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to keep it regular. The maintenance of this regularity of breathing is rightly insisted upon by
Surgeon-Major Lawrie, and constitutes the key to the safe administration of the anæsthetic.
The two occasions on which I have experienced any danger in connection with chloro--
form administration were:—
(1)I n t he c a s e of a c hi l d 2½ ye a r s of a ge on whom t he ope r a t i on of c i r c umc i s i on wa s
being performed. In the middle of the operation he began vomiting, and during a violent in
- s p i r a t o r y e f f o r t s u d d e n l y s u c k e d a p i e c e o f g u a v a a b o u t t h e s i z e o f a n a l m o n d i n t o t h e l a r y n x .
Respiration absolutely ceased, and were it not that I had the good fortune to hook the piece of
g u a v a o u t wi t h t h e f i n g e r ( a p r o c e s s wh i c h mu s t h a v e t a k e n a b o u t h a l f a mi n u t e t o c a r r y o u t ) ,
the case must have been fatal if an opening were not made into the larynx. The operation was
performed about 9 a.m., the mother having been previously told that the child was to have
nothing but a little milk that morning before the operation, and as a matter of fact she did
not know that the child had stolen into the garden and partaken of guava. All through the
period during which the lump of guava effectually blocked up the rima glottidis , my assistant
informed me that the pulse beats were regular.*
(2) The second case was one of phlegmonous erysipelas of the scalp, into which latter
incisions were to be made. The man (an old clerk in the Revenue Department of His
Highness the Nizam's Government) was placed on the table, and my assistant was directed to
give chloroform in the usual way. I was in an adjoining room about eight yards off, and told
the assistant to send in word when the patient was anæsthetised. In about four minutes' time he
rushed into the room and said that the respiration had stopped. I found that it had ceased.
The patient was restored by artificial respiration. In this case, likewise, the pulse was to be
felt during the whole period of the cessation of respiration. This accords with Professor Syme's
principles, and with the experience of both Hyderabad Chloroform Commissions.
My personal experience with regard to the administration of chloroform is limited to
about 1,500 cases, yet in these, it has been given under almost every conceivable circumstance,
but always according to the principles laid down by Professor Syme. In six cases I have kept
patients continuously under chloroform for over twelve hours, in three of puerperal eclampsia,
two of tetanus, and one of hydrophobia; and in one case—that of strychnine poisoning—for
five hours. All these cases except that of hydrophobia, recovered. In my student days I was
taught the administration of chloroform on Syme's principles, and I have consistently adhered
to them during the last eleven years.
I have known Surgeon-Major Lawrie to give chloroform on these principles for
the last fourteen years with perfect safety, and his experience in this respect is probably unique.
The late Professor Syme's and Surgeon-Major Lawrie's uninterrupted series of cases without a
single death form a monument of evidence in favour of the principles upon which they have
administered this anæsthetic. The students under Surgeon-Major Lawrie's instructions give
* A case precisely similar to this one, but occurring in an adult, and terminating fatally, was recorded in the Madras
Mail in 1888. The coroner's verdict was death from "accidental causes".