132 REPORT—1862. 
drops of ammonia, seldom fails to rouse the most flagging pulse (as easily con- 
ceivable) through these very nerves. Explain it how we will, the clinical fact is 
of the utmost importance. 
This is shown in another direction in this manner :—if we render an animal deeply 
narcotic by chloroform, in fact all but dead, and then allow it to come back slowly to 
its usual condition, there is one point where, if the laryngeal nerves be pinched 
with a forceps, it causes sudden spasm of the glottis, the diaphragm stops acting, 
and, for want of breathing, the animal fails back again into a state of narcotism or 
asphyxia, and may die. 
With this recent discovery as to these nerves we may perhaps couple the group 
of facts that there is greatly increased danger attached to surgical operations about 
the larynx or neck (as observed in practice), arising from cutting or injury of its 
nerves, or catching them up in forceps whilst tying arteries, &c., some intimately 
associated with nerves of the cardiac plexus, others with the larynx itself, &c. 
If the act of breathing freely continues during the administration of chloroform, 
we may be almost certain all is right, and the pulse good; but if the breathing 
becomes slow or intermittent, stopping and going on again, we are not so safe. Some 
patients, it is true, seem to take the chloroform slower than others, but it is a fatal 
error to push it on; the chloroform will accumulate in the system, and the after- 
effects will be tedious, if the surgeon, for want of time or other causes, hastens the 
administration. 
Is death from chloroform, so called, sometimes a coincidence ? 
It is well to remember that very marked syncope, and even death from syncope, 
may occur without the use of chloroform at all: intense sudden pain may cause 
death and syncope; injury of a tendon, or a large bleeding, or even such a trifling 
thing as touching the urethra in sounding for stone (as remarked especially by 
Heurtaloup), may induce most alarming syncope; great weakness from want of 
food, as in soldiers sometimes after a battle, will also give a great tendency to syn- 
cope: so that it is always of advantage to learn more or less of a patient’s history 
when we are about to administer chloroform. 
Accidents from syncope and chloroform may occur from apprehension of pain, 
rather than actual shock, or actual pain, or deep chloroform narcotism; hence so 
many accidents in the early part of the administration, before the patient is uncon- 
scious at all. Thus of 125 deaths carefully analysed, fifty-four occurred immediately 
before operation, forty-two during operation, but none as the result of long-con- 
tinued narcotism or anesthesia; yet chloroform has now to bear all the obloquy of 
all fatal accidents in the operating-theatre, a certain large percentage of which are 
obviously the effect of purely mental causes or fear. 
Persons with strangulated hernia, about to be operated on, are known to have 
died before any incision at all (without chloroform), the patients taking the shaving 
of the pubis for part of the operation. Bichat saw a patient die on the instant of 
passing a simple seton. Dr. Watson tells of a patient dying suddenly at the sight 
of a trochar about to be used in tapping the chest. Desault was one day about to 
perform the operation for stone; the patient did not present anything unusual in 
his manner, and was placed in the usual position: Desault traced simply a line with 
his thumb-nail on the perineum; the patient uttered a shriek, and fell stone-dead. 
Mr. Stanley used to tell of a similar case—Chopart was about to operate for circum- 
cision on a lad, when the boy fell dead the instant the knife touched him, Garen- 
got had a patient with a thecal abscess, who had a shudder and sudden death on 
seeing the tendon move. 
Syncope thus becomes a complication, in modern surgical operations, of much 
greater seriousness than before. That death occurs not from over-narcotism is at 
once evident, as it arises from apprehension of pain, the patient being quite conscious 
when these syncope accidents have occurred. 
These deaths (and they amount to about thirty in the hundred of all the deaths) 
are observed to happen while the patient is having the chloroform administered, 
before the surgical operation (at sight of knives, saws, surgeons’ aprons, a crowd of 
students, dressers, strangers, &c., in the operating-theatre), showing how much wiser 
it is to have the patient placed under chloroform in the sick-ward, than to be exposed 
to this mental shock. In some London hospitals it is so, in others the point 1s not 
