160 ON ‘ANAESTHETICS 
chloroform, not to a specialist or to a person of very large experience, but to 
a succession of senior students, changing from month to month, whose only 
qualification for the duty is that they must previously have served the office 
of dresser, and that they strictly carry out certain simple instructions, among 
which is that of never touching the pulse, in order that their attention may not 
be distracted from the respiration. I have also systematically abstained from 
making any preliminary examination of the heart, thus avoiding needless alarm, 
which we know to have been the cause of some fatal events both with chloroform 
and with ether.t. Such has been my practice since IJ first obtained the office 
of full surgeon to a large hospital twenty-one years ago, and I have never had 
reason to regret it. 
During this long period I have often operated upon patients known to be 
affected with disease of the heart, and among the rest there must necessarily 
have been included many affected with fatty degeneration of its muscular 
fibres, which is regarded as the most formidable condition with reference to 
chloroform. 
It happened not long ago that an elderly lady, whose mamma I removed 
for scirrhus, died a few days after the operation from the singular complication 
of perforation of the duodenum by an ulcer caused apparently by the irritation 
of gall-stones. She had taken the chloroform quite well, but I found on post 
mortem examination that the heart was affected with as extreme a degree of 
fatty degeneration and at the same time thinning of the ventricular walls as 
I could well imagine to be consistent with the maintenance of the circulation. 
Such being my own experience, and well knowing how apt the adminis- 
trator is to fail to notice the insidious obstruction of the respiratory passages, 
I cannot help believing that in many of the cases reported in the journals where 
primary failure of the heart is stated to have occurred, mere respiratory move- 
ment without respiratory function has been mistaken for true breathing con- 
tinuing after cessation of the pulse. 
It is, alas! true that I can no longer speak of never having had in my own 
experience a death occasioned by chloroform. One unmistakable instance of 
this fearful calamity occurred lately in my private practice. But the circum- 
stances were such as seem to me to preclude the idea of syncope. They were 
as follows :—- 
A strong, healthy man, twenty-seven years of age, came under my care with 
a lumbar abscess unconnected with the vertebrae. I proposed to open it under 
chloroform, which was administered from a folded towel. The patient struggled 
rather more than usual during the administration, which had not been carried to 
+ For an instance of death from fright at the commencement of the inhalation of ether, see Brit. 
Med, Journ., November 17, 1877; case reported by Dr. Lowe, of Lincoln. 
