284 INORGANIC AGENTS 



It will be seen that all the advantages are in lavor of 

 chloroform, except that of safety. ** Ether is more expen- 

 sive than chloroform, but cheaper than a funeral." (Edes.) 



ACCIDENTS AND DANGERS ATTENDING ANAESTHESIA. 



Asphyxia may occur from mechanical obstruction in 

 the air passages. The tongue may fall back upon the 

 epiglottis and prevent the free entrance of air. The latter 

 accident is obviated by pulling the tongue forward with the 

 hand, or, in the case of the smaller animals, by means of 

 forceps, or suture passed through the tongue. Mucus, 

 blood or vomitus may obstruct the mouth, pharynx, larynx, 

 or trachea, and should be removed if possible by swabbing 

 with absorbent cotton.* The head should be extended and 

 the lower jaw of the patient held forward during anaBsthesia, 

 and no impediment to the free movement of the chest is 

 allowable. Struggling is to be avoided, as far as possible, 

 since it leatls to irregular respiration and asphyxia, and 

 causes the auaesthetizer to push the inhalation, strains the 

 heart, and favors cardiac dilatation, with chloroform. 

 Struggling may be prevented to some extent by giving the 

 anaesthetic well diluted with air at the outset. Asphyxia 

 results also from tetanic fixation, or relaxation of the res- 

 piratory muscles. The signs of asphyxia include cyanotic 

 mucous membranes, muscular twitchings, shallow, feeble, 

 slow and irregular breathing, with long intervals between 

 the respiratory movements, and dilation of the pupils. If 

 death occurs, the heart continues to beat after the breath- 

 ing stops. The condition of the diaphragm during etheriza- 

 tion is an important guide. At first the contractions of the 

 diaphragm are so vigorous that the viscera are forced 

 backward, and the abdominal wall bulges outward during 

 inspiration. As the inhalation is prolonged the diaphragm 

 becomes flaccid and powerless, the respiratory movements 

 are shallow, and the breathing thoracic. The abdominal 



* To prevent excessive secretion of mucus in the air passages, it is 

 wise to give atropine subcutaneous! y fifteen minutes before etherization. 



