231 



4. The inhalation should never be continued after the full anae- 

 sthetic effect is produced, which can generally be recognized at once 

 by the stertorous or sonorous sleep. Nor should it ever be given 

 after the pulse begins to fail in frequency and force. It is advisa- 

 ble that the pulse should never be allowed to fall below 60 or 65 per 

 minute ; when it reaches this point, the sponge should be removed 

 and atmospheric air alone be inhaled until the pulse recovers its 

 tone. It is also to be borne in mind, that the depressing agency of 

 chloroform continues to increase for several seconds after it is with- 

 drawn, differing, in this respect, from ether, which does not appear 

 to be cumulative in its operation, for the patient never becomes more 

 depressed than she is at the moment of ceasing the inhalation. 



5. In cases of labour where we wish our patient to derive the full 

 benefit of this agent, the ether or chloroform should be reapplied at 

 the accession of each pain — a few drops (20 or 30) being placed on 

 the handkerchief each time for this purpose. This may be continued 

 with perfect safety, in all ordinary cases, to the termination of the 

 labour, even if it should last several hours. 



6. As a general rule, the inhalation should not be commenced 

 until the labour pains are fairly established, and recur at regular 

 intervals, as the chloroform, if given before this period, might inter- 

 fere with their regular recurrence, and thus protract the labour, 

 while this result need never be apprehended if its use is delayed to 

 the proper time. 



The utmost caution should be observed by the practitioner in rela- 

 tion to the purity of the article he employs. Its specific gravity 

 should not be less than 1480, the best quality being as high as 1500. 

 Another test is, that pure chloroform, applied to the skin or mucous 

 membrane, produces simple redness, without cauterization or vesica- 

 tion. When mixed with a small quantity of absolute alcohol, it 

 acquires caustic properties. Whenever, therefore, the chloroform 

 used in medical practice has caused vesication of the lips or nostril, 

 with irritation of the bronchial tubes, it is proof positive that it can- 

 not be pure. 



The committee do not think it important to express an opinion as 

 to the comparative value of sulphuric ether and chloroform in ob- 

 stetric practice. While the latter is more convenient, the former is 

 probably more safe, owing to the fact, perhaps, that it is not cumu- 

 lative in its operation. They are both efficient, and either may be 

 employed at the option of the accoucheur. 



HARVEY LINDSLY, 

 GEORGE C. M. ROBERTS, 

 JOSHUA RILEY, 

 C. R. GILMAN. 



