CHLOROFORMUM. 1 4 5 



At the same moment, or almost immediately after, the 

 chloroform rouses the spinal or muscular centres, and various 

 gesticulations and spasmodic or struggling movements may cnsm . 



The medulla oblongata is next affected, the centres of cir- 

 culation and respiration heing stimulated, so that the pulse and 

 respiration become more frequent (although the latter is more 

 shallow), the face flushed, the blood pressure raised. At this 

 point the skin becomes moist, a red rash in irregular patches 

 may appear on the neck and chest ; and the pupils may dilate 

 slightly. 



These phenomena vary greatly in different instances, with 

 the constitution and condition of the nerve-centres, the tem- 

 perament and habits of the individual, laughing or crying or 

 noisy struggling being the most prominent feature in many 

 cases. 



b. Second stage. The second effect of chloroform on the 

 nerve-centres is depression. The same parts continue to be 

 affected by the drug, but their functions, instead of being in- 

 creased or simply disordered, are first diminished, and at last 

 completely arrested. Consciousness now ceases, with the appear- 

 ance of heavy sleep. Perception and sensation are annulled : 

 the patient sees nothing, hears nothing, feels no pain. For the 

 same reason, reflex excitability is first diminished and then 

 lost : irritation of any part by tickling or pinching no longer 

 induces movements of the limbs ; at last, even touching the 

 cornea causes no reflex rolling of the eye-ball or winking of the 

 lids. 



As the anaesthesia deepens, the reflex and automatic 

 excitability of the cord and medulla is also diminished, and the 

 phenomena that ensue affect all the parts supplied by these 

 centres. The muscular tone is lost, and the voluntary muscles 

 become paralysed and relaxed. The pupil is semi-contrartrd, 

 and may dilate on stimulation of afferent nerves. The heart :m<l 

 respiratory organs are no longer excited, but their centres in 

 the medulla being now depressed, their action is laboured, the 

 pulse falling in frequency (a striking change from the previous 

 ition) and in strength, and the respiratory movements 

 being slow, heavy, and attended by noise or stertor. 



Now is the time for the surgeon to operate, 

 being complete, whilst the depression of the vital fund ; 

 still within safe limits. The eifects may be expected to pass off 

 in a few minutes if the administration be stopped; and 

 although the amount required to complete the second 

 varies greatly with the subject and other circumstances, it may 

 be said that from 1 to 4 fluid drachms will probably ha\ 

 given up to this point. 

 K 8 



