102 
HEPORT ON CHLOROFORM. 
Rules relating to the Administration of Chloroform. 
The anaesthetic should on no account be given carelessly, or by the inexperienced >* 
and when complete insensibility is desired, the attention of its administrator should be 
exclusively confined to the duty he has undertaken. 
Under no circumstances is it desirable for a person to give chloroform to himself. 
It is not advisable to give an anaesthetic after a long fast, or soon after a ineal; the 
best time for its administration being three or four hours after food has been taken. 
If the patient is much depressed, there is no objection to his taking a small quantity 
of brandy, wine, or ammonia, before commencing the inhalation. 
Provision for the free admission of air during the patient’s narcotism is absolutely ne¬ 
cessary. 
The recumbent position of the patient is preferable ; the prone position is inconvenient 
to the administrator, but entails no extra danger. In the erect or sitting posture there 
is danger from syncope. Sudden elevation or turning of the body should be avoided. 
An apparatus is not essential to safety, if due care be taken in giving the chloroform. 
Free admixture of air with the anaesthetic is of the first importance, and, guaranteeing 
this, any apparatus may be employed. If lint, or a handkerchief, or a napkin is used, it 
should be folded as an open cone, or held an inch or an inch and a half from the face. 
The anaesthetic should invariably be given slowly. Sudden increase of the strength of 
the anaesthetic is most dangerous. Three and a half per cent, is the average amount, 
and four and a half per cent, with ninety-five and a half of atmospheric air, is the maxi¬ 
mum of the anaesthetic which can be required. Given cautiously at first, the quantity, 
within this limit, should be slowly increased according to the necessities of the case, the 
administrator being guided more by its effect on the patient than by the amount exhibited. 
The administrator should watch the respiration of his patient, and should keep one 
hand free for careful observation of the pulse. 
The patient who appears likely to vomit whilst beginning to inhale the anaesthetic 
should be at once brought fully under its influence, and the tendency to sickness will 
then cease. 
The occurrence during the administration of an anaesthetic of sudden pallor or of sud¬ 
den lividity of the patient’s countenance, or sudden failure or flickering of the pulse, or 
feeble or shallow respirations, indicates danger, and necessitates immediate withdrawal 
of the anaesthetic until such symptoms have disappeared. On the occurrence of these 
symptoms, and especially if they should become so urgent as to threaten death from 
failure of respiration, of heart-action, or of both together, the following rules of treat¬ 
ment are to be observed:—Allow free access of fresh air; pull forward the tongue, and 
clear the mouth and fauces ; keep or place the patient recumbent; dash cold water on 
the face and chest, and aid the respiratory movements by rhythmical compression of the 
thorax. In the more threatening cases artificial respiration must be commenced instantly; 
and this rule applies equally in all cases, whether the respiration has failed alone, or the 
pulse and respiration together. Galvanism may be used in addition to artificial respiration, 
but the artificial respiration is on no account to be delayed or suspended in order that 
galvanism may be tried. 
Few if any persons are unsusceptible of the influence of chloroform, from two to ten 
minutes being required to induce anaesthesia. The time, however, varies with age, tempe¬ 
rament, and habits. 
The mixture of chloroform, ether, and alcohol should be given in the same w r ay as 
chloroform alone; care being taken, w r hen lint or a handkerchief is used, to prevent the 
too free escape of the vapour. 
Use of Chloroform in Surgical Operations. 
With heart disease the anaesthetic may be given in any case which requires an opera¬ 
tion, although when there is evidence of a fatty, weak, or dilated heart, great caution is 
demanded. Valvular disease is of less importance. 
In phthisis, when an operation is unavoidable, the anaesthetic may be given with im¬ 
punity. 
For all operations upon the jaws and teeth, the lips, cheeks, and tongue, the anaesthetic 
may be inhaled with ordinary safety. By care and good management the patient may 
be kept under its influence to the completion of the operation. In these cases, blood, as 
it escapes, if not voided by the mouth, passes into the pharynx. If any small quantity 
