4
and occurs in a late stage of the administration. The primary syncope is rarely, if ever, possible
to induce in dogs, although, unfortunately, it is this form of chloroform heart failure which does
occur in human beings, and which it is almost impossible to remedy. While welcoming the attention
paid to the subject by the Hyderabad Commission, we cannot but feel that, should the Commission
inculcate a disregard of the heart as a factor in chloroform dangers, it will do harm and provoke a
slipshod carelessness in the use of that valuable anæsthetic which must in the long run do damage to
the cause the Commission has espoused.
[" The Lancet," May 11, 1889.]
BY SURGEON-MAJOR E. LAW RI E, RESIDENCY SUR GEON, HYD ERABAD, AND
PRINCIPAL, HYDERABAD MEDICAL SCHOOL.
In " The Lancet " of March 2nd, 1889, page 438, there is an annotation criticising certain remarks
of mine on the subject of chloroform in which the writer states that* " all those who are familiar
with chloroform are well aware that syncope, when primary, as a rule supervenes in the initial stages
of inhalation while secondary syncope due to respiratory embarrassment is the result of accumulation
of chloroform in the blood leading to paralysis of the medullary centres, and occurs in a late stage of
the administration," and that unfortunately it is the primary form of chloroform heart failure which
occurs in human beings, and which it is almost impossible to remedy. I have no wish to say any-
thing to give offence to those who hold the same views as the writer of the annotation, but I hold that
those views are wrong, and that there is no such thing as chloroform syncope.
It is conceivable that syncope may occur in the initial stages of inhalation of chloroform, but
in
the course of a very large experience I have never met with a single instance of such an accident,
and if it ever does occur it cannot be due to chloroform poisoning, though it might be caused by
fright or shock. Owing to the numerous accidents that have happened with chloroform, to the
discussions prevalent in the profession, and to the mistaken notion that the risk of heart failure is
inseparable from its use, the public dread its administration much more than they dread surgical
operations, and fainting from mere fright in the early stages of inhalation is no less intelligible than
it is easy to prevent, in cases where it is likely to occur, by a preliminary dose of alcohol. On the
other hand, it is equally intelligible that syncope may be induced if an operation be commenced in
the initial stages of chloroform administration, before the patient is rendered insensible to shock by
being brought fully under its influence. With regard to secondary syncope, " The Lancet " states
that it is due to respiratory embarrassment (through the respiratory centre ;)—which is an indirect
cause, and, in the same sentence, that it is the result of paralysis of the medullary centres (cir-
culatory ?) from accumulation of chloroform in the blood,—which is a direct cause.† Both these
statements cannot be true. The truth is that secondary syncope has no more real existence than
primary syncope. In poisoning by chloroform the heart fails when the respiration ceases, and never
before. With the cessation of respiration, the further accumulation of the drug in the blood neces-
sarily ceases, and the heart rapidly or gradually stops beating, as a direct result of the stoppage of
respiration, and as an indirect effect of the poisoning with chloroform.
" The Lancet " asserts that the statements made in my address are utterly at variance with the
experience alike of experiment and practice as carried out in Europe. They are nevertheless based
* This sentence should run :—" All those who are familiar with deaths from chloroform in human s.ubjects"—E. L.
† I may have interpreted the writer's meaning wrongly, but it does not affect the argument.