George Foy
1892 The Lancet  
56 unsafe it would be criminal to use it. What is it precisely that the Hyderabad Commission has proved ? It has proved conclusively that as long as chloroform is given in a diluted form, with perfectly regular respiration and is not pushed after anaesthesia has set in, there is no possibility of the heart being affected. When the heart is affected it is by interference with the breathing or by an overdose, whether directly or indirectly need not at present matter. Therefore to take the pulse
more » ... a guide for the effect of chloroform is to watch for results which, under proper administration, cannot occur and when they do occur are proofs that there has been maladministration. Without entering into the argument as to whether the respiration or the heart stops first, the Hyderabad Commission has proved that if the above conditions are fulfilled and the breathing remains regular there can be no possible danger. To watch the breathing, therefore, is the only safe way to ensure that condition in the patient which is absolutely essential and necessary for his safety. As soon as the pulse gives a signal of danger I maintain that safe limits have been overstepped and one or perhaps all the rules laid down by the Hyderabad Commission have been broken. ' Let anyone show me a single case in which these rules having been strictly followed the pulse has shown a sign of danger. This is the point between me and my opponents and until they can prove this no amount of assertion will avail. Under the London system of chloroform administration deaths are constantly occurring, whereas we can show a clean record without a single death during forty-five years. This is a plain hard fact which no argument can get over, and if Mr. B. B. understands that to follow a method under which deaths occur and to neglect a method which is free from deaths and danger is criminal, he is a person of sound common sense, whether he is a layman or a professional. The writer in THE LANCET says that the practice of the London anæsthetists has been more than once put before the profession in its columns and he again repeats that their system is to watch the respiration as well as the pulse. Our system is to watch the respiration only and the difference is irreconcilable. If we watched the pulse we should stultify ourselves by looking for effects which cannot be produced unless the patient's breathing has been obstructed or he has been poisoned by an overdose. We have had no deaths because we have no overdoses, and it is by watching the respiration only and never allowing the patient to inhale anything but air when it is irregular that we prevent their possibility. There is no necessity on this occasion to discuss the manner in which the overdose takes effect, whether by respiratory narcosis or by cardiac syncope. Allwecontend is, administer according to our system and there will be no such thing as an overdose. Mr. B. B. advances no " charge of wholesale crime against the bulk of the profession, " as the writer in THE LANCET says. But until these facts are controverted I agree with him that in future it will be criminal to watch the pulse. Nor is it the large bulk of the profession that follows the unsafe and dangerous system. Lawrie's remarks upon our annotation are simply a reiteration of his views. Some experimenters refuse to admit his results and English chloroformists naturally decline to accept his statements that they do not know how to give chloroform. Deaths, moreover, have occurred both in Scotland and England when Syme's rules have been faithfully followed. We can therefore only repeat that at present it behoves all concerned in this controversy to adhere strictly to the methods of science and avoid ex-cathedrâ statements or arguments based on premises which are themselves at present sub judice.—ED. L.
doi:10.1016/s0140-6736(01)97451-3 fatcat:gbodgu4qlfh7vcrytum3ailcbu