ONTANAESTIMETICS 143 
best introduced by a short account of what ordinarily occurs in the mode of 
administration with which I am most familiar. A common towel being arranged 
so as to form a square cloth of six folds, enough chloroform is poured upon it 
to moisten a surface in the middle about as large as the palm of the hand, the 
precise quantity used being a matter of no consequence whatever. The patient 
having been directed to loosen any tight band round the neck, and to shut 
his eyes to protect them from the irritating vapour, the cloth is held as near 
the face as can be comfortably borne, more chloroform being added occasionally 
as may be necessary. After a time, varying considerably in different individuals, 
but generally longest in adults who have been accustomed to the free use of 
narcotics, and shortest in young children,’ signs of excitement begin to manifest 
themselves in various ejaculations and muscular efforts, which soon give place 
to a state of complete repose. The struggles of the patient are sometimes so 
violent as to require considerable force to restrain them, and, for this reason, 
at least one efficient assistant should always be in attendance. On the other 
hand, I have seen chloroform induce nothing but a tranquil slumber ; and it is 
important to bear in mind that the stage of excitement cannot be reckoned on 
as invariably declaring itself at all. 
The most convenient test of the patient being prepared for undergoing the 
operation is presented by the eye ; not in the size of the pupil, which is incon- 
stant in its indications, but in what is commonly spoken of as insensibility of 
the conjunctiva, though in truth it has no relation to sensation, which is 
abolished considerably earlier ; but when unconscious winking no longer occurs 
on the eyeball being touched with the tip of the finger, we have a good criterion 
of the suspension of reflex action in the body generally. At this period the 
pulse is in about a normal condition, and the respiration is usually either natural 
or very slightly stertorous, though persons with a strong tendency to snore 
may do so almost from the commencement of inhalation. But if the adminis- 
tration of the chloroform be further persisted in, strongly stertorous breathing 
will soon be induced, and will become aggravated till it passes into complete 
obstruction to the entrance of air into the chest, though the respiratory move- 
ments of the thoracic walls still continue. Occasionally, however, the pre- 
monitory stertor is deficient, and the breathing becomes more or less suddenly 
obstructed. This is a point of great importance, for without close attention 
1 IT once met with an instance in which chloroform seemed incapable of affecting a patient. It 
occurred in the private practice of Mr. Syme, who was about to perform an operation, for which we 
proceeded to administer the anaesthetic ; but after we had used the cloth till we were tired without 
any apparent effect, Mr. Syme went on with the operation while the patient was conscious. Such 
a case is, no doubt, excessively rare,’ but it is interesting as giving some colour to the hypothesis that 
idiosyncrasy in the opposite direction has existed in some very few fatal cases, which seem to admit 
of no other explanation, as alluded to in the text. 
