Preparation of the Patient.—The pa tient should be in an entirely-loose gar ment and in the recumbent position. A quiet, well-ventilated, and well-lighted room should be selected.
Any foreign body, such as false teeth, tobacco, or any accumulation of mucus, should be removed from the mouth, naso-pharynx, and nasal passages.
All solid food should have been with held for at least four hours and no liquid food for at least two hours before the administration of the anmsthetic, al though a small quantity of brandy or whisky may be given a few minutes be fore if the patient be at all debilitated.
[This recommendation is of the great est importance; for the regurgitation of food when the patient is under the antes thetic may. by ent ering the larynx, cau.se asphyxia. SA.tot.s.] The patient's fear should, as much as possible, be allayed by kindly and en couraging words, death being sometimes caused by heart-syncope, resulting from fright. A show of surgical instruments should be avoided.
Mental factors may be influential causes in the production of chloroform death. Fear and anxiety may cause pro found circulatory disturbance, and this condition may predispose to danger when an antesthetic is given. In such.cases an hypodermic injection of morphine should be administered, and ether should he employed instead of chloroform if there is no contra-indication. Hobert Ballard (Lancet, Alay 7, '08).
If the operation is at all to be pro longed or be of such a nature as to cause severe pain in the waking state, an hypodermic injection of morphine, 1/4 grain, should be administered twenty minutes before the chloroform is given.
Administration and in the case of other agents, it is obvious that the purest chloroform obtainable should be employed. Many instruments were devised for the purpose of administering anmstheties in general (the principal ones will be described under ETHER), but these are seldom employed outside of hospitals. Except under certain condi tions, when the anmsthetic is admin istered in the presence of gaslight, the simplest way to apply chloroform is on a towel or handkerchief; or a cone or funnel may be made with a folded towel into which the anmsthetic may conven iently be dropped.
On account of its irritant action, chlo roform should not be allowed to come into contact with the eyes or face. In the ease of a fair-skinned female patient, it is advisable to apply vaselin or cold cream where the chloroform-vapor is likely to touch the skin.
A drop-bottle should be employed for the arnusthetic, the pouring-out method usually employed being a dangerous procedure.
The patient lying upon his back, his chest is bared, a compress placed over his mouth, and 2, 3, or 4 drops of chlo roform poured upon it. The compress or cone is held so as not to close com pletely the nostrils and mouth, thus en abling the patient to inhale well-diluted vapor at first. In fifteen seconds the chloroform will have evaporated. when 4 or 5 drops more are then allowed to fall on the centre of the compress, this being turned rapidly so as to avoid an excessive intake of fresh air. This ma inmuvre is repeated about every half minute. 'When narcosis is complete, 2 or 3 drops of the anmsthetic are used every minute. Coughing indicates that the air inhaled is too heavily charged with chlo roform, while struggling in the first stage tends to show that the patient is feeling the 1-vant of air—a terror-inspir ing sensation.
The extreme danger of rapid chlo roformization was repeatedly emphasized by Richardson, who argued that fatal re sults follow upon the siidden impact of chloroform—an irritant vapor — upon the nervous periphery of the breathing surfaces. (See influences upon the nasal mucous membrane, infra.) This sudden impact causes, in his opinion, a contrac tion of the pulmonary arterial vessels; thence results ischmmia of the lungs and overfilling of the right heart, leading to cardiac stand-still. A few minims of chloroform injected into a vein kills the heart-muscle outright and beyond recov ery. If the animal is healthy the lungs prevent such a catastrophe when the chloroform is inhaled; but the author contends that when the heart is not healthy the lethal dose may be so small that it may pass through the lungs and reach the heart, causing fatal syncope. 'While gradual, rather than rapid, chlo roformization (two minutes for infants, three for children, and four or five for adults—Snow) is recommended, the dan ger is urged of overcaution, as the blood grows highly saturated with chloroform before amesthesia is obtained, and the organs and tissues are so saturated with chloroform that. should any causal acci dent arise, it is fatal in spite of all efforts to withdraw the chloroform from the blood, since reabsorption into the blood takes place from the tissues.