2i8 Transactions of the Canadian Institute. [Vol. VII, 



chloroform poisoning it might be justifiable to thus operate in the hope 

 of producing this reflex effect. 



Forcible Pulling Forward of the Tongue seems, as has long been 

 noted clinically, to stimulate respiration, and in several of the dogs it 

 seemed to be the last straw starting respiration. Professor Syme in a 

 clinical lecture delivered in 1884^ said, " Attention to the tongue is 

 another point we found of great consequence. When respiration 

 becomes difficult or ceases we open the mouth, seize the tip of the 

 tongue and pull it well forward, and there can be little doubt that death 

 would have occurred in some cases if it had not been for the use of this 

 expedient." It has been recently demonstrated that pulling on the 

 tongue does not open the glottis, and it would seem more probable that 

 it reflexly stimulates the respiration. The chloroformist who has been 

 trained in Edinburgh always has a pair of fenestrated artery- forceps 

 handy for this purpose. 



The preceding notes and tracings emphasize the following points as 

 regards the effects of chloroform. 



First, that any struggling during its administration greatly hastens 

 the toxic effects, and that hence the drug should be removed while such 

 lasts, and then should be given more gradually when the patient is 

 quiet again. One frequently sees clinically the chloroform pushed at 

 such a juncture, especially if the struggling has been started by the 

 surgeon commencing the operation ; but struggling without any such 

 cause generally indicates that the vapour is too concentrated, and 

 struggling due to this is doubly dangerous. 



Second, a fall in blood pressure is hard to detect accurately clinically, 

 but it is usually accompanied by slowing of the pulse, and such is a 

 danger signal, and the chloroform should be at once removed. This 

 slowing may occasionally be of a transient nature and due to stimulation 

 of the vagi by concentrated vapour; or it may be the more serious 

 slowing in the wake of which lies respiratory failure. 



Third, if respiratory failure should occur — and it is much more likely 

 to do so during the preliminary administration than later on — then 

 artificial respiration is by far the most valuable method of restoring it. 

 Artificial respiration not only keeps up the respiratory tide but also, as 

 shown in Tracing 45, directly stimulates the circulation and raises the 

 blood pressure, in fact the circulation may be feebly carried on for a 



I Lancet, June 21st, 1885. 



