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With Honor Melvin Laird in War Peace and Politics 1st
Edition Dale Van Atta Digital Instant Download
Author(s): Dale Van Atta
ISBN(s): 9780299226800, 0299226808
Edition: 1
File Details: PDF, 3.56 MB
Year: 2008
Language: english
 
Honor
 
Honor



M    L   
in War,
Peace,
and Politics

Dale Van Atta

    

 The University of Wisconsin Press
 Monroe Street, rd Floor
Madison, Wisconsin -

www.wisc.edu/wisconsinpress/

 Henrietta Street
London  , England

Copyright © 
Marshfield Clinic / Laird Center for Medical Research
All rights reserved

    

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Van Atta, Dale.
With honor : Melvin Laird in war, peace, and politics /
Dale Van Atta ; foreword by Gerald R. Ford.
p. cm.
Includes bibliographical references and index.
 --- (cloth : alk. paper)
. Laird, Melvin R. . Cabinet officers—United States—Biography.
. United States. Dept. of Defense—Officials and employees—Biography.
. United States—Politics and government—–. . United States—
Politics and government—–. . Nixon, Richard M. (Richard Milhous),
–—Friends and associates. . Vietnam War, –—United States.
. Legislators—United States—Biography. . United States. Congress.
House—Biography. . Legislators—Wisconsin—Biography. I Title.
.. 
.—dc
[B]

  
A , ,   
who served our country courageously and honorably in Vietnam.
       

Foreword by Gerald R. Ford / ix

Acknowledgments / xv

Prologue / 
. The Man from Marshfield / 
. Guns and Butter / 
. A House Divided / 
. Laird Also Rises / 
. Cloud Riders / 
. Into the Quagmire / 
. Fight Now, Pay Later / 
. The Resurrection of Richard Nixon / 
. Looking for an Exit / 
. Off the Menu / 
. Going Public / 
. Dueling Machiavellis / 
. Ending the Draft / 
. Objections Overruled / 
. Black September / 
. Friends in High Places / 
. “Management by Walking Around” / 
. Minority Report / 
. The Secret War / 
. The Hawks Have Flown / 
. Withdrawal Symptoms / 
. Easter Offensive / 
. No Time for Quitters / 
. Watergate / 
. Picking a President / 
. Kitchen Cabinet / 
. A Second Career / 
. War and Peace and War / 
. Another Vietnam? / 
Epilogue / 

Notes / 
Bibliography / 
Index / 
      

Jimmy Carter once said: “Of all the cabinet officers who served in the first
Nixon term, Mel Laird, with his quiet and somewhat modest demeanor, as
well as absence of self-promotion, was the most underestimated.” Henry
Kissinger and I often remarked how underrated and certainly underappre-
ciated have been the enormous contributions of this remarkable man. This
book is long overdue since no respectable historian tracing the evolution
of this country during the second half of the twentieth century can afford
to overlook the life and legacy of this “Man from Marshfield” who so thor-
oughly changed the course of America’s history.
Without Melvin Laird as our country’s tenth secretary of defense, there
likely would have been no end to the Vietnam War during the Nixon admin-
istration, no end to the draft, no steady military modernization during the
country’s most virulent antimilitary years, and no arms control treaties with
the Soviet Union. This laudatory list does not include all that the Honorable
Melvin Laird did in the sixteen years before becoming defense secretary.
I was not surprised on that January  day in the House Chamber when
Speaker Sam Rayburn swore in this thirty-year-old political prodigy from
central Wisconsin. Months earlier, members of the Wisconsin delegation—
Johnny Byrnes and Glenn Davis—had tipped me off to an outstanding young
state senator from Marshfield whom they were absolutely convinced would
be elected in the House in . For Mel, it was the first of nine triumphs
at the polls; over the next sixteen years, he more than lived up to the advance
billing given to me.
From the outset, Mel was a highly effective member of the House Com-
mittee on Appropriations, serving on both the Defense and Health Subcom-
mittees, which together controlled two-thirds of the federal budget. I was

ix
x      

his seatmate on the Defense Appropriations Subcommittee, where I was the

ranking member, and he was right behind that. With his quick mind and
endless capacity for hard work, Mel quickly became one of the best-informed
House members on military affairs. He was our sharpest and most relent-
less interrogator of the defense establishment when they came testifying. Mel
was the only congressman who so rattled Defense Secretary Bob McNamara
that he lunged across the witness table when Mel called him out on a lie.
He was a tower of strength for us on that subcommittee.
But his best work was on the Health, Education, and Welfare Subcommit-
tee. As the senior member on the Republican side, he won the respect and
confidence of the members on both sides of the political aisle. Long before
today’s talk of a health crisis in America, Mel Laird was legislating in hopes
of averting such a crisis. Among many significant achievements, he and the
chairman, Rep. John Fogarty, worked closely to legislate a vast and rapid ex-
pansion of the National Institutes of Health. It’s no exaggeration to refer to
health care’s renaissance from  through  as the Fogarty/Laird Years.
Though Mel often exemplified the epitome of bipartisanship, he was a
committed, progressive Republican who was always intensely interested in
electing a Republican majority so we would have a Republican Speaker of
the House. In the late s, when a group of so-called young Turks joined
forces to overthrow Joe Martin in favor of Congressman Charlie Halleck
of Indiana, Mel and I were a part of that group. Then, in the wake of the
Goldwater debacle in , history repeated itself. Only this time around,
these by-now middle-aged Turks were looking for a candidate to challenge
Halleck. Mel urged me to run, and thanks in no small part to his efforts, I
won that election by the landslide margin of  to .
Mel became the Republican conference chairman. For the next four
years, we worked in tandem on legislative programs that helped revitalize
the Republican Party and elect Dick Nixon president in .
To Mel, politics is the “art and science of government.” More than almost
anyone I’ve known, Mel has the political equivalent of perfect pitch; he
has a long-range view of what’s going to happen, and he knows what to do
about it. He’s a prodigious worker. He was abrasive at times, and enjoyed
scheming—not for any sinister reason but to keep the pot boiling. He is an
idea man; he pushed hard, and I responded to that kind of challenge. Ours
was a good combination: we respected one another and confided in one
another. We were the closest of friends; we played together, and often prayed
together. I never made a serious move in the House or the White House
without consulting this friend and partner.
       xi

I well remember a day in December of  when we found ourselves in

Palm Springs, California, attending a Republican governors’ conference. It
was there I learned that Nixon intended to appoint Mel as his secretary of
defense. I felt sadness for my friend and myself. It would be a grisly job for
him, coming at a terrible time of trauma in American history. And I didn’t
look forward to the House without him. But knowing of his impressive
military record in the Navy in World War II and his subsequent service
with me on the Defense Appropriations Subcommittee, I believed that Mel
would be of enormous help to President Nixon and get us out of the morass
of Vietnam honorably. In my judgment, Nixon was very, very lucky to have
Mel working with him and Henry Kissinger to extricate us from Vietnam.
With due credit to Henry for the Paris Accords, it was Mel who really
brought our troops home. He unilaterally began withdrawing them faster
than Nixon and Henry wanted to, but slower than Mel wanted to. There
was not a single month while he was secretary of defense that the number
of American troops in Vietnam increased. Mel was lampooned by editor-
ial cartoonists as a “missile head,” while too many missed the fact that
he was adroitly doing the heavy lifting in the Nixon administration on all
things military. He deftly negotiated the crosscurrents of the views of the
uniformed military leadership, the White House, the Congress, and the
American public. To keep American defense strong in the face of the Soviet
military threat while ending the draft and conducting myriad other initia-
tives was no small feat.
At a time when our returning soldiers were being spat upon by their
fellow Americans, and some on Capitol Hill seemed to have lost their com-
mon sense, Mel stood strong for the defense of America and never lost one
vote in Congress. At a time when obsessive secrecy in the Nixon adminis-
tration was actively undermining the good it would do, Mel was the most
open, candid, and fearless of the cabinet officers. At a time when it was not
easy to hold onto one’s integrity and honor and pride, Mel was able to do
that not only for himself but all who served with him. Few public servants
were so tested by events as Mel Laird in those days of tumult and challenge,
and fewer still came out unblemished.
Mel announced during his confirmation hearings that he would serve
only one term as secretary of defense; the taxi to take him home was already
ordered. But by then he was Washington’s Indispensable Man, and Nixon im-
mediately drafted him as Presidential Counselor for Domestic Affairs when
the unraveling Watergate scandal forced the resignation of John Ehrlichman
and H. R. Haldeman. During his year at the White House, as Mel kept the
xii      

necessary budget-making gears of government working, he once again stood

out as a model of personal and political integrity.
The October  resignation of Vice President Agnew touched off spec-
ulation over who Nixon might choose to replace him, and it was Mel behind
the scenes who maneuvered Nixon to choose me. Two days after Agnew’s
departure, my wife, Betty, and I were at home in Alexandria, Virginia, hav-
ing a quiet family dinner, when the telephone rang. It was Mel. He told me
that the Democrat-controlled House and Senate were very unlikely to con-
firm Nelson Rockefeller, Ronald Reagan, or Nixon’s favorite choice, John
Connally, for the job. He asked whether I would be interested. My ambition
was to be Speaker of the House, not vice president, but that evening, Betty
and I agreed those three and a half years as vice president would be a nice
way to end my political career in the nation’s capital. I assumed that would
be history’s footnote for me.
But history doesn’t stop for anyone—not for Mel, and not for me. I be-
came president and Mel a key member of my unofficial “Kitchen Cabinet.”
He has been quietly but forcefully advising every president and secretary of
defense since. He exemplifies a magical blend of principle and pragmatism
that is sorely needed in our country today. In fact, it is what Americans
want. Most Americans are pragmatists. We want to make things work. We
value authenticity at least as much as ideology. As far as Mel and I are con-
cerned, there are no enemies in politics—just adversaries who disagree with
you on one vote and might be with you on the next. We’ve always thought
that you had to listen before you could lead, and it’s hard to listen if you’re
screaming at one another. It’s even harder to hear the voice of those who
sent you to Washington in the first place.
Political partisanship offends most Americans because the partisans have
forgotten that ours is a representative democracy. To many voters—and even
more nonvoters—parties today are suspected of being decidedly unrepre-
sentative. At worst, they appear as little more than conduits for special inter-
est money. Our parties will never regain confidence of the voters until they
look beyond the consultants and the tracking polls. At the end of the day,
no leader worth his salt will take comfort in the polls he conducted or the
tactical victories he may have racked up. Anyone can take a poll; only a
leader can move a nation. All his life, Mel has been that kind of leader.
In the words of the Reader’s Digest—the magazine Mel has served for
more than three decades now—I count Mel Laird among the “most unfor-
gettable characters” anyone could ever have the privilege of meeting. He
remains today what he has always been: a model public servant; a can-do
       xiii

conservative who went into politics because he liked people; a man who re-
flects honor upon Washington and the people who sent him there; a patriot
before a partisan. This thoroughly researched biography by Dale Van Atta
bringing to life the lessons of Mel’s life and service couldn’t come at a bet-
ter time. The reader who peruses these pages of history will soon come to
understand how those of us who have known him are so much better for
it, as is this country.
G     R. F   J .
December 
            

Mel Laird never intended to write a book about his life, and it took me
three long years to talk him into letting me write an authorized biography.
My first approach to Laird was in early . We crossed paths at the
Reader’s Digest Washington, D.C., office where he was (and is) the senior
counselor for international affairs, and I was (and am) a contributing edi-
tor. In several conversations with Bill Schulz, the Digest Washington bureau
chief, I became intrigued with his accounts of how former Secretary of
Defense Laird had survived, honor intact, from the Nixon administration.
As I looked deeper, it became clear to me that Laird was largely responsi-
ble for ending U.S. involvement in the Vietnam War.
My two other chief mentors at the time were also surprisingly high on
Laird. One was Dick Brown, a longtime friend and top official with the
General Accounting Office. He could not say enough good things about
Laird, whom he had come to know through his boss, GAO Comptroller
General Chuck Bowsher, who had worked under Laird at the Pentagon.
And there was Jack Anderson, my partner on a nationally syndicated col-
umn. Jack had won a Pulitzer Prize uncovering the duplicity of Richard
Nixon and Henry Kissinger over the Indo-Pakistan war, and he was at the
top of Nixon’s enemies list. When I mentioned I was thinking about a Laird
biography, Jack slapped my back and said, “Do it!” He told me Laird was
one of the most honest, effective, and yet unheralded politicians the coun-
try has seen in the last century.
Sy Hersh, the well-prized New York Times reporter and author of the
Kissinger biography The Price of Power, vouched for Laird’s integrity. David
Broder of the Washington Post and CBS’s Bob Schieffer were equally effusive.

xv
xvi            

Both said Laird’s contribution to American history had been too long
overlooked. Dozens of others of all political stripes, from Hillary Rodham
Clinton to Dick Cheney to Colin Powell, said the same.
Finally, in , when Mel turned seventy-five, Bill Schulz and I finally
persuaded him it was time. It took another two years to secure enough
funding to begin the project on solid ground. That came from Laird’s be-
loved Marshfield Clinic, whose nonprofit Heritage Foundation generously
agreed to back the project. Once Laird was in, he was all in. His memory was
extraordinary, as was his attention to detail. He had a long list of people
to interview, and a huge cache of material about the Nixon administration
that had never before been made public. The fact that it took so many years
to finish the book had as much to do with Laird’s insistence on fairness and
perfection as with my personal commitment to tell his whole story well and
accurately.
When a book project lasts more than a decade, the list of those who
should be thanked is voluminous. At the top of the list are five individuals
who were with this project from the beginning and without whom it would
have been impossible: Mel Laird; Robert Froehlke, who is Laird’s oldest
and closest friend and served him as secretary of the Army; Robert Pursley,
Laird’s military assistant at the Pentagon; Daryl Gibson, my friend and col-
league for thirty-five years and a freelance book editor; and Kathy Weaver,
Laird’s executive assistant.
Reed Hall, executive director of the Marshfield Clinic, has been a cham-
pion of this work in recent years. His loyalty to Laird has been both touch-
ing and tenacious as numerous obstacles to the book’s final publication
arose. The Laird family was also gracious and unswervingly helpful, begin-
ning with his wife, Carole Howard Laird. His three children—John, Alison,
and David—and his stepdaughter, Kimberly, were also cheerfully helpful
and encouraging. He is justifiably proud of all of them.
More than three hundred people were interviewed for this book, and I
am grateful for all their contributions. Former presidents Gerald Ford,
George H. W. Bush, Jimmy Carter, Ronald Reagan, and Bill Clinton all
offered their insights on Laird, as did Dick Cheney. Also granting inter-
views out of respect for Laird were ten former secretaries of defense—
Robert S. McNamara (–), Clark M. Clifford (–), Elliot L.
Richardson (), James R. Schlesinger (–), Donald H. Rumsfeld
(–, –), Harold Brown (–), Caspar Weinberger (–),
Dick Cheney (–), William J. Perry (–), and William S. Cohen
             xvii

(–). Many of the military leaders of those various eras, including

the Joint Chiefs of Staff, also contributed.
Among the other hundreds interviewed, those who went above and
beyond in their assistance included but are not limited to (alphabetically):
Senator John Chafee, who granted an interview two days before he unex-
pectedly died; former Secretary of State Larry Eagleburger, a fellow Wis-
consinite and loyal friend; Jerry Friedheim, whose anecdotes and “lists” of
things the book should cover were superb; Laurie Hawley, Laird’s congres-
sional and Defense Department executive assistant, who thankfully preserved
all the appointment books; Henry Kissinger, who gave time even though he
knew some of the book’s themes would be critical of him; Jack Mills, racon-
teur and Laird buddy; former Japanese Prime Minister Yasuhiro Nakasone;
former West German Chancellor Helmut Schmidt; Donna Shalala, former
Clinton Health and Human Services secretary; and Senator John Warner,
one of Laird’s favorite protégés and friends.
A debt is also owed to various historians, among them David Horrocks
of the Gerald R. Ford Presidential Library and Dr. Alfred Goldberg and Stu-
art Rochester, historians for the office of the secretary of defense. There
were also Barbara Constable, Dwight D. Eisenhower Presidential Library;
Carol Hegeman, Eisenhower National Historic Site; as well as archivists at
the John F. Kennedy Presidential Library, Lyndon Baines Johnson Presiden-
tial Library, Richard Nixon Library, and the Nixon Presidential Materials
section of the National Archives. The folks at my local Loudoun County
library in Ashburn, Virginia, were unstintingly helpful and understanding
as I spent many months at the corner table that became my satellite office.
The bibliography of this book includes many journalists and historians who
are long-standing experts on Laird’s period in world history, and whose
work prepared me with countless words of background. Among the most
notable are military historians Lewis Sorley and Bruce Palmer.
The folks at the University of Wisconsin Press—acquisitions editor Gwen
Walker, interim director Sheila Leary, and managing editor Adam Mehring—
were as helpful and insightful as they were tough and professional. The
readers and I have been well served by them.
Finally, no author can work more than a decade without help from
friends, a few of whom I acknowledge here: the aforementioned Dick Brown
and his wife, Hazie, Mike Binstein, Lynn Chapman, Clark and Kathy Kidd,
Ryan McIlvain (my unpaid “intern”), Shad and Tiffany McPheters, Phil and
Joni Broderick, Warren and Anne Cordes, and Paul Smith.
xviii            

The most miraculous thing about my wife, Lynne, is that I am still priv-
ileged to call her my wife at the end of this project, which had its shares of
ups and downs. She unfailingly supported me with love and patience.
The final miracle of this book is the greatest tribute this world-weary
and cynical investigative reporter can offer Mel Laird: after exhaustively re-
viewing his life, I respect and admire him more at the end of this process
than when I began.
 
Honor
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inch of vapour at 60°, when its specific gravity is 4·2; and, when the
vapour is inhaled, it expands somewhat, as it is warmed to the
temperature of the lungs; but it expands only to the same extent as
the air with which it is mixed, and therefore the proportions remain
unaltered. But air, when saturated with vapour of chloroform at
100°, contains 43·3 cubic inches in 100; and
As 0·767 : 43·3 :: 0·0177 : 1.
So that if the point of complete saturation be considered as unity,
0·0177 or 1–56th, will express the degree of saturation of the air from
which the vapour is immediately absorbed into the blood; and,
consequently, also the degree of saturation of the blood itself.
I find that serum of blood at 100°, and at the ordinary pressure of
the atmosphere, will dissolve about its own volume of vapour of
chloroform; and since chloroform of specific gravity 1·483 is 288
times as heavy as its own vapour, 0·0177 ÷ 288 gives 0·0000614, or
one part in 16,285, as the average proportion of chloroform by
measure in the blood, in the second degree of narcotism.
It is evident, from the experiments numbered 9 to 12 inclusive,
that two grains of chloroform to each hundred cubic inches of the
inspired air cause a state of very complete insensibility,
corresponding with what I have designated the fourth degree of
narcotism; and by the method of calculation employed above we get
0·0354, or 1–28th, as representing the degree of saturation of the
blood, and 0·0001228 the proportion by measure in the blood.
In experiments 6, 7, and 8, in which quantities of chloroform were
employed intermediate between one and two grains to each hundred
cubic inches of air, a moderate amount of insensibility was induced,
corresponding very much with the state of patients during operations
under chloroform.
The experiments from 13 to 18 show that quantities of chloroform,
exceeding two grains to 100 cubic inches of air, have a tendency to
embarrass and arrest the function of respiration, if the inhalation is
continued. I have not yet been able to determine satisfactorily the
exact proportion of chloroform which requires to be absorbed to
arrest the respiration of animals of warm blood. I believe there is a
definite proportion which has this effect, but there are two reasons
why it is not so easy to ascertain it, as to ascertain the proportion
which causes the minor degrees of narcotism. In the first place, the
breathing often becomes very feeble before it ceases, so that the
animal inhales and absorbs but very little chloroform, and remains
on the brink of dying for some time. In the next place, the
temperature of the body falls in a deep state of narcotism, especially
in small animals; and, as the temperature falls, the amount of
chloroform which the blood can dissolve from any given mixture of
air and vapour increases.
Judging from the experiments numbered 14 to 18, three grains of
chloroform to each hundred cubic inches of air must be very nearly
the quantity which has the power of arresting the breathing when the
temperature of the body is 100°; and as three grains of chloroform
produce 2·3 cubic inches of vapour, and air at 100° is capable of
taking up 43·3 per cent. of its volume, it follows that the blood must
contain between 1–18th and 1–19th as much chloroform as it is
capable of dissolving, at the time when the respiration is arrested. In
the 14th experiment, the breathing of the two mice was on the point
of being stopped by two and a half grains of chloroform in each
hundred cubic inches of air, but during the thirteen minutes which
the mice breathed the vapour, their temperature fell to about 90°.
Air, when saturated with the vapour of chloroform at this
temperature, contains 35 per cent., and two grains and a half of
chloroform yield 1·917 cubic inches of vapour; so by a calculation
similar to that made at page 68, the mice at the time when the
breathing was about to cease must have absorbed 1–18th part as
much chloroform as their circulating fluids were capable of
dissolving.
 The reader will have observed that, in the experiments related
above, the mice became much more quickly affected than the
guineapigs and cats. The reason of this is their quicker respiration
and circulation, and much more diminutive size. Little birds, such as
linnets and sparrows, are also very quickly affected by chloroform.
Frogs are more slowly affected, owing to their languid respiration,
unless the vapour to which they are exposed is very strong.
They can, however, owing to their low temperature, be rendered
insensible by proportions of vapour too small to affect animals of
warm blood; and as they have no proper temperature of their own,
the amount of vapour (in proportion to the air in which they are
placed) that will affect them, depends entirely on the temperature of
that air.
The following experiment was several times performed on frogs
with the same result, the temperature of the room being about 55°,
as it was in winter.
Experiment 19. 4·6 grains of chloroform were diffused through the
air of a jar of the capacity of 920 cubic inches, and a frog was
introduced. In a few minutes, it became affected, and at the end of
ten minutes, was quite motionless and flaccid; but the respiration
was still going on. Being now taken out, it was found to be insensible
to pricking: it recovered in a quarter of an hour.
In a repetition of this experiment, in which the frog continued a
few minutes longer in the vapour, the respiration ceased, and the
recovery was more tardy. On one occasion, the frog was left in the jar
for an hour, but when taken out, and turned on its back, the
pulsations of the heart could be seen. In an hour after its removal, it
was found to be completely recovered.
The first of the experiments related above (page 60), showed that
an atmosphere containing half a grain of chloroform to each hundred
cubic inches, produced scarcely any appreciable effect on animals of
warm blood; but the following calculation explains why this quantity
acts so energetically on the frog, and proves that this creature is
affected by chloroform according to the same law as animals of warm
blood. The vapour is absorbed into the blood and lymph of the frog
at the temperature of the external air, whose point of relative
saturation therefore remains unaltered, both in the lungs and in
contact with the skin of the animal; and as half a grain of chloroform
produces 0·383 cubic inches of vapour, and air at 55° contains, when
saturated, 10 per cent. of vapour; 0·0383, or 1–26th, expresses the
degree of saturation of the air, and also of the blood of the frog. And
this is a very little more than the quantity (0·0354 or 1–28th) which
was calculated above to be the greatest amount which could be
absorbed with safety into the blood of the mammalia. It must be
observed, however, that the pulmonary respiration of the frog was
arrested by this proportion of 1–26th as much chloroform as the
blood would dissolve, whilst we calculated that it required about as
much as 1–18th to arrest the breathing of animals of warm blood. It
must be remembered, however, that the pulmonary respiration of
frogs is a process of swallowing air, which only goes on when the
creature is comparatively active. In the torpid state, the respiration
takes place only by the skin, and the frog never breathes with the aid
of the same muscles and nerves as mammalia and birds.
By warming a frog, together with the air in which it is placed, it is,
in accordance with the law explained above, rendered comparatively
proof against an amount of chloroform which would otherwise
render it insensible.
Experiment 20. A frog, which had been a few days previously
subjected to the experiment just narrated, was put into the same jar,
which was placed near the fire, till a thermometer inside marked 75°
Fah.; 4·6 grains of chloroform were then introduced, and diffused
through the air in the jar. The jar was kept for twenty minutes, with
the thermometer indicating the same temperature within one degree.
For the first seventeen minutes, the frog was unaffected; and only
was dull and sluggish, but not insensible, when taken out. Air at 75°,
when saturated with vapour of chloroform, contains 22 per cent.,
and therefore the 0·383 per cent. of vapour, which at 55° was capable
of saturating the fluids of the frog to the extent of 1–26th of what
they would dissolve, was, at 75°, capable of saturating them only to
the extent of 1–57th.
At one of Dr. Wilson’s Lumleian Lectures, at the College of
Physicians, on March 29th, 1848, I had the honour of performing
some experiments, and making some remarks, on chloroform, and I
combined together two experiments on frogs and small birds, in a
way which shows how entirely the effects of a narcotic vapour
depend on the quantity of air with which it is mixed, and on other
physical conditions.
Experiment 21. I introduced a chaffinch, in a very small cage, into
a glass jar holding nearly 1,000 cubic inches, and put a frog into the
same jar, covered it with a plate of glass, and dropped five grains of
chloroform on a piece of blotting paper suspended within. In less
than ten minutes, the frog was insensible, but the bird was not
affected.
Experiment 22. I then placed another frog and another small bird
in a jar containing but 200 cubic inches, with exactly the same
quantity of chloroform. In about a minute and a half, they were both
taken out,—the bird totally insensible, but the frog not appreciably
affected, as from its less active respiration it had not had time to
absorb much of the vapour.
The blood in the human adult is estimated by M. Valentin to
average about thirty pounds. M. Valentin’s experiments were so
conducted that this quantity must include the extra vascular liquor
sanguinis, as well as the blood actually contained within the vessels.
On this account, his estimate is all the better fitted for calculating the
amount of chloroform absorbed, since this medicine, when inhaled
gradually, passes by exosmosis through the coats of the bloodvessels
into the fluid in which the tissues are immediately bathed. The above
quantity of blood would contain 26 pounds 5 ounces of serum,
which, allowing for its specific gravity, would measure 410 fluid
ounces. This being reduced to minims, and multiplied by 0·0000614,
the proportion of chloroform in the blood required to produce
narcotism to the second degree (see page 68), gives 12 minims as the
whole quantity in the blood. More than this is used in practice,
because a considerable portion is not absorbed, being thrown out
again when it has proceeded no further than the trachea, the mouth
and nostrils, or even the face-piece. But I find that if I put twelve
minims into a bladder containing a little air, and breathe it over and
over again, in the manner of taking nitrous oxide, it suffices to
remove consciousness, producing the second degree of its effects.
To induce the third degree of narcotism, or the condition in which
surgical operations are usually commenced, would require that about
18 minims should be absorbed by an adult of average size and health,
according to the above method of calculation; and to induce the deep
state of insensibility, which I have termed the fourth degree of
narcotism, would require 24 minims; whilst to arrest the function of
respiration would require that about 36 minims should be absorbed.
 PREPARATIONS FOR INHALING
CHLOROFORM.
The only direction which it is usually requisite to give beforehand,
to the patient who is to inhale chloroform, is to avoid taking a meal
previous to the inhalation; for chloroform is very apt to cause
vomiting, if inhaled whilst there is a quantity of food in the stomach.
The sickness is not attended with any danger, but it constitutes an
unpleasantness and inconvenience which it is desirable to avoid. The
best time of all for an operation under chloroform is before
breakfast, but the customs and arrangements of this country do not
often admit of that time being chosen, and it is unadvisable to make
the patient fast beyond his usual hour. It answers very well to
perform an operation about the time when the patient would be
ready for another meal, or, if the time of operation fall two or three
hours after the usual time of eating, to request the patient to make
only a slender repast at that time, so as just to prevent the feeling of
hunger. It is impossible to prevent vomiting in some cases with the
best precautions, for the stomach occasionally will not digest when
the patient is expecting a surgical operation, and the breakfast may
be rejected in an unaltered state hours after it has been taken. In
other cases the patient does not vomit, even when he inhales
chloroform shortly after a full meal.
The most convenient position in which the patient can be placed
whilst taking chloroform is lying on the back, or side, as he is then
duly supported in the state of insensibility, and can be more easily
restrained if he struggle whilst becoming insensible. The semi-
recumbent posture on a sofa does very well, and there is no objection
to the sitting posture, when that is most convenient to the operator.
In that case, however, the patient should be placed in a large easy
chair with a high back, so that the head as well as the trunk may be
supported without any effort, otherwise he would have a tendency to
slide or fall when insensible. It has been said that it is unsafe to give
chloroform in the sitting posture, on the supposition that it would in
some cases so weaken the power of the heart, as to render it unable
to send the blood to the brain. Observation has proved, however, that
chloroform usually increases the force of the circulation; and
although the horizontal position is certainly the best for the patient
under an operation in all circumstances, I consider that the sitting
posture is by no means a source of danger, when chloroform is given,
if the ordinary precaution be used, which would be used without
chloroform—that of placing the patient horizontally if symptoms of
faintness come on. I have preserved notes of nine hundred and forty-
nine cases in which I have given chloroform to patients in the sitting
posture, and no ill effects have arisen in any of these cases.
The person who is about to inhale chloroform is occasionally in a
state of alarm, either about that agent itself or the operation which
calls for its use. It is desirable to allay the patient’s fears, if possible,
before he begins to inhale, as he will then be able to breathe in a
more regular and tranquil manner. In a few cases, however, the
apprehensions of the patient cannot be removed, and they subside
only as he becomes unconscious from the inhalation. It has been said
that chloroform ought not to be administered if the patient is very
much afraid, on the supposition that fear makes the chloroform
dangerous. This is, however, a mistake; the danger, if any, lies in the
fear itself. Two cases will be related hereafter in which the patients
died suddenly from fear, whilst they were beginning to inhale
chloroform, and before they were affected by it; but the probability is
that, if they had lived till the chloroform took effect, they would have
been as safe as other patients who inhaled it. If chloroform were
denied to the patients who are much afraid, the nervous and feeble,
who most require it, would often be deprived of its benefits.
Moreover, the patients would either be prevented altogether from
having the advantage of surgery, or they would be subjected to the
still greater fear of the pain, as well as the pain itself; for whatever
undefined and unreasoning fears a patient may have when the
moment comes for inhaling chloroform, he has only chosen to inhale
it on account of a still greater fear of pain.
Fear and chloroform are each of them capable of causing death,
just as infancy and old age both predispose to bronchitis, but it
seems impossible that fear should combine with the effects of
chloroform to cause danger, when that agent is administered with
the usual precautions. Fear is an affection of the mind, and can no
longer exist when the patient is unconscious; but the action of that
amount of chloroform which is consistent even with disordered
consciousness is stimulating, and increases the force and frequency
of the pulse, in the same way as alcohol. I believe that no one would
assert that a person would die the sooner of fright for having taken a
few glasses of wine, or a small amount of distilled spirits, whatever
might be the state of his health. When chloroform has been absorbed
in sufficient quantity to cause unconsciousness, fear subsides, and
with the fear its effects on the circulation. It is a subject of almost
daily observation with me that the pulse, which is extremely rapid
from some ill defined apprehension, when certain patients begin to
inhale chloroform, settles down to its natural frequency after they
become unconscious.
The practice I have always followed has been to try to calm the
patient, by the assurance that there was nothing to apprehend from
the chloroform, and that it would be sure to prevent all pain; but
where it has been impossible to remove the fears of the patient in
this way, I have always proceeded to remove them by causing a state
of unconsciousness. It would of course be wrong to choose a moment
for beginning the inhalation, when fear was producing a very marked
depression of the circulation. On feeling the pulse of a gentleman,
about twenty-one years of age, in March 1855, who had just seated
himself in the chair to take chloroform, previous to having some
teeth extracted, by Mr. Thos. A. Rogers, I found it to be small, weak,
and intermitting, and it became more feeble as I was feeling it. I told
the patient that he would feel no pain, and that he had nothing
whatever to apprehend. His pulse immediately improved. He inhaled
the chloroform, had his teeth extracted, woke up, and recovered
without any feeling of depression. Now if the inhalation had been
commenced in this case, without inquiry or explanation, the syncope
which seemed approaching would probably have taken place, and it
would have had the appearance of being caused by the chloroform,
although not so in reality.
MODE OF ADMINISTERING CHLOROFORM.
The experiments previously related show that air containing rather
less than two grains of chloroform, in one hundred cubic inches, is
capable of causing a state of insensibility, sufficiently deep for
surgical operations; but in a creature the size of the human being, an
inconvenient length of time would be occupied in causing
insensibility with vapour so much diluted. About four cubic inches of
vapour, or rather more than five grains of chloroform to each
hundred cubic inches of air, is the proportion which I have found
most suitable in practice for causing insensibility to surgical
operations. In medical and obstetric cases, it should be inhaled in a
more diluted form.
Dr. Simpson recommended chloroform to be administered on a
handkerchief—the method in which sulphuric ether was
administered by Dr. Morton, in the first case in which he exhibited
that medicine. The objection to giving chloroform on a handkerchief,
especially in surgical operations, where it is necessary to cause
insensibility, is that the proportions of vapour and of air which the
patient breathes cannot be properly regulated. Indeed, the advocates
of this plan proceed on the supposition that there is no occasion to
regulate these proportions, and that it is only requisite that the
patient should have sufficient air for the purposes of respiration, and
sufficient chloroform to induce insensibility, and all will be right.[53]
The truth is, however, that if there be too much vapour of chloroform
in the air the patient breathes, it may cause sudden death, even
without previous insensibility, and whilst the blood in the lungs is of
a florid colour. Chloroform may indeed be inhaled freely from a
handkerchief without danger, when it is diluted with one or two parts
by measure of spirits of wine, but the chloroform evaporates in
largest quantity at first, and less afterwards, until a portion of the
spirit is left behind by itself. The process, however, of inhaling
chloroform from a handkerchief is always uncertain and irregular,
and is apt to confirm the belief in peculiarities of constitution,
idiosyncrasies and predispositions, which have no existence in the
patient.[54]
 The most exact way in which it is practicable to exhibit chloroform
to a patient about to undergo an operation, is to introduce a
measured quantity into a bag or balloon of known size, then to fill it
up by means of the bellows, and allow the patient to inhale from it;
the expired air being prevented from returning into the balloon, by
one of the valves of the face-piece to which it is attached. I tried this
plan in a few cases, in 1849, with so much chloroform in the balloon
as produced four per cent. of vapour in proportion to the air. The
effects were extremely uniform, the patients becoming insensible in
three or four minutes, according to the greater or less freedom of
respiration; and the vapour was easily breathed, owing to its being so
equally mixed with the air. I did not try, however, to introduce this
plan into general use, as the balloon would sometimes have been in
the way of the surgeon, and filling it with the bellows would have
occasioned a little trouble. It seemed necessary to sacrifice a little of
absolute perfection to convenience, and I therefore continued the
plan which I had already followed.
The great point to be observed in causing insensibility by any
narcotic vapour, is to present to the patient such a mixture of vapour
and air as will produce its effects gradually, and enable the medical
man to stop at the right moment. Insensibility is not caused so much
by giving a dose as by performing a process. Nature supplies but one
mixture of diluted oxygen, from which each creature draws as much
as it requires, and so, in causing narcotism by inhalation, if a proper
mixture of air and vapour is supplied, each patient will gradually
inhale the requisite quantity of the latter to cause insensibility,
according to his size and strength. It is indeed desirable to vary the
proportions of vapour and air, but rather according to the purpose
one has in view, whether medicinal, obstetric, or surgical, than on
account of the age or strength of the patient; for the respiratory
process bears such a relation to the latter circumstances, as to cause
each person to draw his own proper dose from a similar atmosphere
in a suitable time.
The inhaler represented in the adjoining engraving is, with some
slight alterations, the same that I have employed since the latter part
of 1847. It is made of metal, and consists of a double cylinder, the
outer space of which contains cold water, and the inner serves for the
evaporation of the chloroform which the patient is to breathe. Into
the inner part of the cylinder there is screwed a frame, having
numerous openings for the admission of air, and four stout wires
which descend nearly to the bottom of the space, and are intended to
support two coils of stout bibulous paper, which are tied round them,
and reach to the bottom of the inhaler. In the lower part of this paper
four notches are cut, to allow the air to pass in the direction indicated
by the arrows. As the quantity of chloroform which is put in should
never fill the apertures or notches, the air which passes through the
inhaler meets with no obstruction whatever. There is a glass tube
communicating with the interior of the inhaler, and passing to the
outside, to enable the operator to see when the chloroform requires
to be renewed. The elastic tube which connects the inhaler to the
face-piece is three-quarters of an inch in internal diameter, to allow
of the passage of as much air as the patient can possibly breathe. On
the introduction of the practice of inhaling sulphuric ether there was
no tubing in this country fit to be breathed through; that in ordinary
use was only about one-third, or three-eighths of an inch in
diameter,—not more than a quarter of the proper calibre.
 The face-piece, to include both the mouth and nostrils, of which
that shown in the engraving is one of the modifications, is one of the
greatest mechanical aids to the process of inhalation which has been
contrived in modern times. Dr. Francis Sibson is its inventor. Dr.
Hawkesley did indeed contrive a very similar one about the same
time as Dr. Sibson,—early in 1847,—but he did not make it known.
Dr. Ingen Housz made patients inhale oxygen through the nostrils by
means of a bottle of India rubber with the bottom cut off; and Mr.
Waugh, of Regent Street, had more recently contrived a mouth-piece
to be adapted outside the lips, but the usual practice of inhalation
previous to 1847, was for the patient to draw in the medicated air by
means of a tube placed in the mouth. This led generally to great
awkwardness at first, as the patient usually began to puff as if he
were smoking a pipe; and it had the further inconvenience, in the
administration of ether, that the tube dropped from the mouth, and
the patient began to breathe by the nostrils, just as he was getting
unconscious. The sides of the face-piece delineated in the engraving
are made of thin sheet lead, which is pliable, and enables it to be
adapted exactly to the inequalities of the face, and the patient can
breathe either by the nostrils or mouth, just as his will, or instinct, or
other nervous functions, determine.
I have introduced two valves into this face-piece, one which rises
on inspiration, to admit the air and vapour from the inhaler, and
closes again on expiration, and the other which rises to allow the
expired air to escape. I contrived the latter valve to turn more or less
to one side, as indicated by the additional line in the engraving, and
thus admit more or less of the external air to dilute still further that
which has passed through the inhaler, and become charged with
vapour. By this means the patient can begin by breathing air
containing very little vapour, and more and more of the air which has
passed over the moistened bibulous paper can be admitted, as the
air-passages become blunted to the pungency of the vapour.
The object of the water-bath is to supply the caloric which is
rendered latent, and carried off, as the chloroform is converted into
vapour, and thus to render the process of inhalation steady and
uniform. Without the water-bath, the evaporation of the chloroform
would soon reduce the temperature of the inhaler below the freezing
point of water, and limit very much the amount of vapour the patient
would inhale; and if the apparatus were warmed by the hand, the
temperature would be too high, and the amount of vapour too great.
A medical author of great reputation in Paris sent to inquire at what
temperature I used the water-bath, and being informed, at the
ordinary temperature, published his opinion that it had no effect,
and might as well be left off. He appeared not to have considered the
relations of heat, either to liquids or vapours.
In arranging the bibulous paper in the inhaler, it is my object to
contrive that the air passing through, in the ordinary process of
inhalation, and at the ordinary temperature of about 60°, shall take
up about five per cent. of vapour. This quantity can be diminished, as
much as is desired, by turning the expiratory valve of the face-piece a
little to one side; and in winter I usually place a short coil of bibulous
paper against the outer circumference of the inside of the inhaler, in
addition to the central coils which are delineated.
I commonly put two, or two and a half, fluid drachms of
chloroform into the inhaler at first. About a drachm of this is
absorbed by the filtering paper, and the rest remains at the bottom of
the inhaler; and in a protracted operation, when it is seen, by means
of the glass tube, that the latter part of the chloroform has
disappeared, more is added, by a drachm or so at a time, to prevent
the paper ever becoming dry. Mr. Matthews, 8, Portugal Street,
Lincoln’s Inn Fields, makes the inhaler. There are smaller face-pieces
for children. The patient never inhales in so upright a posture as the
artist has represented.
There are several other kinds of apparatus in use for the inhalation
of chloroform. The most usual consist of Dr. Sibson’s face-piece more
or less altered, and with a small piece of sponge placed inside. The
apparatus which is in most reputation on the continent is that of M.
Charrière; it consists of a glass vase with suitable valves, and a fabric
for exposing a surface wetted with chloroform to the air which passes
through it.
M. Duroy, of Paris, has contrived an ingenious, but very
complicated, apparatus, which he calls an anæsthesimeter. The
object of it is to regulate the amount of chloroform which is inhaled
in a given time, and this can be varied from four to sixty drops in the
minute; but the experiments which I have related show that the
quantity of chloroform employed is not so important as the
proportion of it in the inspired air; and although each of these
circumstances has considerable influence over the other, in many
cases there are conditions in which no regular relation exists between
them. For instance, if the inhaler were supplied with sixty drops of
chloroform per minute, these sixty drops weigh twenty grains, and
produce 15·3 cubic inches of vapour; and if an adult patient were
breathing the average quantity of four hundred cubic inches per
minute, the air he would breathe would contain nearly four per cent.
of vapour, which would answer extremely well; but if the breathing
were slow or feeble, or if he should hold his breath for an interval
and commence again, he might breathe air much more highly
charged with vapour. Indeed it would depend on the amount of
surface moistened with chloroform, the temperature of the air, and
other physical conditions, whether or not the air he inhaled might
not be charged with chloroform to a dangerous degree; whilst, on the
other hand, if the breathing were deep and rapid, as often happens
whilst the patient is getting slightly under the influence of the
chloroform;—if, for instance, the patient were to breathe at the rate
of 1,600 cubic inches, instead of 400, the air he would inhale would
contain less than one per cent. of vapour, and he would not become
insensible with the utmost supply of the anæsthesimeter, till his
breathing should be moderated. M. Duroy also follows the rude and
objectionable plan of using a nose clasp, and thus compelling the
patient to breathe by the mouth alone.
It is advisable to request the patient to breathe gently and quietly,
when he commences to inhale chloroform; in other words, to do
nothing but conduct himself as if he were about to fall asleep
naturally; for, if he breathes deeply, the vapour feels much more
pungent than it otherwise would do, and is apt to excite coughing, or
a feeling of suffocation.
In using the inhaler described above, the patient should commence
to inhale with the expiratory valve of the face-piece turned on one
side, and it should be gradually advanced to the required extent, over
the opening it is intended to cover, as the sensibility of the lungs
becomes diminished. Not only patients with phthisis or bronchitis,
but many sensitive and irritable persons with sound lungs, have a
great intolerance of the vapour of chloroform at first, on account of
its pungency; and it is necessary to occupy two or three minutes in
gradually commencing the inhalation, before the patient makes any
appreciable progress towards insensibility. In administering
chloroform to children also, it is desirable to begin very gently; by
this means, and with a little persuasion, one generally succeeds in
getting them to inhale voluntarily; although, occasionally, it is
necessary to use a little force to accomplish one’s purpose.
In certain cases of the medicinal application of chloroform, and
also in obstetric cases, where the pains are not severe, it is
unnecessary to render the patient unconscious, but for surgical
operations this is nearly always requisite. No force should ever be
employed so long as the patient is conscious, unless it be to children
or lunatics; but some patients become excited as soon as they are
unconscious, and attempt to leave the couch, or push away the
chloroform; under such circumstances, if they cannot be calmed by
what is said to them, they should be held, and the vapour should be
steadily and gently continued, for a minute or two, till a state of
quietude is produced. By far the greater number of patients remain
quiet as they become unconscious, but there is no difficulty in
ascertaining whether a patient is unconscious or not. If the eyelids
remain open, the countenance shows whether the patient is
conscious or not; and, if they are closed, it is only necessary to touch
them gently, to ascertain this circumstance. If he is still conscious, he
will look at his medical man, and probably speak, or, at all events,
show intelligence in his countenance.
Signs of Insensibility. The absence of consciousness, and a state of
quietude, are both requisite before the commencement of a surgical
operation, and they go a good way towards the preparation of a
patient for it, but these symptoms may be present and the patient not
be ready for an operation. The surgeon wishes to know whether he
will lie still under the knife, or whether he will make a resistance and
outcry which he would probably not make in his waking state. Some
surgeons have recommended that the patient should be pricked with
the point of a knife or some other instrument. This is not a good or
satisfactory plan, however, for a person will often show no sign of
feeling a slight prick, when a severe incision would rouse him to
resistance. A more elegant and successful plan is to raise the eyelid
gently, by placing one finger just below the eyebrow, and then to
touch its ciliary border very lightly with another finger. This should
not be done roughly nor too frequently, for fear of exhausting the
sensibility when it is slight. Just after unconsciousness is induced,
the eyelids are often closed very strongly when their margins are
touched, especially in females, and there seems to be a positive
hyperæsthesia; this, however, is only apparent, and arises from the
control of the will being removed, whilst sensibility remains. By
continuing the chloroform, the sensibility of the edges of the eyelids
diminishes until, at last, they may be touched without causing
winking. Under these circumstances, the most severe operation may,
in almost every case, be commenced without sign of pain. I have
employed this test of the sensibility or insensibility of the patient
ever since chloroform has been in use, and also in the employment of
ether in 1847, and I am satisfied that it affords more reliable
information on this point than any other single symptom. It even
indicates the amount of sensibility where a little remains; when, for
instance, touching the margin of the eyelids causes very slight and
languid winking, the patient will commonly flinch a little if the knife
is used, but only in a manner that can be easily restrained, and will
not interfere with the majority of operations. The cases, in which the
indication afforded by the eyelids is not always to be depended on,
are those of hysterical patients, in whom there is sometimes no
winking on touching the eyelids, even when unconsciousness is
scarcely induced. In such cases, one must judge by the other
symptoms, and also by the length of time the patient has inhaled, the
strength of the vapour, and depth and activity of the breathing.
Indeed, these conditions should be observed and taken into account
in every case; and all the symptoms exhibited by the patient should
be watched, such as the expression of the face, the state of the
breathing, and the condition of the limbs with regard to their tension
or relaxation. The last is indeed sometimes relied on as the chief or
sole sign whether the operation may be commenced, but it is of itself
very insufficient, and even fallacious. The patient may allow his
limbs to lie relaxed when he is scarcely unconscious, and not at all
insensible, merely because he is not exerting his will upon them; if
the arm is lifted, it may fall listlessly down again, at a time when the
knife of the surgeon would rouse the patient to active resistance.
Indeed, the limbs, which have been lying relaxed, may become tense
as the effect of the chloroform increases, and may remain so during a
short operation, in which there is no sign of pain.
 Although the pulse of itself gives no indication as to how far a
patient is under the influence of chloroform, it is proper to pay
attention to it, not only during the first administration of the
chloroform, but also throughout the operation, especially if it be
attended with much bleeding. The pulse sometimes becomes
intermittent or irregular during the administration of chloroform,
more especially in elderly persons. This more commonly happens in
the first exhibition of it, than when it is repeated during the course of
an operation. I have not seen any harm from either of these
conditions, but it is well to intermit the chloroform for ten or fifteen
seconds, and let the patient have a few inspirations without it, if the
pulse is not in a satisfactory condition. If the precaution be taken to
ensure that the air the patient breathes shall never contain more
than five per cent. of vapour, the pulse can never be seriously
affected by the direct action of the chloroform, and the state of the
breathing affords the best warning against continuing the inhalation
too long at a time.
The breathing is fortunately also a sign that cannot be overlooked.
It is by the breath that the chloroform enters, and it is extremely
improbable that any one would go on giving the vapour after the
breathing became stertorous and laboured.
The patient sometimes holds his breath after he is unconscious,
and before he is insensible; this occurs under two conditions: first,
after deep and rapid breathing, during which the patient seems to
absorb more oxygen than is immediately required, under the
circumstances; and in this condition, I have known him hold his
breath for a whole minute, whilst the pulse was unaffected. The other
condition in which the breathing is suspended, is when there is
rigidity in the third degree of narcotism, and the respiratory muscles
seem to partake of the general rigidity; the holding of the breath in
these cases seldom continues so long as under the former
circumstances. I do not consider that there is any danger from either
of these kinds of suspension of breathing. I believe it always returns
as soon as there is a want of oxygen in the system. Of course the
inhaler need not be applied to the face when the patient is not
breathing, and he may as well have an inspiration or two without
chloroform when the breathing is renewed. It is seldom requisite to
carry the effects of chloroform so far that the breathing becomes
stertorous, and whenever stertor is observed, the inhalation should
be suspended; under these circumstances, the patient is always
insensible. In some cases, in which a little more chloroform has been
inhaled than is necessary, the patient breathes for half a minute or so
by the diaphragm only, and breathes in fact hardly at all. The
abdomen rises and falls freely, but, from the muscles of the chest not
fixing the ribs, hardly any air enters the lungs, and the face becomes
rather livid; meanwhile the pulse goes on very well, and at last the
patient draws a deep, sonorous inspiration, the face resumes its
proper colour, and all is right again. I have not heard of any accident
from chloroform commencing in this manner. This state of
breathing, when it does occur, usually takes place a few seconds after
the inhalation has been left off, and arises from the accumulation of
the effects of the chloroform, owing to the absorption into the system
of the vapour which was contained in the lungs at the time when the
inhalation was discontinued.[55] This accumulation or increase of the
effects of chloroform lasts for about twenty seconds; it is not
dangerous unless the vapour is inhaled of too great strength, but it
should be borne in mind in all cases. It may be prevented altogether,
by reducing the strength of the vapour, just as the patient is getting
insensible, or by giving it with intermissions of a few seconds, at this
time.
The rigidity and struggling previously mentioned (pages 39 and
50) as occurring occasionally in the third degree of narcotism, more
particularly in robust persons, often form a very prominent feature
in the effects of chloroform; and have sometimes caused the medical
man to discontinue the exhibition of chloroform, under the belief
that it did not agree with the constitution of the patient, and that its
further exhibition would be unsafe. The proper course to pursue is to
continue the inhalation gently, till the struggling and rigidity are
subdued. The patient is often insensible before these symptoms are
subdued, but it is necessary to have him quiet, in order to enable the
surgeon to operate with convenience and safety. I have always
succeeded in subduing the involuntary struggling and rigidity, but
have occasionally occupied five or six minutes in doing so. It is
desirable to proceed slowly and cautiously, because, when these
symptoms occur, the patient has already absorbed nearly the usual
quantity of chloroform, and he often holds his breath, and then takes
a sudden and deep inspiration, when he might inhale an overdose of
vapour, unless it were presented to him in a well diluted state.
When the rigidity and struggling are subdued, the breathing, in
some cases, becomes stertorous, and relaxation of the muscles takes
place, the limbs appearing quite flaccid; but by proceeding gently,
these effects may generally be avoided, and the patient becomes
quiet, whilst the breathing is natural, and the muscles are in a
moderate state of tension. If the operator should be afraid to proceed
with the exhibition of chloroform, on account of the violence of the
muscular spasm and rigidity, it will be satisfactory to him to know
that, if the inhalation is resumed in a few minutes, these symptoms
will be less violent than at first.
Struggling and rigidity are less likely to occur, when chloroform is
administered slowly, than under opposite circumstances; but it is
impossible to prevent these phenomena altogether in certain
patients. After they are once subdued, they but very rarely recur
during the operation; the patient, in most cases, seems to take on,
when he is subdued by the chloroform, the same relation to it that
women, children, and persons in a state of debility have from the
first. M. Chassaignac has called this condition one of tolerance of the
chloroform. It is a condition in which the patient bears both the
chloroform and the operation very comfortably; but tolerance of a
medicine is generally meant to imply that the patient can take it in
larger quantity than before. But this is the reverse of what occurs
when the patient is in a tranquil state from chloroform; he has
already absorbed a considerable quantity, which has most likely
penetrated deeply into the tissues, and he certainly does not require,
and could not bear, so much as in the earlier stage of inhalation,
where he is restless and breathing more quickly, and thus exhaling
and getting rid of the chloroform at a greater rate.
It might be a question whether the absence of muscular
excitement, in a number of cases, does not arise from the
circumstance that anæsthesia, or absence of common sensibility, is
obtained, and the operation performed, at a stage of narcotism
anterior to that in which the muscular rigidity and spasm occur. This
is true in a few cases, but I am satisfied by careful observation that,
in the greater number of instances in which muscular excitement is
absent, it would not occur at all, though the inhalation should be
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