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form in the horizontal position, taking care that there is no article of clothing constricting the
neck, and we never continue beyond the point when the patient is fully under the influence of the,
anæsthetic."
The Commission has demonstrated that the aim of the surgeon must be to give chloro-
form so that the blood-pressure should fall regularly throughout the whole administration, and
that the blood-pressure can only be kept free front irregularities by absolute regularity of the
breathing. The chloroform must therefore be inhaled in such a way that the breathing
is natural and regular throughout. Feeling the pulse during chloroform inhalation is no guide
whatever either to the blood-pressure or to the one thing necessary for safety, which is
to keep it regular; and it has been shown above that the pulse is of no value as a sign of
approaching danger, since it is only affected dangerously (a) when the respiration has been inter-
fered with or (b) by an overdose. Lastly
, in order to keep the breathing regular, the whole of
the administrator's attention must be concentrated upon this point alone; and it is therefore
clear that if, as is now recommended in most of the text-books, part of the chloroformist's atten-
-tion is to be given to the pulse, an important element of danger comes into the administration.
We can no longer contend, with regard to chloroform, that the results of clinical ex-
perience and of experimental
research do not agree. The investigations of the Hyderabad
Commission have brought to light a strikingly precise and complete agreement between
both. I have stated in THE LANCET of April 5th, 1890, that the late Mr. Syme's and my own form
a continuous series amounting to more than 45,000 cases of almost daily (and often several
times a day) chloroform administration, extending from 1847 to 1890, in which the respiration
alone was taken as a guide, without one death
resulting. Mr. Roger williams
has proved in
THE LANCET of February 8th, 1890, from the statistics of one of the largest hospitals in
London, (which, he says, may be accepted as reliable averages of all the London hospitals ),
in which the pulse is taken as a guide, and is carefully watched as well as the respiration that
the deaths amount to one in every 1,236 administrations. We thus see that in a long series of
45,000 cases, extending over 40 years, in which the chloroformist's
attention was concentrated
on the respiration alone, and in which the chloroformists were students, there were no deaths
at all; while in another series of 12,368 cases, in which a part of the chloroformist's attention
was devoted to the pulse, and in which the
chloroformists were specialists (anæsthetists), there
were no less than 10 deaths,—a fraction over one in every 1,250 administrations. These clinical
results correspond w ith the conclusions arrived at by the Hyderabad Commission, and are
sufficient to show what a tremendous difference to the patient the mere method of administra-
tion may make. One of the London journals, the St .James's Gazette, recently published an
article on the question "Is Chloroform?" and answered it by saying, "It depends upon
who gives it." We now know that it does indeed depend upon who gives it, but we also
know that any intelli g ent third or fourth year's medical student may he trained to give it
safely, so as to do good without the risk of evil.
1 think I have shown that the Hyderabad Commission has proved Syme's principles
to be true. The rationale of the proof and the keystone to the work of the Second Com-
mission is to be found in the discovery of the safeguard action of the vagus nerve, and in the