1?hythinical l'raction of the Tongue.— Laborde's method has been successfully employed. in a number of cases. Labbe employed it in a case in which flagella tion, artificial respiration, and galvanism had been tried in vain. Verneuil extols the method, especially when alternated with flagellations of the epigastrium with a wet cloth.
After-effects.— Headache, nausea, vomiting, bronchial irritation, and hys terical symptoms frequently present themselves after the use of anmsthetics, but less so after chloroform than after ether.
"When gastric symptoms—nausea, vom iting, etc.—prevail, milk and lime-water frequently succeeds in allaying them. If they are stubborn, lavage with a luke warm solution of bicarbonate of soda will usually master them. An h-ypo dermic injection of morphine, 1/, grain, with Vio, grain of atropine, may be used with confidence when the means pre viously indicated fail.
It is a commonly observed fact that vomiting after ansthetization is asso ciated with a severe degree of circulatory depression and not infrequently with actual syncope. Editorial (Lancet, Nov. 10. '94).
[Several eases in the year's literature vividly sustain this point. ED.. ,:knnual, '96.] The nausea after chloroform anms thesia will not occur if for several weeks before undergoing operation the patient will take chloroform-water so as to ac custom the system to it. In order to avoid as much as. possible the unpleasant taste and smell of chloroform, the follow ing mixture may be given :— Aq. chloroform., 6 ounces.
Spin menth. pip., Spir. anis., of each, 4 drops.
Filter after twelve hours. Weber (Bull. Gen. de Ther., Apr., '99).
The value of inhalations of vinegar to control nausea and vomiting after chloro form is frequently extolled. Accord ing to Lewin, the free chlorine—one of the products of chloroform and which is a marked irritant to the pharyngeal mucous membrane and induces vomit ing—is neutralized by the acetic acid.
Of 174 eases of vomiting following the administration of chloroform, 125 pa tients were relieved by causing. nein to inhale the fumes of vinegar previously placed upon a towel and left over the face of the patient for a number of hours after the chloroform-mask had been re moved. Tf tile vomiting returns after this treatment is stopped a renewal of it will be sufficient to check the relapse. Lewin (La Al6d. Mod.; Titer. Gaz., 'Mar. 15, '98).
Paralysis sometirnes ensues. It is usu ally due to pressure against the edge of the table or to strained position of the members. Strychnine and electricity are indicated in such cases, with mass age calculated to increase the activity of the local circulation.
Case which presented complete paraly sis of right arm; still present three months after antesthetization. Post chloroformic paralyses generally due to compression of the brachial plexus. Franke (La Tribune Med., July 17, '95).
Case of musculo-spiral paralysis from pressure. Patient's arm pressed against an iron bar. Several similar eases have been reported. Commonest in laparoto
mies where operator stands at the side and the arm pulled up to be out of his way. Bruns (Archives Clin. de Bor deaux, Nov., '95).
Paralysis arises from several causes: First, from the position in which the patient is lying, whereby pressure is ex ercised upon a supplying nerve, or as a result of tractions on the arm or leg of a violent nature. Second, the employ ment of impure chloroform, which seems capable of poisoning the nervous system and producing such paralysis, at the same time developing transient or per manent albuminnria. Ta,sse (La Semaine Med., Mar. 10, '97).
Therapeutics.—The therapeutic uses of chloroform are somewhat restricted. It is an invaluable agent, however, in the treatment of general convulsions of any kind and of whatever origin: eclamp sia, epilepsy, etc. As a smaller quantity than is necessary for snrgical purposes suffices, the inhalations are not attended with after-effects.
One of the many elements in the toxaemia of puerperal eclampsia is the changing of urea into ammonium car bonate. This salt is demonstrable in the fxces eelampsia, and it is the result of the principal change in that complex blood poisoning which b2,- its effects on the nervous system give rise to the con vulsions which are so characteristic. It is also well known that chloroform pro duces a temporary glycosuria ; hence we may readily assume that we must have glucose in the blood. If we admit the presence of this sugar in the blood, we can easily demonstrate by our test-tube that it does prevent the changing of urea into ammonium carbonate. 'Hence chloroform, with its accompanying gly cosuria, is the antesthetic par excellence in puerperal convulsions. Not that if will inhibit the development of all the poisons in the toximnia, but it will limit the production of the chief one. D. H. Stewart (Medical News, Jan. 3, 1903).
WHOOPING-COUGH.—In whooping cough inhalations of chloroform some times act in a remarkable manner as a calmative. Violent attacks of cough may usually be stopped by pouring a few drops on the hand and holding the lat ter a few inches under the child's nose.
It is also credited with value in chorea, but the almost continuous abnormal movements in this disease render its use inadvisable.
PARTURITION.—The suffering of labor may also be greatly mitigated without danger by a small quantity of chloroform inhaled from a cone just prior to the on coming pains. The labor is not retarded and the success of the case is not com promised. The aim should not be to produce unconsciousness, but to blunt the sensibility; given in sufficient dose to produce surgical amesthesia, the gen eral relaxation of the uterine tissues pro duced tends to increase the dangers of haemorrhage. Bedford Brown, however, states that the alterations in the vaso motor system of the pregnant woman enable her to resist the toxic action of chloroform to a greater extent than usual.