ON ANAESTHETICS 147 
breathing was proceeding freely. Knowing from what had gone before that 
those efforts were doing nothing for the respiratory function, and feeling that 
there was no time for discussion, I stepped out of my province so far as to seize 
the tongue myself and draw it forward, when a long and loudly stertorous in- 
spiration demonstrated the necessity for the interference. Had the delusive 
movements of the chest been trusted, it is probable that they might have con- 
tinued till the heart had become so enfeebled by the asphyxial state as to cause 
no perceptible pulse at the wrist ; and had death occurred under these circum- 
stances, the case would have been set down as one in which the circulation failed 
before the respiration. The administrator would thus have been absolved from 
all blame, and the fatal event would have been attributed to idiosyncrasy, or to 
any heart disease which might have been discovered on post mortem inspection. 
The very prevalent opinion that the pulse is the most important symptom 
in the administration of chloroform is certainly a most serious mistake. As 
a general rule, the safety of the patient will be most promoted by disregarding 
it altogether, so that the attention may be devoted exclusively to the breathing. 
The chance of the existence of heart disease may seem to make this practice 
dangerous, but having followed it myself with increasing confidence for the 
last eight years, and knowing that it has been pursued all along by Mr. Syme, 
who has also acted on the maxim that every case for operation is a case for 
chloroform, and must, therefore, have given it to very many patients in whom 
cardiac disorder existed unknown to him, besides some in whom its presence 
had been ascertained, I feel no hesitation in recommending it. Even when 
serious disease of the heart is known to exist, it must be remembered that there is 
much less risk of syncope than of obstruction to the respiration; and while 
the latter will demand and repay immediate attention, the former, should it 
by any chance occur, being in all probability independent of any excess of 
chloroform, would not imperatively demand its discontinuance ; nor would it 
be much influenced by treatment, supposing the patient to be already in the 
horizontal posture, which is generally considered safest in all cases when chloro- 
form is given. 
From these considerations it appears that preliminary examination of the 
chest, often considered indispensable, is quite unnecessary, and more likely to 
induce the dreaded syncope, by alarming the patient, than to avert it. 
* From the views expressed in the text regarding the relation of syncope to the administration 
of chloroform, it might be inferred that no great danger would be incurred by giving it in the sitting 
posture when circumstances particularly require it; and accordingly Dr. Snow informs us that he 
has done this on several occasions without any bad result. But considering the possibility of an over- 
dose, and the feebleness of the heart which that seems to entail, it is no doubt wisest, as a general rule, 
to have the patient reclining. Dentists, it is true, give chloroform in the sitting posture; but, so far 
as I have seen, they do not carry the administration beyond a slight degree, sufficient to deaden sensa- 
tion without affecting reflex action, dexterously managing to open the mouth and operate upon it 
while the muscles of the jaws are rigid. 
L2 
