LETTER FROM DR. SHAND.
TO THE EDITORS OF " THE LANCET."
SIRS,—This being a most important subject, I feel morally called on, as one who has
had nearly fifty years' experience in practice, to express my dissent from two at least of the
conclusions arrived at by the Chloroform Commission. I may premise that I used ether first
with satisfaction till chloroform appeared, and saw it extensively employed in 1848 on the
wounded from the various engagements on the advance of the Prussian troops to the relief of
Radstadt and the restoration of the Grand Duke of Baden. So that I was the first English
doctor (and from Scotland too) who saw chloroform used in gunshot wounds. With regard
to the second conclusion, namely, the necessity of recumbent position in inhaling chloroform,
I beg to state that two of my most satisfactory operations were performed many years ago
under chloroform in the sitting position. One was a gunshot wound of the right hand, which
so smashed all the metacarpal bones that it was only possible to preserve the thumb and fore
-
finger. The gentleman is in London at present, and could exhibit thec l a w ,
a s
he terms it, with
whi c h he wr i t e s a nd s hoot s a s of ol d. I s a w hi m s oon a f t e r t he a c c i de nt , a nd w i t h
the
assist
-
ance of a butler placed him in an arm-chair, chloroformed him, and performed the operation.
The second was a case of incarcerated inguinal hernia of the left side. I fixed the patient in
a chair with the counterpane of his bed and gave him the chloroform, while I s a t
on a chair
facing him close to the window with my back to the light. The cure was rapid and perfect,
and the patient required no truss. He was well in four weeks or less. I give you these
two cases in respect to position. A large percentage of people respire more freely in that
position than in the recumbent one; and although I do not think the heart's action is to be
neglected, yet even for its benefit the respiration is the key. My experience of pure alcoholic
chloroform, administered by an expert, is that it is the most manageable, safe, and effective of
anæsthetics, although I quite agree with Sir Spencer Wells, that, provided the administrator
is an expert in h is own choice, any of at least three will answer equally well. The next
material point is as to a d m i n i s t e r i n gmorphia, either hypodermically or otherwise, before chloro
-
form. A dose of morphia often appears harmless, and obtains a good response. I have extract
-
ed a pebble from the hip, the patient resting on his face in bed, and succeeded well enough,
though, as might be anticipated, I had to r e s t o r e
r e s p i r a t i o n i n t h e
m i d d l e o ft
h e
operation
by
pressure of the ribs at an open window. I have administered sufficient chloroform several
times to keep the patient asleep for about twenty-four hours right off, and without accident.
P.S.—Since writing the above I notice that one of your correspondents mentions two
important points in last week's issue, one of which is the advantage of placing the head on one
side during the inhalation of the drug, to allow the saliva to flow out of the corner of the
mouth. It also al most prevents the falling back of the tongue over the epiglottis. This
arrangement I have frequently alluded to and acted upon with satisfactory results.
I remain, Sirs, yours faithfully,
JOHN SHAND, M.D., F.R.C.P., ED.
Edinburgh, January, 1890.