178 IMMEDIATE AND REMOTE 



patient is far from under, perhaps struggling and 

 shouting, and then without warning draws a few 

 deep breaths and dies. Here also, those who seem 

 to be under, but whose heart and respiration cease on 

 being lifted into position for the surgeon. Here, 

 again, those who have been given a mere whiff of 

 the anaesthetic for a trifling operation, and whose hfe 

 ebbs away at the bare touch of the knife. 



Until recently, it was supposed that these fatalities 

 were due to sudden reflex stoppage of the heart by 

 way of the vagus, and that view was given in our 

 previous editions. Very important research work by 

 Goodman Levy appears to demonstrate that the 

 chloroform acts directly on the ventricular muscle, 

 and causes it to fibrillate, that is, to enter into 

 flickering irregular contraction of individual fibres, 

 instead of performing its proper rhythmical systoles. 

 Working with cats. Levy was able repeatedly to 

 observe fatal ventricular fibrillation, usually heralded 

 by cardiac irregularity, and always when the chloro- 

 form anaesthesia was light, not deep. Stimulation 

 of sensory nerves under a light anaesthesia frequently 

 caused death in this way ; in other cases, the animal 

 recovered. The effect was just the same if both 

 vagi were previously cut. Levy found great diffi- 

 culty in discovering exactly by what means the 

 sensory stimulus affected the heart. The connection 

 is probably complex. If the chloroform is given in a 

 perfectly continuous manner without intermissions, 

 sudden death — in cats at any rate — can be avoided. 

 StruggHng, both in man and animals, is dangerous. 



An apology must be made for saying again what we 



