148 ON ANAESTHETICS 
The obstructed state of the breathing, if allowed to continue long, would 
lead to a far more serious affection—paralysis of the nervous centre concerned 
in the respiratory movements. Pulling out the tongue would then of course 
have no good effect of itself, but it should be done to clear the way for artificial 
respiration, which is the means to be essentially trusted to under such circum- 
stances ; and if the air still fail to enter freely into the chest, an opening ought 
to be made without delay through the crico-thyroid membrane. Cold water 
should also be occasionally dashed upon the face and chest ; and if a galvanic 
battery happen to be in readiness, one of its poles may be applied over the 
spinous processes of the upper cervical vertebrae, and the other to the prae- 
cordial region, with the object of rousing the respiratory and cardiac ganglia. 
This, however, is a means not very likely to prove beneficial, and if used in too 
intense a form it may do harm instead of good. 
Preparatory to taking chloroform the patient should be directed to omit 
the last meal which would naturally precede it,.as any food in the stomach is 
almost sure to give rise to troublesome vomiting during the inhalation. The 
only after-treatment necessary is to allow the effects of the chloroform to pass 
off ina quiet sleep ; and the only bad consequence likely to arise is a tendency 
to sickness, which sometimes causes annoyance during the first twenty-four 
hours or so." 
Chloroform is universally applicable in the various departments of surgery, 
except in some few cases in which the assistance of the patient is required, and 
in operations involving copious haemorrhage into the mouth. Blood may 
trickle in small amount into the pharynx without risk of choking, deglutition 
being carried on unconsciously during anaesthesia ; and even in some instances 
when the bleeding is more serious, as in removing portions of the jaws, pain 
may be avoided to a great extent by giving the chloroform during the more 
superficial parts of the operation, and allowing the patient to recover partially 
before undertaking its deeper stages. 
The main conclusions arrived at in this article may be expressed in a few 
words. It appears that chloroform, though resembling many other valuable 
means of treatment in being deadly when mismanaged, is free from danger 
1 It has been supposed by some that the use of chloroform increases the risk of pyaemia after 
capital operations ; but experience has now abundantly proved the groundlessness of this apprehension. 
To take a single instance, the veins of the pelvic viscera being perhaps, next to those of the bones, more 
liable than any others to originate phlebitis after surgical interference, lithotomy would be much more 
fatal now than formerly were there any foundation in fact for the notion. The reverse, however, 
appears to be really the case. Thus, Mr. Cadge, one of the surgeons of the Norfolk and Norwich Hospital, 
an institution long celebrated for the successful treatment of stone, in a district abounding in calculous 
disease, informs me that the mortality after lithotomy has been still further reduced there since the 
introduction of chloroform. 
