External

Chloroform is employed in the form of the liniment to produce rubefacient and irritant effects in cases of chronic rheumatism, myalgia and chronic inflammations.

Internal

It may be used as a local anaesthetic for toothache, the tooth being plugged with a piece of cotton soaked in chloroform. It disguises the taste of nauseous medicines, and therefore Aqua Chloroformi is a very common vehicle and Spiritus Chloroformi is much used as a flavoring agent. In the stomach it acts like alcohol, and is given in the same varieties of dyspepsia as are benefited by that drug. Small doses may be used as a cardiac stimulant.

Inhalation

It is inhaled to abolish sensations of pain, whether from surgical operations, biliary, renal and intestinal colic, or parturition. In the last case but little need be given. It is also inhaled to relax muscular spasm, as in the reduction of dislocations or hernias, or for the relaxation of muscles for diagnostic purposes, as, for example, when we wish to feel the abdominal viscera thoroughly, or to ascertain whether a swelling is a phantom tumor; or, lastly, it is inhaled to relax spasm in cases of tetanus, hydrophobia, or other varieties of convulsions. The A. C. E. mixture, which consists of alcohol, 1, chloroform, 2, and pure ether, 3 vols., is very commonly employed for all these purposes. It is said to be safer than chloroform. All of its three constituents volatilize from it at an equal rate.

The following points should be attended to in the administration of chloroform:

1. The anaesthetizer must be skilled, and give his attention exclusively to the production and maintenance of narcosis.

2. The respiration and pulse should be carefully watched for any signs of failure.

3. The operation should never be begun till reflex action is profoundly depressed - that is to say - till the stage of muscular relaxation has commenced. Many patients have been lost from neglect of this precaution, for the stimulus of the knife has reflexly stopped the heart. It is a common and dangerous error to think that, because the operation is trivial, it may be begun early; most of the deaths from chloroform have taken place when the operation has been slight.

4. Great care must be exercised if the heart is fatty or feeble from any cause, or if the patient suffer from disease of the lungs, or if he may be very old.

5. In operations about the mouth care must be taken to see that no blood gets down the trachea.

6. It is desirable to have the stomach empty, therefore no solid food should be given for some hours before the administration. The patient's head must be so directed during vomiting that no vomited matter can get into the larynx.

7. False teeth should be taken out of the mouth.

8. The chloroform must be pure.

9. It should not be too concentrated. About 5 per cent. of chloroform to 95 per cent. of air is a good mixture.

10. The head should be a little raised, and the lower jaw held up so that the tongue shall not fall back over the larynx.

11. Special care must be taken when the operation necessitates awkward positions, especially if respiration is interfered with, as in the lateral position used in obstetrical, gynaecological and renal cases.

12. Because the temperature falls the patient should be kept warm.

13. Chloroform should never be administered without an hypodermatic syringe, in good order, being at hand. Amyl nitrite, ether and ammonia should be in readiness.

If the breathing becomes very weak, or stops altogether, artificial respiration should at once be commenced, the tongue being pulled forward by forceps to allow free entry of air to the lungs. The face and abdomen should be flicked with wet towels, a capsule of amyl nitrite may be inhaled, and ether injected subcu-taneously. Brandy should not be administered hypodermati-cally. The heart may be stimulated by large rectal injections of hot normal saline solution, or of hot decoctions of coffee, if at hand. It is extremely questionable whether galvanization over the cardiac area is of any use; it doubtless does harm. If symptoms of improvement do not appear at once, the patient should be inverted. Artificial respiration should be maintained at least an hour or so, even if there is no sign of returning life; and if there is the slightest evidence of a cardiac beat, or a single automatic respiratory movement, artificial respiration must be persevered in even for many hours. If the face be pale, the head should be lowered, and amyl nitrite is especially likely to be useful. In spite of all care in administration and the observance of all precautions, one death takes place in about three thousand administrations. Hare and Thornton, after a painstaking series of experiments, believe chloroform to be safe for the majority of cases, provided it be given by one skilled in its use, and who not only knows how to give it, but to detect signs of danger. The respiration should be watched, because so soon as enough chloroform is used to endanger the circulation, the respiration will show some abnormality. Death in the healthy animal is always due to respiratory failure, accompanied by circulatory depression which may be severe enough to cause death, even if artificial respiration be skillfully used. Chloroform may be chosen in hot climates; when a large number of persons are to be anaesthetized; in Bright's disease; in aneurism; or in great atheroma of bloodvessels; in children or adults who already have bronchitis; and in persons who struggle violently.