l6o POISONS : THEIR EFFECTS AND DETECTION. [§ igi. 
the conductivity of the cortical substance of the brain, and leaves the 
grey substance intact. Corresponding to the cerebral paralysis, the 
blood-pressure sinks, and the heart beats slower and weaker. 1 The 
Hyderabad Commission made 735 researches on dogs and monkeys, 
and found that in fatal narcosis, so far as these animals are concerned, 
the respiration ceased before the heart, and this may be considered the 
normal mode of death ; but it is probably going too far to say that it is 
the exclusive form of death in man, for there have been published cases 
in which the heart failed first. 
§ 191. Symptoms. — {a) Inhalation. —There is but little outward differ¬ 
ence between man and animals in regard to the symptoms caused by 
breathing chloroform ; in the former we have the advantage that the 
sensations preceding narcosis can be described by the individual. 
The action of chloroform is usually divided into three more or less 
distinct stages. In the first there is a “ drunken ” condition, changes 
in the sense of smell and taste, and it may be hallucinations of vision 
and hearing ; there are also often curious creeping sensations about the 
skin, and sometimes excessive muscular action, causing violent struggles. 
Epileptiform convulsions are seen occasionally, and delirium is almost 
always present. The face during this stage is generally flushed, 
covered with perspiration, and the pupils contracted. The first stage 
may last from one minute to several, and passes into the second stage, 
or that of depression. Spontaneous movements cease, sensibility to all 
external stimuli vanishes, the patient falls into a deep sleep, the con¬ 
sciousness is entirely lost, and reflex movements are more and more 
annihilated. The temperature is less than normal, the respirations are 
slow, and the pulse is full and slow. The pupils in this stage are usually 
dilated, all the muscles are relaxed, and the limbs can be bent about 
in any direction. If now the inhalation of chloroform is intermitted, 
the patient wakes within a period which is usually from twenty to 
forty minutes, but may be several hours, after the last inhalation. 
The third stage is that of paralysis ; the pulse becomes irregular, the 
respirations superficial, there is a cyanotic colouring of the lips and skin, 
while the pupils become widely dilated. Death follows quickly through 
paralysis of the respiratory centre, the respirations first ceasing, then 
the pulse ; in a few cases, the heart ceases first to beat. 
According to Sansom’s facts, 2 in 100 cases of death by chloroform, 
41-6 per cent, occurred before the full narcosis had been attained, that 
is, in the first stage, 34-7 during the second stage, and 20-6 shortly after. 
So, also, Kappeler has recorded that in 101 cases of death from chloro¬ 
form, 47-7 per cent, occurred before the full effect, and 52*2 during the 
full effect. This confirms the dictum of Billroth, that in all stages of 
anaesthesia by chloroform death may occur. The quantity of chloroform, 
1 Kobort’s Lehrbuch der Inioxicationen. 2 Op. cit. 
