Conclusions. This is the more strange, as the Commission certainly proves that the circulatory
apparatus is first influenced by the chloroform, and it is by vaso motor paralysis that death is
caused. Why, then, disregard it in administering the drug?
As attention to the pulse is so easily managed without neglect of the respiration, and
a proper knowledge of the state of the circulation has been proved to be most essential to the
intelligent administration of an anæsthetic , it is advisable that the pulse should always be ob-
- s e r v e d ; i t c a n , a t l e a s t , d o n o h a r m , a n d , i n c o n j u n c t i o n w i t h t h e r e s p i r a t i o n , i s a v a l u a b l e h e l p ,
quite apart from any information it gives of the general condition of the patient.
The assistant in charge of the anæsthetic must endeavour to be more than a mere doler
out of innocuous doses of chloroform; he should keep himself in touch with the whole condi--
tion of the patient all through the operation,* To endeavour to narrow his work to mere watch--
ing of the respiration is mistaken policy.
In reference to the question of cardiac rersus respiratory paralysis, the following remarks
appeared in the Lancet for September 21, 1889.
"In the Scotch capital, failure of respiration is regarded as the chief or only danger;
while, in the metropolis, failure of the heart is more feared. It is quite possible that the sur--
geons in both cities are right, and that the habits or mode of living of the people may lead to
differences in resisting power of the cardiac or respiratory apparatus respectively. The propor-
-tion of gouty patients is much larger in London than in Edinburgh, and when we consider
that the natives of India appear to resemble the Scotch in their comparative immunity from
cardiac paralysis by chloroform." . . . As most cases of death from chloroform are put
down as due to cardiac paralysis, and this is said to be rare in Scotland, the impression is con-
veyed that fatal cases of chloroform narcosis are unknown or rare in that country, and there is
certai nl y an i dea abroad to thi s effect. It i s not, necessary to resort to a compari son of the
habits of the people to explain their immunity from fatal. results.
In Scotland fewer people die from chloroform, simply because fewer people inhale it.
A population of 3,991,499 must necessarily give fewer chances for the administration of chloro--
form than one of 28,247,151 and consequently fewer possibility of fatal cases. Another point is,
that such cases as do occur are not always, from the absence of coroners' inquests, brought to
light a large number, if not the majority of the fatal chloroform cases in England, owing their
publicity to the newspaper reports of the coroners inquests.
But deaths from chloroform do occur in Scotland and even in Edinburgh. A casual
search in the medical journals gives the following figures: Edinburgh Royal Infirmary (1878
to 1880), three deaths; Western (Sir George Macleod's Hospital) Infirmary, Glasgow (1883
to 1885), three deaths; Royal Infirmary, Glasgow (1883 to 1885), two deaths; other parts of
Scotland (1881 to 1883), six deaths. England, 110 deaths; Scotland, 14 in same period,
England, population 28,247,151; Scotland 3,991,499.
[
*Vide Note by the Commission at the end of Mr. Wilson's Article.]