POISONING BY CHLOROFORM 179 



all know, yet never can know too well. It is courting 

 disaster to hurry the patient under. We must feel 

 the pulse all the time, as well as watch the pupil and 

 the respirations. " Whiffs " are far more dangerous 

 than proper anaesthesia. No lifting, or cutting, or 

 painful pressure is permissible until the patient is 

 properly under. There is no danger of an overdose 

 during quiet breathing if the mask is kept half an 

 inch away from the face. If Levy's results are to be 

 accepted, the mask must not be entirely withdrawn 

 if strugghng occurs, but every effort made to keep 

 the administration constant. 



What is to be done if the calamity is not success- 

 fully averted, and the heart and breathing cease ? 

 The books advise a dozen expedients. A moment's 

 consideration of physiological principles will lead us 

 to put most of them aside. How can amyl nitrite, 

 which is simply a vasodilator, possibly help a heart 

 that is fibrillating ? Strychnine and brandy are 

 perfectly futile. It is no use giving oxygen to a 

 patient who is not breathing. " Galvanization of the 

 phrenics " is equally hkely to galvanize the vagus. 



There are just four measures which matter. The 

 first is to have the head low, so as to keep the vital 

 centres alive. The second is, of course, artificial 

 respiration, which fills the auricles with blood as 

 well as the lungs with air, averts death from asphyxia, 

 and so gives the heart a chance to recover if it can. 

 The tJiird is to stimulate the heart to contract again 

 by manual compression, if possible througn the 

 diaphragm. The fourth is to administer as quickly 

 as possible atropine, which must be injected right 



