TRANSACTIONS OF THE SECTIONS. 137 



of hybernating mammals. On the other hand, if respiration by fresh pungent 

 chloroform, vomited matter, &c, be disturbed, slight spasm of the glottis may 

 take place through the recurrent laryngeal nerves. This occurs occasionally in 

 strong and healthy, but nervous subjects, and especially in trivial cases ; and the 

 occurrence of death in such instances from a few drops of chloroform is to be 

 attributed to this disturbance and stoppage of the respiratory muscles at the end 

 of the irritant or second stage — this being the dangerous point in administration of 

 chloroform. It may be considered almost as an established law, that patients suf- 

 fering under old disease and severe nervous irritation or neuralgic pain bear chlo- 

 roform best. 



Dr. Kidd thinks that statistics for future use ought to be examined in two ways : 

 first inductively, and then by comparing the several groups of facts collected, and 

 deducing from them conclusions applicable to practice. Single " positive instauces " 

 lead only to false conclusions. Though a single instance in a case of pure physical 

 science may be all that is requisite, as in the case of measurements of atomic ele- 

 ments, angles, &c, this is not the case in so complicated a matter as the one under 

 discussion, in which it is necessary to generalize, not from single facts, but from a 

 comparison of groups of facts. 



In surgical practice under chloroform we have to fear, not so much deep insen- 

 sibility as the production, first, of apnea from muscular inaction, or spasm of the 

 parts of the heck by irritation of the excito-motor respiratory apparatus. The 

 deaths from chloroform may be proved to be of an accidental character, and many 

 deaths during operations are charged to chloroform which would have occurred 

 equally before chloroform was used, and would then have been put down to some 

 other cause. For instance, of 45 deaths recorded by Dr. Snow, 6 were attributable 

 to fright. Those which really follow chloroform commonly occur before the ope- 

 ration, and seldom or never as the result of a long tedious operation : of 85 deaths 

 which have been classified, 9 were cases of delirium tremens, and of the remainder 

 not one followed a capital operation. 



The fact also that in 300,000 operations of all kinds chloroform has saved from 

 6 to 10 per cent, of lives, as held by Prof. Simpson and the author, also tends to 

 prove that the cause of death, at least in hospitals, is of an accidental character. 

 From a general survey of the facts, the author finds that the deaths from chloroform 

 are all sudden, and many of the nature of " fit." Chloroform has a powerful irritant 

 action upon the pneumogastric nerve; and it is found that a similar irritation by 

 electricity causes vomiting and stops the action of the heart. Hence syncope may 

 possibly occur, if this irritation or (tetanoid ?') apnea of the respiratory muscles 

 and laryngeal nerves be reflected to the heart through the cardiac nerves of the same 

 pneumogastric trunk : this mode of death is most remarkable, for instance, under the 

 analogous agent— amylene. The general effect of the introduction of chloroform into 

 surgical practice has been good ; and where it acts badly the author believes that 

 the cause may often be found in the tendency in patients themselves to defer sub- 

 mitting to an operation till too late. Upon a comparison of the present surgical 

 death-rate with that of 1846 immediately before the introduction of chloroform, it 

 appears 10 per cent, lower ; and further, of the deaths which have taken place, 

 one-fourth have been in persons who have previously taken chloroform without ill 

 effect. Both these facts support the author's view of the accidental nature of 

 death from chloroform. 



The fact of death from chloroform occurring in slight operations and early in 

 the administration, has been remarked by all the chief observers, viz. MM. Robert 

 of Paris, Denonvilliers, Paget, Snow, and Brown-Sequard. The opinion that this 

 is due to disease of the heart is erroneous. In most fatal cases the heart has not 

 been found diseased. Thus in 4 cases in London hospitals, the post-mortem ex- 

 aminations of which were attended by the author, the heart-fibres were examined 

 and found healthy, though one of them (at Guy's) was reported in the medical 

 Journals as a marked case of fatty heart. In 18 deaths reported in Journals which 

 presented some visible lesion, 3 only showed diseased heart. Again, in 24 deaths 

 from ether, the cause appears to have been extreme hebitude, muscular relaxation 

 and exhaustion, and in some consequent haemorrhage following operations. 



On the other hand, numerous patients known to have diseased hearts have taken 

 chloroform without any bad result, and in hundreds of animals death has been 



