CilLOROFORMUM. . 149 



patient's head should be placed in such a position on the edge 

 of a pillow that the saliva may flow from the mouth instead of 

 into the stomach, and that the tongue may not fall back and 

 produce dyspnoea. It is essential that the patient's chest and 

 abdomen should not be compressed in the slightest degree by 

 clothes or by the arms of the assistants, or confined by ban- 

 dages. The most comfortable position for the patient is on the 

 side, with one hand and fore-arm beneath the pillow ; and as 

 a rule it is better to induce insensibility in this position, and 

 afterwards arrange the patient for the surgeon, than to 

 senasthetise him in the constrained attitude often required in 

 operations. 



/. Administration. The confidence of the patient should 

 first be gained by a few minutes' conversation, whilst he is 

 reassured as to the result and instructed how to breathe. 

 When inhalation has commenced, the administrator must not 

 even for a single instant cease to watch the face, respiration, 

 and pulse. The degree of insensibility necessary for dif- 

 ferent cases varies greatly, the least being required for uterine, 

 the most for rectal operations. The loss of the corneal reflex, 

 and stertorous breathing, are generally employed as tests of 

 insensibility, but no single sign can be relied upon. The 

 smallest possible quantity of the drug should always be given ; 

 and patients once thoroughly ana?sthetised by ether may be 

 kept under its influence for many minutes by rebreathins^ the 

 air of expiration loaded with its vapour mixed with some 

 fresh air. 



g. Complications and unfavourable symptoms. Vomiting is 

 generally preceded by pallor of the face or a few deep inspira- 

 tions. When it occurs, care must be taken that nothing is 

 dnt\vn into the larynx ; the head should therefore be thrown 

 forward, and the mouth opened by pressure on the symphysis of 

 the jaw, or by inserting a pair of forceps between the teeth. 

 Should vomited matter be inhaled into the respiratory j 

 and asphyxia threaten, laryngotomy must be immediately PT- 

 formed. 



Lividity of the face and prolonged deep stertor should be 

 checked by raising tin- shoulders so that the diaphragm may 

 1 more easily, and by making the patient hreath.' fivsh air. 

 The position of the head'is to be ehanp'd until respiration is 

 more easy; the vessels of the head and neck must be allowed to 

 empty themselves well and quickly; and the mouth may have 

 to be opened to its fullest extent, which induces a dt^-p inspi- 

 ration, the following expiratory effort oi'tm i-lcarinir the larynx 

 and fauces of tenacious mucus which had been obstructing the 

 entrance of air. 



