 

 fessor Miller had only proceeded the length of dividing the skin when 

 the patient fainted and died with the operation unfinished. If the 

 chloroform had happened to be used and this fatal syncope had 

 occurred while the patient was under its action the whole career of the 

 new anaesthetic would have been at once arrested. Such cases teach 

 us at least that caution is required in our reasoning and inferences, 

 seeing death may occur and has occurred in operations without chloro- 

 form, and with phenomena quite similar to those ascribed to the action 

 of chloroform." The distinction between deaths from chloroform and 

 deaths simply occurring during the administration of chloroform is even 

 more important to-da\' than it was in Simpson's time. Nowadays so 

 many patients have a dread of chloroform that one would expect cases 

 of syncope to occur occasionally when patients are going under the 

 anaesthetic and are still conscious and afraid. R. Ballard' discusses 

 this point well and argues that children and dogs are less apt to be 

 afraid, and hence are less likely to suffer from syncope ; and the British 

 Medical Journal in an annotation suggests'-' that the reason why 

 parturient women are less apt to suffer from chloroform is that they do 

 not dread it. Snow^ mentioned several cases in which, although chloro- 

 form was administered, death was attributed by him to fright. In all 

 only a small quantity of chloroform had been given and that freely 

 diluted, and in every case great fear and apprehension were noted 

 before the administration. The fact that many deaths which occur 

 during the use of chloroform are not due to the use of the anaesthetic, 

 is further brought out by the recent Report of the Anaesthetic Com- 

 mittee of the British Medical Association. Out of eighteen cases of 

 death " under chloroform " they found that only three were due 

 entirely to the drug, four were chiefly due to it, and the remaining 



1 Lancet, 189S, Vol. I, p. 1,253. 



2 British Meilical Journal, 1900, Vol., p. 35. 



3 Treatise on Anaesthetics, 1858. 



