393
H. M. S.
F. 9 27 45.—Talking incoherently.
G. 9 28 15.—Cornea insensitive; stopped chloroform. Anæsthesia
k e p t u p
a f t e r w a r d s u n t i l t h e o p e r a t i o n w a s f i n i s h e d
at 10h. 0m. 45s.
As a clinical record of facts the above cases are no less valuable in their
Way than the record of the facts observed in the experiments of the Hy d e r a b a d
Commission, of which they form the counterpart. Clinical experience confirms
the experimental data of the Commission, and proves that the first effect of chlo-
roform inhalation with regular breathing is normal narcosis, so called because
it is free from risk. Accordingly the first step in chloroform administration
should be to secure inhalation with regular breathing. and the Commission's
experiments as well as the clinical cases co-incide in showing that this is the
main difficulty the chloroformist has to contend
with. Both prove that apart
f r o m m e r e
r e s i s t a n c e . a n y
i d i o s y n c r a s i e s
t h a t m a y d i s p l a y t h e m s e l v e s ,
whether in man or animals. before the stage of full narcosis is reached, are
not due to the direct effects of chloroform. but are caused by the peculiarities
i n . o r t h e d i s t i n c t i v e f e a t u r e s o f t h e r e s p i r a t i o n i n t h e s u b j e c t o p e r a t e d u p o n .
F o r e x a m p l e .
t h e
d i s t i n c t i v e
f e a
t u r e s o f t h e r e s p i r a t o r y f u n c t i o n w h i c h e n a b l e
r a b b i t s t o b u r r o w i n s a n d , a n dg
o a t s t o c a r e e r a c r o s s r o c k y h e i g h t s , l e n d
themselves very readily to the irregular respiration, holding the breath, and
prolonged reflex stoppage of the heart, which make it by no means easy
to obtain regular blood-pressure tracings with these animals in the first stage
of chloroform administration.* Similar effects may be produced clinically in
patients under chloroform by peculiarities of the respiration depending upon
t e m p e r a m e n t a n d d i s e a s e . † I n t h e b e g i n n i n go
f c h l o r o f o r m i n h a l a t i o n
fear or excitement or certain phases of disease may give rise to irregular re-
spiration, which. though harmless in itself, may lead to irregular inhalation and
overdosing. It is therefore incumbent on the chloroformist never to allow the
patient to inhale chloroform when the breathing is irregular or abnormal. In
this way normal anæsthesia can be ensured. and accidents in the early stages of
chloroform narcosis. which are said to be unavoidable and due to chloroform
syneope, can be prevented. When once surgeons admit that normal anæsthesia
*Vhle Experiments Nos. 101. 102. 152. 171 and 172 on rabbits: and Nos. 136. 137. 141. 143.
1
75 and 176 on goats. it isextremely difficult to make any animal respire regularly in the
first stage pf chloroform inhalation. especially rabbits and goats. This difficulty may be overcome by artificial respiration through a tracheal tube and pumping
chloroform into the lungs with bellows: but this unnatural process entirely vitiates the experiment. Natural
breathing is no longer possible. and the normal oxygenation of the blood must be interfered with.
†Vide Clinical cases. Nos. 285. 290. 316 and 325, which show the effect of temperament; and Nos. 309 and 317
which show the effect of disease.
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