In summing up the results of the latest Commission on chloroform it is to be remem
- b e r e d t h a t , i n t h e o p i n i o n o f m a n y p e r s o n s , a s r e g a r d s t h e f i r s t p a r t o f t h e i r w o r k ,
v i z
. , t h e
investigation of the point, does chloroform paralyse the heart? nothing new has been added to
our knowledge.
The result has been to confirm the work of some of the previous experimenters, but
without explaining how the theory of cardiac paralysis appeared to be borne out by the experi
- m e n t s o f D r . S n o w . T h e r e h a s a l w a y s b e e n s i n c e t h e d i s c o v e r y o f c h l o r o f o r m s u f f i c i e n t
evidence to prove that it is very difficult, if not impossible, to produce sudden cardiac paralysis
by it in animals, and an equal amount of clinical evidence to justify the supposition that such
can occur in man.
To estimate the value and importance of the second part of the report, it must be noticed
that the action of chloroform on the heart was (by the advocates of this anæsthetic) considered
to be the only obj ect i on t o i t s general use. It was t hi s supposed power of causi ng i rremedi abl e
cardiac paralysis which made people afraid of it. If this property could be shown to be non
-existent the harmlessness of the drug would be established.
This is easily understood, from the facts that artificial respiration is so readily carried
out, and cessation of respiration remedied by artificial respiration so common, that the impres--
s i o n i s p r e v a l e n t t h a t i t i s e a s yt
o b r e a t h e f o r a p e r s o n , b u t t h e r e m e d y i n g o f t h e c e s s a t i o n o f
the heart-beat presents insuperable difficulties.
It was not imagined that chloroform might possess other dangers—it is for a knowledge
of these that we are indebted to the Commission, v i z
. , t h e i m p o r t a n c e o f t h e p a r t p l a y e d b y
vaso motor paralysis in the causation of death, and the fact that the paralysis of the respiratory
centre may be final at the moment that attention is drawn to the cessation of respiration.
If the conclusions of the Commission are accepted in full without reserve, chloroform
has no power of paralysing the heart; one danger is removed, but it is replaced by one as great
in every respect v i z
. , p a r a l y s i s o f t h e v a s o m o t o r c e n t r e . T h i s m a y s e t i n v e r y s u d d e n l y , w i t h
hardly any warning; it is as far beyond treatment as cardiac paralysis, and it is as fatal. If
the cardiac paralysis from chloroform does not exist, vaso motor paralysis must have been the
cause of the numerous deaths recorded against chloroform; and how sudden and irremediable
this is the reports of fatal cases abundantly testify.
When death occurs from vaso motor paralysis it is clearly imaginable that the vaso
motor centre may be hopelessly damaged or rapidly reaching that stage, while the pulse is still
present and the heart attempting to keep up the pressure. So that for some seconds there may
be a deceptive condition in which both pulse and respiration are present, yet a fatal termination
is imminent. That this death from vaso motor paralysis does occur in man is shown by the
very rapid running pulse mentioned in some cases as preceding the fatal termination.
The extensive experiments of the Commission have left the chloroform question in the
following condition: It was not found possible to directly paralyse or affect the heart by