The tension of the intercellular fluid and the lymph in the eye appear to be diminished, so that the mammae become flaccid, the intra-ocular tension is diminished, and irregular astigmatism may occur.

The nervous system appears to be paralysed in the following order: first, the cerebral hemispheres; next, the grey matter of the cord; next, the white matter; next, the reflex power of the medulla oblongata; next, the automatic power of the respiratory centre, and lastly, the cardiac ganglia.

The order in which the nerve-centres are paralysed may sometimes be changed, and the heart may be affected before the espiration.

Dangers of Chloroform. - Cases may arise where it is im-possible to obtain assistance, but whenever it is possible to obtain help, anaesthetics should never be given without the presence of third person, both for the sake of the administrator and of |he patient. In consequence of neglecting this rule, a number of medical men have suffered severely from false charges of assault and rape brought against them by female patients. These barges, though perfectly false, have frequently been brought by atients in all good faith, and under the belief that they were true. The action of alcohol on the sexual centres in the brain (pp. 448 and 450) is surpassed by that of chloroform, and sexual excitement caused by the latter (p. 798) may be accompanied by delusions, which are afterwards remembered and believed by the patients to have been real events. By having an assistant in the room false charges arising from such delusions may be disproved.

For the patient's sake also no one should attempt, if it can possibly be avoided, both to administer anaesthetics and to operate, for this' is more than a single man can do, and the attempt to do both is likely to lead to failure in either one or both.

The dangers resulting from the employment of chloroform are: (1) death by stoppage of respiration; (2) death by stoppage of the heart. Usually the respiration stops before the heart. This order, however, may be somewhat varied, because occasionally the heart will fail before the respiration. This may sometimes be due to the employment of too strong chloroform vapour, because this very quickly paralyses the heart; but sometimes the stoppage of the heart before the respiration may be due to the shock of the operation, and not to the chloroform.

The respiration may stop from (1) obstruction to the entrance of air into the glottis by the tongue, by vomited matters, or by blood, (2) by mechanical interference with the respiratory movements, (3) by paralysis of the respiratory centre. If the heart is naturally feeble it is more apt to become paralysed. Aortic or mitral regurgitation do not by themselves contra-indicate the use of chloroform; but in all cases the heart should be previously examined, and if it is found to be weak and dilated, as in emphysema, and especially if there should be reason to suspect fatty degeneration, it is safer to employ ether. This is especially the case in persons who have been addicted to the use of alcohol.

Precautions.-(1) If the patient should partially wake from chloroform-narcosis during an operation, sickness is very likely to occur. In order to prevent this, it is well that the patient should take no solid food for four or five hours before the operation; but, at the same time, his strength should be kept from sinking by the administration of beef-tea, along with some alcoholic stimulant three hours before. When vomiting does occur, the head of the patient should be turned on one side, so as to allow an easy exit to the vomited matters, which should, if necessary, be removed from the mouth. Mr. Mills tells me that the most common causes of obstruction to the respiration are either falling back of the tongue or depression of the chin. Both of these may be remedied by changing the position of the head by turning it on one side, or forcibly drawing the chin away from the sternum at each inspiration. Very seldom it may be necessary to draw the tongue forwards with dressing forceps.

(2) Mechanical interference with the respiratory movements may occur from unwary pressure upon the chest, interfering with the thoracic movements. The most common cause of this is the weight of the patient's own body, when any operation upon the back requires him to be laid upon his face. In such cases, special watch should be kept upon the respiratory movements. Mechanical interference with respiration may occur in old people who have lost their teeth. The flaccid lips and the alae nasi are in them drawn inwards at each inspiration, and acting as valves prevent the entrance of air into the trachea. In such cases the mouth should be opened by the fingers (Esmarch).

Stoppage of the respiration may occur from the patient spasmodically holding his breath during the stage of excitement, but this usually soon passes off if the anaesthetic be pushed. The struggling is less if the anaesthetic be given gradually. (3) Paralysis of the respiratory centre takes place when the drug is pushed too far. It may sometimes occur suddenly, after a fresh quantity of chloroform has been poured upon the cloth used in administration. If the respiration ceases the administration of chloroform should be discontinued, and the patient roused by flicking the cheeks and breast with a wet towel. The tongue should be drawn forwards with forceps and artificial respiration begun if necessary. As a rule the patient can be restored with comparative ease by means of artificial respiration, provided the heart continues to beat, but on rare occasions even the prolonged use of this means does not induce any further voluntary respiratory movement. The easiest way of performing artificial respiration is to press the sternum forcibly inwards, and allow it to return to its normal position by its own elasticity. The pressure should be exercised synchronously with the operator's own respiration. Each time the sternum is depressed the ends of the fingers may be pressed under the cartilages of the ribs on the left side, so as to stimulate the heart mechanically also.