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to put certain circumstantial questions as to the method in which the chloroform had been given, and to insist on satisfactory answers. If the answers were not satisfactory, and the coroner refused to accept them as such, and occasionally returned a verdict of manslaughter, the reign of the stiflers would not last long. The public would become educated, and would begin to inquire whether, when an anästhetist tries to hurry them into unconsciousness, he is doing so in their interests or in his own.
When it is considered how large a body of medical men of the widest experience are single-minded in their wish to perfect the system of administering chloroform, and how unanimously they agree as to the necessity of allowing sufficient air with the vapour of the chloroform, it seems unaccountable that any one should be permitted to smother a patient in the way that undoubtedly is often done. Dr. Waller, in the article from which I have already quoted, puts the necessary proportion as 1 part of vapour in 100 parts of air, and quotes Dr. Lawrie as saying that “the essential factors in safe administration of chloroform are diluted chloroform and regular breathing. It is obvious that this latter condition is incompatible with the frantic gasping and struggling caused by putting a bag closely over the patient's nose and mouth; and yet I am told that nowadays, unless a young medical man has the regulation apparatus, a bag and a mouthpiece, he refuses to administer chloroform.
A high authority has expressed his opinion that the only hope of reform is to get the matter reduced to a legal formula. He would wish to see covers for the mouth forbidden—a wish most earnestly echoed by all who have ever known the agony of having one put on --and would have the old-fashioned way of administering the chloroform on an open cloth, held not nearer than a regulated distance, laid down by law. He would also wish to have it made a punishable act to put any one under chloroform in less time than eight minutes. Other medical men also tell me that time is the essential consideration, and put it at from ten to fifteen minutes.
If the public could be thoroughly roused, and the matter brought before Parliament, the question would be threshed out without wasting time, as Dr. Waller calls it, in the quarrel as to how chloroform kills. How to administer it most mercifully as well as safely would be the question on which medical men would be required to give their advice with a view to legislating upon it. The doctors, it seems, need not be expected to move in this matter; they are too much in the hands of the anaesthetists, who appear to have acquired a kind of vested interest in the administration of chloroform. They further enhance their own importance and tyrannise over other medical practitioners by representing the grave responsibility and danger attending the administration of chloroform by any one not a specialist; and they make students nervous about having anything to do with it, by dwelling on its dangers and on the necessity of having special apparatus for administering it. It is nevertheless well known to medical men that students can and do administer it ip the East with practically complete safety by adopting a simpler and more humane method than that which I denounce.
If it were the rich and powerful classes who were the chief sufferers under the present system there would be a far more immediate prospect of reform than it is to be feared there is at present. But the immense majority of the victims killed by chloroform, as also of those who merely suffer the pains of death without dying, are drawn from the ranks of the poor and helpless who are treated in hospitals. They are as a class ignorant and inarticulate, with little power of making themselves heard, even if such an idea entered their poor foggy minds as that it was possible to object to anything the doctor might do. They are as dumb and helpless as sheep in a slaughter-house, and in the event of one of them dying there are few who will ever hear of it, and those few entirely uninfluential persons.
If it is found impracticable to regulate by law the method to be employed in giving chloroform by all professional men, it would seem at least within the range of possibility that the law should interfere in behalf of the poor and helpless who are treated in hospitals, more particularly in such hospitals and infirmaries as are in any degree supported by public funds. Richer patients have recourse to private anæsthetists, and when they know of the alternative choice of methods it rests with themselves to say in which way they will take chloroform. But the patients who go to a hospital for treatment have no such choice, and the law might reasonably take them under its protection by prohibiting the use of the stilling method in all public institutions.
A correspondent tells me he is painfully struck with the callousness shown in chloroforming patients in the operating theatre at hospitals. The wretched patient, highly nervous at the prospect of an operation and the mysterious terrors of chloroform, has to face all the young students in the theatre, who are watching his agony of fear with far more curiosity than sympathy. To them he is only a ' case.' A natural instinct prompts every animal, whether brute or human, to hide himself when in pain or grief, and this exposure to a crowd of callous, curious strangers at such a crisis must be a very terrible ordeal to go through.
It is an ordeal of humiliation to which only the poor are subjected. but it must not be thought that it is necessitated by poverty. My correspondent says it is quite as easy to administer the chloroform quietly in bed, with the nurse and doctor only present, and then immediately to remove the patient to the operating theatre, and that in some hospitals this is the custom. When to the misery of publicity is added the agony caused by suffocation, it would seem to
a thinking person as piteous a spectacle of human wretchedness as could well be witnessed. I am told by a doctor that he has seen a patient blue in the face with suffocation, and held down by four assistants.
There are numbers of medical men, and those of the highest distinction, who feel and deplore these things as deeply as any one who may read this; but they say they are powerless to bring about a reform. A correspondent who was himself on a British Chloroform Committee says: 'I have been doing a little from time to time to call the attention of medical men to these matters, but I am afraid the anæsthetists will not listen.'
How can they be made to listen ?
In the second article on chloroform in the April number of this Review, Dr. Ramsay tells us that it is a common thing to use chloroform which is not pure, and which is difficult and painful to breathe, and that this at least is a wholly unnecessary aggravation of the patient's distress. He says the anæsthetist should test its purity in his own person by a couple of inhalations, instead of experimenting vicariously in the person of his unhappy patient who has no choice but to inhale it whether pure or impure.
But who is to insist on this? Who has the right to insist either on this or any other reform until the whole question has been made the subject of inquiry and legislation ?
If one of our writers who can dip his pen in fire and write words that burn themselves into the
the matter and rouse the public apathy, much might be done. But let me urge him first to let himself be chloroformed, secundum artem, by means of the stifling bag. Statistics show convincingly that it is very improbable he would die; but he would know what it was to be taken down by a painful road to the very threshold of the Gates of Death, and the memory of it would wing his words as nothing else would.
In the meantime let all who have the cause of reform at heart, all who may some day have to take chloroform themselves, remember that each individual may do much to contribute towards the desired end. Let each one of us refuse resolutely to take chloroform, or allow any member of our family to take it, without previously ascertaining what method will be employed by the anæsthetist, and obtaining a guarantee that only an open cloth will be used, and that at a distance that will permit of entire freedom of respiration throughout the operation. By so doing a pressure will be brought to bear upon the professors of the stifling method that must eventually break down the cruel system now so frequently practised, and confer an unspeakable benefit on our fellow-creatures in the future.
E. A. KING.
THE MICROBE IN AGRICULTURE
Among the sciences astronomy might formerly have been regarded as the one which most strikingly appealed to the imagination of the public; it may be doubted, however, whether astronomy is still first favourite. It has, at any rate, a formidable rival in bacteriology—the science of that infinitely minute life which, as recent research has shown, is everywhere so abundant. Astronomy, it is true, may impress our minds in a more profound manner by the conception it presents of the vastness of the universe; yet the marvels and mysteries of the micro-organic life of our globe are certainly little less impressive. That in an area not larger than a penny-piece we may have a minute world as densely populated as Europe itself, with its three hundred and fifty millions, is surely no less calculated to excite our wonder than the conception of the enormous dimensions of those vast worlds, so far removed from our planet, which it is the province of astronomy to describe.
The extreme minuteness of bacteria, their ubiquity, the rapidity with which they reproduce themselves, the enormous importance of the functions they perform, and their role as propagators of many of the deadly diseases which afflict humanity, all serve to invest them with the deepest interest. There is, for the human mind, an intense fascination in the study of these “invisible friends and foes,' which are present, in their teeming millions, in the air we breathe, the food we eat, the water we drink, and in the soil beneath our feet; and on whose action our comfort, our health, and even our very existence itself may be said to depend.
The strides which our knowledge of bacteriology has made within recent years are well known to all. Not merely has the ubiquitous microbe been shown to be a potent agent in the propagation of disease; it is being demonstrated, more and more every year, to be implicated in many industrial processes of the most diverse nature. Bacteriology has already done much to revolutionise not a few of our large industries, and it bids fair to revolutionise many more. Among processes in which microbes play an important part may be mentioned the fermentative industries, so widespread in extent and involving such an enormous amount of capital. Any one who has
even the most elementary knowledge of brewing knows of what assistance a knowledge of bacteriology has proved to the brewer. Alcohol, in whatever form it occurs, is the product of minute life; hence the light which the study of the nature and habits of alcoholproducing microbes is able to throw on its manufacture is great. Again, such a widely used article as vinegar is another product of microbic life; while in such industries as tobacco, linen, jute, hemp, leather, citric acid, opium, indigo, and many others, bacterial life is more or less implicated. There are also certain processes in Nature—of such importance that the continuity of vegetable and animal life may be said to be dependent on them—that are caused by the agency of germ life. Such are the processes of the decomposition and putrefaction of organic matter. Few people, probably, ever reflect on the significance of such processes in Nature's economy, or realise that these processes are the chief agencies at work in effecting that vast circulation of matter which is constantly going on. To grasp the true significance of this great law, it must be remembered that the total amount of matter on the earth's surface available for the formation of fresh animal and vegetable life is limited. Modern science has taught us that matter is not destroyed; all that can happen to it is change of form. It goes through a great variety of changes, it is true, but the sum total always remains the same. In effecting this great cycle of change bacteria are every day being recognised to a greater extent as the most potent agents.
It is only just, therefore, to the much-maligned microbe to emphasise this highly beneficent róle it performs, since in the popular mind it is chiefly associated with disease. Such a view is really most unfair to the useful microbe, which, after all, is ten thousand times more abundant than his pathogenic (or diseaseproducing) brother. Even with regard to disease-producing microbes it must be remembered that while they produce disease they have also furnished man, in the so-called anti-toxines they give rise to, with a means of defence against the very diseases they cause.
In this paper we purpose to attempt to show briefly how beneficent their action is in the greatest as well as the oldest of all human industries, agriculture. The article has been suggested by the announcement, which has recently been made, of a highly interesting development of agricultural bacteriology-viz., a further application of the practice of soil inoculation—a practice which was first introduced some two years ago.'
Before, however, describing this latest development of agricultural bacteriology, reference may be made to some of the functions which the microbe has already been shown to perform in agriculture.
1 See paper in Contemporary Review for August, 1896, on ‘Nitragin : An Important Advance in Agriculture,' by the present writer.