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it is a well substantiated fact that drugs do not always affect human beings and the lower ani-
mals the same way, e.g., elaterium kills dogs but does not purge them, pigeons bear enormous
doses of morphine, and rabbits cannot be killed with belladonna. The weight of clinical evi-
dence alike of England (Snow), Germany (Kappeler), and America, Dr. Reeve avers, is
entirely against, the Commission's finding that primary heart failure does not occur in chloroform
narcosis, and cases are cited in which it is stated the heart stopped before respiration ceased.
He concludes by saying: "I protest, in the interest of patients, against the doctrine that chlo-
roform can be administered with absolute safety;" and Dr. Reeve insists that such a conclu-
sion can only be arrived at by "ignoring a vast amount of evidence, both experimental and
clinical,—evidence which outweighs all theories and all doctrines, no matter whose names may
be appended to them." We consistently with our motto, " Audi alteram partem," can at present
only weigh evidence, and are most willing to receive testimony both for and against the views
which have been advance by Snow and Clover on the one hand and Syme and Lister on
the other.
[Dr. Reeve's "vast amount of clinical evidence", like Dr. Dudley Bux-
ton's "considerable bulk of direct evidence pointing to the existence of primary
heart failure under chloroform", is worthless evidence of what occurs in abnor-
mal chloroform administration. All reliable evidence supports the dictum of the
Hyderabad Commission that normal chloroform anæsthesia is free from risk.]
ARTICLE IN THE LANCET. MARCH 14TH, 1891.
BY
S U R G E O N - M A J O R E D W A R D L A W R I E .
SINCE the publication of my clinical lecture in The Lancet of Nov. 29th, 1890, I have
received numerous letters from Europe and from different parts of India requesting me to draw
up authoritative rules showing briefly the method of chloroform administration which experi-
ence, based upon Syme's principles and upheld by the Hyderabad Commissions, has shown to
be uniformly safe:
—
(1) The chloroform should be given on absorbent cotton stitched into an open cone or
cap. (2) To ensure regular breathing th e patient, lying down, with everything loose about the
neck, chest, and abdomen, should be made to blow into the cone held at a little distance from
the face. The right distance throughout the inhalation is the nearest which does not cause
st ruggling, or choking,o r h o l d i n g o f t h e b r e a t h . P r o v i d e d n o c h o k i n g o r h o l d i n g o f t h e
breath occurs, the cap should gradually be brought nearer to, and eventually may be held
close o v e r , t h e mo u t h a n dn o s e a s i n s e n s i b i l i t y d e e p e n s . ( 3 ) T h e a d m i n i s t r a t o r ' s s o l e o b j e c t
while producing anæsthesia is to keep the breathing regular. As long as the breathing is
regular, and the patient is not compelled to gasp in chloroform at an abnormal rate, there is
absolutely no danger whatever in pushing the anæsthetic till full anæsthesia, is produced. (4)
Irregularity of the breathing is generally caused by insufficient air, which makes the patient
struggle or choke or hold his breath. There is little or no tendency to either of these untoward