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from heart syncope secondary to respiratory failure, and both will submit that such deaths
should not occur; that they mean in many cases carelessness and deviation of the anæsthetist's
attention from the patient, and both will assert that most of such patients can be brought. out of
their peril by prompt and skilful employment of artificial respiration, &c. It then becomes
necessary to consider the evidence upon which these rival schools of thought and teaching base
their opinion and practice. In this connection I would point out a most valuable source of
information which has up to the present been but lightly laid under contribution, and which is
capable of furnishing the most valuable testimony. I refer to the frequent cases which are met
with by those who have a large practice in chloroforming in which untoward symptoms occur,
but which not ending fatally are not recorded in the medical press, and perhaps noticed only
by the chloroformist himself.
Upon the question of primary heart failure the Hyderabad Commission have definitely
assumed the position that respiration always fails before cardiac syncope; in other words, that
cardiac syncope is invariably secondary. The immense care with which the work of the Com-
mission was conducted, the great help it received from the experience of Surgeon-Major Lawrie
in chloroforming and that of Dr. Lauder Brunton in physiological research, render its conclu--
sions of especial value, and justify us. I think, in saying that if primary heart failure from chloro--
form is a delusion the Hyderabad Commission were competent to prove the same up to the
hilt. The evidence adduced is now common property, so that detailed quotation is needless.
In chloroforming considerably under one thousand dogs, rabbits, &c., the Commission failed to
induce primary syncope, and Surgeon-Major Lawrie in, say, 40,000 inhalations in human beings
the bulk of whom we may assume were Asiatics, never lost a patient. Two classes of fatalities
occurred among the lower animals—(1) death from failure of respiration, and (2) accidental
deaths, the cause of which the report fails to recognise, except that it assumes it was due to an
overdose. An effort was made to bring about fatty changes in the dog's heart by giving
phosphorus, &c., but even then primary heart failure did not occur, nor were the Commissioners
able to show any evidence of shock occurring in the lower animals whilst under chloroform.
If this brief statement fairly represents the outcome of the Hyderabad Commission's work,
we find their evidence to be wholly negative upon this important matter. But the question of
primary heart failure does not rest solely upon the negative evidence mentioned above. Snow
and the older authorities fully recognised the condition; and the Glasgow Committee, both in
their original and recent reports, have distinctly asserted that even, among the lower animals
primary heart failure occurs, while has been left for Professor MacWilliam of Aberdeen
to explain the modus opperadi of the prejudicial action of chloroform upon the heart. Again,
the independent testimony of Professor Wood of Philadelphia has been given to the occurrence
of primary heart failure under chloroform, and quite recently lie had been at the pains of
re-investigating the matter, with a result confirmatory of' his original decision. Reverting to
the careful research of Professor MacWilliam, we find the following phenomena narrated and
graphically recorded by an ingenious arrangement of apparatus. Animals kept under artificial
respiration worked by an arrangement which ensured equal and tranquil breathing, and at the
same time enabled the operator to give any definitep e r c e n t a g e o f c h l o r o f o r m , w e r e w a t c h e d t o
see what effect the chloroform so given had upon the heart. This effect is notable. The heart