_Case 34_ occurred on October 20th, 1853, a few days after the last. The patient was a young woman named Ann Smith, aged 22 years, under the care of Mr. Paget in St. Bartholomew’s Hospital, who was about to apply the actual cautery to a sore of cancroid nature in the vagina. She was a stout, florid young woman, formerly of dissolute habits, but apparently in perfect health, with the exception of the local ailment. She had been put under the full and prolonged influence of chloroform a fortnight previously for the application of the cautery, without the occurrence of any untoward symptoms whatever. The chloroform was administered by Dr. Black, one of the assistant physicians. “The usual form of inhaler was employed,—a padded metal cup, fitting over the nose and mouth, and supplied with valves. A drachm, by measure, was first poured on the sponge, but as the administration did not immediately commence, a considerable part of this was no doubt wasted; after a short inhalation, a second drachm was supplied, and subsequently the further quantity of half a drachm. The patient had gone through the usual stages of excitement, etc., and the last dose was scarcely used, as she sank off, almost immediately after its application, into a state of complete insensibility, unattended by any alarming symptoms. About five minutes had been occupied by the inhalation, and probably not more than a drachm and a half of the fluid really inhaled. The apparatus was now removed from the face, and the patient having been drawn into the proper position, Mr. Paget was about to commence the operation, when Dr. Black, who throughout had kept his finger on the pulse, noticed it to have become extremely weak and fluttering. Almost immediately afterwards, the patient’s countenance was observed to be dusky, turgid, and congested, and the respiratory movements began to be performed at long intervals, and by slight catching efforts. No time was lost; cold water was at once dashed on the thighs, face, and breast; and, the failure of the respiration becoming shortly complete, Mr. Paget immediately began artificial insufflation of the lungs, by alternately blowing into the nostrils, and compressing the chest. Just before commencing this process, Mr. Paget had ascertained, by drawing the tongue forwards and examining the glottis with the finger, that the epiglottis was not pressed down.” Other means were employed, but no further signs of life appeared. It is further recorded that, “immediately after the first alarming symptoms, the pupils were of the medium size, neither contracted nor dilated. All efforts at respiration ceased about two minutes after the first indications of failure; the pulse, however, as a very feeble flutter, was felt occasionally for at least two minutes later.”[104]