From Augustin Prichard’s presidential address to the
…..or,
lastly, such as the account given last year of amylene.
5.
Anaesthetics. Some months ago we were startled by the announcement that
a new anaesthetic had been discovered, equal to chloroform in every respect,
and superior to it in this one most important particular, that it was devoid of
the amount of danger to life which all reasonable persons admitted to be
connected with the use of chloroform. It at once struck many of us to ask, with
some degree of doubt, how any agent which has so powerful a control over the
nervous system as to make the recipient of it insensible to every kind of
stimulus can be called free from danger? and how this
opinion could be hazarded of it, a priori, by one who had not the least
experience of it practically? The result of the experiments was not long
delayed, and amylene proved fatal much sooner than chloroform had done. Is it
true that chloroform has affected unfavourably the results of operations ? This is a very serious question, which ought,
if possible, to be answered. But as yet no answer has been given deserving of
reliance. How can the decision of such a question be rested upon the
statistical account of operations performed over a course of two or three years
only, and these not the same years, and by cases numbered by tens or twenties,
and not by hundreds or thousands. The point must be settled during the lifetime
of the present race of operating surgeons, or probably not at all; and if the
numerical method is to be employed, and statistics called in to decide the
matter, the experiments must be on a large scale, and established simply to
ascertain the truth. My friend and colleague, Mr. Harrison, told me that when
he was first appointed surgeon to the Bristol Infirmary, at the time when many
more legs were cut off than is the case at present, of his first twenty
amputations he did not lose a patient, and began to think his success certain,
and the operation not so fatal as was supposed; but three or four deaths
followed in rapid succession, bringing the average down to what it was with his
colleagues. I believe that chloroform has materially lessened the frequency of
amputations, and has thus indirectly saved many more lives than it has
destroyed. We are able to perform tedious operations in the neighbourhood of
joints, such as the removal of diseased bone, or the opening of cavities in the
cancellous structure of their articular
extremities, which, without chloroform, would not have been attempted, because
of the pain and the degree of uncertainty as to the result; but notwithstanding
this item to the credit of the anaesthetic, if we are in the constant habit of
using any agent which destroys life once in the course of many thousand cases,
which chloroform certainly does, it is a very grave matter; and although I have
always been an advocate for it from the first, and use it constantly, my
deliberate opinion is that we are not justified in using it for every trivial
operation, and that if we wish to relieve pain in those cases we must do the
best we can with local anaesthetics, such as the application of cold.