NA TURE 



289 



THURSDAY, JANUARY 30, 1890. 



THE HYDERABAD CHLOROFORM 

 COMMISSION. 



THE safety of anaesthetics is a subject of the deepest 

 personal interest to everyone, either on his own 

 account or on that of his family or friends. For this 

 reason, the general public, as well as the medical pro- 

 fession, have been looking with interest for the Report of 

 the Chloroform Commission which has lately been trying 

 to work out the subject under the generous auspices of 

 the Nizam and his Minister Sir Asman Jah. As we 

 pointed out in Nature of December 19, 1889, p. 154, 

 two views regarding chloroform are commonly held. 

 The one view is that it may kill by paralyzing the heart 

 directly. The other is that it really kills by paralyzing the 

 respiration, and only stops the heart indirectly through 

 the asphyxia which quickly follows stoppage of the 

 respiration. The first view is generally held in London, 

 the second in Edinburgh, where it was strongly insisted 

 on by the late distinguished surgeon Prof. Syme. As 

 we learn from the Report now published, it was in con- 

 sequence of his reverence for Syme's teaching, that 

 Surgeon-Major Lawrie moved for the appointment of 

 the Commission, which was generously granted by the 

 Nizam's Government. This teaching was founded on 

 clinical experience, but the results of some physiological 

 experiments appeared to show that it was incorrect, and 

 that chloroform paralyzed the heart directly. To en- 

 sure anything like general acceptance of Syme's teaching 

 it was necessary that it should be shown that these ex- 

 periments did not really disprove it. But this necessitated 

 a complete revision of the whole question of the modus 

 operandi of chloroform, and of the production of an 

 immense amount of experimental evidence. This has 

 been supplied by the present Commission, and the re- 

 sult of their labours appears to be that there is some truth 

 in both views, but that when chloroform is given in the 

 ordinary way by inhalation, it is the respiration which 

 stops first. When chloroform vapour is blown down the 

 trachea the heart may be stopped by it, but when the 

 vapour is drawn into the lungs in the usual way by 

 the movements of the chest, this is not the case, for, the 

 respiratory movements being arrested first, their stoppage 

 prevents any more chloroform vapour from being taken 

 into the lungs. Embarrassment of respiration constitutes 

 the first sign of danger, and should be at once attended 

 to. The breathing should not be allowed to stop, but if 

 it should do so by any accident, life may still be pre- 

 served by the immediate use of artificial respiration. 

 Should the interval of asphyxia between the stoppage of 

 natural breathing and the commencement of artificial 

 respiration be too long, the heart may fail to such an 

 extent that artificial respiration is in vain ; and if the 

 administrator waits for a failing pulse to warn him of 

 danger, the warning may come too late. In a former 

 research by the Glasgow Committee of the British 

 Medical Association, some of the experiments, in the 

 opinion of the Committee, seemed to show that chloro- 

 form not only lowers the blood-pressure and paralyzes 

 Vol. xli.— No. 1057. 



the heart, but does so sometimes in an unexpected and 

 capricious manner. The Commission has repeated their 

 experiments, and found a similar fall of the blood-pressure 

 and slowing of the pulse, but has come to a different 

 conclusion regarding their causation, and attributes them 

 not to chloroform but to asphyxia. If this opinion be 

 correct, it shows how much care is necessary to avoid 

 asphyxia, for the Glasgow Committee appear to have 

 overlooked its presence, notwithstanding the serious effects 

 it was producing on the heart in the animals on which 

 they were experimenting. The work of the Hyderabad 

 Commission points strongly to the conclusion that deaths 

 from chloroform in man are likewise due to asphyxia, 

 and the Commission considers that by careful attention 

 to the respiration all deaths may and should be pre- 

 vented. The Report points out that instead of the con- 

 clusions at which the Commission has arrived being 

 opposed to those of Claude Bernard, they are almost 

 exactly those at which that distinguished physiologist, 

 so well known for his accurate work, had arrived, 

 although his name is often quoted in support of the 

 doctrine that chloroform kills by paralyzing the heart. 

 The number of experiments on which the Commission 

 bases its conclusions is very large, no fewer than 430 

 having been done without recording apparatus, and 1 57 

 with recording apparatus. The former consisted chiefly 

 of experiments, firstly, on the general action of chloro- 

 form given in various ways, in various dilutions, and in 

 different conditions of the animal, e.g. fasting, after 

 meals, after a preliminary dose of spirits, &c. ; and, 

 secondly, on the limits within which artificial respiration 

 could restore life, and the effect of morphine, strychnine, 

 atropine, &c., in modifying the action of the anaesthetic 

 and the reviving power of artificial respiration. The 

 necessary apparatus was taken out by Dr. Lauder 

 Brunton, and on his arrival at Hyderabad the Com- 

 mission was at once constituted : Surgeon-Major Lawrie, 

 President ; Drs. Lauder Brunton, Bomford, and Rus- 

 tamji, members ; Dr. Bomford acting as secretary. 

 They were greatly aided in their work by the members 

 of the first Commission, Drs. Hehir, Kelly, and Chama- 

 rette, as well as to Messrs. Tripp, Carroll, and Mayberry, 

 the latter of whom gave the chloroform. To Dr. Chama- 

 rette's energy and fertility of resource the success of the 

 experiments was mainly due. The work was continued 

 daily from 7 a.m. to 5 p.m., except on Sundays and 

 holidays, from October 23 to December 18. From a 

 speech made by Dr. Lauder Brunton at a dinner given 

 to the Chloroform Commission by the Nawab Intesar 

 Jung, we learn that the facilities for work afforded to the 

 Commission were such as were not to be found even in 

 the great laboratories of the continent of Europe ; and, 

 indeed, the large number of experiments which were 

 made in a comparatively short time, is sufficient of itself 

 to show this. At this dinner the Nawab Intesar Jung 

 reminded his guests that Europe is indebted to Moham- 

 medan writers of the schools of Bagdad and Cordova 

 for the preservation of medical science during the dark 

 ages ; and as Dr. Lauder Brunton very truly said in his 

 reply, the Nizam has not only followed the traditions of 

 the Mussulmans in selecting the subject of research, but 

 has rivalled the generosity of Haroun-al-Raschid and 

 Abdurrahman in supplying the Commission with every- 



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