1. The period of life, according to Dr. Snow, in which Chloroform acts most pleasantly is childhood. There is no case on record of death from Chloroform under five years of age (Sansom*). It is never necessary to carry the narcotism further than the beginning of the third degree in children, and very often not beyond the second. As age advances, the action of Chloroform, though equally safe and effectual, is not so uniformly pleasant in appearance. In old age there is frequently either groaning or • slight degree of stertor; and the patients are generally longer than others in recovering their consciousness.
2. Persons who are debilitated, either by long sickness or any other cause, become more quietly and quickly narcotised than those in robust health. In these last there is often considerable mental excitement, and resistance to the anaesthetic influence. Dr. Sansom states that the age most prone to death from Chluroform is that called the prime of life, the average being between thirty and forty. Men are also more prone to death from this agent than females. There has been greater fatality amongst persons about to undergo slight operations for maladies which have not interfered with their general health, than amongst patients who have taken Chloroform previous to capital operations.
3. It has been the practice in some of the London hospitals, to give a light and moderate meal two or three hours previous to the administration of Chloroform. M. Aran, however, insists strongly upon the necessity of its employment upon an empty stomach. MM. Perrin and Duroy also, from the observations of the phenomena produced by Chloroform after a hearty meal in the dog, assert the importance of administering Chloroform only when the stomach is empty.
4. During the administration of Chloroform, the patient's mind should be kept as quiet as possible, not distracting him by unnecessary questions, or attracting his attention by surrounding objects.
6. In operations in the mouth and nose, it must be used warily, if at all, in consequence of the risk of asphyxia by blood escaping into the air-passages. (Mliller.)
7. In operations, an assistant, who should do nothing else, should always be employed to administer the Chloroform, to watch its effects, &c. (Lizars.)
8. If vomiting ensue, the operation should be suspended until this action ceases, otherwise there is imminent risk of suffocation. (Lizars.)
9. After the inhalation has been discontinued, the patient spontaneously recovers from its effects. It is better not to speak to him prematurely, but quietly to await the complete return of consciousness.
1. Do not be too anxious to obtain a rapid effect. 2. Be careful that a large proportion of atmospheric air be mixed with and inhaled at the same time as the Chloroform. The proportion of Chloroform to atmospheric air should not exceed 3 1/2 per cent. For the purpose of insuring accuracy in the proportion, it is safer to administer the Chloroform by an inhaler - e. g. Snow's, Clover's, or Sansom's. 3. It should be given with great caution when extensive disease of the lungs or heart exists. 4. It should never be given when the pulse is weak and intermitting. 5. It is contra indicated in poisoned conditions of the blood, as uraemia: and in acute cases of alcoholism, e.g. delirium tremens. (Sansom.) 6. It should not be given in cases of advanced organic disease. 7. It is not advisable to induce profound insensibility during pregnancy. 8. It should never be employed without the presence of a medical man.
* Sansom on Chloroform, Medical Times and Gazette, Nov. 7, 1863.