430 ONE or THE causes of death under CHLOllOrORM. 



teeth extracted. The following account of what occurred was 

 given by two female friends of hers who were present at the 

 operation : — " The respiratory movements appeared to be free ; 

 chest heaving. Whilst inhaling the face became pale. At the 

 expiration of about one minute the instruments were applied, 

 and four roots of teetli were extracted. The patient groaned, 

 and manifested what they regarded as evidences of pain while 

 the teeth were being extracted, although she did not speak or 

 exhibit any other sign of consciousness. As the last root came 

 out, which was about two minutes from the beoinnino; of the 

 inhalation, the patient's head turned to one side, the arms 

 became slightly rigid, and the body drawn somewhat backwards, 

 with a tendency to slide out of the operating chair. At this 

 instant, Mrs. Pearson states, she placed her finger upon the 

 patient's pulse, observed it was feeble, and immediately ceased 

 to beat. The face, which was previously pale, now became 

 livid, as did also the finger nails ; and the lower jaw dropped, 

 and the tongue projected a little at one corner of the mouth, and 

 the arms were perfectly relaxed. The females regarded her as 

 being then quite dead." 



In two of these cases death occurred after the inhalation of 

 chloroform had been discontinued, and in the third the chloro- 

 form seemed to have no bad effects until the operation was 

 begun. In all of them the death followed the operation, and 

 must, I think, be attributed to the shock caused by it. But 

 what is shock ? and is there more than one kind of it ? for the 

 symptoms were not the same in all these cases. In two of them 

 tlie heart seemed to stop suddenly, while in the third it failed 

 gradually, although it ceased before the movements of breath- 

 ino: ; and the death must therefore be attributed to arrest rather 

 of the circulation than of the respiration. The circulation is kept 

 up in the body by the heart constantly pumping the blood out 

 of the veins into the arteries. Whenever the heart stops pump- 

 ing, or whenever it gets no blood to pump, the circulation will 

 stop. It does not matter how much blood is in the vena cava 

 or right auricle waiting to be sent into the arteries, if the heart 

 be not beating ; nor is the case a whit better when a wound in 

 the jugular has drained away all the blood, so that no efforts of 



