ON-ANAESTHETICS 139 
to have been simply a coincidence, the real cause of death being mental emotion, 
acting usually upon a disordered heart. 
Dr. Snow mentions a distinct example of this, where a mere profession of 
administering chloroform was made, and the patient died of fright ;! and I am 
able to give, from Edinburgh experience, an instance in which chloroform was 
still more remotely concerned. The late Dr. Richard Mackenzie, being called 
to see a gentleman who had fractured his radius, had some thought of employing 
chloroform in examining the arm, but, changing his mind, made the necessary 
manipulations without it. He then proceeded to leave the house, but had 
not got down the steps leading from the door when he was called back with the 
announcement that his patient had suddenly expired. 
Had chloroform been held near the face a few seconds before this occur- 
rence, it would certainly have been blamed, though with manifest unfairness 
and a similar injustice seems to have been committed with regard to several 
cases in which fatal syncope has taken place early in the administration of the 
anaesthetic, when the brief period of inhalation concurred with the symptoms 
in showing that the patient was little, if at all, under its influence. A fear of the 
chloroform itself seems to have been the exciting cause in some of these cases ; 
and one reason why no such instance has occurred in the Edinburgh Infirmary 
is probably the unlimited confidence reposed in this agent by the inmates of 
that institution. 
It might, perhaps, have been expected a priovt that chloroform, in the 
early or exciting stage of its operation, would act upon a diseased heart like 
mental emotion, and cause irregularity or cessation of its contractions. This, 
however, does not seem to be the case; and, judging from my own experience, 
I should say that it tends rather to remove intermission or irregularity of the 
pulse. On the whole I believe that chloroform, by preventing shock and mental 
effort during the operation as well as anxiety before it, is in reality a great source 
of safety in heart disease ; and that if a person with known cardiac affection 
decides to place himself in the hands of the surgeon, so far from being unsuited 
for the anaesthetic, he is before all others the man who stands most in need 
of its protecting influence. 
Nevertheless, even when the heart is perfectly healthy, it is quite possible 
to administer chloroform so as to produce a directly sedative and deadly influence 
upon the cardiac ganglia. This truth was deeply impressed upon me eight 
years ago by the following occurrence. 
An eminent London physician, desirous of making some experiments upon 
the heart, selected a young donkey for the purpose, and. “requested me to maintain 
artificial respiration, which was done by means of a large pair of bellows con- 
* Snow on Anaesthetics, p. 201. 
