166 ON ANAESTHETICS 
But there is reason to believe that other important advantages will be 
gained by more uniform administration. It would appear that there are serious 
objections to allowing the patient to recover from time to time from the effects 
of the chloroform. Dr. Kirk of Glasgow made, several years ago, some inter- 
esting observations bearing on this subject, which have not yet been published, 
but which he kindly allows me to refer to. He found that if a cat was placed 
in a jar containing an anaesthetic mixture of chloroform with air, and removed 
when it was only partially anaesthetized, and at once examined with the stetho- 
scope, the pulse always made a sudden and considerable rise from the depression 
which the chloroform occasioned, and not unfrequently this rise was followed 
by a complete suspension of audible cardiac pulsations, lasting it might be for 
an entire minute. If, however, the animal was retained in the jar till complete 
anaesthesia was effected, such suspension of pulsation was never observed. 
I am not aware that anything exactly corresponding has been observed in the 
human subject. But I have often seen great pallor precede vomiting under 
chloroform, and it seems probable that this vomiting, and the depression 
which accompanies it, have been due to the fitful way in which we have been 
in the habit of giving chloroform with the folded towel. For Dr. Kirk, who 
has paid great attention to this subject, informs me that he has never seen 
vomiting occur under chloroform except during recovery from the anaesthesia. 
And this experience is strikingly confirmed by Mr. Meredith, of the Samaritan 
Hospital, who tells me that he avoids vomiting during ovariotomy by giving 
chloroform with Junker’s inhaler, in which air is driven by Richardson’s hand- 
bellows through a bottle of the liquid, and thence into a vulcanite mask over 
the mouth and nose, where it mixes freely with pure atmospheric air inhaled 
through a valve in the mask. In this way the chloroform is given in a mild 
and very uniform manner till the patient is fully anaesthetized, and afterwards 
any approach to recovery is anticipated by the occasional use of the bellows. 
And not only is vomiting prevented during the operation, but the further highly 
satisfactory result is obtained that the patient is not affected to any material 
extent with the after-sickness which formerly proved so serious in ovariotomy, 
and induced Dr. Keith to abandon chloroform in favour of ether. 
Vomiting under anaesthesia is a serious matter, requiring prompt attention 
in the way of turning the head well to one side, in order to avoid the risk of 
vomited matter passing into the larynx. Ether seems more liable to cause 
vomiting during actual anaesthesia than chloroform, and several of the deaths 
under ether which have been published have been from this cause. But after- 
sickness appears to be much more frequent and more distressing with chloroform 
administered by means of a folded towel than with ether ; and it will be a great 
