The well-known measure of slapping the surface with wet towels is generally utilized, but does not represent an ef fective procedure in serious cases.
Nitrite of reliance is placed, by IV. M. Killen, on immediate use of nitrite of amyl, combined with artificial respiration. Marsh states that it is at the initial stage of heart-failure that it is invaluable. Dudley Buxton argues that whatever value nitrite of amyl may possess, it does not, he thinks, act as an antidote to chloroform. He has found it most serviceable in failure of the circulation from prolonged severe operations, in collaps.e. and fear-syncope.
Injections of Sall Solution.—The in jection, either intravenous or hypoder mically, of the physiological solution (6 per cent.) of sodium chloride has been advocated in chloroform toxcemia. The quantity to be injected depends upon the amount of blood lost during the op eration.
For chloroform toxannia the injection either intravenous nr hypodermically of the physiological solution of sodium chlo ride is very highly recommended. Bob roll' (Lancet, Jan. 9, '92).
Infusion of salt solution in heart failure advocated. Rein] (Centralb. f. Chin, Nos. 17, 19, '95).
Suprarenal Capsules.—The extract of these organs has recently been recom mended owing to the powerful action of this agent upon the vasomotor system.
Conclusions reached after a series of observations made upon dogs for the pur pose of testing the action of the supra renal extract upon these animals when they have been narcotized by chloroform almost to the point of arrest of the heart and respiration: 1. The intravenous in jection of the suprarenal extract is ca pable of saving the lives of dogs suffer ing from extreme chloroform narcosis. 2. Compared with the procedures of other investigators. notably those of SeIiiiller, Laborde, and of Kiinig-Maas, intravenous injections of the extract are preferable on account of its more rapid action. 3. Ex tract of suprarenals exercises a marked influence upon the respiration. the blood pressure, and the tone of the heart muscles even in such small amounts as from 15 to 30 g-rains of a 1-per-cent. solu tion. Hence it should be borne in mind that it is a powerful remedy and should not be given in large (loses. 4. During
chloroform narcosis it is wise to have prepared a fresh solution of suprarenal extraet„ preferably sterilized by boiling, in order to controvert any sudden col lapse. 5. The be.st results, in eases of im minent death due to chloroform, are ob tained by means of combined procedures, such as intravenom: injections of supra renal extract. massag.e of the cardiac re gion, and the subcutaneous injection of physiological salt solution. F. A. Magn kovsky (Russian Archives of Path. Anat.: Amer. Medico-Surg. Pull_ May 10, '9S).
Two drug,s which promnte contraction of the arteries, and in consequence must antagonize the dangerous fall of blood pressure produced by chloroform, are atropine and extract of suprarenal cap side. Extract of suprarenal capsule in creases remarkably the rate and the force of the heart-beat. Schafer (Lancet, Feb. 5, '98).
enesection.—This is an old measure which, nevertheless, has merit. The es sential point seems to be that the veins to be opened should be as large and. near to the heart as possible, in ord.er that the issuing stream of blood should be of con siderable volume and the relief to the heart as rapid and thorough as possible.
Case of arrest of the heart's action and of respiration during chloroform ames thesia in which the internal jugular vein was opened; compression of the lower chest to relieve the distended right ven tricle then resorted to. Several ounces of blood rapidly escaped, and, after the jugular had been clamped by two forceps, artificial respiration was resumed. In less than half a minute the patient made a faint inspiration, followed in a few seconds by another, and, artificial res piration being continued energetically, the heart was heard to beat, at first slowly; but soon the pulse and respira tions gained in strength and frequency. The operation was now completed with out further administration of an anms thetic. This case is deemed of impor tance. as demonstrating that the bleeding, from the internal jugular vein, by reliev ing the distension of the right heart, was the main factor in bringing about the recovery of the patient from an appar ently hopeless condition. H. F. Water house (Brit. _lied. Jour., July 18, '96).