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Das Chloroform-Eine Zusammenstellung der bisher über dasselbe gemachten wichtigsten Erfahrungen und Beobachtungen vorzüglich in physiologischer und medizinischer Beziehung. Von DR. FRIEDRICH SABARTH. Würzburg: 1866. Pp. 276.

Chloroform-A Collection of the Most Important Experiments and Observations which have hitherto been Made on this Substance, chiefly in a Physiological and Medical Point of View. By DR. SABARTH.

THE plan of the work before us is sufficiently explained in its title. The object of the author is not so much to record his own observations and conclusions, as to collect from various scattered sources and to arrange systematically all that has been written by others on the medicinal uses of chloroform. This design he has accomplished with the laborious and painstaking industry which is so characteristic of German writers.

The earlier sections are devoted to the chemistry of chloroform, its production, chemical and physical properties, signs of purity, &c.; after which is an account of the different modes which have been employed from the earliest times to the present for the production of anesthesia. We then come to a long chapter containing an account of the experiments which have been made on animals in order to ascertain the physiological action of chloroform inhalation, and to determine how it causes death. The results arrived at by different experimenters are somewhat discrepant. We choose for quotation those of the French Commission appointed by the Society of Emulation, as being the fruit of numerous and carefully made observations. 1. The rapidity with which chloroform acts varies with the concentration in which its vapour is inhaled; the phenomena which it produces develop themselves always in the same succession, and with the same characters. 2. Chloroform abolishes the excito-motor influence of the nervous centres and the sensibility and motility of the spinal nerves; the excitability of the spinal cord and the power of the nerves to excite motion under the stimulus of electricity still persist. 3. Chloroform has a special affinity for the nerve centres, in the substance of which it accumulates during inhalation; here it is found after death in greater quantity than in other parts. 4. In chloroformed animals the movements of respiration cease before those of the heart; the heart is the part of the

body which dies last. 5. The animals die if left to themselves after the cessation of respiration. 6. Chloroform is very quickly removed from the body; the lungs are the organs which are most active in this elimination; the skin helps but little. 7. Electricity exhausts quickly the irritability of the nerves in animals who have arrived at the last stage of chloroform poisoning. 8. Death, when it arises from chloroform inhalation, is the consequence of an annihilation (vernichtung) of the influence of the nervous system, and not the consequence of asphyxia or of paralysis of the heart. 9. The dilution of the vapour of chloroform with a large and constant proportion of atmospheric air can, if not quite remove the danger, at least greatly postpone and diminish it.

With these conclusions the results obtained by Weber for the most part agree; he, however, objects to the seventh and eighth conclusions of the Commission. He can find no evidence to show that in a chloroformed animal the nerves are exhausted by electricity more quickly than in an animal not under the influence of the anesthetic, and he argues that though the apnea and the stoppage of the heart are caused by the abolition of nervous influence, yet that they are the immediate cause of death, as is shown by the recovery of the animal if the action of the heart be kept up by artificial respiration till the poison is eliminated. No mention is made in this chapter of the recent experiments of the Chloroform Committee of the Medico-Chirurgical Society. This is to be regretted, as they were better conducted and more conclusive than any of those which have been recorded by Dr. Sabarth.

In the next chapter we find details of 119 cases in which death is said to have been caused by chloroform inhalation. After an accurate examination of these the author thinks that in 48 only can, with certainty or high probability, the fatal event be attributed to the anesthetic. Of these 48 deaths 36 were caused by asphyxia, 11 by syncope, and 1 by spinal apoplexy. Although asphyxia is thus shown to produce the greatest number of deaths, yet syncopal symptoms are more frequently met with; they are, however, more easily combatted than is asphyxia.

Dr. Sabarth finds, like Dr. Charles Kidd, that fatal effects are more frequently produced when chloroform is administered for small operations than when it is given for amputations or other operations of the first magnitude. With regard to the stage of inhalation at which death most frequently takes place, he gives the following numbers, taken from the works of Snow, Scontetten, and Kidd.

Of 121 cases, death occurred in 54 during the administration of the chloroform and before the commencement of the operation; in 42 during the performance of the operation; and in 25 after the completion of the operation, either immediately or after an interval. Hence it appears that the early stage of inhalation, or that of excitement, is the most dangerous. Of 133 fatal cases recorded by the same authors, in which the sex is noted, 90 occurred in men, and 43 in women.

After death from chloroform the post mortem appearances are not at all characteristic. A dark and fluid condition of the blood, emptiness, pallor and flaccidity of the heart, and gas bubbles in the veins, are among the most important of those which have been recorded. On the whole subject of death from chloroform the author thus concludes:-" When compared to the innumerable multitude of those to whom chloroform has been administered and to whom it is yearly and daily administered, the small number of cases in which death can be with certainty or probability attributed to this agent holds but a very small proportion. We must further consider that of the hundreds of thousands who have been chloroformed certainly many more would have died of anxiety, disquietude, or fear before the operation-of pain or agitation during its performance, or of its consequences, if chloroform had not been employed, than have succumbed to the poisonous effects of the latter. So that, considered in this light, the advantages of chloroform greatly preponderate over its disadvantages."-P. 156.

The precautions to be used in giving chloroform by inhalation, and the means to be employed when dangerous symptoms arise, are treated of at considerable length. These matters have, however, recently been brought under the notice of our readers in the review of Dr. Sansom's work on chloroform. We, therefore, think it unnecessary again to go into the subject, more particularly as in the abstract from Dr. Sansom's book, to which we refer, more information will be found in a few sentences than can be extracted from the thirty pages which Dr. Sabarth devotes to the administration of chloroform, and the means of restoring suspended animation. We may mention, however, that the latter author prefers to give the chloroform on a folded towel or handkerchief, believing that with proper precaution this method is just as safe, and less terrifying to the patient, than that in which an elaborate inhaler is

• Dub. Quart. Jour., May, 1866, pp. 354; et seq.

used. Some very striking cases are recorded in which, after all the ordinary means had failed to restore the suspended respiratory movements, galvanism succeeded, one pole of the battery being placed over the phrenic nerve in the neck, the other over the origin of the diaphragm. In one successful case twenty minutes had elapsed from the commencement of the asphyxia before the pulse and respiration were restored.

In the next chapter we find the opinions of authors on the value of chloroform in the treatment of medical diseases. To enumerate all the maladies in which this drug is said to have been employed with the most perfect success, would be to give the entire nosological list, from hiccup to tetanus and hydrophobia, We must confess ourselves somewhat sceptical as to its applicability or value in some of the cases in which it appears to have been largely used. Thus, first on the list stands pneumonia, a disease which seems to lend itself with equal complaisance to swell the tables of successes of every mode of treatment from calomel and blood-letting to homeopathy; and we find the chloroformist as fortunate as Sangrado or Hahnemann. So, we read, that of 193 cases treated by chloroform inhalation by Drs. Wachern, Baumgärtner, Helbing and Schmidt, only nine died; and that Dr. Varrentrap, of Frankfort, treated twenty-three cases (nineteen exclusively) by chloroform inhalation, and of these only one died. These results are very encouraging; but in the absence of any details as to the age of the patients, the amount of lung tissue involved, the condition of other organs, and the various other circumstances which, much more than the treatment, make the difference for the patient between life and death, we must confess our unwillingness to repeat the experiments of our German brethren.

In spasmodic affections of the respiratory organs, unaccompanied by structural change, we can readily believe in the advantages to be derived from chloroform. And under this head we find cases of spasmodic asthma, hooping cough, hysterical cough, laryngismus, stridulus, and hiccup, reported as yielding readily to chloroform inhalation.

In the paragraph on hepatic colic and gall-stones, we find the internal administration of chloroform in solution in alcohol strongly recommended on the authority of M. Bouchut, but are somewhat surprised not to meet with one word advising its inhalation in these circumstances; a mode of exhibition of the drug which would