Chloroform and Hyderabad

Hyderabad has the distinction of many ‘firsts’ in judicial, administrative and economic reforms, and in medical research and discovery. Due credit has not been given to it for those contributions.

Of special significance in the field of medicine, one relates to research relating to the risk entailed in the administration of chloroform to human beings, and the other is the discovery of the malaria parasite and the process of its transmission. The second won for its discoverer, Sir Ronald Ross, the Nobel Prize for Medicine in 1902. Both occurred towards the end of 19th century when the pleasure-loving and popular ruler, Mir Mehboob Ali Khan was the Nizam of Hyderabad. Incidentally, both were made by two British members of the Indian Medical Service while serving in Hyderabad.

Chloroform as an aid to surgery was discovered in 1837 and it revolutionized surgery all over the world. It was first used in 1847 by Dr.James Simpson in Edinburgh.

They were two theories about the risk implicit in the administration of chloroform. One was the Scottish theory propounded by Prof. Syme in 1854. He held that what needed to be monitored during the administration of the chloroform was respiration. The English theory, on the other hand, held that chloroform constituted a risk to heart and that the anesthetic should monitor the pulse throughout its administration.

Edward Lawrie was born on 17th May, 1846 and was educated at the Edinburgh University, and in Paris. He was Professor Syme’s house surgeon at Edinburgh. He joined the Indian Medical Service in March, 1972 and rose to the rank of Lieutenant Colonel. He served in Calcutta and Lahore and finally in 1885 became the Residency Surgeon at Hyderabad, the premier Indian State. He was simultaneously principal of the Hyderabad Medical School, superintendent of the Afzal Gunj Hospital (now the Osmania Hospital), and personal physician to Nizam VI.

Lawrie, being a disciple of Syme and committed to the Scottish School, was keen to prove the truth of Simpson’s theory. He therefore persuaded the Nizam to finance a scientific investigation into the safety aspects of the use of chloroform. A Commission was accordingly set up in 1888. It consisted of Lawrie and three of his colleague. In January, 1889 the Duke and Dutchess of Connaught came to Hyderabad and presided over the prize-giving ceremony of the Hyderabad Medical School. At that function Lawrie talked about the achievement of the Hyderabad School and the conclusions of the Hyderabad Chloroform Commission, and claimed that “in the 40-50,000 administrations which he had superintended he had ever seen the heart injuriously or dangerously affected by chloroform.” He added that, “he had no doubt deaths would go on occurring until the London schools, which of course influence the whole world, either entirely changed their principles and ignored the heart in chloroform administration, or else confined themselves exclusively to the use of an anaesthetic like ether, which, with all its disadvantages, they know how to manage”.1

When the report of this speech was published, the Lancet, the journal of the British Medical Association observed that Lawrie’s conclusions were “utterly at variance with the experience alike of experiment and practice as carried out In Europe…. We should require more than the scanty statements of experiments performed upon dogs”. It added that “ while welcoming the attention paid to the subject by the Hyderabad Chloroform Commission, we cannot but feel that should the Commission inculcate a disregard of the heart as a factor in chloroform dangers, it will do harm and provoke a slipshod carelessness in the use of that valuable anesthetic, which must in the long-run do damage to the cause the Commission has espoused”.2

Thereupon Lawrie persuaded the Nizam to constitute a Second Commission and invited the Lancet to nominate one of the experts from London to sit on the Commission. The Nizam offered to pay 1,000 pounds sterling to meet the expenses of his travel and to treat the nominee as the guest of the government during his stay in Hyderabad. The Lancet accepted the offer and nominated Dr. Lauder Brunton as its representative. The Commission consisted, besides the members of the first Commission, of Dr.Lauder Brunton, Maj. General Gerald Burmford (appointed by the Government of India) and an Indian, Dr. Rustamji of the Hyderabad Medical Service. It started its work on the 23rd of October, 1889 and continued it for 57 days. It used to start its work at 7 in the morning and continued till 5 in the evening. It conducted experiments on about 600 different animals.

It is interesting to note that the Nizam demonstrated his interest the project by witnessing himself the administration of chloroform to three animals – a goat, a horse and a monkey on 29th November, 1889. The Second Commission confirmed the findings of the first that it was the care of respiration and not of the heart that was crucial to the administration of chloroform. Even before the Commission concluded its experiments, Dr. Brunton sent the following telegram to the Lancet:

“Four hundred and ninety dogs, horses, monkeys, goats, cats and rabbits used. One hundred and twenty with manometer. All records photographed. Numerous observations on every individual animal. Results most instructive. Danger from chloroform is asphyxia or overdose; none whatever heart direct”.3

This report of the Second Hyderabad Chloroform Commission was published in five monthly installments in the Lancet from January, 1990 onwards. Later, it was also published in a single volume. A summary of its findings was also published in the issue of Lancet of 21st June, 1890 and while still expressing his reservations, the editor expressed the gratitude of the medical profession to the Nizam ‘for the opportunity of scientific progress which his unbounded liberality afforded’.

The controversy did not stop there. Later, the Scottish- Hyderabad theory was proved wrong. But it contributed to the final conclusion which is how science makes advances. Lawrie with his enthusiasm, and the Nizam with his patronage, advanced the cause of science.

Lawrie retired in 1901 and went away to England where he died in 1915. His widow was left in poor financial circumstances. The Nizam, out of his regard for Lawrie, sanctioned a pension of 600 pounds sterling per an annum for the rest of her life.

The importance of the contribution of the two Chloroform Commissions of Hyderabad can be gauged from the fact that W.Stanley Sykes in his book: ‘Essays on the First Hundred Years of Anesthesia’ Vol. III (1982) devotes four chapters out of 19 to the Hyderabad Commissions, their findings and their evaluation.

In 1988 the government of A.P. celebrated the centenary of the First Hyderabad Chloroform Commission and the Department of Post and Telegraphs expressed its recognition of the contribution by issuing a special cover with the photograph of Dr.Edward Lawrie on 28th March, 1988. Nine years later, the centenary of the other achievement of Ronald Ross was celebrated.

These two events do Hyderabad and its people legitimately proud.

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