138 ON ANAESTHETICS 
with fatty degeneration, such as would be regarded as sufficient explanation 
of sudden death under any circumstances. The particulars of this case, how- 
ever, presented peculiar features, which lead me to take a different view of the 
part played by the chloroform from what might at first be assumed. The 
patient was a man above the middle period of life, affected with cancer of the 
penis, for which amputation of the organ was to be performed. The gentleman 
in charge of the chloroform, considering the momentary nature of the operation, 
purposely abstained from giving it as fully as usual, and had removed the cloth 
containing it from the face before the operation was commenced. The surgeon 
now placed his finger on the patient’s wrist, and having ascertained that the 
pulse was good, at once effected the amputation almost instantaneously. I 
observed that the passage of the knife through the member was accompanied 
by a start of the patient’s body ; the bandage used to controi the bleeding was 
then removed, but no blood flowed from the arteries; he was found to have 
no pulse at the wrist ; in short, he was dead. From these facts we can hardly 
doubt that death was a consequence of the shock of the operation acting on 
a diseased heart ; and the only question is whether the circumstance that he 
had taken chloroform promoted that result. From the foregoing considerations 
such a thing seems altogether improbable, as we have seen that chloroform 
protects the heart from the effect of shock. The fact that the patient started 
proved that reflex action was not abolished in the voluntary muscles, and con- 
firmed the statement of the administrator that the chloroform was imperfectly 
given. My own impression is, that 1f it had been pushed to the usual degree 
the fatal occurrence would have been averted. 
I have given this case in detail because I believe it may be regarded as 
typical of a considerable class in which death has taken place suddenly at the 
commencement of an operation with imperfect administration of chloroform, 
which stands to the fatal event in the relation of an accidental concomitant, or 
rather a preventive insufficiently used ?. 
A death essentially similar, though more obviously unconnected with 
chloroform, took place on the occasion when it was intended to have adminis- 
tered it for the first time in the Edinburgh Infirmary ; but Dr. Simpson being 
prevented from attending, the operation was commenced without the anaes- 
thetic, and the patient died suddenly immediately after the first incision. It 
has been often remarked that if the original intention had been carried out, 
chloroform would never have been heard of again in Edinburgh, but it is very 
likely that the man might then have lived to testify to its benefits. 
There is another class of fatal cases in which the use of chloroform seems 
* An observation made several years ago by Mr. Bickersteth, of Liverpool, has an interesting bearing 
upon this class of cases. He noticed on three occasions in amputation of the thigh that the pulse stopped 
suddenly at the moment the knife entered the limb, but recovered itself in a few seconds. The patients 
were under the influence of chloroform ; but as Mr. Bickersteth never observed the same thing again, 
though he watched the pulse carefully at the same period in a great number of capital operations under 
chloroform, it seems probable that the anaesthetic was not administered to its full degree in those 
instances. (See Monthly Journal of Medical Science, September 1853.) 
