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plainly that the plan is faulty, if not impracticable; in fact, it stands self-condemned. There
is never any dangerous enfeeblement of the general circulation or of the heart in the method of
giving chloroform recommended by the Hyderabad Commission. Dr. Dudley Buxton can
readily satisfy himself of the truth of this statement by giving our method a thorough and
impartial trial. None of our critics have done this yet, but if one fair-minded man of Dr
. B u x t o n ' s c a l i b r e w e r e t o d o s o , h e w o u l d i n f a l l i b l y c o n v e r t h i m s e l f t o o u r v i e w s , a n d t h e c o n v e r s i o n o f t h e r e s t o f L o n d o n w o u l d f o l l o w i n t i m e a s a m a t t e r o f c o u r s e . D r . B u x t o n
states that "having once seen the heart relax and dilate under chloroform, as in Professor
MacWilliam's experiments, one recognises the anatomical counterpart of the procession of events
which one has encountered again and again in the operating theatre. This statement goes far
to prove that there must be some fallacy about Professor MacWilliam's experiments. As a
surgeon I care very little what happens to the heart when it is subjected to such abnormal treat
- m e n t a s i s i n v o l v e d i n l a y i n g o p e n t h e t h o r a x a n d p u m p i n g c h l o r o f o r m i n t o t h e l u n g s i n o r d e r
to prove that it is directly affected by chloroform. We might just as well pump in boiling
water, and then tell old women they are not to inhale steam when they get bronchitis. But it
is interesting to be told by such an authority as Dr. Dudley Buxton that Professor MacWilliam's
results form the anatomical counterpart of a method of chloroform administration which causes
general feebleness of the circulation and of the heart, and there is very little doubt that they
do. Professor MacWilliam's premiss that heart failure is not necessarily accompanied by a fall
of blood-pressure is manifestly unsound, and his description of rhythmic cardiac relaxation and
dilatation, under chloroform, is open to time fatal objection that he has not shown that the move
-ments of his base line, by which they were estimated, were not produced by relaxation of the
diaphragm, pushing up the heart through his artificial opening. If his heart dilatation can
really occur without fall of pressure, or when chloroform is properly given, it must be a
natural condition and free from risk.
The Hyderabad Commission has proved that there is no such thing as chloroform
syncope, and that in death from an overdose of chloroform the respiration always fails before
the circulation. What the harmless fall of blood-pressure in normal chloroform administration
is due to, as well as what happens to the heart after the respiration fails from overdosing, which
are the only two points left open to discussion by the Hyderabad Commission, must be entrusted
to physiologists to determine. In the telling words of Dr. Bomford, "it is sufficient for us
as practical men to know (1) that the heart is the very last organ to give in under the action of
chloroform, and (2) that there is no more danger of permanently paralysing it in. chloroform
administration, than there is of paralysing the legs and giving the patient paraplegia."
LETTER FROM DR. DUDLEY W. BUXTON,
TO THE EDITORS OF "THE LANCET."
SIRS,—Surgeon-Major Lawrie's personal reference to me calls for a brief reply My
paper was not intended to instruct in the elementary methods of administering chloroform,
so I omitted details which I thought were familiar to all who had mastered the subject of
chloroform administration, and were not so wedded to one method as to allow themselves to