Chloroform

Up to the year 1889 the opinions on chloroform held by the medical profession in Great Britain were influenced by two factors, one clinical and the other experimental, both curiously alike. In the operating theatre deaths had taken place under chloroform, generally during trivial operations, though Syme and his followers, who entirely disregarded the pulse when chloroform was given, had few accidents and hardly any fatalities. Some of the deaths occurred so rapidly that they appeared to be sudden, and inexplicable on any other ground but that of direct failure of the heart. The experimental results obtained by various observers were no less contradictor}'. Wakley and others had found that when animals were poisoned by chloroform, the respiration stopped and then the heart; but the Committee of 1864 of the Ro}7al Medico-Chirurgical Society, who first employed scientific instruments in the investigation, arrived at the conclusion that chloroform is dangerous to the heart, and paralyses it because the}7 discovered that it lowers the blood pressure. In 1879 the Com: mittee of the British Medical Association concluded that paralysis of the heart is produced b}7 chloroform, and that it may sometimes be sudden and capricious, because they discovered that the fall of the blood pressure under chloroform is sometimes sudden and apparently j capricious. In the 3'ear 1889 the 11yd erabad Commission proved that the fall of the blood pressure which is produced by chloroform is not in itself dangerous, and cannot therefore be due to direct paralysis of the heart. The Commission also proved that the sudden falls of pressure which occasionally occur under chloroform are caused, not by any direct effect upon the heart, but by the deprivation of air or asphyxia, from choking, struggling, or holding the breath. The experiments of the Hyderabad Commission were confirmed by the late professor Rutherford in Edinburgh in 1890. In 1892 the Nizam of Hyderabad subsidized experimental enquiries in Philadelphia by Professors Hare and Thornton, and in Cambridge by Drs. Gaskell and Shore. The American experiments confirmed those of Wakley, while Messrs. Gaskell and Shore devised the cross-circulation experiments, by means of which it was ultimately proved that chloroform has no direct action on the heart. I.?The Physiological Action of Chloroform.