From Augustin Prichardís presidential address to the Bath and Bristol branch of the British Medical Association July 9th 1857, reported in Brit. Med. J. July 25, 1857.

 

Ö..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.