ANESTHESIA—KRANTZ 471 
transversely against a white background, no color is seen in either 
liquid.” 
CHLOROFORM 
When the news of this important discovery of ether bridged the 
Atlantic, James Simpson of Edinburgh, began an assiduous search for 
substances as good as, or perhaps better than, the American ethyl 
ether. It seems strange indeed that scientists in England did not pre- 
cede those in America in the use of ether because Michael Faraday, 
distinguished pupil of Sir Humphry Davy, was one of the first chem- 
ists to produce ether. Simpson’s experiments were fraught with many 
failures. Ether was better as a general anesthetic than most every 
substance that he and his associates tried. One day, as he was fum- 
bling through the papers on his desk, he found a vial of a colorless 
liquid which had been sent to him by the German apothecary, Justus 
von Liebig. And Simpson tried it—the liquid was chloroform. Sey- 
eral times did he anesthetize himself and his associates, Keith and 
Duncan, to unconsciousness with at least apparent impunity. It is 
recorded that immediately Simpson recommended the use of chloro- 
form to alleviate the pain of childbirth. To this the clergy of England 
objected. They contended that this pain was a penalty pronounced 
upon Eve for her transgression in the garden of Eden and in conse- 
quence all subsequent generations of women should endure it with 
patience and complacence. Simpson was a careful investigator, but 
also was astute at repartee. To this criticism he very aptly replied, 
“The Lord caused Adam to fall into a deep sleep before appropriating 
his rib; out of which he created Eve.” God administered the first 
anesthetic. Queen Victoria, that pioneer of English customs, broke 
the spell of superstition by permitting Simpson’s chloroform to be 
used in her seventh confinement. 
Chloroform is about five times more potent than ether as an anes- 
thetic. Itisalsomuch more toxic. The decline in the use of chloroform 
in general anesthesia is due to its striking toxic action upon the heart 
and liver. Ether does not exhibit this. Most deaths under chloroform 
anesthesia occur in the induction stages. The mechanism of the acute 
intoxication probably takes place in the following manner. Chloro- 
form stimulates the vagus centrally and slows the heart. Through the 
excitation of induction endogenous epinephrine stimulates the cardiac 
accelerator, thus the simultaneous effect of stimulation and depression 
of the heart rate produces fibrillation of the auricles and ventricles. 
In addition, chloroform is carried from the alveolar air to the left 
chambers of the heart in concentrations which are cardiotoxic. Before 
this has been diluted by the general circulation, cardiac stoppage is 
produced. The approximate mortality under chloroform anesthesia 
is of the order of magnitude in 1 in 2,500; with ether, 1 in 10,000. It 
619830—45——31 
