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Syme's teaching, two distinct methods of chloroform administration are, and always have
been, practised. In one the pulse, as well as the respiration, is taken as a guide, and deaths
have been numerous. In the other, the pulse is never, under any circumstances, taken as a
guide, and in Syme's practice and in my own, extending over a period of forty-three years,
no deaths from chloroform have ever occurred. In 1879 the British Medical Association
appointed a Committee in Glasgow to experiment with anæsthetics. They made a limited
number of observations on dogs and rabbits with self-recording apparatus, and they showed
by tracings that chloroform lowers the blood-pressure, and that sometimes during chloroform
inhalation the fall is unexpected and capricious. The lowering of the blood-pressure the
Glasgow Committee called the normal, but dangerous, effect of chloroform. The sudden falls
with slowing of the heart indicated, in their opinion, a source of extreme danger. The tracing
and report of the experiments of the Glasgow Committee appeared to demonstrate (1) that
lowering of the blood-pressure is due to weakening of the heart's action ; (2) that this effect
is peculiar to chloroform and is never observed with ether ; and (3) that death may occur
at any time during chloroform inhalation by sudden stoppage of the heart. The terms 'primary
and secondary chloroform syncope' crept into use and settled themselves in the nomenclature
of medicine. The effect of the Glasgow Committee's report was enormous, far-reaching,
and disastrous. No blame is to be attached to the Glasgow Committee, because they
published their tracings, and anybody is at liberty to form his own opinion about them.
Having accepted them, we made ourselves just as much responsible for them as they
were.
No one stopped to inquire whether a general fall of blood-pressure is harmless
or dangerous, or whether the fall of blood-p ressure registered in their experiments
was due to direct weakening of the heart or not. Common sense was cast to the winds,
and two erroneous principles became established on pseudoscientific basis. One is, that
the pulse must be felt during chloroform administration, and the other is, that ether is not
only a safe anæsthetic, but is. under all circumstances a cardiac stimulant. To such an amazing
pass have these two principles been pushed that the public have been made to believe that
feeling the pulse is a safeguard in chloroform administration, and that it requires a
specialist to do it. On the other hand. the blind and unfounded belief in ether as a cardiac
stimulant has led to its employment. hypodermically in cases of chloroform-poisoning, and
even in ether-poisoning itself. The clinical experience and statistics Which the Lancet call-
ed for after the Hyderabad Commission's report was published, have only brought out the
c ur i ous f a c t t ha t a l l c hl or of or m de a t hs now- a - da ys a r e pos s i bl y t he r e s ul t of hypode r mi c
injections of ether, which is always resorted to as soon as possible after symptoms of danger
appear. It would be just as wrong to give subcutaneous injections of chloroform in ether-
poisoning as to give subcutaneous injections of ether in chloroform-poisoning.
"The report of the Glasgow Committee was accepted by the whole profession as practi--
cally final. I remember, when it was published in 1879, I felt at first as if Syme's position
was no longer tenable. As time went on, however, and it was found that chloroform could
still be given on Syme's principles with the same safety as before, I began to realise that there
must be some flaw in the experiments or conclusions of the Glasgow Committee.
Accordingly in 1888 Sir Asman Jah, the Minister of Hyderabad, sanctioned the