158 ON ANAESTHETICS 
Sesemann, in which the following sentences will be found: ‘ If any interruption 
in the breathing occur, or 7 the pulse should be indistinct’ (the italics are mine), 
‘the face-piece need only be removed for one inspiration. The dark colour 
of the blood is a less reliable test of the need of air than the symptoms mentioned.’ 
We cannot, therefore, be surprised to find that occasionally death takes place 
under this method of administration by primary failure of the heart. 
In the British Medical Journal for July 15 of the present year Mr. Lawson Tait 
has put upon record what seems a perfectly clear example of such an occurrence. 
The patient, aged forty-five, was sent to Mr. Tait to be operated on for a large 
abdominal tumour. She was at first very anaemic and feeble, but improved 
in the hospital, so that it was decided to proceed to operation. She was placed 
under ether by means of Ormsby’s inhaler, but before complete anaesthesia 
had been produced, Mr. Tait, who was observing the pulse, noticed that it had 
disappeared. Meanwhile ‘ the breathing was perfectly regular and deep’. The 
inhaler was at once removed, but in spite of artificial respiration, with lowering 
of the head, the breathing rapidly failed. ‘ Death took place at the heart at 
least one minute before the respiration was interfered with.’ On post mortem 
examination the right side of the heart was found filled with clot, and the left 
side empty. The muscular substance was not distinctly diseased, but the 
organ was unusually small. 
As a matter of physiological theory, supposing the heart to be diseased, 
and therefore liable to have its rhythmical action suspended by comparatively 
trivial disturbing causes, we could well understand that the unusual labour 
thrown upon the right side of the organ by asphyxial impediment to the pul- 
monary circulation might prove extremely serious, even in spite of a stimulating 
action of the ether upon it. 
With regard to chloroform I fear some of the more recent experiments upon 
the lower animals have had an injurious practical tendency. Since the time 
of Dr. Snow we have understood that there is a most important difference in 
the effects of chloroform according to the proportions in which the vapour is 
mixed with the air inhaled: that when it is present in a concentrated form, 
it acts as a deadly sedative upon the heart, but that when largely diluted 
with the atmosphere, this effect is no longer observed, but if the agent is pushed 
far enough to cause death, the respiration probably fails before the circulation. 
Yet in the experiments conducted by the Committee of the British Medical 
Association appointed to inquire into this subject, the question of the proportion 
of the anaesthetic to the air seems to have been entirely neglected. Starting 
with the assumption that chloroform, from its depressing influence upon the 
heart, is more dangerous than ether, while ether is much less convenient for 
administration, the attention of the Committee was chiefly directed to an en- 
deavour to discover some agent intermediate between them in these respects ; 
