211
reputation was at stake. Again, we have long acknowledged the danger of death from
asphyxia occurring during chloroformisation, and Snow pointed out long ago how over-dosage
would, by paralysing the medullary centres, bring about death; but our experience—and it
must he conceded that a daily round of experiment and observation made upon human beings
and conducted through many years gives practical anæsthetists a right to a moderately authori-
tative judgment in the matt e r—repeated again and again, tells us that in a certain number of
persons the pulse flags, loses tension, and fails, even though respiration remains unimpaired
until with cardiae failure respiratory rhythm ceases. That deaths occur in the initial stage of
chloroform inhalation is commonly reported; but if it be contended that such arise from fear,
as in the oft -quoted case of Simpson, confusion becomes worsec o n f o u n d e d , f o r p a t i e n t s
exposed
to the same terrors from nitrous oxide gas, which has been administered many millions of
times, and from ether, do not die in the same way; so that we are forced to believe chloro
-
form, however it does it, does kill in a way peculiar to itself, which no forethought can antiei-
pate and no care or skill call obviate. Again, we must remember that temperature has much
to say to shock and heart failure, and it may not be irrelevant to suggest that the Tropics in
this way may contrast favourably with temperate zones. Dealing with the comparative safety
of chloroform and ether, I thinkwe may be pardoned if we decline to accept as proven the
conclusions arrived at by the Hyderabad Commission. In the first place Dr. Brunton told u
s
that his ether was impure; secondly, that in the climate of India it is impossible to obtain
anæsthesia by ether and maintain it unless air be so rigidly excluded that suffocation occurs.
Under such circumstances, ether is no doubt a deadly anæsthetic. In temperate countries
ether is not given in this way, and no asphyxial phenomena are present. To describe
ether narcosis as semi-anæsthesia is to prove that the modern methods of giving ether
are unknown to the writers, and to invalidate their strietures upon that safe and most
valuable anæesthetic. In conclusion, I would add that the experiment undertaken by the
Commission to elucidate shock under anæsthesia is again totally opposed to our clinical expe
-
rience. Were the conclusions advanced to be accepted by us, we should find it hard to explai
n
the fluctuations in the pulse the differences in respiratory rhythm which occur in laparotomie
s
when the intestines are han dled, the pediele of an ovarian eyst is dragged upon, or a bladder
is seized and held while punctured in suprapubic eystotomy. The division into "chloroform-
ists" and "etherists" is irrational and harmful: every anæsthetist learns sooner or later that
every case is sui generis
and a l awt o i t s e l f , a n d for each must he decide between not only
chloroform and ether but between them and the many other methods of mixed narcosis with
which we are now familiar. Without fear or dread must he be prepared to give one or the
other anæsthetic, but he must be keenly alive to a l l
t h e p o s s i b l e c o n t i n g e n c i e s o f
e a c h , a n d
not live in a fool's paradise that if he only obeys certain rules and directions he and his patient
are safe and he may administer his anæsthetic "with perfect ease and absolute safety so as to
do good without the risk of evil."
DUDLEY W. BUXTON,
Anæstheist to University College Hospital.
M o t i m e r - S t r e e t , W . , F e b . 1 8 9 0 .