This type of breathing is precisely similar to that which is often seen in a patient dying of respiratory failure from other causes.
Under the influence of chloroform the pupil first dilates and then contracts. The dilatation of the pupil of incomplete chloroform narcosis is due, according to Arthur -Ward, to mental, sensory, or sympathetic impulses affecting the semi narcotized cerebrum, and so giving rise to reflex inhibition of the centre of the third nerve. The activity is, therefore, due to the fact that the centre itself is not narcotized. In complete narcosis the contracted pupil is due to the com plete subjection of the cerebrum, while the unopposed third-nerve centre re mains active, all cerebral reflexes being now barred. In dangerous narcosis the third-nerve centre itself becoming poisoned, its action no longer controls the pupil, which dilates and grows less and less sensitive to light, while the globe becomes fixed. This fixation of the eyeball, to crether with the stertor of breathina and the sluggish pupils, forms the contrast between the danger-stage of chloroform sleep and the second stage, when dilata tion of the pupil is associated with shallow breathing, efforts at vomiting, pupils reacting to light, and return of conjunctival and other reflexes. The period of going under is, Ward thinks, the one of most danger. The patient then, by holding his breath, debilitates the respiratory- centre by cutting off its oxygen-supply, and so predisposes it to injury by any access of strength of the chloroform-vapor.
Any material dilatation of the pupils means either that the patient is coming around—pupil active and other reflexes will follow—or that the patient is getting too far under,—stertorous breathing. sluggish pupil, fixed eyeballs. In first case more chloroform; in second, drlig to be withheld till contraction recurs. A. H. Ward (Cleveland „Med. Gaz., Sept., '95).
The degree of narcotism present may, to a great degree, be determined by pu pils. Breathing, pupil, and pulse mitst be watched. White (Brit. Med. Jour., Apr. 20, '95).
When breathing as:sumes automatic character, indicating that patient is un conscious, the amount of chloroform should be regillated by the size of the pupil; pin-point pupil is the safest sign ; large pupil may mean narcosis. R. Gill
(Jour. Amer. Mod. Assoc., June 3, '95).
The pupil becomes smaller as the pa tient goes under the influence of the (Irm,-r,, and just enough chloroform should be given to keep the pupil a moderate size. Although the moderately con tracted pupil reacts when one eye is opened, yet, when both eyes are opened, the pupils suddenly become contracted. This is the limit of the pupillary reac tion to light in chloroform narcosis. A few more drops may then be added slowly; but, if lie is almost awake, they must be dropped on rapidly. Adolf Flockemann (C'entrall). f. Chir., May 25, mon.
1VIethods of Resuscitation.— When there are indications of syncope, no time should be lost in ascertaining the degree of clanger present and the most active means, artificial respiration by Syl vester's method or inversion, while an assistant is giving hypodermic injection of 1-/3,, grain of strychnine, should at once be resorted to.
Whether artificial respiration will or will not succeed depends, according to B. AV. Richardson, upon several circum stances: (1) the time which has elapsed since apparent cessation of vital action in the lower animals, even after seven minutes' restoration has occurred; (2) a high temperature, which favors clot ting in the pulmonary circulation; (3) extreme cold; (4) rough movement; (5) inexpert artificial respiration may give the coup de grace to the enfeebled heart.
The defects usually witnessed consist in too-rapid motions, and incomplete emptying of the lungs, so as to induce rapid elimination of the chloroform.
Murray-Aynsley lays stress npon the fact that artificial respiration should not be begun by an act of inspiration; that is, by dragging the arms above the head, for such a proceeding serves to promote further absorption into the blood of the chloroform from the saturated air in the lungs. They should first be brought down close to the body; the thorax is then compressed and the arms are only elevated when the chloroform-laden air is as much as possible forced out. Care shonld bc taken to clear thoroughly the mouth and throat of saliva, mucus, vom ited matter, blood, etc., that may be present.