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events if sufficient air is given with the chloroform. If they do occur the cap must be removed and
the patient must be allowed to take a breath of fresh air before the administration is proceeded
with. (5) Full anæsthesia is estimated by insensibility of the cornea. It is also indicated by
stertorous breathing, or by complete relaxation of the muscles. Directly the cornea becomes
i n s e n s i t i v e , b r e a t h i n g , o r b y c o m p l e t e s t e r t o r o u s , t h e i n h a l a t i o n s h o u l d b e s t o p p e d . T h e b r e a t h - i n g m a y b e c o m e s t e r t o r o u s w h i l e t h e c o r n e a i s s t i l l s e n s i t i v e . T h e r u l e t o s t o p t h e i n h a l a t i o n
should notwithstanding be rigidly enforced, and it will be found that the cornea always be
-comes insensitive within a few seconds afterwards. It is only necessary to add that the patient
should be so dressed for an operation that his respiratory movements can be seen easily by the
chloroformist. In the climate of India this is not difficult to manage, but it is difficult to
manage in the climate of Europe; so that in this respect, and in this respect alone, the chloro
-formist in England is placed at a distinct disadvantage compared with the chloroformist in
India. Proceeding in the above way chloroform never produces any bad effects, and its admin
-istration, in any case which is fit for an operation, is entirely free from danger.
[The Hyderabad Commission unequivocally adopts the suggestion of
Dr. William MacEwen in the great discussion on Anæsthetics in Glasgow that
"every one of the patient's respirations should be registered on the admin-
istrator's tympanum."
]
I have drawn attention to the danger of taking the circulation as a guide as to the effect
of chloroform,* and should not further allude to it but for an article on chloroform administra
- t i o n b y D r . D u d l e y B u x t o n i nT
h e L a n c e t
o f D e c . 1 3 , 1 8 9 0 . T h i s a r t i c l e i s b y f a r t h e
cleverest that has yet appeared front our adversaries, but Dr. Dudley Buxton's teaching con
- d e m n s i t s e l f . H i s p l a n o f g i v i n g c h l o r o f o r m i s — " ( 1 ) T o u s e L i s t e r ' s o p e n m e t h o d o r K r o h n e
and Sesemann 's recent and useful modification of Junker's inhaler; (2) to test the vigour of
respiration by placing my hand over the mouth; (3) to watch the colour of the patient's face
and ears; (4) to keep a finger upon an artery—always testing the initial rate and force of the
pulse in that artery at the commencement of the operation."
The first remarkable point in these rules is that no fixed principle of chloroform
administration is laid down. The chloroformist may employ indiscriminately the open method or
an inhaler, according to his fancy. In the second place, if the chloroformist places one hand
over the mouth to test respiration, and keeps the finger of the other upon an artery, as Dr.
Buxton recommends, it is difficult to understand how the anæsthetic is to be administered,
unless the patient is to do it himself. The severest condemnation of the method, however, is
to be found in Dr. Dudley Buxton's own words. He says: "Proceeding in this way I
have sometimes found that the heart flags even when the respiration, judged by the eye
and the plan above mentioned, shows no alteration; that not only is there evidence of
general feebleness of circulation, but that distinct and unmistakable cardiac enfeeblement
occurs. Further, this is progressive, and likely, it has appeared to me in more than one case
to end in cardiac syncope, unless prompt and vigorous measures were used." This shows
* The Lancet, November 29, 1890.