232
LEADING ARTICLE.
The Lancet, June 21, 1890.
IN presenting to our readers this week a selection . of tracings from those obtained by
the Second Hyderabad Commission, we think it may be well to bring shortly again to their
notice the facts about this Commission. Its object was an essentially practical one, and could
not be better defined than in the words of His Highness the Nizam himself, " to save people's
lives ". This object Surgeon-Major Lawrie hoped to attain by showing experimentally what
he, in common with his teacher Syme and many others, had found clinically, that attention to
the respiration was the safeguard against death during chloroform anæsthesia. At his sug-
gestion, the first Hyderabad Commission was appointed by the Nizam's Government, but the
results were so different from those obtained by many other experimenters that we hesitated to
accept them when they were forwarded to us. At Dr. Lawrie's instance a Second Commission
was appointed, and the Nizam generously forwarded to us £1,000, with the request that THE
LANCET would nominate an expert to assist in the investigation, and Dr. Lauder Brunton
kindly acceded to our request to act as our representative. To take up the whole general
action of anæsthetics, although interesting, would have occupied more time than the Commis-
sion had at its disposal, and consequently it restricted its experiments to those having a direct
practical bearing.
In a subject of such vital interest as the mode of action of anæsthetics it is important
that no conclusion should be accepted without the most thorough criticism, and it is with the
view of enabling our readers to draw their own conclusions from the experiments of the Second
Hyderabad Commission that we present them with a selection from the tracings obtained.
Nearly 600 experiments in all were performed by this Commission, about 150 of them being
blood-pressure, and each blood-pressure, as a rule, involving three or four tracings or more.
Out of the total number of tracings, amounting to 400 or 500, we now select 32 in order to
illustrate some of the most important points.
The facts on which the Commission lay most stress are that when chloroform is given to
animals by inhalation, in the same way as it is given to patients during operations, the respi-
ration invariably stops before the heart, and if the administration of the anæsthetic be stopped
and artificial respiration be begun as soon as natural breathing ceases, life can invariably be
restored. The great slowing of the heart's action which has been observed, more especially
by the Committee of the British Medical Association, and which has been regarded as due
to the action of chloroform, the Hyderabad Commission regard as due to asphyxia, inasmuch
as they entirely failed to obtain this tracing by giving chloroform with free admixture of air,
but were able to obtain it at will by simple obstruction of the animal's respiration. Moreover,
instead of looking at this slowing of the heart's action as a cause of danger, the Commission
regard it rather as a means of safety, preventing the anæsthetic from being carried too rapidly
from the lungs to the nerve centres. From the observations made by the Commission there
seems to be little doubt that while chloroform given with a free supply of air by inhalation