5
on the principle taught by Syme and Simpson, in Edinburgh, and long before the Hyderabad Com-
mission was formed, I had satisfied myself that they are entirely true.*
The Hyderabad Commission was appointed by the Nizam's Government to verify or refute the
opinion that if chloroform is properly given it has no injurious or dangerous effect upon the heart.
The experiments of the Commission were performed publicly and with every precaution against
inaccuracy, and the conclusions they arrived at are irresistible. The chloroform was given in every
possible way, and in no case did the heart become dangerously affected until after the breathing had
stopped. This is not, as " The Lancet" avers, a scanty statement of experiments performed upon
dogs : it is a summary of the results of more than two hundred complete experiments carried out by
the Commission, and it tallies exactly with my own experience. If direct heart failure were one of the
risks of chloroform, it must have occurred in some of the administrations which I have superintended ;
but I have never seen the heart directly affected by chloroform, nor have I ever seen the inhalation
carried so far in human beings as to affect it indirectly. Neither I nor the Hyderabad Commission
have any desire to '' inculcate a disregard of the heart as a factor in chloroform dangers, and so to
provoke a slipshod carelessness in the use of that valuable anesthetic ". Our object is the very reverse
of this, as a consideration of the difference between the position we take upon this point and that of
those who hold the same views as " The .Lancet" will show. " The Lancet" would trust to the heart
and circulation for signals of danger in chloroform administration. Our contention is that, if the ad-
ministration is ever pushed far enough to cause the heart to show signs of danger, the limits of safety
have already been exceeded, and a fatal result must almost inevitably ensue. So far from disregard-
ing the heart as a factor in chloroform dangers, we say that any affection of the heart, either direct or
indirect, is the one danger to avoid. But we say further that the respiration invariably gives warnings
when a dangerous point is approached, and consequently that it is possible to avert all risk to the heart
by devoting the entire attention to the respiration during chloroform administration.
I am well aware that these opinions appear to go in the very teeth of the conclusions at which
the Commission appointed by the Royal Medical and Chirurgical Society and by the British Medical
Association arrived and " are opposed to the careful and painstaking experiments of such scientific
observers as Snow, Claude Bernard, and McKendrick,"† as well as to the teaching of the great London
Schools. But this opposition is more apparent than real. " The Lancet " states authoritatively that
chloroform syncope is notoriously difficult to produce in dogs. The - Hyderabad Commission confirms
this statement, and says it is impossible to produce it at all. This difference may be fully accounted
for by the fact that the experiments of the Hyderabad Commission were numerous, while those quoted
by " The Lancet " were not only not numerous, but many of them were performed under conditions
which impair their value. Moreover there are certain points connected with the effects of chloroform
on dogs, which a careful perusal of all their reports has convinced me neither the Commissions nor
the distinguished physiologists appreciated. In any case I would ask whether anything can be more
discreditable or unsatisfactory to the whole profession than the present position of chloroform.
During the last forty years, while enormous progress has been made in every branch of medicine and
surgery, the position of chloroform has decidedly deteriorated, and the principles necessary for its
safe administration have been lost sight of., From the date of its first introduction there was a
divergence of opinion between the Edinburgh and London Schools with regard to the way we should
* Vide Lecture reprinted from Indian Medical Gazette for March 1889, Appendix D.
† vide page 19 of this Report.