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I greatly fear that, as a result of the Hyderabad Commission, the opinion that death
from chloroform is always prefaced by some change or sign of danger in the patient's breathing
will gain ground. But does the Commission prove this ? I think not. What it does prove
is that in dogs and monkeys and some other animals, in India, respiration always gives warning
of an overdose and ceases from one to ten minutes before the heart stops for ever. This is
no new statement, for in Snow's work on Anæsthetics, published in 1857, we find the following
passage : “ The greater number of experimenters who have killed animals with chloroform
have found that the action of the heart continued after the breathing ceased, but they did not
either control or ascertain the proportion which the vapours of chloroform bore to the inspired
air. In Mr. Thomas Wakley's experiments the action of the heart continued after the
breathing had ceased ; and this was the case in a great number of experiments performed by
a Commission which reported to the Society of Emulation of Paris in 1855.” This Com
–mission came to the conclusion that “ in all instances in which animals are killed by chloro-
–form the action of the heart survives the respiration ; but they might have administered chloro-
form to an equal number of human patients without any one of them being cut off by sudden
paralysis of the heart.” Evidence, as we all know, is of two kinds—positive and negative ;
and if three cases of death in the human subject are brought forward which have happened in
England or in climates resembling ours in which the heart has ceased beating and the patient
has gone on breathing afterwards, then I affirm that these cases are of far more importance to
us as practical anæsthetists, and far outweigh the 430 experiments which were performed on
dogs, monkeys, and other animals in the tropical heat of India.*
The Commission states that it has searched the records of accidental deaths from chloro
–form in Great Britain since 1855, and they find that there is not a single death from chloro
– f o r m r e c o r d e d i n w h i c h i t w a s p r o v e d t h a t t h e r e s p i r a t i o n a l o n e w a s a t t e n d e d t o t h r o u g h o u t
the inhalation. I also have carefully gone through these same cases, and the conclusion I
arrive at is that all these cases were watched with the greatest care on account of the admin–-
istrator not knowing from which quarter danger might arise, and although it is not specially
stated that the respiration was watched, I cannot for one instant doubt that it was well attended
to. But to my mind this is a side question altogether, for, from the details of cases quoted a
little further on, there can be no doubt that the primary cause of death was cardiac failure,
cessation of respiration being secondary. One very important point to note is that in these
cases death took place in one instance in 120 seconds, in another in about 60 seconds, and in
a third at five minutes from the commencement of inhalation. Now notice how different i hese
times are from those in the fatal cases of the Commission. Not one of the 197 animals died
in as short a time as the second case quoted ; while the heart of one dog went on struggling
for over ten minutes after respiration had ceased, not counting the time of inhalation. There
is no doubt that in the human subject, when the breathing stops, artificial respiration is the best
proper treatment, and these are the cases which cause the surgeon intense anxiety, but which
do not, or very rarely, end fatally ; but when sudden and general pallor comes over the face
together with sudden loss of pulse, then the patient is dead in ninety–five cases out of a hundred.
It may be objected that in quoting these cases I am going a long period back ; but they
are typical cases, and they have gone on occurring in much the same way up to the present
[The temperature of the Laboratory in which the Commission's experiments were carried out varied from 18°t
o 24° C.]
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