ON ANAESTHETICS 161 
the degree of producing muscular relaxation when he began to make a spurious 
snoring or snorting noise, which is generally a sure indication that the patient 
requires more chloroform. Mr. Watson Cheyne, who was giving the chloroform 
for me, had, however, removed the cloth from the face, and I was about to 
remark that this was an unnecessary precaution, when the patient fell into 
a sort of epileptiform condition, attended with a state of spasm of the respiratory 
muscles and wide dilatation of the pupils, while the face was deeply livid. As 
no respiratory movements were going on, I had him drawn up on the table 
so as to make the head dependent, and commenced artificial respiration, while 
the tongue was drawn forward with artery forceps. The chest, however, seemed 
fixed in the state of expiration, so that compression of the thorax caused no 
escape of air, while the drawing up of the arms equally failed to cause the en- 
trance of any. I have frequently performed artificial respiration, but never 
before met with such a state of things. Cold water was dashed upon the chest 
and abdomen, and, whether as a consequence of this or not, two spasmodic 
acts of inspiration took place, separated by a considerable interval. I opened 
the trachea, but in the condition of the thoracic walls which I have described, 
this procedure was in itself completely futile. Some little time having been 
lost in vain attempts at artificial respiration, I passed down the trachea from the 
wound a piece of wide india-rubber tubing several inches long, and by blowing 
into this succeeded in inflating the lungs, as was indicated by rising of the 
abdomen and very slight elevation of the ribs, and I continued artificial respiration 
in this way for about half an hour in vain. The pulse had been observed to be 
good just before the occurrence of the alarming symptoms. What its condition 
was during their presence we were too much occupied to ascertain ; but the great 
lividity of the face, and indeed of the whole body, clearly indicated that the heart 
continued to drive imperfectly oxygenated blood through the vessels long after 
the respiration had been arrested by muscular spasm. We obtained permission 
to examine the heart twenty-four hours after death, and found its muscular 
substance abundant and healthy, and its valves all competent. With the 
exception of some spots of slight opacity on the mitral valve, it was a thoroughly 
healthy heart. Its cavities contained fluid blood; and this escaping on the 
removal of the organ from the body, the relative amount in the cavities of the 
two sides was not ascertained. I afterwards learned that the patient had been 
in a state of extreme terror at the prospect of taking chloroform ; and I suspect 
that this may have been the cause that determined the occurrence of the strange 
state of nervous excitement which proved fatal to him. By a curious coin- 
cidence it happened that the medical man who recommended this patient to 
my care, on learning of our disaster, wrote to me stating that a short time pre- 
viously he had met with a very similar state of epileptiform spasm of the 
respiratory muscles in a man in whom he was examining a simple fracture 
without chloroform. It lasted so long that my friend considered that it was 
on the verge of proving fatal. Of course in my case the chloroform was the 
cause of the fatal event, but my impression is that it would have been as likely 
to happen under any other anaesthetic. 
Quite recently the subject of the different effects produced by an anaesthetic, 
according to the proportion which it bears to the air in which it is diffused, has 
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