“Many of the fibres have been converted into fat completely; in others, fatty degeneration was beginning. The degeneration, which was in various stages, appeared very general. The fasciculi were broken up, here and there, into masses of small irregular fragments, as they may be found frequently in hearts of this kind. Some large fat globules lay between and upon the fibres. A few fibres showed their transverse striæ plainly, and made the changes in the others look the clearer. On the whole, it may be said that the structure of the organ was greatly damaged, and that its action, consequently, was liable to cease suddenly from slight causes.” I am of opinion that this patient did not die from the direct effects of the chloroform. The air he was breathing just before he died did not contain more than three or four per cent. of vapour of chloroform at the utmost, and he had previously breathed quite as much, both during the same operation and on previous occasions. The patient seemed to be holding his breath at the moment when his heart ceased to beat; and it is whilst holding the breath, and making a straining effort, that patients labouring under disease of the heart not unfrequently expire. Mr. Pollock, who was present when the patient died, expressed to me his belief that he died of his heart disease, and not of the chloroform. After reflecting on this case, I see no reason to regret the course which was pursued. It was the opinion of Mr. Hawkins that the patient could not have borne the operations without the chloroform; consequently, if we had decided not to permit its use any more, in consequence of the alarming syncope which occurred after the operation under its influence on December 4th, 1851, he would probably have died in great suffering from the calculus, instead of having seven or eight months freedom from the complaint. And, on the other hand, if it had been decided to operate without chloroform, it by no means follows that the patient would have been in less danger, judging from what I have observed of the effect of pain on the circulation, as compared with the effect of the chloroform carefully administered, in numerous other cases of disease of the heart.