142 ON ANAESTHETICS 
there can be no mistake about the manner of using the cloth, which is also 
always at hand under all circumstances. 
The theory of syncope from too great strength of the anaesthetic vapour 
when the cloth is employed being erroneous, the greater number of the deaths 
still remain unaccounted for; and, if we except a very few instances for which 
we seem to have nothing to fall back upon but an idiosyncrasy so rare that 
it may practically be left out of consideration altogether, their explanation 
will, I believe, be found in an overdose of this potent narcotic from too long 
continued administration. 
This is what might be expected from a general view of the statistics. Were 
we to ask ourselves in what sort of operations we should have anticipated most 
frequent deaths during the employment of chloroform, we should say in those 
which are likely to inspire great dread on account of their magnitude and 
severity, and to cause great shock and great haemorrhage. More especially 
should these preponderate among fatal cases in general hospitals, where serious 
operations constitute the majority of those performed. The reverse of this, 
however, is what we actually find. Of the whole number of cases recorded 
by Dr. Snow in 1858, as due to the use of chloroform throughout the world 
during ten years, nine only occurred in any considerable surgical procedure 
at a general hospital; remarkably few, considering the enormous number of 
important operations that must have been performed during so long a period, 
and the variety in the qualifications of those who administered the chloroform. 
On the other hand, fourteen took place at similar institutions in connexion 
with the most trivial matters, such as the removal of a toe-nail, the amputation 
of a finger, the passing of a catheter, or the cauterizing of a wart. The only 
rational explanation of this seems to be, that when some great operation is 
to be performed, like the amputation of a thigh or the removal of a stone from 
the bladder, plenty of well-qualified assistants are present, and each of them, 
including the giver of the chloroform, is duly impressed with the importance 
of his office, and bestows the requisite pains upon it. But when some trifle 
is to be done, the whole affair is apt to be regarded too lightly, and the adminis- 
tration of the anaesthetic is perhaps confided to some unsuitable person, who 
also allows his attention to be distracted by other matters. This conclusion 
is entirely in accordance with my own experience, which, while it has convinced 
me more and more of the safety of chloroform if properly given, has impressed 
me deeply with the necessity for more vigilant care in its employment than is 
sometimes apt to be bestowed. 
But an overdose of chloroform may be caused by attention misapplied, 
as well as by want of attention. The requisites for safety in using it will be 
