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in what manner the anæsthesia is induced. Death from primary cardiac syncope never took
place." Further, "With regard to the anæsthesia produced by chloroform in dogs, once in
- s e n s i b i l i t y i s b r o u g h t a b o u t , s o l o n g a s r e s p i r a t i o n i s k e p t u p , t h e r e i s n o f e a r o f a c u m u l a t i v e
effect, the drug is rapidly eliminated. Interference with this eliminative process brings about
changes in the respiratory mechanism, which ought to arouse suspicion and prepare us for arti
-ficial respiration. The keenest watchfulness of the respiration was indispensable from the begin-
ning to the close of chloroformisation, if safety was to be guaranteed." I am thoroughly
convinced that the same remarks hold good with regard to chloroform anæsthesia in the
human being.
These conclusions were arrived at from simple observation, and record of the pheno
- m e n a o c c u r r i n g d u r i n g t h e c h l o r o f o r m i s a t i o n o f d o g s . T h e y w e r e a d e q u a t e l y s u b s t a n t i a t e d ,
supplemented and placed on a scientific foundation by the experiments of the second Hydera
- ba d Chl or of or m Commi s s i on, a nd ha ve not , a s f a r a s I ha ve be e n a bl e t o gl e a n f r om t he va r i ous
discussions that have arisen on the question, been as yet successfully controverted.
Before the conclusions of the Second Hyderabad Chloroform Commission were made
known, the fact that respiration is always affected before the heart caused the most scrupulous
attention to be paid by the adherents of Syme's principles to the condition of the former during
chloroform anæsthesia, and it was found that if the respiration ceased, which it occasionally did,
there was always time to restore the patient by artificial respiration, Under this old system of
administration, in all probability overdosing with the vapour not unfrequently took place, but
the rapid elimination effected by the prompt artificial respiration, which was sometimes demand
-ed, rendered the patient exempt from real danger. Surgeon-Major Lawrie has gone a step be
- y o n d h i s f o r m e r t e a c h i n g : h e n o w r e m o v e s t h e a m æ s t h e t i c a s s o o n a s t h e r e i s a n y i m p e d i m e n t
to the respiratory mechanism, beginning it again as soon as uniform breathing is re-established.
He now insists on (1) chloroform being given in such a way that the respiration is regular
throughout the administration, and (2) the anæsthetic being entirely removed, and the patient
taking a breath of fresh air if any struggling, holding of the breath, or irregular respiration
occurs. The observance of this simple practical rule is an absolute safeguard against overdosing
with chloroform vapour, and with this plan of administration it is difficult to imagine a death
from chloroform inhalation taking place otherwise than under a combination of fortuitous
circumstances, or as a purely accidental event. Formerly the respiration was watched for
warnings whereby danger might be arrested, now it is attended to in such a way that danger
can never arise.
One great lesson to be learnt from the results of the Second Hyderabad Chloroform
Commission 's experiments is that regularity of the respiration is to be maintained throughout
the administration of chloroform, and that a continuance of the anæsthetic during any inter
- f e r e n c e w i t h r e g u l a r r e s p i r a t i o n i s a s s o c i a t e d w i t h d a n g e r . P r e v i o u s t o t h e a n n o u n c e m e n t o f t h e
conclusions of the Second Commission, all those who give chloroform on the late Professor
Syme's principles watched the respiration, knowing that when it became shallow, embarrassed,
or ceased, danger was to be apprehended if prompt artificial respiration was not resorted to; but
now, in addition to watching the respiration, it is incumbent on us to the utmost degree possible