232 
G. ARCHIE STOCKWELL. 
Dr. Snow long since reconciled the differences between 
the results of experiment and clinical practice, by showing 
that fatalities might happen in one of two ways, according to 
the amount absorbed: 
1. Chloroform gradually inhaled until death results, kills 
by gradual paralysis of respiration, the heart continuing to 
beat after cessation of respiration: 
2. But when a large dose of the drug is suddenly taken 
into the system, the heart ceased beating before the respira¬ 
tion stopped: 
3. It is also thought that this sudden paralysis might set in 
before insensibility is produced. The cardiac paralysis is con¬ 
sidered to be the chief factor in the fatal result, because effi¬ 
cient artificial respiration does not resuscitate these cases. 
There is an impression that cessation of the respiration may 
be entirety remedied by artificial respiration, but that the 
affection of the heart is necessarily fatal.* 
These views are further confirmed by the Commission of 
the Medico-Chirurgical Society, London, 1864, and by a 
Committee of the British Medical Association in 1879, who 
state: 
Chloroform has sometimes an unexpected and apparently 
capricious effect upon the heart’s action. It may cause death 
in dogs by paralyzing either the heart or respiration. The 
series of experiments upon it with great care. We have also varied and ex¬ 
tended these experiments in order to determine whether chloroform paralyzes 
the heart by direct influence, or by an indirect action through the vagus. * * 
In all cases accurate tracingshave been made by means of the kymographion and 
the respiratory tambour. 
* * * “ The experiments * * * show that chloroform acts as a power¬ 
ful depressant poison upon both respiration and circulation ; that sometimes the 
influence is most felt at the heart, and death results from cardiac arrest; that in 
other cases the drug paralyzes primarily the respiratory centres, whilst in other 
instances it seems to act with equal force upon both medulla and heart. So far 
as practical medicine is concerned, it makes little difference whether the heart 
stops just before or after respiration, so that those cases in which cardiac and 
respiratory arrest are almost simultaneous, are, for the purposes of the clinician, 
the same as those in which arrest precedes respiratory paralysis. Finally, the 
results of our new experiments also coincide with our previous experience in the 
laboratory, and with what we believe to be the general belief of physiologists— 
that cardiac arrest is specially prone to occur when chloroform is administered 
rapidly and in concentrated form.” 
* Medical Chronicle , London, vol. xii, p. 2. 
