ON ANAESTHETICS 137 
has overthrown the old rule of deferring amputation in cases of injury till the 
patient has recovered from the state of collapse, thus shortening the period 
of mischief to the system from the presence of the mangled limb, and in extreme 
cases sometimes saving life where it would be hopeless to wait for returning 
consciousness. Indeed, an amputation performed under chloroform has often 
the effect of improving instead of lowering the pulse. 
The most striking instance of this that has fallen under my notice occurred 
in a labourer, whose right arm and thigh had been destroyed by a railway acci- 
dent, just enough sound tissue being left to admit of amputation through the 
hip and shoulder joints, which was accordingly performed as a forlorn hope 
by the surgeon in charge of the case. The vital powers being in a state of 
extreme depression, it is probable that without chloroform this severe measure 
would have killed him outright, but by help of the anaesthetic it was followed 
by marked improvement of the pulse, which continued for some hours, so as 
to lead us to entertain hopes of his recovery. 
Faintness during the operation, a species of shock, is also got rid of by 
chloroform ; and this, besides its obvious convenience, has the advantage of 
lessening the chance of secondary haemorrhage ; for the vessels which require 
ligature declare themselves as such by bleeding, instead of deceptively eluding 
observation in consequence of the feebleness of the heart and the general arterial 
contraction which coexist in the state of syncope. 
The welfare of the patient is besides greatly promoted by the mental tran- 
quillity arising from the prospect of immunity from suffering, which also induces 
persons to submit much more readily to the necessary operations, and often to 
undergo without hesitation treatment which was formerly impracticable because 
intolerable. 
Such being the great benefits conferred by this agent, it is melancholy to 
reflect that in many parts of Europe, and even of the United Kingdom, it is 
either withheld altogether or given so scantily as to be nearly useless. This 
arises from fear, inspired by several fatal cases that have occurred. But when 
I state that Mr. Syme has given chloroform about five thousand times without 
ever meeting with a death, and that Sir J. Simpson’s experience, also very 
extensive, has, so far as I am aware, been equally satisfactory, it is clear that it 
may be used so as to be practically free from any risk whatever. 
How then are the fatal cases to be accounted for? Heart disease has 
been supposed to be a common cause of them; and it is a prevalent opinion 
that it is highly dangerous to administer chloroform to persons affected with 
cardiac disorder. 
It happens that the only death I ever witnessed under chloroform occurred 
in a person whose heart proved, on examination, to be extensively affected 
