239
as they signify that the patient has not been breathing properly, or that he has been asphyxiat-
ed, or that the respiratory centre has been paralysed. They do not indicate, as has hitherto
been supposed, that chloroform has any direct effect upon the heart; but whenever they occur,
at whatever stage of chloroform administration, they show most unmistakably that it has been
given in such a way as to interfere with the breathing.
The most important point of all in the tracings is to be found in the invariably gradual
and regular fall of blood-pressure when chloroform is properly administered. This is shown
in many of the Commission's experiments, especially from No. 164 to the end (vide 169),
and in the tracings of March 6th, 1890. In tracings 3 and 4 of March 6th the fall of blood-
pressure is gradual and perfectly regular, and they demonstrate the only method of chloro-
form administration compatible with absolute safety. Though fall of pressure is inseparable
from chloroform administration, there is never the least danger if it falls regularly, and if the
inhalation is stopped directly the state of the cornea shows that the patient is "under".
Regularity of the blood-pressure depends entirely upon regularity of the respiration. Any
irregularity, therefore, in the fall of blood-pressure during chloroform inhalation indicate
irregularity of or interference with the respiration: and, per contra, any irregularity of or
interference with the respiration at once causes irregularity in the fall of blood-presure; but
as long as the respiration is regular and not interfered with, the fall of the blood-pressure will
exactly correspond with it, and will cease long before a dangerous point is reached
i f t h e i n h a l a t i o n i s s t o p p e d
when the cornea become insensitive, or other signs show that the patient is
" under". If the respiration is kept up without struggling, holding the breath, o r asphyxia,
chloroform may be given slowly or quickly, freely and with perfect confidence, without the
slightest risk to the patient.
From the standpoint of medical education it is a serious misfortune that ether has been
allowed to displace chloroform in any of our large hospitals. The public has a right to de-
mand that every medical man shall he able to administer an anæsthetic with safety in any part
of the world; and there is no anæsthetic which can be thus universally employed except chlo-
roform. If ether is used as the sole recognised amæsthetic in the hospitals attached to our
medical schools, students cannot learn how to give chloroform; or if anæsthetics are only to
b e
a d m i n i s t e r e d
b y
specialists, students cannot learn anæsthesia practically; and it is notori-
ous that the advance of ether has been accompanied by a decrease in the employment of
anæsthetics by the general practitioner, and has limited their usefulness.
In conclusion, I desire to do justice to the wisdom of my old masters by comparing
the principles Syme laid down for the safe administration of chloroform,—principles which he
always said he took from Sir James Simpson,—with the physiological proof the H yderabad
Commission has succeeded in determining from their experiments. In the lecture to which I
have so often referred, which was published in THE LANCET of Jan. 20th, 1855, Mr. Syme states:
" T h e p o i n t s t h a t w e c o n s i d e r o f t h e g r e a t e s t i m p o r t a n c e i nt
h e
a d m i n i s t r a t i o n
o f
chloro-
form are: fi rst , a free admi xt ure of ai r wi t ht h e
v a p o u r o f c h l o r o f o r m ; s e c o n d l y , w e d o n o t
stint the quantity of the chloroform; then, and this is most important, we are guided as to the
effects, not by the circulation, hut entirely by the respiration. We also always give chloro-