Definition. - A liquid consisting of from 99 to 99.4 per cent., by weight, of absolute chloroform, and from 0.6 to 1 per cent. of alcohol.

Description and Properties. - A heavy, clear, colorless, mobile, and diffusible liquid, of a characteristic ethereal odor and a burning taste. Specific gravity, not below 1.476. Soluble in about 200 times its volume of cold water, and in all proportions in alcohol, ether, benzene, petroleum benzin, and fixed and volatile oils.

Chloroform is volatile, even at a low temperature, and boils at 6o to 61 C. (140o-141.8 F.). It is not inflammable, but its heated vapor burns, emitting a green flame. It should be kept in dark, amber-colored, glass-stoppered bottles, in a cool and dark place.

Dose, 2-15 minims (0.12-1.0 Cc.) [5 minims (0.3 Cc), U. S. P.].

Official Preparations

Aqua Chloroformi - Aquae Chlorof6rmi - Chloroform Water. - Dose, 1-4 fluidrachms (4.0-16.0 Cc).

Emulsum Chloroformi - Emtilsi Chloroformi - Chloroform Emulsion. - Dose, 1-4 fluidrachms (4.0-16.0 Cc).

Linimentum Chloroformi - Linimenti Chloroformi - Chloroform Liniment. - For external use. Chloroform, 30; soap liniment, 70 parts.

Spiritus Chloroformi - Spiritus Chloroformi - Spirit of Chloroform. - Dose, 10 minims-1 fluidrachm (0.6-4.0 Cc.).

Antagonists and Incompatibles. - Chloroform will not mix with weak spirits or glycerin. Circulatory and respiratory stimulants and galvanism antagonize to some extent its poisonous action. There is no chemical antidote.

Synergists. - Anesthetics, alcohol, morphine, chloral, and many of the hypnotics.

Physiological Action. - Externally and Locally. - Its action is similar to that of ether, though when confined on the skin it produces vesication. It is more of an irritant to mucous membranes than ether, yet when inhaled it is less irritating to the respiratory tract.

Internally. - Digestive System. - Its action upon the digestive tract is nearly identical with that of ether, except that when taken in a concentrated form it occasions marked irritation of the stomach and intestines, often resulting in violent gastro-enteritis.

Circulatory System. - Chloroform depresses the heart and circulation, the former by weakening the cardiac muscle, and the latter by lowering arterial pressure by depressing the vaso-motor center. It frequently produces an intermittent pulse by stimulating the inhibitory ganglia of the heart.

Nervous System. - It affects the brain and spinal cord in the same manner and order as ether, like it producing death, usually by respiratory failure, though sometimes the heart first succumbs to the influence of the drug.

Respiratory System. - Its action closely resembles that of ether, though its operation is more rapid and powerful.

Absorption and Elimination. - Chloroform affects the kidneys by irritation, certain investigators claiming that acute nephritis ensues, blood and albumin being often present; it is certainly less irritating than ether.

Temperature. - It depresses the temperature.

Untoward Action. - If there be any marked idiosyncrasy against chloroform, death has been known to occur suddenly after a few inhalations of the drug.

When applied externally there is produced not infrequently an urticaria-like eruption or an eczematous condition of the skin; vesicles may result. If applied to sensitive portions of the skin, such as the scrotum, severe and persistent pain is sometimes occasioned. Frequently, when applied to wounds and mucous membranes, it causes intense irritation, so much so that the mucous membrane may be shed in pieces.

The symptomatic manifestations of chloroform-anesthesia, the methods of administration, and the treatment of chloroform accidents are in the main similar in general principle to ether, and will be considered only in so far as certain differences are concerned.

The appliances used in producing anesthesia by the aid of chloroform are various, the simplest, as in the administration of ether, being a cone formed of a napkin or a towel enclosing a sponge or not, a sponge alone, or a handkerchief, upon which a small quantity of chloroform - not exceeding from a half to one fluid-drachm (2.0-4.0 Cc.) at a time - is poured. The utmost vigilance is requisite in the administration, the respiration, pulse, and facial indications being constantly observed; a supply of air is allowed to mingle with the anesthetic to obviate the dangerous effect of its concentrated vapor. The drug should be instantly withdrawn upon the slightest indication of untoward symptoms, such as lividity of the face, debility of heart-pulsation, and stertorous or spasmodic respiration, and an ominous dilatation of the pupils.

Although the symptomatic features of chloroform-narcosis, especially those which accompany collapse and death, have been studiously examined, the conditions causing disaster are still but imperfectly understood. Nevertheless, premonitory indications are seldom wanting which mark clearly enough the limit of safety in administration. Of these, extreme mydriasis and failure to produce reflex action in the conjunctiva are alone symptoms to be regarded with the gravest apprehension.

Relative Safety. - Comparisons as to the relative safety of ether and chloroform are misleading. Statistics pointing in both directions have been compiled, and certain surgeons have distinct biases. It would appear that more untoward accidents occur under chloroform-anesthesia than under ether, and a fair estimate may be made of 1 death in 2500-3000 anesthetizations, while for ether observations of numerous surgical services show an average of 1 in 10,000 - 15,000. Gurlt's statistics on over 300,000 anesthesias resulted in 1 in 2000 for chloroform to 1 in 5000 in ether. 11