ACTION OF CHLOROFORM UPON THE HEART AND ARTERIES. 335 
pression of the thorax in attempting artificial respiration; and, as a matter of fact, 
Scnirr, BateLui, and others* have succeeded in restoring the circulation by heart 
_ massage combined with artificial respiration (both in dogs and cats, and in one or two 
ee 
rare cases in the human subject), even although a considerable time (fifteen to twenty 
minutes) had elapsed after complete cessation of the circulation. We ourselves have 
not succeeded in restoring an animal after the condition here described appeared to be 
fully established, and we should be disposed to regard the possibility of resuscitation 
in such cases as remote.t 
ANTAGONISING AGENTS. 
(1) Atropine.—lt is apparent from the results obtained by other experimenters, as 
well as from our own observations, that the chief danger to be guarded against in the 
administration of chloroform is the inhibitory influence which it produces upon the 
heart. As we have already pointed out (pp. 328, 329), this influence can be in great 
measure controlled by the prior administration of a moderate dose of atropine, at least 
in so far as the primary and secondary instances of inhibition are concerned, and these 
are the most dangerous because they are apt to occur without the warning which 
manifests itself in the case of the final heart paralysis, by the prior arrest of respiration. 
Atropine is therefore to be placed first in the list of antagonising agents; a dose of 
roo gt. to 5 gr. for an average man being administered hypodermically half an hour 
before the administration of chloroform. 
(2) Adrenalin Chloride.—The employment of this has been suggested in chloroform 
poisoning by Gorriies.{ In the two instances which we have recorded on pp. 333 and 
334, which were attended by an entirely unusual measure of success so far as resuscitation 
after apparent death from chloroform had occurred, we administered successive doses 
of adrenalin, injected into the pleural cavity, as part of the treatment. These happened 
to be the first two experiments of the series undertaken by us, and we were led to ascribe 
much of the success which attended them to the use of this drug, and formed high hopes 
of the value of its administration in cases of chloroform poisoning. Subsequent experi- 
ence showed, however, that adrenalin by itself is of little or no avail to restore a heart 
paralysed by chloroform, and even in conjunction with other remedial measures—of 
which the most important is without doubt artificial respiration by chest compression— 
we are not in a position, as the result of a number of trials, to affirm that it is able 
materially to contribute to the process of resuscitation. 
(3) Ammonia Vapour.—Rincer § first showed that in the frog’s heart ammonia acts 
as a direct antagonist to chloroform, and may even set in activity a heart which has 
* For references see M. Bourcart, Rev. méd. de la Suisse Romande, October 20, 1903. 
+ This is no doubt the condition referred to by RicuEt (Dict. de physiol., article “ Anesthésie,” 1895, p. 523) 
when he avers that when cardiac syncope occurs artificial respiration never succeeds in effecting restoration ; for 
the statement does not apply to the syncope caused by the secondary inhibition previously referred to. 
} Arch. f. Path. u. Pharm., Bd. 37, p. 98, 1896. See also Brepi, Wien. klin. Wochenschr., 1896. 
§ Practitioner, vol. xxvi. p. 436, 1881. 
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