349
taken as a guide, and it is manifestly unreasonable to compare the risks of ether and chloroform
without stating with regard to chloroform which of these methods is employed. The importance
of this point lies in the fact that there is not one case of death from chloroform recorded in
which it is proved that the pulse was not taken as a guide; whereas in Syme's practice and in
my own, where the pulse has never been taken as a guide, no death from chloroform has ever
occurred. If the pulse is affected under chloroform it indicates chloroform poisoning either
direct or through abnormal respiration. All the chloroformist has to produce is normal
a n æ s t h e s i a , a n d o f t h i s t h e p u l s e c a n n e v e r b e a n y t e s t w h a t e v e r . I t i s t h e r e f o r e p o s i t i v e l y
dangerous and useless to take it as a guide. The following table places the available figures
in a most striking light:—
M o r t a l i t y S t a t i s t i c s o f E t h e r a n d C h l o r o f o r m
.
A n æ s t h e t i c e m p l o y e d .
S o u r c e o f S t a t i s t i c s .
P e r i o d .
N u m b e r o f d e a t h s t o a d m i n i s t r a - t i o n s .
Chloroform ...
... Julliard
...
...
... Not stated
...
... 1 to
3,258
Ether ...
...
... Julliard
... ...
...
Do.
...
... 1 to
14,987
Chloroform ...
{Bartholomew's Hospital ( Ro-
ger Wi l l i ams) . . . . . . }10 years. 1878 to 1887. . . 1 to 1, 236
Ether ... ...
{ Bartholomew's Hosptal (Ro-
ger Williams) . . . . . . } Do. . . . 1 to 2, 754
Chl oroform . . . . . . Syme and Lawri e . . . . . . 43 years . . . . . . . . . No deat h.
If statistics are of any value, this table ought to carry conviction With it because it shows
clearly that chloroform administered on Syme's principles is even less dangerous than ether
administered in accordance with the most approved methods. But the Hyderabad Commission
has no desire to institute further comparisons between them. All we say is, let anybody use
ether who chooses, but if chloroform is to be employed, let it be given in the right way.
Surgery cannot yet do without chloroform, and the only way to give it with invariable safety
is to be guided, as Syme was, not by the circulation, but entirely by the respiration. What
Dr. Julliard says about ether I can say mutatis mutandis about chloroform. During fourteen
out of the seventeen months* that have elapsed since the Hyderabad Commission demonstrated
t h a t t h e k e y t o t h e s a f e a d m i n i s t r a t i o n o f c h l o r o f o r m c o n s i s t s i n r e g u l a r b r e a t h i n g , I h a v e g i v e n c h l o r o f o r m s e v e r a l t i m e s d a i l y . N o t o n l y h a v e I n o t h a d a n y d e a t h s , b u t I h a v e m e t w i t h n o
accident of any kind. I have not once had to do artificial respiration or to pull forward the
tongue. Neither have I had to interrupt an operation in order to ward off any accident due to
chloroformisation. There is no element whatever either of luck or of chance about these results.
Any surgeon can administer chloroform without risk who will take the trouble to assure himself
that the patient's breathing is normal and regular throughout the administration, and to stop
the inhalation in good time, i.e . , d i r e c t l y f u l l a n æ s t h e s i a i s p r o d u c e d . S t a t i s t i c s s u c h a s those of
Dr. Julliard and Mr. Roger Williams, which are intended to show the danger of chloroform,
a r e , a s my t a b l e p r o v e s , s u s c e p t i b l e o f a v e r y d i f f e r e n t i n t e r p r e t a t i o n . I f t h e y h e l p t o p r o v e
anything, it is that no anæsthetic is absolutely safe except chloroform administered on Syme's
principles, and the more proof we have of this kind the better.
* For three months I was absent on leave.—ED. L.