THE RECENT DEATH FROM CHLOROFORM AT THE HOSPITAL.

Auckland Star, Volume XXXV, Issue 96, 22 April 1904, Page 3

THE RECENT DEATH FROM CHLOROFORM AT THE HOSPITAL.

(To the Editor.) Sir, —The recent occurrence of an- ] :other death from chloroform at the . Auckland Hospital should not be passjed over with a mere • passive acquiescence in the verdict of the jury. Tlie public safety is the supreme law, and that certainly cannot be guaranteed by I a trial before the most incompetent I tribunal for judging of a purely seien- ! tilic question that the wit of man could i devise. You take seven men absoluteIly ignorant of medical science, or, inj deed, of any science." not. educated to j compare and weigh evidence, or to de- | tect logical fallacies, and you set them |to pronounce a judgment on a technical question, which may be of the most difficult kind, and you bring before them a mass of evidence which, if correctly reported would bewilder and confuse oven an expert, j I propose. Therefore, in the public inj tere-i, to make a few remarks based jon a personal experience of chloroform j administration extending over nearly I hfij-'Six years. I first saw chloroform given for an amputation in June or July, iS4B; it had been discovered by the late Sir James Simpson, in 1847 (September. I think). Since then I have given it or seen it given probably a thousand times, and I have never seen a death from it But L have seen several rases where death would have resulted but for prompt action on the part of the anaesthetist. The price of freedom from death by chloroform is unceasing- vigilance and instantaneous action if either heart or respiration begins to fail. Some anaesthetists administer a hypodermic of morphine before givmg chloroform. I have never done this myself, As I prefer to have to deal with the anaesthetic alone. As regards the cause of death in this case, I see no reason for doubting tbe correctness of Dr. de Clive Lowe's opinion, as he performed the autopsy in a very careful manner, and detected an unusual morbid condition. Buf the •question arises, and was not, I think, satisfactorily answered at the inquest —Why was chloroform given at all for such a trivial operation as removing stiches? Why was not cocaine or eucaine used. And this leads mc to remark, that, ac-: cording to the evidence of Dr. Collins, chloroform is used most extravagantly often in the Auckland Hospital. He talks about the mortality being only one in 18,000 (sixteen thousand), but where on earth doe., he get the sixteen thousand ? I was house surgeon to a London hospital, the Middlesex, which contained then 376 beds, of which 176 were for surgical purposes. During my three years as a student I held every office that a student could hold in connection witb the patients. I was out and indoor dresser, clinical clerk to the outpatients and in patients, junior and senior house surgeon, and for two months acting junior apothecary, as the resident medical officers were then styled. I was in offiiee the whole time, with the exception of two months. I certainly saw nineteen out cf twenty of the cases in which chloroform was given, and I think that I am well within the mark if I say that there were not four hundred cases a year of chloroform administration, and yet the Middlesex was in a densely populated part of London, the only one near Oxlordstreet, except University College, aud it wns. double the size of the latter. Where on earth do they get their cases for anaesthetics? Dr. Walsh is said to have given chloroform 500 times, and I think has been at the Hospital about a couple of years. I have not given chloroform myself five hundred times in the fifty years that I have been a member of the Royal College of Surgeons. Do they give chloroform every time they open an abscess, or remove a small sebaceous cyst? Or do they give it when they put up a fracture?

I do not ask these questions In a hostile spirit; I have the very highest respect for Dv. Collins; he is an earnest student, and his intellectual capacities are of very high order. I think the Hospital very fortunate in getting such a man, and I think the operating surgeons of last year—l have not seen any operations this year, and I believe there are some changes on the staff — were as good as those of any hospital in London in my time, except King's College. I have seen some beautiful operations done, and done with the greatest care to obtain complete The only criticism I have to make applies to the surgeons of the present generation- — they are such a prodigiously long time over the operations. We. who were educated by men who all their lives until 1847 had been accustomed to inflict the most frightful torture on their patients when operating, were taught that rapidity in operating was second only to accuracy. You must, of course, operate ccr. ectly, hut if you wanted to be called a good operator you must be rapid. We got into the way of rapid operating, and I confess I could not get out of itThere is one caution I would like to give to the junior members of the profession who may have to give anaesthetics. It is this—from the moment yea become a qualified member, of the profession you cannot divest yourself of your personal responsibility for anything you may do, or leave undone, by the plea that your seniors or superiors directed you. If you think there is danger in giving chloroform (or any other anaesthetic), absolutely refuse to give it, or continue giving it, as the ease may be. even if the presidents of the Royal Colleges of Physicians and Surgeons were to order you to do so. The anaesthetist is not only the best judge, but must be the supreme judge. Of course, if some one else takes his place, he assumes the responsibility; and if all goes on well the first man Is in an ugly fix- Therefore he must be careful and prudent. I remember once I was giving chloroform during a very serious operation for a well-known surgeon. The operation was a long one. and twice I had to stop the administration on aeount of failure of heart and respiration. When we had rallied the patient the second time I put away the chloroform, and told the surgeon I would give no more. "Bat how sun. I to finish the operation." he asked. "Without chloroform, as far as T am concerned." was my reply. It so happened that none of the other surgeons present would take the responsibility, and the operation was finished without any more Qhloroform, the patient remembering nothing after he had come round, though he kicked and cried out when the stitches were being put in. This letter is already too long, or there are some other points. I should have touched on. —I am, etc., R. H. BAKE WELL, M.D. Lovoni, Symonds-street, April 22nd. 1904.