CHLOROFORMUM. 147 



paralysis respectively of the third nerve or its cerebral 

 The other involuntary muscles are less obviously paralysed, 

 and the parturient uterus contracts freely in complete anaes- 

 thesia, with some loss, however, of vigour and regularity. 



3. Specific uses of chloroform. The circumstances under 

 which chloroform anaesthesia may be employed are the follow- 

 ing: (1) In operations attended by pain. These need not be 

 particularised. (2) In operations where muscular action or spasm 

 has to be overcome : reduction of hernias, dislocations and frac- 

 tures ; catheterism. (3) In diagnostic manipulations : explora- 

 tion of the abdomen externally and per rectum. (4) In diseases 

 attended by excessive pain, especially biliary and renal calculus. 

 (5) In parturition, in certain subjects and conditions, the 

 degree of anaesthesia induced being generally slight until the 

 moment of birth. (6) In spasmodic diseases, such as tetanus, 

 hydrophobia, uraemia, puerperal convulsions, the status epi- 

 lepticus, severe chorea, and hiccup. 



4. Method of administration, and principal precautions 

 to be observed in chloroform anaesthesia. This is a purely 

 practical subject, to be learned by experience and not in theory. 

 The student has frequent opportunities of witnessing the ad- 

 ministration of anaesthetics by skilled persons, and he must 

 closely and carefully observe every effect of the chloroform upon 

 the patient. He will do well to interpret every phenomenon as 

 it arises, such as mental and muscular excitement, the 

 character of the breathing, the colour of the countenance, and 

 (if possible) the state of the pulse, into exact physiological 

 terms, as explained above ; as, for example, stimulation of the 

 convolutions and cord, interference with the respiratory centre, 

 etc. He will thus come to appreciate accurately the condition 

 of the patient at any moment, and be prepared to assist in 

 administering anaesthetics himself. Many purely j >ract i< al points 

 will then have to be learned : the selection of suitable cases for 

 anaesthesia ; the preparation of the patient ; the choice of the 

 anaesthetic and of an inhaler; the position of the patient ; 

 the method of watching the face, eyes, pulse and respiration ; 

 the detection of unfavourable symptoms, and thrir immediate 

 treatment ; and, finally, the after treatment of the case. All 

 these and other matters connected with the administration of 

 anaesthetics can be but briefly referred to in the folio wing para- 

 graphs : 



a. Selection of cases. Chloroform must be given with great 

 caution to the aged and infirm, to persons who are sul 

 attacks of faintness, or known to suffer from fatty degeneration 

 or dilatation of the heart, to very fat. and very anaemic 

 persons, to epileptics, to chronic drunkards, to the subjects of 



