ON ANAESTHETICS 157 
chloroform), occurs some hours later from bronchitis. At any rate, there have 
been two such deaths from ether at the Leicester Infirmary during the last 
nine years, against two from chloroform in the same period. It is scarcely 
necessary to remark that a fatal event brought about in this manner, though 
less appalling, is as much a death from ether as if it occurred on the operating 
table. 
It would not be right, however, to look upon the close method as simply 
the open method deprived more or less of the risks attendant on chilling of the 
lungs. The close method is, as before remarked, a combination of partial 
asphyxia with etherization, and constitutes a new departure in anaesthesia 
which must be judged of independently. 
From experiments which have been performed upon some of the lower 
animals it has been inferred that there is an essential difference between ether 
and chloroform as regards their action upon the heart: that whereas chloro- 
form, after a brief period of stimulation, depresses it, ether for a long time fails 
to produce any lowering influence, or even acts as a persistent cardiac stimulant,! 
and this has been held to afford clear proof of the greater safety of ether. 
There can, however, be no doubt that any agent capable of producing 
anaesthesia must, if continued in operation for a considerable time, exercise 
a lowering effect upon the whole vital powers. Ether, moreover, has its own 
special risks. Its vapour has an irritating effect upon the air-passages, such 
as is not caused by chloroform. Hence it increases the bronchial secretion, 
and tends to produce asphyxial complications, so that even its warmest advo- 
cates do not advise its employment when the respiration is seriously embarrassed, 
as in chronic bronchitis or emphysema. But asphyxia, even when carried to 
a minor degree, has a depressing effect upon the circulation ; and accordingly 
on reading reports of death from ether, we often find it stated that the pulse 
and breathing ceased simultaneously. 
In the close method of administration, anaesthesia being only partly brought 
about by the ether, asphyxial complications due to the action of the ether fer se 
are necessarily less than in the open method. But, on the other hand, the 
partial asphyxia by which the action of the ether is supplemented in the former 
method, has a lowering effect upon the circulation. Hence a stimulating action 
of the ether upon the heart can by no means be reckoned on when this method 
is employed. On the contrary, the pulse may become, within a very short 
time, greatly reduced in force. This is illustrated by the instructions which 
accompany Mr. Clover’s smaller inhaler as supplied by Messrs. Krohne and 
1 See Report of a Committee of the Medico-Chirurgical Society, Med.-Chiy. Trans., vol. xlvii, 
1864, P. 335- 
