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half a century’s experience at our back, it is surprising,—in these days of advancing science
and greater accuracy in many respects,—to find that even now we have no really reliable in-
-formation as to the relative frequency of such occurrences. Rough estimates there are in
abundance, the value of which may be judged from the fact that they vary, for chloroform, from
1 in 36,500 to 1 in 2,666 administrations.
My object in writing this letter is to point, out that a perfectly reliable source of inform
-ation is now available, so that in future there can be no excuse for ambiguity. For many
years past there has been kept at St. Bartholomew’s Hospital a most admirable record of the
administration of anæsthetics and of the fatalities which have occurred. These have been
published from year to year with the annual statistical reports of the hospital. Believing the
subject well worth a little trouble, I have tabulated these records for the ten years 1878—1887.
During this time chloroform was administered 12,368 times, with 10 deaths (1 in 1,236).
During the same period ether was administered 14,581 times, with 3 deaths (1 in 4,860). In
9,072 of these cases ether was preceded by gas; 1 fatal case belongs to this category. In the
other 5,509 cases ether alone was given, and 2 deaths occurred.* These facts are very eloquent ;
they require no lengthy comment. I have long been aware of the greater safety of ether, and
have therefore preferred it to chloroform in most cases, notwithstanding its disadvantages in
some other respects. I believe this is the goal towards which professional opinion is steadily
moving; and I think this movement likely to be most beneficial. Experience at other hospitals
leads me to believe that the results obtained at St. Bartholomew’s may be accepted as reliable
averages. There can be no doubt, in these cases at least, that most of the fatalities occurred in
spite of the greatest skill and care being used in the administration of the anæsthetic agents.
Such being the case, it is impossible to arrive at any other conclusion than that such occur
-rences are unavoidable in a certain proportion of cases.
I cannot conclude this letter without emphatic protest against the dictum of the
Hyderabad Commission, that such deaths must be ascribed entirely to carelessness on the part
of the administrators. Such a statement is opposed to all clinical experience, and it is simply
preposterous.
1 am, Sirs, yours truly,
Welbeck-Street, W., Jan. 30th, 1890.
W. ROGER WILLIAMS.
LETTER FROM SURGEON-MAJOR EDWARD LAWRIE.
To THE EDITORS OF “ THE LANCET”.
SIRS,—In The Lancet of Feb. 8th and 15th, 1890, there are important letters on the
relative safety of anæsthetics. Mr. Roger Williams gives certain statistics of the administra-
tion of anæsthetics and of' the fatalities which have occurred at St. Bartholomew’s Hospital,
which, ho says, may be accepted as reliable averages at the other London hospitals. From
* I t i s r i g h t t o s t a t e t h a t i n e a c h t h e s e c a s e s t h e p a t i e n t w a s i n a n e x c e e d i n g l y f e e b l e a n d c o l l a p s e d s t a t e b e f o r e e x h i b i t i o n o f t h e a n æ s t h e t i c o w i n g t o p r o l o n g e d i n t e s t i n a l o b s t r u c t i o n . — W . R . W .
* It is right to state that in each of these cases the patient was in an exceedingly feeble and collapsed state
before exhibition of the =esthetic owing to prolonged intestinal obstruction,--W, R. W.