686 
USE OF CHLOROFORM IN SURGERY. 
we speak of had fatty heart, but nobody could have suspected 
it, and I must also tell you that it is a species of disease very 
difficult to make out ; you will remember his respiratory 
muscles stopped, he gasped, and in spite of everything we 
tried, he was beyond recovery. This is so serious a matter 
that students can scarcely realise it ; a whole family may 
thus be thrown on the world, and very great mischief done. 
Experiments have been tried on the lower animals ; you may 
lay open the thorax, and watch the heart beating, but it will 
be as suddenly stopped by an over-dose of chloroform as by 
any over-dose of the most powerful poison ; the muscles of 
the heart will not respond either to the action of galvanism ; 
when we have this impending death from syncope, as I said 
before, you will find the pulse sink. This is the starting 
point, so to speak, of a set of fatal symptoms which soon 
follow, including stoppage of the beatings of the heart, 
impeded action of the lungs, &c. 
“ The next point that offers itself to our notice is one also 
of very great interest, namely, whether nervous depression 
should prevent or contra-indicate the use of chloroform, it is 
one at present very much discussed ; whether, in a word, we 
should use chloroform during the shock of a severe injury, 
as in a gun-shot wound. We should not make this a ques- 
tion of this or that school (Edinburgh, or Constantinople, or 
London) but learn what is the truth. I believe chloroform 
may be safely used during nervous shock from gun-shot 
wound, as we use it in hysteria, or the shock of delirium 
tremens; nay more, I rather think it acts beneficially, I 
think it rather lessens e shock after operation.’ We cannot, 
of course, use too much caution or care when the constitution 
has received a serious injury, but I should not be at all 
inclined to deny a patient chloroform on that account alone ; 
pain is a much more horrible shock and depressor of the 
nervous system than chloroform, pain of a knife is not at all 
a stimulant. There is another form of disease, as in that 
man we operated on for last with varicose veins, which I 
think contra-indicates chloroform much more than 6 shock of 
an injury.’ I allude to old bronchitis. Where we have a man 
with one lung, or a lung and a half, I am very chary of using 
chloroform ; take care of those cases of men with chronic 
cough and feeble pulse. I fear I cannot say much on fatty 
heart, it is a very obscure affection, we know it by the usual 
phrase — the c heart is weak ;’ it is an affection, as I have 
also said, not easy to diagnose ; we can easily make out 
valvular disease of course, but the signs of fatty heart are 
rather negative than positive. 
