'Chloroform and ether robbed of their danger' : to the editor of the British Medical Journal.

  • Smith, G. Cockburn.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: 'Chloroform and ether robbed of their danger' : to the editor of the British Medical Journal. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    “CHLOROFORM AND ETHER ROBBED OF THEIR DANGER.” To the Editor of the British Medical Journal. Sill, The continued reports of death during the administra- tion of chloroform urge me again to endeavour to induce you to draw attention to the easy way of preventing it, advocated in a letter I sent you, and which afterwards appeared in the Lancet of October 10, 1891. I again alluded to it in a communication on “ Bromide of Ethyl safely administered,” “ Cocaine given without risk,” “ A. caution against the rise of Hyoscine.” Do you refuse to air the subject because the Hyderabad Commissioners, reasoning from theory, not from experimental ‘ observation, discountenance the use of drugs that modify the inhibitory action of the vagus, which they consider to be a safeguard against the toxic effect of chloroform 1 Happily it is rare for an operation to continue long enough to enable the poisonous effect of the ansesthetic to endanger life by acting directly upt>n the vital centres in the medulla oblongata. The main- tenance of too light a state of amesthesia is the great danger, and all the dangers, except the remote toxic one, are of reflex origin, besides the controlling influence of the higher centres being abolished the reflexes act with greater vigour, being unchecked. Now the small quantity of atropine, ‘001 gramme, and of morphia, -01 gramme, more or less according to the patient, injected subcutaneously 25 minutes before the administration of the amesthetic, falls far short of a poisonous dose, but is sufficient to keep in abeyance the inhibitory action of the pneumogastric (1 spinal accessory), it also facilitates the narcotic action of the amestlietic, ■u’cndering much less of it necessary, and so greatly minimising even its toxic effect. I have myself used it in numbers of instances, and at all ages, without any untoward consequent. At Lyons only one death, and that under peculiar circum-