ON ANAESTHETICS 173 
through the intervention of the same nervous agency, out of all proportion 
to any effect which the increased pressure of the blood upon their walls through 
gravity could occasion. We therefore understand how ‘anaemia of the brain’, 
or languid flow through constricted arteries, may be caused by unwonted eleva- 
tion of the head, and how relaxation of the cerebral arteries, and correspond- 
ingly free flow of blood through them, may be induced by placing the head 
unusually low. 
I have myself seen some striking examples of the advantage of acting on 
Nélaton’s suggestion. 
I once operated for fissure of the anus on a lady above middle life, who 
was so exceedingly liable to fainting fits that two medical friends of hers who 
were present had great dread of her taking chloroform. For my part, I believed 
that if she was to be operated on at all, chloroform would prove advantageous 
by protecting her heart from shock. It was accordingly administered, and she 
took it perfectly well; but before she was fully under its influence I yielded to 
the entreaties of my colleagues, and against my own judgement proceeded to 
the operation. As the knife passed through the sensitive part she ceased to 
breathe, and became deadly pale. I instantly turned her round across the bed, 
so that her head and shoulders hung over its side, and performed artificial respira- 
tion by Sylvester’s method. In a short time natural breathing recurred ; and 
when it had continued for a while, I replaced her in the horizontal position. 
No sooner was this done than the alarming symptoms returned ; but they were 
again dispelled by a repetition of the same treatment. This time I took care 
to keep the head dependent for a considerably longer period, and the result 
was permanent recovery. In that case my belief was that a more complete 
action of the chloroform would have obviated the collapse. 
In another case no such explanation of the syncope was possible. 
I had performed a trifling operation upon the arm of a delicate little girl 
under chloroform in King’s College Hospital. Nothing unusual had occurred, 
and she was sent off on a wheeled couch to the ward, about thirty yards distant. 
Whether she was made to sit up as she was lifted into bed (a thing which 
ought never to be done) I do not know; but she had hardly been placed 
there when she fell into a state of collapse, and I was at once summoned. 
Running to the ward, I found her face blanched, and respiratory movements 
entirely absent. I immediately did as in the former case. No sooner was 
her head placed dependent than a rosy colour suffused the white cheeks ; 
and after a short time of artificial respiration by Sylvester’s method, she was 
breathing naturally. 
I have had occasion to refer more than once to Sylvester’s method of arti- 
