(Chloroform §jeaths. 
IS | : 
By W. W. DAWSON, M. D. 
sxJE/Ca-EOisr to cixsrcxi'TiT.A.Ti hospital. 
ROUT. CLARKE * CO., FKS., CIN. CHLOROFORM DEATHS. 
Twelve Unpublished Cases. 
Comparison and T qti c^. 
JAate and Pause of pEATH. 
MODE OF ADMINISTRATION—MEANS OF RESUSCITATION. 
W. W. DAWSON, M. D., Surgeon to Cincinnati Hospital. 
“He laughs at scars who never felt a wound,” is an old and sig- 
nificant saying, uttered long before anaesthetics were thought of, 
or at least realized; it is, however, peculiarly applicable to those 
who have never met with an accident in the use of those agents. 
A gentleman may go on for years, for half a score and more of 
years; he may give chloroform thousands of times, as did the cel- 
ebrated Simpson, and many others equally renowned, equally 
skillful, and never meet with an unfortunate case; but suddenly 
and unexpectedly that case comes, as it did to the distinguished 2 
CHLOROFORM DEATHS. 
discoverer of the amesthetic properties of chloroform ; and when it 
does come, it comes with a pronunciation distinct, startling, arrest- 
ing, a pronunciation calculated to arouse in him the deepest inter- 
est, the most profound reflection, the most earnest inquiry. The 
question immediately presents itself: Could this have been pre- 
vented ? 
In his lecture on “Death from Chloroform,” Dr. Benjamin W. 
Richardson, of London, says: “The time is fitting for a careful 
study of the important question before us, for deaths from chloro- 
form seem to be—I do not say they are—seriously on the increase, 
and the hearts of the boldest are in some fear whenever they 
summon the agent to their aid.” There can be no doubt that the 
mortality of chloroform is increasing, and what Dr. Richardson 
speaks of as a probabil it}', is an unquestioned fact. The statistics 
of chloroform are defective, imperfect, far from complete. In a 
few weeks—since the 13th of October last, the date of my unfor- 
tunate case—I have collected, with but little trouble, the history of 
twelve hitherto unpublished cases, most of them having occurred 
in this vicinity. 
General and Local Anaesthesia aro the means presented to 
the surgeon when about to perform an operation. The latter, 
local amesthesia, can claim for itself entire safety; that it may be 
applied without the slightest danger is patent to all; but, unfor- 
tunately, it has so limited a range in its application, that it can 
only be used for the most insignificant operations—operations in- 
volving small and superficial regions. Apparent as this seems to 
bo, it was not without surprise that a case—a painless case—of 
Ovariotomy was reported a few years ago, in which Richardson’s 
apparatus was employed for the production of the amesthesia. A 
duplicate of this case has not been published. Until local ames- 
thesia is brought to a greater perfection, general amesthesia, with 
its dangers, must be accepted. 
Dr. B. W. Richardson, the author of local amesthesia, in the 
lecture upon this subject, already referred to, says : ,£In the outset 
of our work, I think it best we should honestly admit this truth, 
that whatever our admiration may be of the scientific advancements 
which have in our day been made for the relief of pain during 
surgical operations, we are bound to season the admiration with 
the disagreeable knowledge that the blessing we confer on hu- 
manity, when we resort to the application of general amesthesia, CHLOROFORM DEATHS. 
3 
is not unmixed with danger and sorrow. At present we are 
forced to know, for example, that the administration of this, the 
most common agent employed for anaesthesia—chloroform—is at- 
tended with a certain fixed mortality. We are bound, therefore, 
to consider whether that is necessarily to remain; wo 
are bound to inquire if the mortality be an essential part of the 
administration ; and, if so, we are bound further to ask whether 
the general value of the agent is commensurate with the special 
evil. It has been urged that if any other medicinal agent than 
chloroform had caused as many deaths, it would long ere this 
have been ruthlessly expunged from practice. The assertion is 
true and untrue; true, on the argument that an agent of doubtful 
usefulness, or of limited usefulness, produces a certain evil; untrue, 
on the argument that an agent of certain and most extended use- 
fulness produces an occasional evil. But chloroform is an agent 
which is of certain and most extended usefulness; therefore the 
argument against chloroform, when carried to the expulsion of it 
because of its evil, is untrue. 
“Behind all these remains the inquiry whether we ought to ac- 
cept the necessity of danger from general anaesthesia at all. Can 
we avoid every danger and supply every good? Perhaps we can 
not; we ought nevertheless to try so to do, and perhaps we may 
succeed. In endeavoring to avoid danger we have two lines of 
research before us. We may inquire whether wo can so reform 
the anaesthetic process altogether as to insure success; we may 
inquire whether we can so master the effects of anaesthetic agents 
that we can use any with perfect safety, and especially that agent 
chloroform, with which the world and the profession are most fa- 
miliar. I, for one, have trodden both these lines of research. I 
have introduced new methods, which, I have hoped, would con- 
duce to safety in anaesthesia. I have studied much to make local 
anaesthesia a ready and perfected process, and, on the whole, I 
have reason to be satisfied with the results which have fallen to 
me. In science, however, it is quite hopeless in any man to har- 
bor a prejudice or ignore natural truth ; and so I am open to con- 
fess that, however we may yet perfect the only perfectly safe—I 
mean the local—method of abolishing pain, we shall still often re- 
quire a general anaesthetic.” 
For general anaesthesia we have a number of agents which we 
may call to our service. At the head of the list stands Chloroform; 
then comeslfther,]yitrousOxide,Bichloride of Methylene, Tetrachloride 4 
CHLOROFORM DEATHS. 
of Carbon, the “ Vienna mixture ” consisting of one part of chloro- 
form and six of absolute ether and other combinations of ether 
and chloroform, varying in the relative proportion of the two 
agents. The late Dr. Mussey used them in the proportion one 
part of the latter to two of the former; others again mix them 
equally. Unfortunate cases, “ accidents,” if you please, have fol- 
lowed the use of all of these anesthetics. Chloroform leads them 
all in popular and professional favor, as it does in the number of 
its victims. 
Rate of Death from Anaesthetics.—From an article on “ The 
Relative Dangers of Anaesthesia by Chloroform and Ether, from 
statistics of 208,893 cases,”* I am enabled to present the subjoined 
table: 
Sulphuric Ether 1 death to 23,204 administrations. 
Chloroform 1 “ 2,723 ,£ 
Mixed Chloroform and Ether..1 “ 6,588 “ 
Bichloride of Methylene 1 “ 7,000 “ 
Nitrous Oxide No deaths in 75,000. 
These are startling figures, and while they are, no doubt, too 
favorable for ether and nitrous oxide, they hardly present the 
fatality of chloroform. 
In discussing the rate of mortality, Dr. Richardson says: 
“When I was engaged in writing the medical history of England 
for the Medical Times and Gazette, in the years 1864 and 1865, I 
visited, in turn, eight hospitals, viz: Norwich, Lynn, Stafford, 
Wolverhampton, Newcastle-under-Lyne, Brighton, Birmingham, 
General Hospital and Birmingham Queen’s Hospital. From the 
books of these institutions I collected, personally, the number of 
administrations of chloroform in each institution from the first, 
in 1848, and before I arrived at a death, I recorded no less than 
17,000 administrations. Now, one death in 17,000 cases reduces 
the mortality to a nominal value, and if this experience were 
supported by all experiences, we need trouble ourselves little 
for any better agent than chloroform. But mark the result of 
the five years’ subsequent experience in the very same institutions. 
*We find this interesting and valuable article in the Richmond and Louis- 
ville Medical Journal, under the “ Eclectic Department,” and regret that the 
name of its accomplished author is not given. CHLOROFORM DEATHS. 
5 
Since 18G4 there have been in these hospitals 7,500 adminis- 
trations, with 6 deaths, or 1 death in every 1,250 cases. After I 
had visited the hospitals above named, in 1864,1 visited in the 
same and following year six other hospitals, viz: at Lincoln, 
Bath, Oxford, Cambridge, Beading and Nottingham. In these 
I collected the facts of 7,900 administrations, from the year 
1848, with a result of 3 deaths, or 1 in 2,633 cases. In these 
same hospitals, in the subsequent five years, there have been 
2,762 administrations with the result of 1 death. 
“ If, in relation to these large hospital’s statistics, wTe 
put all the facts together, we find that in the twenty-one years, 
from 1848 to 1869, inclusive, in the thirteen hospitals named, 
there were 35,162 administrations of chloroform with a propor- 
tion of 11 deaths. I believe this to be the largest reliable series 
of cases of administration as yet collected, and I know it to be 
just. Doubtful cases of death from this agent there are none, and 
in every case a qualified and competent practitioner was the ad- 
ministrator. 
“If from individual and general Hospital experiences we pass 
to the experiences of particular Hospitals, we find, again, the 
widest difference of results from chloroform administrations. 
Some Hospitals, like some individuals, are fortunate, some unfor- 
tunate. There are before me the statistics of two Hospitals so 
alike that we might call them twins; they have the same average 
of patients, the same average number of administrations a year, 
the same precise length of experience. In one of these, in twenty- 
one years, there have been 1,575 administrations without a death ; 
in the other the mortality has been 1 death in 525 cases. I could 
multiply these illustrations were the labor necessary. It is not 
necessary. My preliminary purpose is fulfilled if I have proved 
that, in the face of the facts of frequent runs of so-called good luck, 
by particular men, or in groups of Hospitals, or in particular Hospi- 
tals, there is, under the most favorable aspect of chloroform, a 
given mortality, which, up to this moment, seems to be a neces- 
sary mortality, just as there is a mortality from accidents and 
acute diseases like fevers. The mortality is, moreover, consider- 
ably greater than is known, for cases occur constantly which are 
not recorded. 1 compute favorably from the facts given above that 
the rate of mortality is as one in 3,500 administrations of 
chloroform (I think it really is greater, and that 1 death in 6 
CHLOROFORM DEATHS. 
2,000 to 2,500 administrations would be nearer the truth); but 
even at this rate we have no other remedial agent which ap- 
proaches chloroform in point of danger.” 
Appalling as these statements are chloroform is still, and will, 
without doubt, continue to be, the favorite with the great majority of 
the profession. The small quantity necessary, its prompt action, 
the profound anaesthesia which it produces, the ease with which 
this insensibility may be prolonged for hours, if desirable, gives 
chloroform an advantage over all agents yet presented : indeed, 
sulphuric ether is, so far, its only rival. 
Sulphuric Ether.—The objections to sulphuric ether as an 
anaesthetic are many. The time necessary to produce anaesthesia 
is much longer than that required by any other agent; the mental 
excitement is very great, the muscular convulsions are very vio- 
lent, the quantity essential to produce and keep up the insensi- 
bility is large; indeed, in some operations, and especially in those 
about the mouth, it is impossible to employ the ether after the 
beginning of the operation. I witnessed a marked example of 
this recently. My friend, Prof. W. H. Mussey, in the Cincinnati 
Hospital, removed the left superior maxillary. He rendered the 
man insensible by ether, but after the incisions necessary to 
detach the skin his patient was perfectly conscious, and had to bo 
left so until the completion of the excision. ' The agony was 
fearful, but it could not be prevented. In such a case a few 
drops of chloroform applied to the nose occasionally would have 
kept up complete anaesthesia, but this could not be done with 
an agent requiring both time and quantity to make its impres- 
sion. 
Upon the advantages of ether, and its manner of killing, I pre- 
sent the following from Prof. Gosselin, Bulletin General de The- 
rapeutique, 1868, Medical Compendium, 1869: 
“Ether presents certain advantages over chloroform. Anaes- 
thetic syncope is less frequent with it than with the latter, but the 
following case which has happened under our eyes shows that death 
may be caused by it. A man came into the wards suffering from 
luxation of the thigh, with fracture, and also a fracture of the 
arm of the opposite side. So far from being in a state of stupor, 
be was in a condition of exalted sensibility, and complained bit- 
terly of the intense pain at the position of the luxation. What CHLOROFORM HEATHS. 
7 
was to bo done ? It was necessary to relieve the luxation on 
account of the agony caused by it. The fractured thigh forbade 
its being done without an anaesthetic. It was, therefore, resolved 
to employ one, and ether was cited as the safer. 
“ Anaesthesia was readily produced, and the luxation reduced. 
The patient, however, did not return to consciousness, and the 
pulse began to fail, although respiration continued normal. 
“ The possibility of anaesthotic syncope immediately occurred 
to us. Cold water was dashed upon the face of the patient, and 
he was switched somewhat; artificial respiration was also prac- 
ticed, although the respiratory movements were normal (! W. W. 
D.) Under the influence of these stimulants the pulse increased 
so as to be very perceptible, but consciousness did not return, and 
the respiration became hurried. Then the face grew blue, the 
lips violet, and the whole anterior portion of the chest cyanosed. 
The breathing continued stertorous for half an hour longer, when 
the patient died. 
“ The autopsy did not reveal anything of moment. The brain 
was healthy; the left cavities of the heart gorged with black 
blood; the lungs congested, and the bronchial tubes a little frothy. 
The autopsy only showed that the immediate cause of death was 
asphyxia. But its cause? Is it necessary to admit an alteration 
of the blood by an absorption of the vapor, and a consequent 
obstacle to oxygenation, or to asphyxia by alteration, which 
received a sufficient quantity of blood in the lungs, but which was 
not able to assimilate it? Was it not rather an asphyxia caused 
by paralysis of the lungs, similar to that seen by Dupuytren and 
Provencal upon cutting the pneumogastrics? ” 
Dr. W. H. Mussey, in the Cincinnati Lancet and Observer 
for January, 18(11, reports a death from sulphuric ether. 
And still further, as damaging to the record of ether, I intro- 
duce the following (Medical Compendium, 1868): 
“It is stated in the British Medical Journal for July 20, 1867, p. 
48, that Lyons is the only city in France, and Boston in the 
United States of America, where chloroform is laid aside and 
ether preferred as an anaesthetic. A death having taken place 
this summer at Lyons, in a woman of delicate constitution, under 
anaethesia. while an orthopedic apparatus was being adjusted to 
her foot to correct some deformity, the fact gave occasion to a 
discussion at the Academy of Medicine in that city. It then 
appeared that, since the resolution had been come to, under a 8 
CHLOROFORM DEATHS. 
certain predominance of opinion, to adhere to the use of ether, no 
less than seven deaths had occurred, under ancesthesia at Lyons; 
whereas, in Paris, during the fourteen years that chloroform has 
been in use, over a much wider range of cases, the same figure 
expresses the total number of casualties, for they have been no more 
than seven." 
Dr. Walter Burnham, in the Boston Medical and Surgical 
Journal, December 8, 1870, reports a death from sulphuric ether. 
It occurred in the army in 1862. The patient was a soldier ; had 
been wounded in the knee, and was placed on the table for ampu- 
tation. lie was a stout-built German ; pulse 80 ; had no symptoms 
indicating either exhaustion or shock. It required about ten 
minutes to render him entirely insensible. While the tourniquet 
was being applied, he showed some signs of returning conscious- 
ness. The ether was again applied for a few seconds, when, on 
complete anaesthesia being manifest, Dr. B. removed the towel 
from his face. The surgeon in charge directed Dr. B. to “ crowd 
that ether.” After one or two more inspirations the patient 
ceased to breathe. Dr. B. says “there was no hemorrhage, or 
any other apparent reason for his death. "Very soon after he 
began to inhale the ether, his pulse was noticed to grow feeble.” 
The editor of the Boston Journal heads the page over this case 
with “ Alleged Death from Sulphuric Ether,” while Dr. B. styles 
his history “ Death from the Effects of Sulphuric Ether.” The 
editor adds, in brackets, “ in an overdose,” and asks the question, 
whether this death was from the use or abuse of ether. Ho unpre- 
judiced reader can avoid the conclusion that Dr. Burnham is 
right, and this death is fairly attributable to the use of ether. 
The statistics heretofore presented are, as I have already sug- 
gested, too partial; on the question of safety they place ether too 
far in advance of chloroform. Were it possible to collect the 
casualties of ether, they would largely, very largely, exceed 1 in 
23,204. 
Nitrous Oxide.—The table quoted, gives 75,000 administrations 
without one death; this is undoubtedly an error. In 1862, a 
death was reported. The patient died within an hour after inhal- 
ing the gas ; it is said, however, that he had consumption and 
was near his end. The Colton Association have now given the 
gas about 100,000 times, and the accident referred to is the only 
one which has followed the use of this agent. Its safety depends CHLOROFORM DEATHS. 
9 
on the fact that persons are kept under its influence but for a 
moment. Protract its administration as we do chloroform and 
ether, and its victims would far outnumber those of all the other 
anaesthetic agents combined. No surgeon or physician who 
has stood by and witnessed a dentist give nitrous oxide for the 
extraction of teeth, would be willing to hazard any individual 
under the full influence of this gas, for an operation which would 
last one-half minute. The appearance of the person while inhaling, 
as he is pushed beyond the point of excitement, to a condition of 
insensibility, is fearful ; the pulse is quick, the breathing labored, 
the vessels of the face and neck are turgid, the face assumes an 
ashy hue; indeed, the whole aspect is one of danger. The relief 
which the sudden subsidence of these alarming symptoms, and the 
return to consciousness of the patient gives, can only be felt, but not 
described by the looker on. “ It can not be too widely under- 
stood,” says Eichardson, “that protoxide of nitrogen is not an 
ancesthetic in the true sense of the word, but an asphyxiating agent 
that its effects are identical with those of poisoning by carbonic acid 
gas." I may add that in those surgical operations performed un- 
der its influence, the patients were merely intoxicated—not insen- 
sible. 
For a momentary operation, such as the extraction of a tooth, 
this gas, powerful as its impression is, seems to be by far the safest 
agent. The erect position usually taken for the extraction of 
teeth, is, as we shall see farther on in this paper, a dangerous 
position for the administration of chloroform. 
Bichloride of Methylene.—The only death so far by bichlor- 
ide of methylene is reported in the British Medical Journal, May, 
1870. The patient was a stout man of 40 years, and was placed on 
the table in Guy’s Hospital, for an iridectomy in each eye. One 
drachm of the methylene was used, but the mode of its adminis- 
tration is not given. The muscular convulsions were violent, 
and “ he became very bluish in color ” beforo anaesthesia was pro- 
duced. The methylene was removed before the operation was 
commenced. “ The operation on the right eye was completed, and 
then the left eye was operated upon. During the second opera- 
tion, the patient’s appearance was normal ; there was no blueness; 
and when the incision was made, he flinched and showed distinct 
signs of pain. The eyes were bound up and the patient left on the 
couch, while one of the assistants noted down the nature of the 10 
CHLOROFORM DEATHS. 
operation. About three minutes had elapsed when it was noticed 
that the respiration was shallow and catching. On touching the 
radial pulse, it could not be felt. The color was normal; except 
at the angles of the mouth, which were blue. The patient was 
immediately turned on his left side. There were a few gasping 
inspirations, then all ceased, the patient remaining pale. For 
about ten minutes the galvanic current, and for about an hour, 
artificial inspiration (Sylvester) were employed without success. 
Post-mortem examination. All parts were perfectly healthy, 
except the heart and lungs. The muscular structure of the heart 
was quite healthy; there was no undue proportion of the fat; the 
walls were strong; the valves healthy; on the surface of the left 
ventricle were small spots of ecchymosis, of the size of pin’s 
heads, about twenty in number. There were none on the right 
ventricle; the left ventricle was empty and contracted ; the right 
contained some fluid blood; the lungs were congested ; the blood 
was fluid and of dark color.” 
How like a chloroform history this sounds? Displace methylene 
and place chloroform in its stead, and the record would faithfully 
describe scores of the deaths by chloroform, which • may be found 
scattered through the medical journals of the day, with the single 
exception of the “ small spots of ecchymosis ” on the surface of 
the left ventricle, these have not been observed in any fatal case 
of chloroform which I have examined. The condition of the cav- 
ities, the empty left ventricle, the congested lungs, and the fluid 
and dark color of the blood generally resemble, very closely, what 
was found in my unfortunate case, that of Bridget Henry. The 
heart in the methylene case could hardly be called a diseased one, 
the ecchymosed spots were evidently due to the antesthetic, and so 
also the congestion of the lungs. Methylene chose, as we see, for its 
first victim, a man in vigorous health. 
Tetrachloride of Carbon.—Prof. E. Andrews, of Chicago, gives 
the conduct of this new candidate for favor, as an anaesthetic when 
put upon trial. He says (I quote from Medical Compendium, 1869) : 
“Nothing remarkable occurred at first, but after the lapse of a 
few minutes the assistant, whose duty it was to watch the pulse, 
observed that it increased suddenly in frequency, so that in a short 
time he was unable to count it. At the same time the patient, 
who was not yet unconscious, complained of a violont pain, as of 
cramp, in the vicinity of the heart, and after a moment more the CHLOROFORM DEATHS. 
11 
pulse and respiration both suddenly ceased. The patient’s head 
was spasmodically drawn backward, the countenance looked pale 
and deathly, and the pupils of the eyes dilated until the iris could 
scarcely be seen. Artificial respiration was at once commenced, 
and strong aqua ammonia was rubbed in the nostrils, under which 
treatment, the patient revived again, although to all appearance 
almost dead. The anaesthesia was then completed by concentrated 
sulphuric ether, without further accident, and the carious bone 
excised in the usual manner. I do not think that there remained 
any prolonged unfavorable effect after the use of the tetrachloride, 
but the sudden advent of such urgent and dangerous symptoms 
made a strongly unfavorable impression on my mind, for thepatient 
was much nearer death than I ever saw one go under ether. I 
certainly shall not venture on the use of the article again, unless 
very extensive experience by others demonstrates its safety.” 
. Sir James Y. Simpson, who introduced this agent to the pro- 
fession as an anaesthetic, although I believe it had been previously 
used as such by others, in an article in the Medical Times and 
Gazette, for 18G5, states that it requires a longer time to produce 
anaesthesia with it than it does with chloroform, that the patient 
is longer in recovering from its effects, and that its depressing 
influence on the heart is greater. 
The Vienna and other Mixtures of Chloroform and Ether, 
are claimed by some to be more safe than chloroform alone, but as 
these agents are of different physical characters, specific gravity, 
density, and as their union is a mere mechanical one, it is appar- 
ent that we get the first effects from the lighter ether and the 
heavier chloroform keeps up the process. It would be more ra- 
tional if there is safety in the two, to give them separately, that 
is, make the first impression by ether and continue it by chloro- 
form. 
CASES. 
Case 1.—Death by Sudden and Continued Contraction of the Heart.— 
Bridget Henry, Cincinnati Hospital, Oct. 13th, 1870. Surgical 
clinic of W. W. Dawson, M. D. Reported by R. J. Clark, M. 
D., resident physician. 
“Bridget Henry, admitted July 7th, 1870, aged 38, married, 
housewife; states that during the autumn of 1869, a swelling ap- 
peared on the dorsum of the right foot, this swelling gradually 
became larger and was quite painful. She consulted a physician of 
this city, and he opened it with a bistoury, hemorrhage ensued— 12 
CHLOROFORM DEATHS. 
the tumor gradually diminished in size, and did not give her much 
trouble until March, 1870, when a dark colored tumor made its 
appearance in the site of the first swelling. This tumor has grad- 
ually-increased in size up to the present time, and has been attend- 
ed with considerable pain. She has been an habitual drinker for 
several years, and was once treated for mania a potu. Present 
condition—She is a woman of above medium size, fleshy, dark hair 
and eyes, abdomen enlarged to about size of third month of preg- 
nancy, has a dark colored tumor, fungus hsematodes, on the dorsum 
of right foot, involving the bases of two of the toes; it is soft to 
the touch and is about size of an English walnut, it frequently 
bleeds, especially when touched. She has not menstruated for 
three years, is the mother of three children. 
On July 28 the tumor was removed by a ligature applied to its 
base and desiccated sulph. zinc applied to the stump. During this 
time it wa? necessary to give the patient large doses of morphia to 
ease pain and procure rest. 
Sept. 10. Attention was again called to the tumor in the abdo- 
men, it was examined and supposed to be a fibroid of the uterus. 
The heart and urine were also examined and nothing abnormal 
found. Pulse from 70 to 80. 
Sept. 12. Stopped morphia and ordered chloral hydrate to be 
given in doses of 3 ss every hour until sleep. 
Sept. 20. Stopped chloral and resumed the use of morphia as it 
seemed to control the pain better. 
Oct. 13. Patient taken before the class, placed under chloroform 
and the foot removed by Syme’s operation. Before the operation 
was completed the patient suddenly died. She had passed easily 
under the influence of the chloroform, and in about one minute 
and a half after becoming insensible, she ceased to breathe. Breath- 
ing and pulse fair up to the very instant when both were arrested. 
Persistent efforts were made to restore her, but without avail. Ar- 
tificial respiration, electricity, &c. The amount of chloroform used 
was 75 minims; a portion of the same chloroform was tested and 
found to be pure. 
An Autopsy was made ten hours after her death. Scalp found 
congested and injection of the arachnoid; small amount of fluid in 
each ventricle; veins of lateral ventricles and septum lucidum 
distended with blood; entire brain substance more moist than 
normal. The lungs were engorged, but beyond this presented 
nothing peculiar. 
Heart—Cavities empty, almost entire right ventricle covered 
with a layer of fat, valves of right side transparent and flexible, 
a band of calcareous matter about f of an inch in length, extend- 
ing from near the base of the mitral to within a short distance of 
one of the semilunar valves ; aortic valves slightly thickened, all 
valves at left side flexible and apparently competent. The mus- 
cular substance of the heart was in a state of fatty degeneration. 
Kidneys—Left one weighed §vj., capsule thin and readily de- CHLOROFORM DEATHS. 
13 
tached, cut section granular, line of separation between cortex and 
pyramids distinct. Eight one weighed % iijss., capsule thickened 
and closely adherent, cut section granular very little pyramidal 
structure, inch thick. 
Liver—Weight ; substance fatty. 
Uterus—One large and one small fibroid tumor were found devel- 
oped in the uterine walls. Dimensions of largest one, 6 inches 
in length and 5 inches in transverse and antero-posterior diame- 
ters, small tumor about inches in its diameter, walls of uterus 
presented appearance of an advanced stage of pregnancy. 
Blood was fluid throughout the body.” 
It will bo noticed in this case that there was a simultaneous 
arrest of the heart’s action, and of respiration, and with all our 
efforts at resuscitation—artificial respiration being kept up for one 
hour and three-quarters—there was not the slightest indication of 
a return to life; the lungs were alternately filled and emptied, 
but the heart remained still, motionless. The blight here was through 
the lungs, directly upon the heart, producing a sudden and con- 
tinued contraction, as shown by the empty condition of the cavities. 
Had this been by a sudden contraction of the pulmonary arterial 
vessels, by which the blood would have been driven back upon the 
heart, the lungs, as suggested by Bichardson, would have been 
found blanched and the right heart filled with blood. In this way, 
death, without question, frequently occurs in a dilated right heart 
or in a fatty heart. The sudden regurgitation of the blood through 
the pulmonary artery, by which the right ventricle is flooded, dis- 
tended and paralyzed, takes from the organ the power to contract, 
death is inevitable. Bridget Ilenry, although her heart was in a 
state of fatty degeneration, did not die in this way, the cavities in 
her case, as we have seen, were entirely empty. 
Dr. E. A. Clark, in the Humboldt Medical Archives, reports a 
case where death resulted in the same manner that it did in the 
case of Bridget Henry. The post-mortem showed the heart, lungs 
and brain healthy, but the cardiac cavities were empty, showing 
that the first damaging effect of the chloroform was upon the 
heart, causing a positive and unyielding contraction. This view is 
supported by the fact that after the patient had been placed on his 
back with his head lowered and cold water dashed in his face, 
“three or four long inspirations” were taken, “without, however, 
affecting the circulation in the least.” Dr. Clark says, “this (arti- 
ficial respiration) was continued without any relaxation for an 
hour and forty minutes, but without in the least reviving the ac- 14 
CHLOROFORM DEATHS. 
tion of the heart, which, I am confident, never beat again from the 
moment that natural respiration ceased; he was dead from that 
instant.” 
Case 2.—Death of an Intemperate Man before the Completion of an 
Amputation of the Leg. Dr. E. Ashton, of Lima, Ohio, reports 
this case, as follows: 
“Sometime in the month of January, 1857, a man named Boston 
Ike, a notorious drunkard, bought a jug of liquor in the evening, 
and started for his home on the line of the D. & M. B. B., then in 
process of construction. On the following morning he was found, 
by his friends, lying beside a stump and badly frozen. I did not 
see him for several weeks, when I was called to amputate both 
lower extremities. Both feet had sloughed off above the ankle; 
he was much emaciated and suffering from an irritable cough, the 
latter the result, no doubt, of that night’s exposure. Seeing the 
condition of the man, I objected to giving him chloroform; but his 
fear of the operation and unwillingness to have it performed with- 
out being rendered insensible to pain, were so great, that his 
attending physician urged its administration. Dr. Curtis admin- 
istered the chloroform from a sponge held in the hand. He 
seemed to have some little difficulty in inhaling the vapor, but 
after a few inspirations, he had no further difficulty, and passed 
quietly and fully under its influence. I proceeded to perform the 
operation, but had barely completed the incisions and was about 
to use the saw, when my attention was called to the patient; from 
his expression and the character of his breathing, I saw that all 
was not right. Upon dropping the saw and placing myself beside 
my patient, I felt his pulse at the wrist; his breathing, however, 
ceased instantly, and all efforts to re-establish it were in vain.” 
The prostration and emaciation in such a case as this, where 
both feet have been lost by gangrene, the result of frost, is neces- 
sarily very great. I saw, some years ago, Dr. Thomas Wood 
operate under chloroform, in a case very much like Dr. Ashton’s; 
both feet had been lost by exposure to cold; the patient, an old 
man of about sixty, was thin, worn and wasted by long suffering; 
but he slept like an infant in its mother’s arms, while Dr. Wood 
worked up the stumps. Emaciation merely is no bar to the use of 
chloroform ; but emaciation in connection with the excessive and 
long-continued use of alcohol, renders the hazards of the anaes- 
thetic much greater. 
Case 3.—Death after Amputation of the Thigh. Second Administra- 
tion of Chloroform. Reported by Dr. J. W. Hadlock. 
“During the month of September, 1865, at Idaho City, Mr. R., a 
stout, robust, vigorous man, of good habits, became engaged in a CHLOROFORM DEATHS. 
15 
personal difficulty, during which he received a shot from a large 
sized Colt’s navy revolver, about the middle of the thigh, the ball 
fracturing the femur to considerable extent. An effort was made 
to save the limb, but after six day’s trial, in that direction, it be- 
came evident that it must be removed. The day previous to the 
amputation, the patient was placed under chloroform and a tho- 
rough examination of the injury made. This examination lasted 
some minutes, the patient coming from under the anresthetic with- 
out any unpleasant symptoms. The following day the operation 
was made at the junction of the upper and middle thirds of the 
thigh. The patient went under the influence of the chloroform in 
an easy and quiet manner, but just as the flaps were being brought 
together, Dr. Bell, who was attending to the chloroform, remarked: 
‘ This man is dying,’ and after two or three faint gasps, he 
stopped breathing. Efforts at resuscitation were made, but were 
of no avail. I make this record from memory, and can not now 
remember whether the heart’s action ceased simultaneously with 
the breathing. The patient was not reduced or emaciated, but 
was in a good condition for an operation.” 
This case evidently belongs to Dr. Reeve’s 6th class, viz : “ Cases 
in which every precaution seems to have been observed, and no 
explanation of the death can be given in the present state of our 
knowledge.”* 
Case 4.—Death while the Anaesthesia was but Partial, patient in 
an erect position for the Extraction of Teeth; had taken it frequently 
to complete insensibility. Reported by Dr. J. G. Wilson, Wash- 
ington C. II., O. 
“On September 29, 1870, Dr. Hamilton called on me to admin- 
ister chloroform to Mrs. Col. Garris, who had come to his office to 
have eight teeth extracted. I met Col. Garris at the foot of the 
stairs leading to Dr. H.’s office, and ho requested me not to put his 
wife fully under the influence; to give her only enough to allay 
pain. I found her sitting in the dentist’s chair. I asked her if 
she could stand it to have her teeth extracted without being insen- 
sible ? She answered : ‘ I expect I can, but I am not afraid of chlo- 
roform; I have taken it a hundred times, and I could have taken 
it myself to-day, without sending for you, but they would not allow 
me to do so.’ I gave it on a napkin, held from to 2 inches 
from the mouth, and after inhaling the vapor two or three min- 
utes, she said : ‘ If the dentist is ready I am.’ When Dr. II. intro- 
duced the forceps, she caught his hands; I removed her grasp to 
mine, and she held my hands firmly. When the tooth was drawn 
* On the causes of death from chloroform, with an analysis of the reported 
total cases from the inhalation of that agent, and an endeavor to classify them 
by J. C. Reeve, M. D.—American Journal of the Medical Sciences, 1867. 16 
chloroform: deaths. 
she screamed so as to be heard across the street. As Dr. H. was 
about to engage another tooth, she caught his hand, and said : 
‘Hold on till I take more chloroform.’ Dr. H. stepped back and 
I saw she was fainting. I laid her on the lounge. I could not 
detect either pulse or heart action. She continued to breathe at 
long and still longer intervals, blowing out the lips at each expi- 
ration. Her breathing reminded me of persons that I have seen 
die of apoplexy. Mrs. G. was 39 years of age, the mother of eight 
or nine children—of delicate health and very nervous. The pulse, 
before the administration, was 80; under the chloroform, it fell to 
70. The amount of chloroform used did not exceed one drachm. 
It was procured from Allen & Co., Cincinnati, O., and on being 
tested, was found to be pure. I had used it before, and frequently 
since. Artificial respiration, electricity, cold water and stimulating 
enema were used.” 
As supplementary to this report, I may mention some facts in 
reference to the chloroform history of Mrs. Garris, as given by 
Dr. Stewart, of Bloomingsburg, Ohio, at the Cincinnati Academy of 
Medicine during the present session. Dr. S. stated that he had 
known Mrs. G. all her life, had given her chloroform in all her 
labors except the last, when it was given by Dr. Wilson ; that he had 
kept her under its positive influence 12 hours during her first confine- 
ment. That he had given it to her on three different occasions for 
the extraction of teeth, and always with the happiest effect and 
with the best results. He expressed the opinion that if chloro- 
form had been pushed to complete insensibility at its last adminis- 
tration, that the termination of the case would have been different. 
Upon the question of the comparative safety of partial and com- 
plete anaesthesia, the following, taken from the paper of Dr. Heevo 
already referred to, is pertinent: “Attention was first called to 
the probability that death, under chloroform, might be explained 
by the depressing effects of the surgical incisions upon the heart’s 
action by Mr. Bickersteth, as long ago as 1853. ‘He relates three 
instances in which the pulse suddenly ceased on the first incision 
by the surgeon, and commenced again in a few seconds, the breath- 
ing going on naturally all the time. All the three cases were am- 
putation of the thigh.’ Snow has never observed this change in 
the heart’s action, although he says he has carefully watched for 
it, and he explains the cardiac irregularity by the direct effect of 
chloroform, its occurrence being just at the time when anaesthesia 
is at its hight. The next investigator of this subject was M. 
Yigoroux, who presented his views to the Academy of Sciences. 
He started from the fact that a painful impression upon the sensi- CHLOROFORM DEATHS. 
17 
tive nerves influences the heart by reflex action in a manner exactly 
similar to a direct excitation of the par vagum, retarding or even 
arresting suddenly its movements. Ho first attempted a solution 
of the question, whether this influence of the external sensory 
nerves upon the heart’s action was exerted during anaesthetic 
sleep, and'decided it in the affirmative. As we have not access to 
the detail of his experiments we cannot decide how justly this 
decision was made, but his further conclusions shake confidence in 
him entirely; they were that the influence mentioned not only 
exists, but is augmented, and that a majority of the deaths under 
chloroform could be attributed to this cause! M. Perrin, to whom 
we are chiefly indebted for a knowledge of M. Vigoroux’s doc- 
trines, disposes of these assumptions most effectually by calling 
attention to the number of deaths which have occurred before the 
operation began—35 out of 65! But M. Perrin investigated the 
subject for himself, and from reason and the careful examination 
of eight cases of operation under chloroform, concludes that it is 
only during the period of partial anaesthesia that this influence 
of external excitation upon the heart’s action manifests itself 
while during complete anaesthesia it is abolished. ‘To admit any 
reflex action whatever after sensibility to mechanical irritants is 
abolished, would be to admit an effect without a cause.’ Mr. 
Bickerstcth also expresses his conviction that accident in this way 
is less likely to occur when the anaesthesia is profound. Mr. Lis- 
ter saw a patient die when partially under the influence of chloro- 
form, and expresses the opinion that he would have passed safely 
through the operation had the influence been complete. This, 
then, brings us to a point at which the doctrine becomes of the 
highest practical importance ; it forces upon us the question, Is 
partial anaesthesia more dangerous than complete ? A question 
beside which the mode of death, simply considered as such, be- 
comes insignificant. In support of the affirmative, we have seen 
that there is considerable respectable authority.” 
In his collection of cases, in the section bearing on partial and 
complete anaesthesia, Hr. Reeve introduces the following one 
which has a remarkable resemblance to that of Mrs. Garris. 
“A lady, San Francisco, (Boston Medical Journal, May 19th, 1864). 
The patient was seated in a dentist chair, and was ‘ much excited, 
by fear of the instruments. At a period when anaesthesia was 
manifestly incomplete as she seized the dentist’s hand and removed 
it from her face, the tooth was extracted ; ‘ but the jaws immedi- 18 
CHLOROFORM DEATHS. 
ately after became clenched, and her head thrown back,’ the 
breathing was arrested and death rapidly ensued.” 
Case 5.—Death of a Boy 14 years of age. Second Administration. 
Mental Depression. Reported by Dr. A. T. Davis, of Wilming- 
ton, O. 
“Chas. Pendry, a healthy industrious boy, had his thigh frac- 
tured Dec. 23d, 1869. Was suffering great pain when I saw him 
two hours after the accident; gave him chloroform while examin- 
ing and dressing the fracture. On the 9th of April following, 
while loading a sled he fell with some heavy boards across the 
lame thigh, aud refractured it at the same point. When I saw 
him two hours after, he was very despondent and said he should 
die, but in all respects appeared to be in good condition. He 
would not, as when first injured, permit me to touch him without 
chloroform. Igaveit; he speedily came under its influence, I ex- 
amined the fracture and left his bedside to prepare bandages. He 
slept about 15 minutes and woke in great pain, and remained 
awake about 20 minutes. I then examined his pulse and appear- 
ance, all seemed right. I again applied the chloroform, and in 
two or three minutes as he began to pass under its influence, I 
handed the towel to an assistant; just as I did this I put my fin- 
gers on the wrist and found no pulsation; the chloroform was im- 
mediately withdrawn, but the heart remained still. The breath- 
ing during the administration of the chloroform was a little 
stertorous, but only such as is often seen in antesthesia. He 
breathed ten or twelve times after the arrest of the heart’s action. 
Insufflation and all other means of resuscitation at command, were 
used, but without effect. The quantity of chloroform used did not 
exceed drachms.’’ 
The death in this case was evidently by the heart, the mental 
depression as he was anxious to have the chloroform could not 
have had much, if anything, to do with the fatal result. In the 
absence of post-mortem revelation it must be mere conjecture 
whether death in this case was by sudden and continued contrac- 
tion, or by paralysis of the heart. 
Case 6.—Death of a robust man after Complete Anaesthesia had 
passed sufficiently for him to answer a question. Surgical Clinic 
of Dr. Thos. Wood, Commercial Hospital, 1865. Reported by 
Dr. Chas. O. Wright. 
“ The patient upon whom Dr. Wood operated for fistula in ano, 
was a man of plethoric habit and aside from the fistula, was in 
apparent good health. It was with some difficulty that we could 
bring him under the influence of the chloroform. For at least one 
minute before the completion of the operation I had ceased the 
administration. After the Doctor had finished the operation and CHLOROFORM DEATHS. 
19 
was about washing his hands, the patient having answered one or 
two interrogatories, and the order had been given to remove him 
from the amphitheater, ho was seen to gasp. Dr. Wood immedi- 
ately seized tho tongue, drew it forward, and the patient breathed. 
Dr. Wood turned to the class and was explaining to them the con- 
dition of things, when, turning round and noticing the patient again 
gasping, he again seized the tongue, artificial respiration was 
established; but in vain, he never breathed afterward. At least 
three minutes elapsed from the time we ceased administering the 
chloroform before unfavorable symptoms were observed. 
Post-mortem.—Rigidity well marked; suggillation lighter color 
than usual; scalp lull of dark and thin blood; dura mater en- 
gorged, serum beneath arachnoid, coagulated lymph upon both 
surfaces of the membranes; fine threads of lymph passed from the 
lateral and under surfaces of the medulla oblongata to the cere- 
bellum ; in the lateral ventricles a small quantity of serum tinged 
with blood; the chloroid plexus pink and adherent to the thalami 
optici ; the veins on floor of ventricles distended; threads of 
lymph passed from floor to roof of lateral ventricles; velum in- 
terpositum covered with firmly adherent lymph ; puncta vasculola 
in right cerebral hemisphere more numerous than usual; surface of 
medulla oblongata much congested. Considerable fat on external 
surface of pericardium, on its inner surface about the roots of the 
great vessel were numerous small deposits of soft caogulated 
lymph. Heart had about the usual amount of fat on its surface, walls 
normal, cavities empty ; valves healthy. The right pleural surfaces 
adherent over the greater part of their extent and the lobes united 
by false membrane; the lobes of left lung united, but pleural 
surfaces free; epiglottis and mucus membrane of larynx were 
dusky, but little fluid in the bronchia; entire upper lobes of both 
lungs dark colored and gorged with blood ; the same condition ex- 
isted in the lower posterior portions; the anterior portions were 
emphysematous. The blood in all parts very thin, dark, and no 
coagula.” 
Case 7.—Death of a Lady—Retching and Vomiting commencing 
with the administration of Chloroform, were arrested during complete 
Anaesthesia, began as soon as the patient was aroused, and continued 
for six days. Exported by Dr. Thos. Wood. 
“ Mrs E., about 26 years of age, bad received laceration of the 
perinseum in child-birth about four years previous to my attend- 
ance on her. The laceration extended back so as to impair, but 
not entirely destroy the integrity of the sphincter ani, but the 
control of the sphincter vagina was so much impaired as to allow 
a descent of the folds of the vagina and bladder, and a dropping 
of the uterus below its natural position. From this unnatural 
state of things, she became nervous and debilitated, and was the 
victim of constant pelvic distress. For her relief I performed the 20 
CHLOROFORM DEATHS. 
usual operation, pairing off the cicatrized surfaces and drawing 
them together by silver sutures. I operated on the 10th of March, 
1870, and six days after she died. The chloroform was admin- 
istered by Dr. Charles Woodward. The first inhalation produced 
retching, followed by vomiting before insensibility was produced. 
The operation lasted about half an hour. As soon as she became 
sensible the vomiting was immediately resumed and continued, 
when there was anything in her stomach to eject, until her death. 
When her stomach was empty she was either retching or making 
an effort to resist it. In twenty-four hours she became delirious 
and tremulous, the pupils dilated, the capillary circulation defi- 
cient, the surface livid.” 
Here we see a new manifestation of chloroform, a pernicious 
influence on the stomach producing persistent, uncontrollable and 
fatal vomiting. In all the cases published I have discovered none 
like this. The poisonous effect of the chloroform seems to have 
spent itself on the gastric branches of the par vagum. 
Case 8.—Death of a Alan having Delirium Tremens and Fracture of 
the Humerus. Commercial Hospital Service of Dr. George C. 
Blackman. 
“ The patient was a man aged about 30, of good muscle. He 
came into the hospital with a fractured humerus and was seized 
with delirium tremens. So violent was he that it was necessary 
to give him chloroform to dress the broken arm. He died during 
the dressing.” 
This case illustrates the peril of administering chloroform to 
inebriates. 
Case 9.—Death of a Young Man three quarters of an hour after the 
Administration of Chloroform had been suspended. Commercial 
Hospital, 1857. Service of Hr. Geo. C. Blackman. Reported 
by N. J. Sawyer, M. D. 
“The patient was a young man about 18 years of age, anemic, 
very much emaciated with a pale, bloodless countenance, feeble 
pulse and extreme general debility. On the front aspect of the 
right thigh, and over the track of the femoral artery, was a 
swelling of considerable extent, and about which thex-e was a 
difference of opinion among those who examined it, as to whether 
it was an abscess or an aneurism. Dr. Blackman, the attending 
surgeon, came to the conclusion that the tumor contained pus 
only, and having decided on this after making his usual morning 
visit, he returned to the hospital in the afternoon to perform the 
required operation. I being on duty in the surgical wards at the 
time, he requested me to give the chloroform, and stood by while 
it was being administered. Dr. Blackman, myself and two nurses CHLOROFORM DEATHS. 
21 
were the only persons present. The patient lay on his bed, with 
the head and shoulders slightly elevated, and was soon under the 
influence of the anaesthetic without having manifested the least 
symptom contra-indicating its use. There was no vomiting either 
during, or after, its administration. The patient simply went 
quietly asleep. Dr. Blackman made an incision toward the outer 
edge of the sac, and went down to the bone; but no pus making 
its appearance, he declined using further efforts to find it. The 
patient fully revived, as we supposed, from the effects of the chlo- 
roform, and talked in his usual manner, giving directions about 
the bandages, the position of the limb, etc. 
“The administration of the chloroform, the operation, the revi- 
val of the patient to his ordinary condition and the complete 
possession of his faculties, occupied about twenty minutes. I re- 
mained until there seemed no further need of my presence, but 
happening to look back as I passed out of the door, I saw the 
patient had raised himself to a sitting posture in the bed. Sup- 
posing ho would lie down again in a moment, I gave the circum- 
stance no attention. In about three-quarters of an hour after 
leaving the ward, a nurse summoned me in haste, saying ‘Bun up, 
quick, that man is dying ! ’ As I reached the patient’s bed-side 
he gave but one gasp, and was dead. The ordinary means for re- 
suscitation were applied when it was too late, and, of course, in 
vain. 
“ The post-mortem revealed the fact that the swelling was an ab- 
scess, containing about a quart of pus, and that the incision had 
missed the sac about a quarter of an inch. 
“ Dr. L. M. Lawson examined the abdominal and thoracic viscera, 
and the brain. The appearances presented were such as might be 
expected in an extreme case of anaemia. The right cavities of 
the heart, however, were found to contain such a quantity of 
coagulated fibrin that Dr. Lawson remarked it was a wonder 
the organ could have performed its functions at all ; and the 
conclusion arrived at was, that extreme depression following 
from the over-excitement produced by the chloroform, super- 
added to the impediment to the pulmonary circulation, and 
to the action of the heart from the deposition of fibrin in its 
right cavities, had caused the death of the patient.” 
We can hardly convict chloroform of the death in this case. Tho 
boy recovered so as to raise up in bed. It was in this erect 
position that the syncope occurred which destroyed him. Tho 
clots here, too, are unusual. In the large majority of cases the 
blood is found in a fluid condition. 
Case 10.—Death of a Soldier to whom Chloroform was given for an 
operation for Fistula in Ano. General Army Hospital, Nashville, 
Tenn. Deported by F. Seymour, M. D. 
“A. B., about 30 years of age, a soldier, had fistula in ano, and, 22 
CHLOROFORM DEATHS. 
although the operation was a trifling one, yet he insisted on an 
ansesthetic. He was taken into the operating room, and placed 
upon the table. A full supply of air was circulating, the windows 
and doors being open. Dr. J. R. Weist, of Richmond, la., admin- 
istered the chloroform ; it was done with skill and care. After a 
few deep inspirations, he commenced struggling, and his features 
becoming somewhat livid, the chloroform was suspended. In a 
few seconds the chloroform was again administered, and he seemed 
to pass under its influence kindly. Just then my attention was 
called from him for a moment, when, hearing an exclamation, I 
turned around, and his breathing had ceased. The mouth was 
forced open, the tongue seized and drawn forward, water was 
dashed in his face; Marshall Hall’s ready method was immedi- 
ately resorted to, and mechanical inspiratory movements were in- 
duced quickly ; but all efforts combined for nearly an hour were 
unsuccessful. Ho post-mortem. The heart and lungs were care- 
fully examined, and found healthy before the use of the anaes- 
thetic.” 
The folly of the dogma that whenever an operation is justifiable, 
chloroform is justifiable, or, as Syme puts it, a case for operation is a 
case for chloroform, is peculiarly illustrated in this instance. The 
operation for fistula in ano is one of the most painless. Ho person 
should be subjected to the dangers of chloroform for a cutting so 
insignificant, and particularly in view of the fact that most deaths, 
so far, have attended trivial operations. This case was not re- 
ported to the Surgeon-General’s office. 
Case 11. Death of a Lady placed under Chloroform for the Extrac- 
tion of Teeth; position recumbent; had taken Chloroform before. 
Reported by Dr. D. C. Rathburn, Middleport, O. 
Mrs. Black died in 1865. She was a person of nervous tempera- 
ment, delicate health, but of no organic disease. Before taking 
chloroform she seemed agitated, pulse about 100. She had taken 
chloroform once before for dental purposes. Her position was re- 
cumbent. before a large open window. The chloroform was ad- 
ministered by folding a handkerchief in the form of a cone, and, 
saturating the apex, applied it to one nostril only. The amount 
used was about three drachms and a half. She never lost con- 
sciousness, but would indicate by a wave of the hand that she was 
ready. This she did until the last of three fangs had been re- 
moved, when, as quick as thought, a deathly pallor came over her 
countenance, indicating syncope or death. 1 immediately applied 
my ear over the heart; it was still. She had died without a 
struggle. Ho time was lost in drawing out the tongue, and in in- 
flating the lungs by the application of my mouth to hers, com- 
pressing the chest after each inflation. Artificial respiration was 
thus kept up for one hour.” CHLOROFORM DEATHS. 
23 
This would seem to be another death from partial antesthesia. 
Case 12.—Death of a Man having Paralysis; had taken Chloroform 
frequently. Good Samaritan Hospital. Reported by Dr. De- 
Courcy. 
“Geo. Davis, colored, aged 29. Admitted with complete paral- 
ysis of upper and lower extremities, resulting from an injury, 
May 5, 1869. It was necessary to put him under chloroform each 
time his bed was changed, owing to enormous bed sores. He boro 
chloroform well, and had taken it quite a number of times, but on 
September 29, 1869, while that agent was being carefully admin- 
istered to him, as usual, by one of the resident phj’sicians, his 
pulse and respiration suddenly ceased. The chloroform had been 
gradually administered to him less than two minutes, on that oc- 
casion. Every effort at resuscitation failed.” 
Cause of Death.— The heart is the organ most frequently smit- 
ten in death by anesthetics. This is certainly true of chloroform, 
whose career has been more carefully studied than that of any 
other agent of this class. In most of the cases reported it will be 
found that the failure of the pulse was followed by failure of the 
lungs. In the majority of cases the heart is paralyzed ; in many, 
and such a one is Case 1st, the chloroform stimulates the heart to 
a positive, unrelenting, fatal contraction; in others the organ is 
broken in force and deprived of the ability to contract by the 
rush of blood upon it from the lungs. “Twenty years ago,” says 
Richardson, “ it was assumed that in nearly every fatal case death 
was owing to cessation of the heart, and we are indebted to Dr. 
Sibson for a very acute and admirable suggestion explaining the 
cause of the suddenness of the death. The heart, said he in 
effect, for I forget his exact words, first feeds itself with blood by 
its coronary system of vessels. It receives, therefore, into itself 
the first impression of every stroke of itself. If the blood with 
which it is fed is normal, it is first fed by it; if the blood is ab- 
normal it is first injured by it; and so when the blood of the left 
side is charged with chloroform the heart is the organ primarily 
influenced by the agent.” 
Ihe lungs, next in frequency, are the organs fatally impressed. 
The chloroform coming in contact with the pulmonary branches 
of the pneumogastric, paralyzes them, respiration ceases, while 
the heart continues, for a limited time, its action. The second 
case reported illustrates the toxic influence of chloroform upon 
the lungs. 24 
CHLOROFORM DEATHS. 
The stomach, in Dr. Wood’s case (Case 7 of this collection), 
was primarily and fatally affected by the chloroform. The first 
inhalation stimulated the gastric branches of the par vagum ; the 
ansethesia, which lasted half an hour, so disordered them that 
vomiting and retching ceased only with the life of the patient on 
the sixth day. 
The tongue, formerly more frequently than now, by falling back 
caused death by mere mechanical obstruction. It belongs to vol- 
untary life, and when the ansesthesia becomes profound the mus- 
cles of which it is composed, and which give it form and hold 
it in position, are relaxed; it falls into the isthmus, closes the air 
passages; apnoea is the result. The recumbent position favors 
danger from the falling tongue. 
The brain is occasionally overcome by 'the toxic influence of 
chloroform. The chloroform narcosis is prolonged, pushed too far 
(but who can give us the limit), and the patient dies in a comatose 
state. 
The Manner of Death.—This may be sudden, gradual or sec- 
ondary. Most deaths, as will be observed by an examination of 
all records, were sudden—in a moment the patient died. Bridget 
Henry had a fair pulse and regular respiration up to the very 
instant when both ceased. In a few cases the death was gradual, 
the fatal result seems to have been delayed, the heart and lungs 
showed feebleness of action, then were arrested; in a moment 
respiration and pulsation were resumed, but only to be followed 
by cessation, and thus arrest and resumption of these vital func- 
tions alternated, sometimes for minutes, sometimes for hours, 
before the death of the patient. Dr. Wood's case peculiarly illus- 
trates secondary death from chloroform. Aroused from the com- 
plete anaesthesia the patient at once resumed the vomiting which 
had been inaugurated by the first inhalation of the vapor, and 
which terminated her life on the sixth day. 
AYIIAT CAN BE DONE TO PREVENT THESE ANAESTHETIC DEATHS?—The 
first question which presents itself under this head, is, What cases 
should be excluded—shut out from the use of chloroform ? Dr. Rich- 
ardson places himself thus : “ I believe I know of one condition of 
body which may be diagnosed as specially dangerous for chloro- 
form, and there my knowledge is brought to an end. This unfa- 
vorable condition is present when careful diagnosis shows the CHLOROFORM DEATHS. 
25 
existence of a weakened and dilated right side of the heart, with 
enlarged hemorrhoidal veins, varicose veins of the lower extremi- 
ties, and large, full, yet not tense veins in the lower part of the 
body. In the body, thus circumstanced, we may be certain that 
the right side of the heart, which is the most important organ to 
be sustained in action under chloroform, is already half dead, and 
will readily succumb if subjected to further injury. * * * If I 
have one further misgiving, in respect to dangerous cases, it re- 
lates to cases of kidney disease with albumen in the urine, and 
disposition to uremic sleep. Here, however, the misgiving is 
based on theoretical reasoning alone, and is greatly negatived by 
the knowledge we have acquired from practical observation.” 
From the fact that so many chloroform post-mortems have re- 
vealed fatty degeneration of the muscular structure of the heart, 
almost all writers exclude persons with this affection; but who 
can diagnose a fatty heart? Writers exclude these cases, but 
practitioners give them chloroform, nevertheless. We can only 
suspect fatty degeneration of the heart; we can not definitely 
diagnose it. Da Costa says, “ There is as yet no sign discovered 
by which we can say that the dangerous disorganization of the 
muscular fibers of the heart is in progress. We may, however, 
suspect it, if the signs of weak action of the heart, feeble impulse, 
and ill-defined sounds, coexist with a pulse permanently slow or 
permanently frequent and irregular, and be met with in a person 
who is the subject of a wasting disease, or who has arrived at a 
time of life at which all the organs are prone to undergo decay.” 
Bridget Henry had a malignant disease of the foot—it was local— 
painful, but had not wasted her. She was plump ; had fat in 
abundance. She had a regular pulse of fair force and volume, 
and a cardiac impulse normal, and yet the post-mortem showed 
what had not been even suspected, much less diagnosed, a fatty 
heart. 
Arthur Ernest Sansom, M. D., in his valuable work on Chloro- 
form, its Action and Administration, thus writes: “The general 
lesson inculcated, would seem to be this : that in cases of marked 
fatty degeneration of the heart, chloroform should not be admin- 
istered ; that in cases wherein a debility of the heart is suspected, 
unusual care should be exercised to administer a free dilution, so 
that the heart should not be paralyzed by the sudden shock of an 
influence which it can not withstand. * * * * What are the 
principles of diagnosis ? Of the first class, viz : fatty degeneration, 26 
CHLOROFORM DEATHS. 
the following are the most important points: The previous history 
of tendency to faintings, the occurrence of occasional dyspnoea 
from congestion of the lungs ; the indication of atheroma of tho 
arteries; feebleness, and especially intermission of the pulse; the 
impulse of the heart, found on stethoscopic examination, to be 
feeble in proportion to its size ; the countenance showing a certain 
yellowness of hue, and a congested state of the capillary vessels of 
the cheeks ; the occurrence of arcus senilis. If the occurrence of 
these signs should give rise to the diagnosis that there is a fatty 
degeneration of the heart, we are not justified in giving chloro- 
form.” 
Bridget Henry had had no “ faintings,” no “ dyspnoea from con- 
gestion of lungs,” no “indication of atheroma of the arteries,” no 
“ feebleness, and especially intermission of pulse.” The impulse 
of the heart was not found “feeble in proportion to its size; ” the 
countenance did not show a “yellowness of hue, and a congested 
state of the capillaries of the cheeks ; ” nor was there “ arcus seni- 
lis.” And yet, as we have seen, hers was a well developed case of 
fatty degeneration of the heart. 
Equally unanimous are writers and observers on excluding from 
chloroform hard drinkers and persons laboring under delirium tre- 
mens. One of Dr. Blackman’s cases (Case 8), and Dr. Ashton’s 
case (Case 2), belong to tho class in which the risks are great. 
Bridget Henry’s ante-hospital history, which I have but recently 
learned from Dr. Maley, who was her family physician for eight 
years, and who has informed me that she was an unusually hard 
drinker, and had had delirium tremens six times, would have ex- 
cluded her, if this rule is made positive, although it must be re- 
membered that from the time she entered the hospital, July 7th, 
until the day of her death, October 13th, she did not drink any- 
thing, and during this period her health was fair. She suffered 
only from the painful condition of her foot. 
Dr. Sansom noticed in these cases “a great primary resistance, 
prolonged muscular agitation, hypersesthesia rather than antes- 
thesia, violent endeavors to assume the erect posture, and, after a 
considerable time, sudden change to deep insensibility, clammy 
perspiration, complete relaxation, snoring respiration, and feeble 
pulse.” 
In Dr. Ashton’s case, and in that of Bridget Henry, there was 
no resistance, but neither were suffering from recent alcoholism— 
long intemperance had damaged the heart in both cases—and in CHLOROFORM DEATHS. 
27 
both death was sudden, by the heart, rather than by a toxic effect 
upon the nerve centers, the direction from which death often 
comes to the intemperate. 
Prof. Gosselin, in discussing the contra-indications to the use of 
chloroform, cites nervous shock after severe injuries-, he would rule 
out these cases. Now, it is an undoubted fact, in the face of all 
that is said of the depressing, paralyzing effect of chloroform upon 
the heart, that it does often increase cardiac action. I witnessed this 
recently in the Cincinnati Hospital. A little boy was brought in 
with the arm crushed to the shoulder; amputation at the joint was 
necessary. He was fearfully mangled and greatl}T prostrated, but 
under the influence of chloroform his pulse increased in force and 
frequency. Dr. Stewart, at the Academy of Medicine, reported a 
similar case where the action of the chloroform was that of a de- 
cided cardiac stimulant. The experience of giving chloroform in 
the cold stage of intermittents looks in the same direction; here 
is a shock, a collapse to a degree—the heart is oppressed, its action 
imperfect, chloroform acts as a stimulant, the shock is broken and 
the chill is of short duration. Prof. C. G. Comegys, in the West- 
ern Journal of Medicine, 1868, gave his experience with chloroform 
in intermittents. He treated one hundred cases in the Cincinnati 
Hospital, giving chloroform on the supervention of the chill ; 
“ and,” says he, “in every case complete relief is obtained in from 
three to five minutes.” “ In the condition of shock, or of great 
depression, as after hemorrhage, the careful administration of 
anaesthetics diminishes the risk of an operation.” (Report to 
Royal Medical and Chirugical Society.) 
Persons in great fear and dread of an operation, although they 
can not be excluded, should have anaisthetics exhibited to them 
with great caution and care. Bridget Henry belonged to this 
class. The position of the physician under such circumstances is 
embarrassing in the extreme. An operation is essential to the 
preservation of life, and yet his patient is nervous, and what is 
worse, has a fear of and an aversion to that operation. The non-pro- 
fessional can not appreciate this situation. 
The conclusion of the whole matter in regard to exclusion, is, 
that we can only decline persons with a dilated right heart and those 
laboring under delirium tremens. To these Richardson is disposed 
to add those persons who are disposed to uremic sleep. 
We may do much in securing safety, by attention to the 
proper position of the patient, the condition of the stomach, 28 
CHLOROFORM DEATHS. 
the temperature of the room, the appliance for and the manner of 
administering the vapor. 
When we reflect that the large majority of persons die of syn- 
cope, there should be no question about the recumbent position 
being the most safe for the administration of anaesthetics. San- 
som says : “ The rule should be, let the patient observe the recum- 
bent posture, unless the exigencies of the operation point other- 
wise. The tendency to syncope is greater in the erect and setting 
position than it is when the body is horizontal. The pulse in the 
latter condition is more slow and quiet; thus, though it maybe 
seventy in the former position, it will frequently sink to sixty-five 
or even sixty, in the latter. The reason, therefore, that the recum- 
bent position is to be preferred is, that the circulation is more 
steady and the tendency to faintness is less.” Richardson says : 
“ The sitting position is certainly unfavorable for the heart, and 
the perfectly recumbent position is unfavorable in many ways. It 
interferes with free respiratory power, it allows fluids accumu- 
lated in the mouth to fall back to the throat, it allows the tongue 
to fall back, and when vomiting happens to come on it enforces 
the necessity for raising the body. For all these reasons the semi- 
recumbent position is the best, as it is the most convenient. To 
this recommendation as to the position, it is essential to add an- 
other, viz : to keep the body from the beginning to the end of the 
administration in the same position, without any upward or down- 
ward movement.” 
This recommendation by Dr. Richardson, of the semi-recumbent 
position is certainly erroneous in principle. It is not an easy pos- 
ition, it is a restrained one and does not favor the free use of the 
lungs as well as the recumbent, nor is it so convenient to the ad- 
ministrator or to the operator. The recumbent should never be 
abandoned for any other position, except when, as Sansom says, 
the exigencies of the operation point otherwise. 
Upon the question of 'position the case reported by Prof. M. B. 
Wright, at the Academy of Medicine, during the present session, 
is peculiarly striking. That lady had taken chloroform, since its 
introduction, in all her labors and they have been many. She was 
the second female in Cincinnati who took it in parturition. She 
commences its use always on the first appearance of pain, and 
often before Prof. Wright’s arrival she is fairly under its influence. 
In labor it has always acted admirably, producing no unpleasant 
symptoms of any kind, but on several occasions, when she inhaled CHLOROFORM DEATHS. 
29 
it in a dentist’s office for the extraction of teeth, the symptoms 
were of the most alarming character. 
Chloroform should not be given while a meal is undergoing di- 
gestion; the stomach should be free from food, and if vomiting 
occurs it should rather bo encouraged than restrained; from three 
to four hours should elapse after a meql before the anaesthetic is 
given. 
Should spirits he given before the administration of chloroformf 
The practice of physicians varies very much on this point. Some 
give it, others do not; my own impression is, that it should never 
bo omitted; it encourages the strong, and strengthens the weak. 
On the means of counteracting the toxic effect of chloroform 
and ether, Dr. Sansom (.Medical Times and Gazette. April 28,1870), 
suggests that when one agent seems to he depressing the patient, an- 
other should be substituted. Unfortunately, however, most of these 
persons die without giving any sign of depression ; the heart or 
lungs, or both are suddenly smitten while respiration is regular, 
and the pulse shows fair force and volume; there is no time to 
displace one anaesthetic, which is acting badly, for another which 
may act kindly. The most rational course, when depressing 
effects are noticed, would bo to withhold entirely, on that occasion, 
at that particular time, anaesthetics, and allow the patient to re- 
cover completely from all effects of the drug ; then the substitu- 
tion of one for another might be made. 
Dr. Sansom also speaks highly of Claude Bernard’s recom- 
mendation to give a subcutaneous injection of morphia in persons of 
feeble heart, and in those given to habitual intemperance, but in this 
connection we must remember that this use of morphia is not 
entirely benign. Dr. Alonzo Clark reported a death, a few years 
ago, from a subcutaneous administration of morphia, and I am 
aware of another death from the same cause. It occurred in this 
State recently. The subject was addicted to drinking, and the 
morphia was used while he was in a debauch. Claude Bernard 
thus recommends, for the correction of the dangers of one agent, 
another agent equally potent for evil. 
Mode of Administration.—Appliances for the administration 
of chloroform range from Morton’s Inhaler, by which chloroform 
alone was admitted to the lungs, to Snow’s apparatus, with which 
the patient receives hut 4 per cent, of the anaesthetic. Just here, 
before discussing the various modes of administration, I may 30 
CHLOROFORM DEATHS. 
make the remark that, although for the last few years the ten- 
dency has been to great dilution of the vapor by the means of 
apparatus, as essential to safety, yet the deaths seem to have been 
on the increase, and I doubt whether there is advantage in any of 
these appliances. It appears folly to talk about the positive safety 
of dilution when a vapor of from 3 to 4 per cent, kills, and kills in 
the same manner that chloroform pure, unmixed with air, does. 
Mrs. Simmons, the second victim of chloroform (Cincinnati, Febru- 
ary 23, 1848), who inhaled pure chloroform from Morton’s Inhaler, 
seems to have died in precisely the same way as did those who 
have perished under Snow’s apparatus. 
Snow's Apparatus.—“ The essentials aro a metallic vessel in 
which chloroform is contained, and through which air passes, 
thus carrying the chloroform-vapor along with it; a tube which 
conveys a mixture of chloroform and air to the face-piece, and a 
flexible mask, fitting over both nose and mouth.” From 3 to 5 
per cent, of chloroform is mixed with the inspired air. The 
inventor of this instrument contended that it rendered chloroform 
perfectly safe, and although never meeting with a fatal case, he 
ha'1 some narrow escapes, his patients being in very great danger. 
Other gentlemen of equal skill, however, were not so fortunate in 
the use of his apparatus; they lost cases, although following “the 
method and practice of Snow.” 
Glover's Apparatus.—“Is a bag for containing the anaesthetic 
mixture; secondly, an arrangement for filling the bag with a cer- 
tain proportion of chloroform and air.” This is an expensive 
apparatus; it is large, unwieldly, and requires time to manufacture 
the anaesthetic atmosphere. It certainly will never come into 
general use. 
Sansom's Inhaler.—“ The receptacle for the chloroform is a small 
metallic cylinder; its hight about three inches, its diameter about 
an inch and a half. It is filled with blotting paper, loosely crum- 
pled, or, what is better, a rolled piece of lint; at the top it is pro- 
vided with a freely perforated plate, for the admission of air, and 
for the introduction of liquid chloroform. An exit tube passes at 
right angles from this receptacle, it being attached a little above 
the center, so that a cup may be kept for the retention of any 
liquid chloroform which may be more than sufficient to moisten 
the blotting paper or lint. Thus arranged, a direct current of air 
in inspiration passes through the apertures over the chloroform, CHLOROFORM DEATHS. 
31 
and of course carries the vapor along with it.” “ Simplicity, 
compactness, and portability,” characterize this instrument. 
Sir James Y. Simpson's Method.—This may be given in his own 
words, taken from the history of his first fatal case : “ I chloro- 
formed the patient. In doing so, I placed a single layer of towel 
over the nose and mouth, leaving the eyes exposed, and dropped 
the chloroform upon the towel.” Sir James, “from first to last, 
reasoned against complicated methods of administration.” 
Cincinnati Hospital Method.—This resembles the simple plan of 
Sir James Simpson. A piece of old muslin, about six inches 
square, is placed over the nose and mouth, and the chloroform 
dropped upon it. This insures a free admixture of air—through 
the interstices of the muslin and beneath it, for it is held a short 
distance from the face. 
U. S. Army Method.—Upon a folded towel, fi’om a towel fash- 
ioned in the shape of a funnel, or from a single layer of lint. Out 
of 80,000 administrations, but eight deaths are reported. 
Skinner's Inhaler.—Skinner, of Liverpool, has the best and most 
simple apparatus. It is a piece of flannel stretched over a wire 
frame in the shape of a shallow ladle; the concavity is held over 
the nose and mouth while the chloroform is dropped upon the 
convex surface. 
Anaesthesia should be produced slowly.—All observers agree upon 
this, no difference what method of administration is adopted. 
How far may chloroform narcosis be carried?—This is a difficult 
question to answer, as some die in an instant, with almost the first 
inspiration, while others sleep under it for hours and awake re- 
freshed. Dr. Reeve criticises severely the administration of chlo- 
roform in Dr. Krause’s case (Cincinnati, 1860)—the length of the 
anaesthesia, half an hour, and the quantity used, one and a half 
ounces. He says, “The operator in this case has followed his pa- 
tient to ‘that undiscovered country’ some years ago; the cause of 
science need not, therefore, suffer on account of sparing the feelings 
of parties interested. That death should follow such a use of 
chloroform as hero detailed can not be surprising. Were there no 
facts to sustain the proposition, that there is danger in a too pro- 
longed administration of the remedy, reason would surely indi- 
cate it. The analogy between the action of anaesthetics and 
alkohol is very striking, and if a man sit and tipple wine or spirits 
all night long it would not surely bo surprising, that when thus 32 
CHLOROFORM DEATHS. 
charged with intoxicating fluids, a small additional draught should 
send him promptly under the table into a fit of prolonged stupor; 
just so with chloroform; if the tissues have become permeated and 
soaked, as it were, with the potent remedy, what more could be 
expected than dangerous symptoms from a sudden, although very 
slight increase of the dose.” 
This criticism is not only too severe, but I think it is hardly 
just. The anaesthesia was partial for 25 of the 30 minutes em- 
ployed, for Dr. Krause says, “I finally proceeded with the opera- 
tion after having three or four times desisted from it on account 
of the patient’s restlessness whenever the lid holders were applied.” 
Here is indubitable evidence that the chloroform was not pushed 
rapidly—that it was given slowly—but it may be said that it was 
given too slowly, but how often do we see patients resist chloro- 
form for ten, fifteen or twenty minutes. Dr. Krause’s patient 
resisted it for twenty-five minutes. He was only in a profound 
sleep 5 minutes when dangerous symptoms arose. In regard to the 
quantity used, it is a well known fact that when chloroform is 
poured upon a folded towel, three-fourths of it is lost in the tissues 
of the cloth. One and a half ounces under such circumstances was 
not an intemperate use of the agent. If this was too prolonged 
an administration of chloroform, what will Dr. Reeve say of those 
parturition cases where the remedy is given for hours? A physi- 
cian tells me that he kept his wife under it for 18 hours. Dr. 
Stewart kept up positive anaesthesia 12 hours in Mrs. Garris, who, 
as we have seen, afterward died before she had taken enough to 
render her insensible. Who has not seen profound insensibility 
maintained for two hours and more in difficult and prolonged 
operations ? 
It is difficult to get rid of the idea that there is an idiosyncrasy, 
that there are some persons and some conditions of the system 
inimical to anaesthetics; who those persons are, or what those condi- 
tions are, can not bo determined in the present state of our knowl- 
edge. Sansom “eliminates” some “of the elements of the so- 
called idiosyncrasy inimical to chloroform,” yet the fact still re- 
mains that healthy and comparatively healthy persons die, and die 
under the most careful and skillful administration. 
Means of Resuscitation.—Artificial respiration is the only re- 
liable means of resuscitation. Stimulants to the nose, cold water 
dashed in the face, flagellation, stimulants per anum, etc., may be CHLOROFORM DEATHS. 
33 
of some avail in persons who show dangerous symptoms while the 
anaesthesia is yet partial, but when life is suspended, or about to be 
suspended in complete anaesthesia, a resort to them is even worse 
than useless. When the knife is unfelt, or the actual cautery sears 
its way unheeded, what impression can such agents make? 
The following taken from “ The report of the Committee ap- 
pointed by the Royal Medical and Chirurgical Society to inquire 
into the uses and the physiological, therapeutical, and toxical effects 
of chloroform, as well as the best mode of administering it, and of 
obviating any ill consequences resulting from its administration,” 
is conclusive. 
“Of the different means available for restoring animation (ex- 
periments on animals), suspended under the influence of anaes- 
thetics, there was but little difficulty in distinguishing artificial 
respiration as both the most efficacious and the most easily 
applied. 
“The action of electro-galvanism and electro-magnetism is very 
decided, and many recoveries were effected with them in circum- 
stances as unfavorable as those in which artificial respiration 
proved successful. In aid of that most valuable operation, either 
of them may doubtless be of service; but the habitual resort to 
them in desperate cases would too often involve a fatal loss of time. 
“In several instances in which a needle inserted in the heart had 
ceased to indicate any movement of that organ, the application of 
an interrupted and weak current of electro-magnetism or electi*o- 
galvanism to the needle, restored the cardiac pulsations; and in 
some cases, even without the aid of any other artificial means the 
animals recovered. The Committee, nevertheless, can not but re- 
gard these restoratives agencies as practically of secondary impor- 
tance, both because the requisite apparatus for employing them 
can rarely bo at hand, and, still more, because the results of their 
application are neither so regular nor so certain as that of artificial 
respiration.” 
Ante-dating these experiments of the Eojml Societ}T with tho 
electro-magnetic current, are those made by Dr. IT. Culbertson with 
the same agent. (Prize Essay Ohio State Medical Society, 1862.) 
Dr. Culbertson succeeded in restoring a pig after the heart had 
ceased to beat by applying insulated pins to the diaphragm on 
opposite sides. 
Positively contradictory to the results attained by the Eoyal 
Society’s Committee and by Dr. Culbertson is the statement, 34 
CHLOROFORM DEATHS. 
founded on experiments also, of M. M. Onimus and Legros. 
(Journal of Anatomy and Physiology, 1868.) These gentlemen 
say: “Interrupted currents of electricity should not be used, as 
they diminish and oven stop the respiration and cardiac move- 
ments.” 
In the presence of authority so respectable and competent, and 
so contradictory, the comparative value of constant and inter- 
rupted currents, must remain for the present a question svbjudice. 
Warvith and friction are important adjuncts to the means of 
resuscitation. Dr. Sansomsays: “The next desideratum is warmth. 
In the case of persons apparently dead from drowning (cases which 
have much in common with those of threatened death from chloro- 
form), Dr. Christian has stated that warmth is an immediate and 
powerful excitant, and that frequently those in whom respiration 
had ceased, on being put into a warm bath, gave signs of return 
of breathing. In one most remarkable case warmth and friction, 
persevered in for eight and a half hours, restored life.” “It ought 
certainly to be borne in mind that the practice of the Royal Hu- 
mane Society, whose rules may be summed up in one word— 
warmth— has been eminently successful.” 
In conclusion, I introduce another quotation from the Report of 
the Committee of the Royal Society on the time for and the man- 
ner of employing artificial respiration. 
“ It is of the most pressing importance that artificial respiration 
should be commenced the moment alarming symptoms exhibit them- 
selves. The delay, even of a few seconds, will doubtless, in some 
cases, destroy the only chance of life. Artificial respiration should 
be practiced in the manner known as Dr. Sjdvestcr’s method, and 
as recommended by the Committee on Suspended Animation. 
Those who are conversant with the use of the bellows adopted to 
artificial respiration by Dr. Marcct, may effect a yet more perfect 
and deep artificial breathing; since by means of it a much larger 
quantity of air may be made to enter and leave the lungs, and one 
chief object, that of eliminating the chloroform may be speedily 
accomplished. 
For the same reason, mouth to mouth insufflation is a most 
valuable method of resuscitation. By it several good recoveries 
have been effected, a large quantity of nearly pure air being 
blosvn into the chest at each insufflation. In all cases in which it 
is employed the nostrils should be closed, and the larynx should 
be pressed against the spine to prevent the escape of air down the 
oesophagus.”