217
LETTER FROM DR. CHARLES E. SHEPPARD.
To THE EDITORS OF "THE LANCET."
SIRS,—The importance of the issues at stake seems to render it incumbent upon every
-
one who has special opportunities for observing the action of anæsthetic agents to record his
opinion concerning the results of the Hyderabad Commission. Many of the conclusions arrived
at are of the utmost importance, and our best thanks are due to the Commission for bringing
these prominently under notice. I allude more particularly to the influence of asphyxial con
-
ditions, the previous exhibition of certain drugs, hæmorrhage in considerable degree, and the
position of the animal anæsthetised. On the other hand, there are many points for the final
settlement of which we had all looked forward with the greatest interest to the experiments of
the Commission, but in which we are, if anything, in a more uncertain position than before.
In the first place, it is unfortunate that all the evidence as regards the occurrence of
primary syncope is negative, and one cannot help feeling that, even were the instances con
-
siderably multiplied, there still would be no certainty that the next experiment might not prove
the exception to the rule. And if we are not justified in arriving at a dogmatic conclusion in the
case of the lower animals, how much less are we warranted in applying the same conclusion to
the human subject. The records of clinical experience, in fact, stand confronted with the re
-
sults of laboratory experiment, and I think that every one will allow more weight to one positive
instance occurring in the former than even to thousands of negative instances in the latter. It
is well known that many of the cases which have suddenly terminated fatally, or shown signs
of serious cardiac failure during the administration of chloroform, come under a certain cate
-
gory, including forcible dilatation of the sphincter ani and other operations which I need not
here specify. Other fatal results have occurred during the performance of trivial operations
where the action of chloroform has admittedly not been carried to complete narcosis. Now,
although there may be some difficulty in attributing the precise cause in each individual case,
whether an overdose of the drug suddenly applied in order to check movement, or whether a
reflex inhibition of the heart in consequence of incomplete anæsthesia, there can be no doubt
as to the symptoms observed, v i z . ,
sudden pallor and failure of pulse, almost coincident with
the commencement of operation, and in many cases absolute failure of all means of resuscita
-
tion, although promptly applied. Now, on referring to the experiments made upon the lower
animals in this connection, we find that, although all the operations associated with shock
and cardiac failure were performed in all stages of chloroform administration, yet there
was nothing beyond a slight variation in blood-pressure to indicate anything approach
-
ing syncope or cardiac failure. Evidently, therefore, in this matter we stand face to face with a
serious dissimilarity between the conditions as occurring in the human subject and in the lower
animals respectively, and yet, on turning to the practical conclusions deduced from the experiments
of the Commission, we find it recommended that "as a rule, no operation should be commenced
until the patient is fully under the anæsthetic, so as to avoid all chance of death from surgi
-
cal shock or fright." With the conclusion I think most chloroformists will agree, but not with
the method of arriving at it; and I maintain that if we followed the indications furnished by
laboratory experiments in this instance we should be led into grievous error.
28