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thorough comprehension of the significance of this fact. As soon as this was demonstrated,
it became clear that chloroform and shock were not associates but incompatibles, and that
the supposed capricious action of chloroform upon the heart was due either to the stimulating
effect of concentrated vapour upon the nervous system, or to the effect of asphyxial blood upon
the nerve centres, resulting in the exclusion of the poison from the system, and not the direct
effect of the absorbed poison upon the heart or its nerves.
APPENDIX TO ARTICLE IN TH E LANCET OF JUNE 21ST, 1890,
BY SURGEON-MAJOR LAWRIE.
THE above paper was written before the Glasgow Committee's criticism appeared in
the British Medical Journal of the 14th instant. I lose no time in exposing the Committee's
fallacies, as I am obliged shortly to retain to India.
The first point to notice in the Glasgow Committee's remarks is their reference to the
paralysing effect of chloroform vapour on the muscular tissue of the heart. "Chloroform
vapour has a paralysing effect upon the muscular tissue of the heart, and indeed upon all kinds
of protoplasm when directly applied. When the heart of a frog is exposed to the direct action
of chl or of or m vapour ' i t became r api dl y weaker t i l l i t ceased beat i ng. ' " The accur acy of t hi s
point may be conceded as far as it goes. It is only necessary to supplement it by stating
that this paralysing effect is never sudden, but always gradual. "As regards the action on the
mammalian heart." the Glasgow Committee performed artificial respiration by pumping air
saturated with chloroform into the lungs of rabbits and dogs through an opening in the trachea.
"It soon became apparent that when chloroform is given in this way there is at once a most
serious effect upon the heart; the right ventricle almost immediately begins to distend; the heart
presently stops, with the right ventricle engorged with blood." It is evident from this descrip-
tion that the serious effect upon the heart is not caused in the heart itself. The distension of the
right ventricle must mean damage to the circulation through the lungs. It is the first effect
of stasis in the lungs. Sir Joseph Lister has shown (ride Professor Roy's paper in the Journal
of physiology , 1 8 7 9 , v o l . i i . , p . 3 2 3 ) t h a t wh e n c h l o r o f o r m i s a p p l i e d d i r e c t l y t o t h e we b o f
a frog's foot stasis immediately takes place; and the same effect is u n d o u b t e d l y p r o d u c e d i n
the same manner in the lungs and is sufficient to account for the ventricular engorgement
which the Committee observed when they pumped air saturated with chloroform into the lungs
of the rabbit. It is incorrect to imply that driving chloroform into the lungs brings it into
direct contact with the heart, or that the process of pumping in the chloroformed air elimi--
nates respiration from the inquiry.* If respiration is not to be taken into consideration in this
way of giving chloroform, we should first require to have it proved that the air driven into the
lungs is sufficient, or sufficiently free from poison, to keep up the respiratory function
independently of the action of the chloroform. Air saturated with chloroform cannot do this.
In any case, the fact stated by the Committee—that the right ventricle was first affected by
distension in their experiment—is proof that it was due to something outside the heart, and not
to any direct action upon the heart itself.
* In Experiment 64 there are two observations of chloroform administration in which respiration as a factor is
e l i m i n a t e d — V i d e F i c k 1 1 a n d 1 7 . ]
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