COMPLETE AN.ESTIIESIA — HORIZONTAL POSITION. 437 



small dose of chloroform, just enough, as in the case I have 

 related, to abolish consciousness without preventing reflex 

 action in the ganglia at the base of the brain, and if the heart 

 of the individual be at the same time peculiarly sensitive to the 

 impression made on the fifth nerve, it may be stopped, and the 

 pressure of blood in the arteries may sink so low that it never 

 rises again. But if, on the other hand, chloroform be given, as 

 Professor Syme recommended, with a free hand, so as to produce 

 total abolition of reflex action, no irritation of the fifth nerve 

 by the extraction of any number of teeth will have any effect ; 

 the heart will pulsate as usual, and no danger is to be appre- 

 hended from this cause. 



I do not at all mean to say that the administration of 

 concentrated chloroform-vapour is free from danger — far from 

 it ; but the limits of my paper will not allow me to enter into- 

 this subject. All I can attempt to do is to direct attention to-^ 

 the observation of Professor Syme, whose acuteness and 

 accuracy few will question, and to try to impress it, by 

 showing the probable physiological reason why one ought 

 always to induce perfect anaesthesia before beginning any 

 operation under chloroform. At the same time, I would 

 observe that, just as the circulation, which had ceased in the 

 frog in Goltz's experiment so long as it hung vertically, went 

 on again when the animal was laid in a horizontal position so 

 that the blood found its way to the heart, so it may go on in 

 man ; and, therefore, the safest position for operations is the 

 recumbent one. 



The two rules, then, for preventing death during the extraction: 

 of teeth under chloroform are : put the patient thoroughly over^ 

 and lay him in a horizontal position. 



