TRANSACTIONS OF SECTION I. 551 
kill an animal with chloroform after the vagi are cut. The protective use of 
atropine with the same object as vagotomy is sound in principle, but it has 
not been availed of by anesthetists chiefly on account of its disturbing effect 
on the pupil of the eye, thereby misleading them as to the depth of narcosis. 
(iii) Resuscitation in Threatened Fatalities during the Administration 
of General Anesthetic Agents. By HE. H. Empuey, M.D. 
Deaths under anesthetics by no means occur from a common cause nor 
under the same pathological conditions. They may be arranged in four 
groups :—I. Syncopal. Il. From excessive tension of anesthetic in the body. 
III. Shock or exhaustion. IV. Pre-existing pathological states and various 
accidental conditions. 
I. Syncopal.—Such cases occur early in the administration. Respiration 
ceases either just before, at the same time as, or just after the heart—mainly 
in consequence of the low or absent arterial blood-pressure. The cessation of 
pulse and the loss of colour from the face are sudden. The heart is arrested 
and the arterioles relaxed by inhibition, not by paralysis. The venous blood- 
pressure is high. Reflex syncope may happen at a later period in the administra- 
tion, but it occurs mostly under light narcosis. 
II. Excessive narcosis.—Respiration invariably ceases before the circulation. 
The loss of colour of face and the progressive diminution in pulse volume and 
tension are relatively much slower than in syncope. In chloroform narcosis the 
respiration has been progressively diminishing up to the time of stoppage. The 
cardio-vascular neuro-muscular mechanism is paralysed, and both the venous 
and the arterial blood-pressures are low. 
III. Shock or exhaustion, whether previously existing or incurred in the 
operation, is indicated by a progressively increasing heart-rate (generally except- 
ing that of old people), with diminution in pulse tension and volume. Loss of 
face-colour and diminishing efficiency of lung-ventilation progress similarly. 
The vaso-motor system is chiefly concerned in the circulatory failure. The 
experimental evidence available up to the present indicates exhaustion of the 
vaso-motor central mechanism, and of the secretory function of the adrenals, as 
the causative factors of the circulatory depression in shock. The venous and 
arterial blood-pressures being low, the heart cavities are imperfectly filled and 
the coronary blood-supply inadequate for the heart’s needs. Respiration is 
defective and the temperature low. 
IV. Drowning by blood, pathological fluids, vomit, &c. Laryngeal obstruc- 
tion by spasm, foreign bodies,- vomit or blood. Respiratory paralysis in cases 
of cerebral pressure. Cidema of the glottis. Retropharyngeal abscess. Ludwig’s 
angina. Septic degenerations. Reflex syncope from surgical afferents, &c. 
I. Syncope.—The aim in treatment is that of cutting short the inhibition. 
Three methods are of value for this purpose :—(a) Raising the blood-pressure 
in the right cavities of the heart and in the great veins adjacent. (b) Artificial 
respiration. (c) Rhythmic manual compression of the heart. 
(a) Raising the venous blood-pressure in the heart and adjacent veins. Some 
evidence seems to indicate that heightening venous tension in these parts is the 
cause of the normal cardiac rhythm. This pressure is high in syncope, but in 
the syncope of anzsthetics the rise of pressure is more or less impaired. It 
may, however, be supplemented by gravity when the patient is inverted head 
down, and by the aspirating effect of artificial respiration. A good head of 
pressure, at the right side of the heart, furthermore affords the requisite blood 
for filling the arterial system when inhibition ceases. 
(6) Although artificial respiration cannot oxygenate the blood with the circu- 
lation arrested, it exercises the afferent impulses whereby reflexly the respiratory 
rhythm is regulated by alternately inflating and compressing the pulmonary 
alveoli, and it assists in helping to restart the heart by the precordial pressure 
of the expiration movements, hesides assisting to raise the venous pressure in 
the great veins adjacent to the right heart. 
(c) Rhythmic manual compression of the heart through the diaphragm.— 
When the above measures fail this should not be neglected, though it entails 
opening the abdomen. Experimentally it invariably succeeded in restarting a 
