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noticed that death has been produced by primary cardiac arrest." Although possessed of these
facts as the result of several years' work in the laboratory, it was determined, upon the publi
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cation of the Hyderabad Commission's report, to re-investigate the matter. This was done
with the result that Professor Wood became more than ever impressed by the fact that chloro
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form can and does kill directly through primary arrest of the heart. One series of experiments
went to show that the heart is directly affected and not reflexly, the view now commonly held
by experts. A second series proved that although when large doses are given, respiration and
the heart's action may cease synchronously, yet frequently the cardiac action ceases a
perceptible period before the respiration comes to a standstill. The conclusions founded upon
these experiments are well worthy of very careful consideration. The authors say chloroform
acts as a powerful depressant poison upon both respiration and circulation; sometimes the
influence is most felt at the heart, and death results from cardiac arrest; in other cases the drug
paralyses primarily the respiratory centres, while in other instances it seems to act with equal
force upon both medulla and heart." And, further, they are led to formulate "that cardiac
arrest is specially prone to occur when chloroform is administered rapidly and in a con
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centrated form." It is also stated by the writers of the paper that they have each witnessed
deaths from chloroform in the human subject, in which the heart ceased some while before arrest
of respiration took place. They suggest that if the report of the Hyderabad Commission is not
materially modified in its main contention, viz., that chloroform does not cause primary cardiac
arrest, the explanation may be found in some peculiarity of Indian pariah dogs, since European
and American dogs unquestionably succumb to primary heart failure when allowed to inhale an
unduly strong chloroform vapour.
In The Lancet of September 21st, 1889, we made the same suggestion as Professor Wood
does now, and pointed out the possibility of the animals experimented on in Hyderabad being
peculiarly resistant to the action of chloroform, and also indicated that differences in resisting
power might also exist between the inhabitants of different cities. We further indicated varia
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tions in temperature as another possible cause of difference in the results of chloroform admin
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istration. There may be other factors still unknown, and which may be ascertained by further
experiment. We have no doubt that the experiments of the Hyderabad Chloroform Commis
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sion and those of Drs. Wood and Hare were made with equal care, and the apparent discrep
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ancies between the results will in the end only lead to a fuller and more perfect knowledge of
the truth. But we have foreseen that it is quite impossible to come to a final conclusion re
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garding the action of chloroform on man from experiments, however numerous and however
careful, on the lower animals. Such experiments are of great value, but the question must
also be worked out from the clinical side, and it is for this reason that we have sent out a re
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quest for information regarding the results of the administration of anæsthetics. We trust that
the difficulty of arriving at exact conclusions without a very large basis of facts will induce all
those who can give us information to do so as fully as possible, and also to remember the
proverb, "Bis dat, cito dat. " When we have received these returns we purpose to have
them collated, and to devote careful consideration to the whole question of the action of anæs
thetics, from its clinical as well as its experimental side.