USE OF CHLOROFORM IN SURGERY. 685 
hearty is one of excitement ; you see the patient pull and 
drag almost as if drunk. You see this every week at opera- 
tions. The chloroform now, in fact, has been absorbed and 
has got into the system ; to this state rapidly succeeds the 
full anaesthetic effect ; there is partial paralysis also of the 
respiratory muscles : the respirations are less frequent, 
the pulse slower* and a very peculiar appearance of the eyes. 
I am led to believe in this state, under the action of chloro- 
form, our patient is on the c verge of death,’ and requires our 
most serious attention ; we must in particular be guarded by 
not giving an over-dose (indeed. Professor Murphy would 
rather err on the side of safety, and operate before sensibility 
is entirely abolished). Patients may be kept a long time 
under the influence of chloroform, in fact for hours, by inter- 
mitting its exhibition for a short time, and then applying it 
again. We now come to a most interesting and most prac- 
tical point, namely — the mode in which death takes place, 
for, after all, this is a point we cannot too seriously study. 
Our experience of deaths from chloroform is yet necessarily 
limited, but the two chief modes by which this fatal result is 
brought about are — asphyxia or syncope ; the former is not 
so common as the latter, but chloroform, it is quite possible, 
may thus kill by simply excluding atmospheric air, as if a 
patient, in fact, were inhaling nitrogen. This remark is more 
applicable as putting us on our guard not to give chloroform 
in a too concentrated shape. We most undoubtedly interfere 
with healthy respiration during the inhaling of chloroform, 
but this is different from entire suspension of the process ; 
we have, in fact, two modes of death, as so well described by 
Bichat. This asphyxia, as if poisoned by carbonic acid or 
nitrogen, and again, syncope, from the heart’s action stop- 
ping. We had a sad instance here lately of observing a case 
of this kind, which was at once a matter of very serious 
anxiety, you recollect, to all of us, as well as a case from 
which you may have learned a great deal. I dwell 
particularly on it, as it is a thing happily not often 
seen, and the less frequently the better ; it is a case which, 
in private practice, may come on any of you like a thunder 
clap, and there is no cleverness or ability in disregarding 
human life. Our art of surgery is all intended to save 
and prolong human life, but if in the moment of doing so 
we do the opposite, it will be looked on by the public very 
unfavourably. We should consider it serious bungling to do 
anything else awkward, and cause death by opening a large 
artery for instance. Let us, then, give all our attention to 
obviate the accident of death from chloroform. This man 
89 
XXVII. 
