144 ON ANAESTHETICS 
it may escape notice, when the patient will be placed in imminent peril. For 
though the respiration may be resumed spontaneously, this cannot be relied on, 
and it would seem that when chloroform is given in an overdose, the cardiac 
ganglia are apt to become enfeebled ; and on this account asphyxia produces 
more rapidly fatal effects under its influence than in ordinary circumstances. 
But if the obstructed state of the breathing is noticed as soon as it occurs, and 
the cloth is immediately removed from the face, and the tip of the tongue seized 
with a pair of artery forceps’ and drawn firmly forwards, the respiration at 
once proceeds with perfect freedom, the incipient lividity of the face is dispelled, 
and all is well. 
I am anxious to direct particular attention to the drawing out of the tongue, 
because I am satisfied that several lives have been sacrificed for want of it. 
In order that it may be effectual, firm traction is essential. I have, more than 
once, seen a person holding the end of the organ considerably beyond the lips 
without any good effect, and, placing my hand on his, have given an additional 
pull that has re-established the respiration. 
A simple experiment, which any one may perform upon himself, is illustra- 
tive of this point. Stertorous breathing, such*as occurs under chloroform, 
may be produced at will, and may be carried on even while the tongue is pro- 
truded to the extreme degree. But if the tongue is laid hold of with a handker- 
chief and pulled so as to cause decided uneasiness, stertorous breathing of any 
kind becomes impossible. That further traction, when extension already exists 
to the utmost, should produce such an effect is an apparent anomaly which it 
seemed important to explain. On investigating the subject, I noticed in the 
first place that stertorous breathing is of two essentially different kinds, of 
which one, that may be called palatine, consists in vibrations of the velum, 
and has either a buccal or nasal character, according as the air passes through 
the mouth or the nose ; while the other, which is the profound stertor essentially 
concerned with chloroform, depends on a cause seated further down the throat, 
and, for reasons to be given immediately, may be termed laryngeal. By digital 
examination of my own throat I found that the latter variety, and the com- 
plete obstruction into which it passes, could still be produced when the tongue 
was separated by a considerable interval from the back of the pharynx, while 
a free passage for the air existed onwards to the lips, which showed that the 
general belief, that the obstruction depends on a ‘falling back of the tongue’, 
is erroneous. Also the epiglottis, instead of being folded back during the 
* The artery forceps are the most convenient means of drawing the tongue forwards. The puncture 
which they inflict is of no consequence ; the patient, if he notices it at all, supposes that he has bitten 
his tongue when under the chloroform. 
