TRANSACTIONS OF THE SECTIONS. 131 
after chloroform—post hoc, but not propter hoc ; they are very alarming, more so than 
the asphyxia cases, as it is very difficult to rouse up the reflex and cardiac nerves 
where syncope occurs, and, curiously enough, it seems to occur by emotion or fright 
irrespective almost of the chloroform. 
The author, being a believer in the value of the deductive philosophy of Mr. Mill 
and Mr. Buckle in inquiries, like the present, of a physiological kind, wishes at 
present simply to state that he finds the immense mass of facts as to chloroform 
(chiefly experiments on the lower animals instituted by the Biological Society of 
Paris, as detailed in the very masterly essay of MM. Lallemand, Perin, and Duroy— 
a mass of facts of the highest importance, only very recently published) entirely 
agree with and corroborate the clinical views he had the opportunity of laying 
before this Association. 
It is a pleasure to be able to state, that every year’s additional study of chloro- 
form in London leads to a feeling of greater and greater satisfaction as to its value 
and safety ; that this impression also agrees with clinical experience in other cities 
of Europe, and even in America, where chloroform has now nearly superseded the 
use of ether. 
The author wished the present paper to be short, to be, in fact, complementary of 
former communications. The aggregate number ofdeaths from chloroform is very 
alarming; but there is reason to think that, in nearly all the cases, the points here 
discussed previously, as to the necessity of good respiration, good pulse, &c., still hold 
good for allcases. It seems very desirable that the results, however, of the hospital 
experience of the members of the Physiological Section of this Association could be 
obtained as to any new facts or observations that may have come under notice ; for 
the entire subject of anzesthetics is, as yet, but in a tentative or rudimentary con- 
dition. 
The physiological data of former discussions were left unsettled and incomplete, 
as said already, in order that a more full consideration might be given to the exact 
value of simple syncope as a source of danger. ; 
The discussion hitherto, in Dr. Snow’s time, as to the nature of death from chlo- 
roform, with the consequent precautions to be observed to ensure its safety in 
practice, had been almost entirely confined to an examination of one question— 
whether these accidents arise from what the late Dr. Snow named “cardiac syn- 
cope,” with engorged state of the right side of the-heart, or from simple syncope, 
the right side not engorged. 
The more philosophical mode of regarding the subject now is to look on both 
causes as active: the “cardiac syncope”’ is a post-mortem result, however, as it is 
described by Snow, and is in reality death from apnoea or asphyxia, and arises in 
some manner, most probably from some error in the administration of the chloro- 
form ; but the second cause of death, or simple syncope, is due to idiosyncrasy. This 
advance in our knowledge is of importance as to saving life in these cases: we were 
before looking, like the knights of old, at only one side of the shield, but now we 
know the shield has two sides. 
Having previously described at Oxford the mode in which accidents, by asphyxia 
or “cardiac syncope,” occur through irritation of the laryngeal recurrent nerve, or 
other more recently described nerves, distributed to the mucous membrane of the 
larynx and air-passages (“ Rosenthal’s nerves”), it is only necessary to state that 
further experience helps to corroborate this view. This form of death by asphyxia 
or apnoea arises by stoppage of action of the respiratory muscles and diaphragm, and. 
can also be brought about in experiments on the lower animals by any even me- 
chanical irritation of these laryngeal nerves ; hence the grave necessity of care, in the 
early stages of the chloroform administration, not to excite or irritate the larynx by 
acid or impure chloroform, which, like some gases, at once induces spasm of the 
glottis, with subsequent signs of asphyxia. This was fully entered into at the Oxford 
Meeting. 
Riteod, so sensitive is the larynx, and so peculiar its tolerance of chloroform, that 
this fact of the irritation of its mucous membrane by a strange vapour is now taken 
advantage of, and where we have to fear simple syncope or faintness, as in for- 
midable operations like ovarictomy, and where syncope is impending in the middle 
of such operation, the addition of a drachm or two of ether to. the inhaler, or a few 
g* 
