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proportions should be given. The use of the above apparatus (which will be more fully de
- s c r i b e d i n t h e
Z e i t s c h r i f t f ü r B i o l o g i e )
o f f e r s a n e a s y m e t h o d o f r e g u l a t i n g t h e s t r e n g t h o f t h e
inhalation, but, if the usual method is adopted, the anæsthetic should be poured on frequently
and in small quantities rather than at longer intervals and in largest doses. By the latter
method of administration the narcosis is rendered unnecessarily, and often dangerously, deep
for a short time, and then quickly passes off; while by the former it is kept at approximately
the same depth throughout.
ARTICLE BY SURGEON-MAJOR EDWARD LAWRIE.
"
The Lancet ", July 15th 1891.
THE article on chloroform and ether by Dr. Arthur R. Cushny in The Lancet of
M a r c h 1 4 t h , 1 8 9 1 , i s a v a l u a b l e a n d o p p o r t u n e c o n t r i b u t i o n t o t h e l i t e r a t u r e o f a n æ s t h e t i c s , a n d i s
especially welcome to the Hyderabad Commission. Dr. Cushny agrees with us in so many
important particulars that it is impossible to regard him as anything else than an ally; and
though the cause of the Commission does not require bolstering, Dr. Cushny's experiments and
report are the best support we have had yet.
Dr. Cushny agrees with us that the effect of ether is precisely similar to that of chloro
-form only less intense, and that it is very difficult to produce narcosis at all with ether apart
from asphyxia. On the practical question he says, "in ordinary chloroform administration
such a simultaneous paralysis of the heart and respiration can never occur," and he further
states that "no such sudden falls of pressure were seen as have been noted by some critics of the
Commission, which is perhaps to he explained by the abundant and uninterrupted supply of air
to the lungs."
On all those points Dr. Cushny is clearly a friend to be welcomed. Where he appears
to be wrong is in overlooking the effect of the residual chloroform in the lungs after he has
finished pumping chloroform into the trachea. It is obvious that artificial respiration must be
much more likely to fail when the air in the lungs is saturated with chloroform than when it
only holds a very small proportion of the poison. The Hyderabad Commission succeeded in
giving chloroform, by the ordinary method of inhalation, in such a dose that artificial respira
- t i o n f a i l e d t o g e t r i d o f i t q u i c k l y e n o u g h t o s a v e t h e a n i m a l ' s l i f e . T h i s o c c u r r e d i n d o g s ;
and in dogs, with Dr. Cushny, artificial respiration was always successful. In these cases he
must allow that the inspired air was fully saturated, and in all of them every by-stander, includ
- i n g
T h e
L a n c e t ' s
chosen representative, Dr. Lauder Brunton, was satisfied that the heart con
- t i n u e d t o b e a t a f t e r , g e n e r a l l y l o n g a f t e r , t h e r e s p i r a t i o n h a d c e a s e d . W h e t h e r o r h o w f a r t h e
Hyderabad Commission experimented with dilute chloroform is a matter of no consequence.
We tried concentrated vapour, in which alone Dr. Cushny can find any danger. We are quite
agreed that extreme concentration is dangerous, but this is so because it leads to the rapid