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guards; and their experimental data correspond with clinical experience. The immunity from
fatalities enjoyed by Syme and by hundreds of his pupils, in whose practice deaths from chloro-
-form have been altogether exceptional, and amount to nothing like the London statistics of 1
death in every 1,236 administrations,* cannot be set aside as accidental or due to chance.
Professor Macwilliam's present position is untenable, and his theory that dilatation of the heart
is a danger of chloroform, and that therefore the pulse must be watched during its inhalation,
has received its death-blow from one of his own supporters. In The Lancet for December 13th,
1890, Dr. Dudley Buxton describes a method of chloroform administration, in which feeling
the pulse and taking it as a guide is an essential principle. This method causes, according to its
author, general feebleness of the circulation with "distinct and unmistakable cardiac enfeeble--
ment," which "is progressive, and likely, it has appeared to me in more than one case, to end
in cardiac syncope unless prompt and vigorous measures were used." Dr. Buxton goes on to
state that the anatomical counterpart of this faulty method is to be found in the relaxation and
dilatation of the heart in Professor Macwilliam's experiments. It is probably true that Professor
Macwilliam's experimental data correspond, as Dr. Dudley Buxton says they do, with "the
procession of events which one has encountered again and again in the operating theatre," but
there is little doubt that this agreement between the two is equally damaging to both, no less
so to Professor Macwilliam's experimental methods than to Dr. Dudley Buxton's plan of
giving chloroform.
The Hyderabad Commission takes its stand on the fact brought out by its own experi-
ments, and since verified clinically, that the only way to keep the pulse regular under chloroform
is to keep the breathing regular. This requires all the unceasing skill, care, and attention of
the chloroformist. Chloroform is administered in practice by inhalation. If the breathing
is regular the anæsthetic will be inhaled in regular quantities; regular breathing constitutes
in reality the only reliable means of measuring the dose; and no capricious or irregular effects
can be produced on the circulation or the pulse. If the breathing is irregular, the chloroform
will be inhaled in irregular quantities, which will give rise to irregularities of the circulation
and of the pulse, and danger will always be imminent. It is obvious that without special risk
to the patient the pulse cannot be taken as a guide by which danger can be averted under chlo
- r o f o r m . F a i l u r e o f t h e p u l s e i n d i c a t e s h e a r t - f a i l u r e , † a n d i s a s i g n , l i k e p a l l o r o f t h e f a c e a n d
dilatation of the pupil, that a dangerous stage has already been reached; and danger in chloro-
form inhalation implies improper administration and overdosing, either from irregularity of
the breathing or from the anæsthetic having been pushed too far. Those who take the pulse
as a guide unconsciously allow "distinct and unmistakable cardiac enfeeblement" to occur, and
then proceed to rescue the patient by "prompt and vigorous measures." The Hyderabad Com-
mission seeks to entirely avert danger in chloroform administration by keeping the breathing
regular, which is the only possible way of protecting the heart and circulation. In short, the
object of the chloroformist must be to give chloroform in such a way that danger can never
* Vide Mr. Roger William's letter in The Lancet of February 8th, 1890.
[ † T h e r e i s o n e e x c e p t i o n t o t h i s r u l e . F a i l u r e o f t h e p u l s e a n d s u d d e n p a l l o r m a y i n d i c a t e i n h i b i t i o n o f t h e h e a r t ' s
action through stimulation of the vagus. These symptoms are in themselves harmless, and are unquestionably a safeguard;
but t he mer e f act t hat t he saf eguar d act i on of t he vagus i s br ought i nt o pl ay i s danger ous, as i t shows t hat t he anæst het i c
has been improperly administered with insufficient air; and it demands the immediate employment of artificial respiration.]