ACTION OF CHLOROFORM UPON THE HEART AND ARTERIES. 341 
Lungs.-—TYhe pulmonary arteries are greatly distended with blood. Otherwise the 
lungs usually present a perfectly normal appearance externally. But in cutting them 
open we found, in six out of twenty cases examined, a considerable amount of frothy 
mucus in the bronchial tubes. 
Abdominal Viscera.—These exhibited marked venous congestion, especially well 
seen in the liver, which may be greatly swollen and project beyond the thoracic cage.* 
It is thus exposed to some risk of rupture if artificial respiration be attempted by the 
Howard method. This happened in one of our cases, although we were aware of the 
danger, and always endeavoured to avoid it by compressing the chest well above the 
liver. 
All these appearances are very similar to those which result from asphyxia due to 
deprivation of air, whether caused by drowning or otherwise. But they are produced 
independently of any asphyxia caused by paralysis of the respiration by the drug, for they 
show themselves equally when artificial respiration has been maintained by perflation, 
and the drug has produced death solely by its action on the heart. Nevertheless, the 
ultimate effect upon the heart of chloroform and of deprivation of air respectively is 
strikingly similar. In both cases the final result is a condition of “‘ paralytic dilatation,” 
or, as we have preferred to term it, ‘‘ inhibition paralysis,” in which the heart is absolutely 
refractory to all kinds of stimuli. In the case of chloroform the exciting cause is 
doubtless the drug itself; in the case of asphyxia, it is probably the carbon dioxide 
which has accumulated in the blood and tissues.t 
* To observe this condition of the liver and abdominal organs, it is necessary to open the abdomen before the 
thorax. For ifthe contents of the latter be first laid bare, and any of the great veins injured, the congestion of the 
abdominal viscera at once subsides, owing to the escape of blood from their vessels. 
+ Cf. on this subject the Report of the Committee on Suspended Animation, Trans. Med. Chir. Soc., 1904, 
Suppl., p. 63. 
