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death beforehand, not by the operation itself, but by terror of the effect of the anesthetic.
The Committee state finally: "As a matter of common prudence, and especially seeing that
when respiration fails we can employ artificial means for its restoration, while if the heart
fails, little or nothing can be done to avert a fatal issue, it is incumbent on every one giving
chloroform to watch both the pulse and the breathing." If this statement is to be acted upon,
it is incumbent on every one giving chloroform to watch the pulse for heart failure, in spite of
the fact recorded by the Committee themselves, that "if the heart fails, little or nothing can be
done to avert a fatal issue." No teaching could possibly be more dangerous. Without deny-
ing that there may be conditions of the heart in which failure and death may occur in some
of the processes connected with chloroform administration, just as a man with a certain
condition of heart may die of heart failure from running to catch a railway train, the Hyder-
abad Commission has shown that sudden death from stoppage of the heart is not a risk of
chloroform itself. If the surgeon is to have constantly before his mind the fear of the sudden
death of his patient by stoppage of the heart from the mere action of chloroform, and is to
carefully watch the pulse for signs which can only have a fatal issue, it is a physical impossi-
bility for him to concentrate his attention on the warnings given by the respiration, by which
alone danger can invariably be averted. The teaching of the Glasgow Committee is wrong,
and if it is followed deaths with chloroform will be as inevitable in the future as they have
been under the same circumstances in the past.
LETTER FROM DR. R. M. WHITTINGTON LOWE, M.D.
To THE EDITORS OF " THE LANCET ".
SIRS,—I have read with much interest and pleasure the paper by Surgeon-Major
Lawrie in your last issue, and only on one point do I venture to point out what appears to me
to be an injustice to the teaching of our great master, Sir James Y. Simpson. Surgeon-Major
Lawrie very properly tells us how Professor Syme used to insist- on watching the respiration
and taking that as the guide in the administration of chloroform; but Sir James Simpson
was strong on this point as early as 1847, that is to say, very soon after he began to use
chloroform. The Hyderabad Commission, generously conceived as it was, and ably carried out
as it has been, has, nevertheless, done little more than to impress on the world at large what
we have been taught at Edinburgh University since Simpson introduced chloroform some fifty
years ago. Yet how slow has been the spread of that teaching. -When did we ever see a
stethoscope used in examination before the administration of chloroform ? When did we ever
see an inhaler, except those on Simpson's lecture table?—for which he had an affectionate
regard as valuable antiques. When have we seen the chloroform measured out drachm by
drachm? Does not all this go to show that we were correctly taught to judge by the
r e s p i r a - t i o n a n d t h e e f f e c t s o f t h e c h l o r o f o r m a n d n o t b y a n y r u l e o f t h u m b a s t o t h e c o n d i t i o n o f t h e
heart and pulse or quantity given of chloroform? It has often occurred to me that supposing
one had a case of sudden death while a patient was under the influence of chloroform (not