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LETTER FROM DR, E. F. NEVE.
To THE EDITORS OF “ THE LANCET.”
SIRS,—The results of the work of the Hyderabad Commissions, important as far as they
go, can only be considered as final on one division of the subject. Where the nervous system
is an important factor, the difference between the highly-organised cerebro-spinal system of
man as compared with animals is not likely to be overlooked. Sometimes the results of clinical
experience may disagree with those of physiological experiment. In such cases practical
men are apt to prefer the former. But even in clinical work sources of error exist. There
are three such which ought to be kept in view :—(l) That those in many respects most
qualified to judge in the question,riz., experts, anæsthetists by profession, are from their very
position apt to have a. distinct bias ; for of the essence of the controversy is the contention
on the one hand, that average ability, great care, and moderate experience are sufficient,
for the safe administration of chloroform, without any special apparatus. Opposed to
this is the reiterated belief, supported of course by the united body of professional anæsthetists,
that both experts and apparatus are required, whether for chloroform or ether. (2) In favour
of the use of chloroform as a routine amesthetic is the weight of conservatism, including the
convenience of administration of the drug. (3) In cases of death under administration,
there is a natural tendency for even an upright and honest man to seek for causes of death
outside the obvious possibility of accidental asphyxia from over-dosage or failure in
resuscitation. A question in which such conflicting interests are involved can only be
settled by facts. The Hyderabad Commission has contributed its quota. When chloroform
was first introduced its use was attended for a long time by a wonderful freedom from mishaps.
Of late years deaths have increased. and pari passu a certain degree of alarm has arisen ? But
are the deaths the cause of the alarm or is the alarm the cause of some of the deaths. The
latter view is by no means untenable. People may die of pure frigh t or of ordinary syncope.
The state of' may increase the possibility of such an untoward occurrence, which
may take place under even nitrous oxide.* If this be so, then a certain responsilbility rests on
all who foster such an alarm by. unguardedly condemning the use of a popular anæsthetic.
But, after all, the crucial question is—What is the mortality in the practice of successful
operators? T h i s i s t h e t e s t w h i c h w e a p p l y t o a l l i m p o r t a n t s u r g i c a l p r o c e d u r e . B y i t w e
eliminate many fallaeies.
Now, with regard to the practice of the Kashmir Mission Hospital, I may state that
there has never been a death under chloroform. Since 1 8 7 7, the number of surgical operations
performed has been 13,275. In connection with these, at the lowest estimate, chloroform has
been administered more than 5,000 times. Many surgeons in Great Britain must have had
vastly greater experience. If it be possible to accumulate facts from such sources, we shall
soon be in a position to judge as to the intrinsic mortality of this, in one sense, the most
important operation in surgery.
I am, Sirs, your faithfully,
ERNEST F. NEVE,M.D.,F.R.C.S. ED.
KASHMIR, December 13th, 1889.
* T h e L a a c e t ,
v o l . I L . , 1 8 8 9 , p a g e 8 0 4 .