172 ON ANAESTHETICS 
of tea, without bread, at seven o’clock to stay the stomach ; a practice which 
I have for many years adopted. It was only after the operation that I was 
informed that he had taken nothing whatever since five o’clock the previous 
afternoon, and that he had only been brought that morning to the house after 
a pretty long journey through London. This exertion, with prolonged fasting, 
combined with his weakly condition, sufficiently accounted for the symptoms 
of depression. While it is desirable that there should be no solid matter in the 
stomach when chloroform is administered, it will be found very salutary to 
give a cup of tea or beef-tea about two hours previously. 
If chloroform carefully given in the simple manner above recommended is 
really as safe a means of producing prolonged anaesthesia as we possess, a con- 
viction that such is the case will be a great relief to the majority of our practi- 
tioners throughout the country ; all special apparatus being avoided, and selec- 
tion of cases needless. For chloroform, if we are once satisfied of its safety, 
has the grand advantage that it may be used alike for the infant and the aged, 
and for those affected with pulmonary, cardiac, or renal disease. Wherever an 
anaesthetic is demanded, chloroform is applicable. 
For the treatment of alarming symptoms of collapse, whether due to idiosyn- 
crasy in the patient or to want of due watchfulness in the administrator, the 
practice suggested by Nélaton has proved of the greatest value. It is sometimes 
spoken of as ‘inversion’ ; but all that is essential is to place the head at a con- 
siderably lower level than the body generally. Of the practical efficacy of this 
treatment no doubt will be entertained if we bear in mind the relief afforded 
in faintness by placing the patient in a horizontal position, or, if he be sitting, 
by depressing the head to the level of the knees; or, again, the converse fact 
of the occurrence of syncope on a patient sitting up for the first time after a long 
and weakening illness. On mere hydraulic principles, indeed, the beneficial 
effect of inversion would be inexplicable ; seeing that gravity, being equally 
balanced in the arteries and veins, cannot of itself promote the flow through 
the blood-vessels, except in so far as the increased pressure due to that cause 
might lead to their distension and so to diminution of friction; while in the 
special case of the brain the enlargement of the vessels as a whole would be 
effectually prevented by the circumstance of the organ being enclosed in an 
unyielding box. But we know, from observations which I have published 
elsewhere,’ that when any part of the body is raised, its arteries, large and small, 
are thrown into a state of contraction through the vaso-motor nervous system ; 
and conversely, when a part is placed low, its arteries become freely relaxed 
* See an address on the Influence of Position on the Local Circulation, Brit. Med. Journ., June 21, 
1879, reprinted at p. 176 of this volume. 
