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dilution of the anæsthetic, and that the most trustworthy as well as the most universally manage--
able guide to safe dilution must be regular respiration. The essential factors in chloroform
administration are diluted chloroform and regular breathing, but whatever be the degree of
dilution regular respiration alone ensures a measured dose and alone maintains regularity of the
heart's action and of the circulation. The sole raison d'etre of an apparatus is to determine safe
dilution. But as this is definitely determined by regular respiration, and as regularity of
the breathing ought to be assured in chloroform inhalation whether an apparatus is employed
or not, it is evident that an apparatus is superfluous. Theoretically the Hyderabad Commission
has no objection to any forms of apparatus or inhaler, except that no appara-tus can ensure
regular breathing; but practically we know that their complicated nature demands some of the
chloroformist's attention and may lead to neglect of the all-important respiration. An appara-
tus is therefore not only superfluous, but introduces an element of danger into the administration.
To keep the patient's breathing absolutely regular during the inhalation of chloroform, and to
sustain the necessary watchfulness for the warnings afforded by the respiration and by the
reflexes whereby overdosing can be avoided, requires the undivided and unceasing attention of
the chloroformist.
1 trust I have made it clear that the Hyderabad Commission has no intention of criticis--
ing Dr. Cushny's admirable work in anything but the most friendly spirit. We are thoroughly
satisfied. Dr. Cushny may still think that there is theoretical danger to the heart, but he is
constrained to admit that it could not occur in practice. Having got so far, we venture to
express a confident hope that he will continue his experiments and observations, and that he will
yet see his way to accepting the whole truth.
THE HYDERABAD CHLOROFORM COMMISSION.
LETTER FROM DR. RICKARD W. LLOYD.
To THE EDITORS "THE LANCET ".
SIRS,- In his article published in THE LANCET of March 14th, Surgeon-Major E.
Lawrie, President of the Hyderabad Commission, emphasises the importance of the respiration
and totally ignores the circulation, as a guide in the administration of chloroform. Undoubt--
edly the respiration is essentially important, but my view, after ten years' practical experience
of anæsthetics, is that the circulation is also sometimes an important guide to the anæsthetist
during an operation, and often most valuable. No method of administering chloroform will
ensure the uniform behaviour of all patients during the induction of chloroform anæsthesia.
The action of chloroform upon a patient is influenced by mental and physical conditions as well
as by disease. The effects of the chloroform upon the circulatory, nervous, and respiratory
systems, especially when they mare diseased, as well as the loss of blood and the duration and nature
of an operation (these being the conditions that have to be met by the practical anæsthetist)
influence the respiration in such a way in some cases as to make it expedient to obtain all the
information that can be gathered of the extent of exhaustion, the probable power of endurance