1. As an Anaesthetic in Surgery. To prevent pain in surgical operations, chloroform is now employed to a vast extent throughout Europe, where it is preferred for this purpose to ether, notwithstanding the numerous deaths which have been reported, and those, probably not less numerous, which have not found their way into the journals. Though it is used also to some extent in this country, I believe that American surgeons generally prefer ether, on account of its greater safety. Undoubtedly, chloroform has some advantages over the latter agent. The quantity of it required is much less; it operates more quickly, and thus saves time; it is much more agreeable in odour and taste than ether; on this account, as also on account of its less tendency to irritate the throat and lungs, it is much more conveniently and comfortably administered; it produces no violent intoxication or delirium, and gives rise to none of those turbulent movements which often embarrass the operator who prefers the rival anaesthetic; finally, its after consequences are less unpleasant, and, if the patient escape its immediate prostrating effect, he will not be liable to subsequent injury, which cannot always be said of the use of ether. There can be no doubt that, in point of convenience, of efficiency, and of comfort both to the operator and the patient, chloroform has greatly the advantage. The only point of inferiority is its greater danger. While scarcely one well authenticated case of immediate death from ether, used as an anaesthetic agent in surgery, can be adduced, and very few even of remoter evil consequences; the recorded list of fatal results ascribed to chloroform has swelled to considerably more than one hundred.* It is true that even this large number sinks to seeming insignificance when compared with the tens of thousands, I might probably with truth say, the hundreds of thousands of cases, in which chloroform has been employed with safety; and, were there no other anaesthetic agent than this, the various advantages accruing from the annihilation of pain in surgery, and probably among them a much larger average number of successful operations, and the consequent great saving of human life, would far overbalance the evil of the occasional fatality. But the question is altered when a substance is at hand, having all the essential properties for securing the same end, almost without danger to life. is not the real controversy between convenience with the risk of life on the one hand, and discomfort with comparative safety on the other ? Has the surgeon the right to sacrifice one in a thousand or in ten thousand lives, for his own convenience, and that of the greater number who escape ? it seems to me that but one answer can be given to this question. The only counterbalancing consideration in favour of chloroform is that, by the comparative quietness of the patient, the surgeon has a better command of success, and that lives may, perhaps, be saved in this way sufficient to outweigh the direct fatality. This may possibly be so; but until the fact is established, I think the American surgeons stand upon somewhat firmer ground of morality than their transatlantic brethren.*

* According to Dr. Kidd, the number of recorded deaths from chloroform, used for anaesthetic purposes, in Europe, up to May 18, 1860, was about 125; and there is little doubt that it now reaches very nearly 200. Other results of Dr. Kidd's researches are that the deaths are more numerous relatively in small than large operations, and that disease of the heart is a very rare cause of death from chloroform. [Med. Times and Gaz., May, 1860, p. 482.)-Note to the third edition.

2. As an Anaesthetic in Midwifery. For the application of the inhalation of chloroform to the relief of pain in delivery, the world is indebted to Professor Simpson, now Sir J. Y. Simpson, of Edinburgh. it has been satisfactorily ascertained that, under the influence of this agent, the pain, ordinarily attendant upon the uterine contractions in childbed, may be entirely annihilated, without in general interfering in the least degree with the efficiency of the contractions themselves, whether in relation to frequency or force. This relief, moreover, may be obtained without carrying the inhalation so far as to suspend consciousness. Another important fact, in connection with this application of chloroform, is that it has a tendency to produce relaxation of the os uteri and of the passages, and thus to facilitate delivery when impeded by rigidity of these parts. Sometimes, when the inhalation is urged to the point of producing coma, and bringing the organic nervous centres under its influence, the contractions are suspended; and Dr. Robert Lee has related five cases, in which it was necessary to have recourse to the forceps under such circumstances; but, on the other hand, it is asserted by Drs. Simpson, Murphy, and others, that, in their experience, the contractions uniformly return on the omission of the chloroform; and Dr. Murphy seems to think that, in the cases mentioned by Dr. Lee, the contractions may have ceased independently of the chloroform, as they do when it is not used, or the inhalation may have been improperly persevered in, after signs of relaxation had presented themselves. {Brit, and For. Med.-chir. Rev., April, 1855, Am. ed., p. 275.) in addition to these grounds of judgment as to the propriety of using this anaesthetic in midwifery, the fact may be mentioned that, notwithstanding the vast extent to which the agent has been for some years employed, the occurrence of death under these circumstances is extremely rare. I have met with the accounts of only three cases, in which there was any ground for suspicion that death resulted from the chloroform. One occurred from the use of it by a nurse, in a case of natural labour, without the presence of a medical man, and is, therefore, to be counted for nothing more than as a proof that the medicine is capable of poisoning. The second is one related by Dr. Ramsbotham, in which, at the end of an hour and a half after the chloroform had been suspended, without any loss of consciousness in the mean time, distressing dyspnoea came on, followed by convulsions and speedy death. it seems to me quite impossible, judging from what is known of the method of operating of chloroform, that it should have been the cause of the fatal issue in this case. Death often occurs from puerperal convulsions, without chloroform, and probably more frequently without than with it. {ibid., p. 211.) A third case is related, in the Buffalo Medical Journal for December, 1853, by Dr. De Wolf, of Chester, Massachusetts, in which death is said to have occurred; but in this also there was the suspicious circumstance, that the patient did not lose her consciousness. (N. Y. Med. Times, May, 1854, p. 300.)* Various other objections have been urged against this use of chloroform. Thus, insanity, epilepsy, peritonitis, phlebitis, and various cerebral disorders following the use of chloroform, have been ascribed to it as effects; but, as seems to me, with as little justice as if all the various disorders occurring after delivery, puerperal convulsions, puerperal fever, and puerperal insanity among them, should be attributed to a dose of opium given in the course of the process. No perceptible effect is produced by the use of chloroform on the foetus.