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patient usually swallows all the saliva which is secreted, often in large quantity, and this pro
–
duces after vomiting ; whereas when the patient is on his side the saliva will run out of the
corner of his mouth, and consequently cannot irritate the mucous membrane of the stomach.
Also, when the patient is lying on his side, the tongue is not liable to fail back and thus
impede respiration ; in natural sleep and in cases of apoplexy how constantly do we notice that
a patient on his back snores heavily and breathes uneasily, but when turned on his side all
noise ceases and he breathes quietly. The next conclusion I agree with, provided the patient
is placed on his side for the reasons above stated. The principles of the next five paragraphs
have been taught in the London schools for years. I can answer for Charing–cross Hospital,
where the pupils are systematically instructed in the th eoretical and practical details of anæs
–thetics.In paragraph 33 of the report the Committee state that they performed a large
number of operations which are reputed to be particularly dangerous from shock, such as
extraction of teeth, evulsion of nails, section of muscles of the eye, &e. These operations were
performed in all stages of anæsthesia , and even when the animal was merely stupefied with
chloroform; in no case was there anything suggestive of syncope or failure of the heart’s
action. And yet in Conclusion VIII.
we find, “ As a rule, no operation should be commenced
until the patient is fully under the influence of the anæsthetic, so as to avoid all chance of
death from surgical shock or fright.” Now , how are we to reconcile these to statements ? Is
it not apparent that do not suffer from surgical shock and cardiac failure, and are in this
respect different from human beings. I venture to state that there is no anæsthetist, even of mode–-
rate experience, who has not noticed cases of shock from insufficient anæsthesia , due to the surgeon
commencing the operation before asking the administrator whether the patient is ready.
Conclusion IX. states : “ The administrator should be guided as to th e effect entirely by
the respiration . His only object, while producing anæsthesia, is to see that the respiration
is not interfered with.”
From the large experience I have had of administering anæsthetics
in England during the last thirty years, I feel absolutely certain that if this deduction is acted
upon , the number of fatal cases, even now too numerous, will rapidly increase. 1 maintain
that the administrator should watch equally the face, the pulse, and the respiration, sudden
pallor of the face being of for more importance than partial interference with the breathing.
The precautions mentioned in the remaining paragraphs are usually c arried out in the London
Hospitals. Time alone will show whether the sanguine future the Commission believe to be
in store for chloroform will come to pass if their rules for its administration are carried out.
I remain, Sirs, yours faithfully,
F e b , 3 r d , 1 8 9 0 .
W O O D H O U S E B R A I N E .
LETTER FROM MR. ROGER WILLIAMS.
THE EDITORS OF “ THE LANCET”.
SIR,—Just as modern industrial life is the outcome of the introduction of steam , so
modern surgery is based upon the use of Whatever relates to fatalities during
anæsthesia is therefore of the greatest importance to every practical surgeon. With neatly