With heart-disease the anaesthetic may be given in any case which requires an operation, although when there is evidence of a fatty, weak, or dilated heart, great caution is demanded. Valvular disease is of less importance.

In phthisis, when an operation is unavoidable, the anaesthetic may be given with impunity.

For all operations upon the jaws and teeth, the lips, cheeks, and tongue, the anaesthetic may be inhaled with ordinary safety. By care and good management the patient may be kept under its influence to the completion of the operation. In these cases, blood, as it escapes, if not voided by the mouth, passes into the pharynx. If any small quantity find its way through the larynx, it is readily expelled by coughing. In operations upon the soft palate, fauces, pharynx, and posterior nares, if sudden or severe hAemorrhage is likely to occur, it is not advisable to induce deep insensibility.

In cases requiring laryngotomy and tracheotomy the anaesthetic may be employed with safety and advantage.

For operations upon the eye, involving the contents of the globe, the use of anaesthetics is open to objection on account of the damage which the eye may sustain from muscular straining or vomiting. If employed, profound insensibility should be induced.

In operations for hernia, and in the application of the taxis, the anaesthetic acts most benefieially. For most operations about the anus profound anaesthesia is positively demanded.

In the condition of shock or great depression, as after haemorrhage, careful administration of the anaesthetic diminishes the risk of an operation.

* Medical Gazette, Dec. 15, 1848.

In all cases, other than those specially referred to, it is sufficient to state, so far as a mere surgical operation is concerned, that an anAesthetic may invariably be administered.

The continuous vomiting occasionally induced by, and following upon the inhalation of anaesthetics, may be injurious by consequent exhaustion, as well as by mechanically disturbing the repair of a wound. With this reservation they do not appear to interfere with the recovery of patients from surgical operations. ]

837. The injurious and fatal consequences which occasionally attend upon the Inha'ation of Chloroform: - 1. Vomiting This has been mostly observed when the inhalation has been practised at an early period after the patient has partaken of a full meal, but it sometimes occurs without any assignable cause. 2. Convulsions. Much difference of opinion appears to exist as to the. frequency of convulsions after the inhalation of Chloroform; those who arc inimical to its general adoption representing convulsions as being a very frequent occurrence, while those who favour its use, and this class, it should be remembered, have employed it most extensively, declare them to be very rare. Dr Nevins * considers the proportion to be one in every six or eight, much too high a ratio; probably one in fifteen or twenty would be nearer the average, but sufficient statistical data are wanting whereon to rest any positive statement. It is fortunate, observes Dr. Nevins, that these convulsions scarcely ever commence during an operation; they are generally manifested as soon as the agent begins to take effect, if they are present at all, and therefore a surgeon is not liable to be betrayed into commencing an operation during their absence, and being interrupted by their subsequent appearance. If they are so severe as to interfere with the operation, he has nothing to do but to wait until the effects of the Chloroform have gone off, and his patient is no worse than if Chloroform had not been known. 3. Depression or Prostration. This occurs more or less in most cases. In the majority, this effect passes off speedily, and leaves no ulterior ill effects; whilst in others (a very small number compared with the number of subjects who have been brought under the influence of this agent;, the depression has been alarming and even fatal. 4. Headache has been observed in many cases, but it passes off in most instances in the course of a few hours. 5. Excoriation of the Lip* and Nose. This may be prevented by taking care to avoid direct contact. 6. Death. Dr. Sansom calculated that at the period at which he wrote (Sept., 1863), Chloroform had been administered 2,000,000 times, whilst the deaths which were known to have occurred were rather over 150. This is a very small number indeed when we consider the powerful character of the agent, the necessarily imperfect know ledge which existed with respect to its laws and operation at the dates immediately following its introduction, and the indiscriminate manner in which it has been employed. No remedy of the same power has been used so extensively and has been produ tive of less mischief. A strict attention to the rules, &c, laid down is imperatively demanded, in order to avoid this or any other ill consequence. The signs of danger from the inhalation of Chloroform are thus deduced by Dr. Sansom from the records of fifty-one fatal cases; - (a.) Sudden stoppage of the pulse. This was the first sign observed in thirty-eight (6) In addition, twenty-five showed pallor of the countenance. (c) Great muscular excitement, immediately followed by collapse, was present in five. (d) Sudden vomiting, with instant cessation of the pulse, in two. (e) Congestion of the face in six. (f) Cessation of breathing was the most noticeable point in eight cases. In cases of danger the great practical point is to restore the movements of respiration, and thus to give the stimulus of properly aerated blood to the failing heart. For this purpose artificial respiration must be performed cither by one of the two postural methods of Dr. Sylvester or Dr. Marshall Hall, or by mouth-to-mouth insufflation, or by galvanism of the phrenic nerve. Before any means of artificial respiration are adopted the tongue must be well drawn forward. Mr, Robinson* found that in cases of prolonged asphyxia from Chloroform, the exhibition of oxygen gas, diluted with atmospheric air, was successful in restoring the patient; but experiment has proved that the insufflation of nitrogen answers the purpose as well as that of oxygen or atmospheric air. The stimulus which recalls the reflex movements of respiration would appear to be as much physical as chemical. In slight cases the application of Ammonia, and dashing cold water in the face, will be sufficient to restore the patient. On the important question of the action of Chloroform on the heart and respiration, the Committee of the s aMedico-Chirurgical Society state that "the first effect of Chloroform vapour lis to increase the force of the heart's action, but this effect is slight and transient, for when complete anaesthesia is produced, the heart in all cases acts with less than its natural force. The strongest doses of Chloroform vapour, when admitted freely into the lungs, destroy animal life by arresting the action of the heart; whilst by moderate doses the heart's action is much weakened for some time before death ensues; respiration generally, but not invariably, ceasing before the action of the heart, death being due both to the failure of the heart's action and to that of the respiratory function.

* Translation of Lond- Pharm., 1851, p. 120.

Sansom on Chloroform, Med. Times and Gazette, .Nov. 7, 1863.

The danger attending the use of Chloroform increases with the degree of stupor it induces, the apparent irregularities in the action of the anaesthetic mainly depending on the varying strength of the vapour employed, on the quality of the Chloroform, and on the constitution of the patient."

For resuscitation, the Committee state "that the most certain means of restoring life after poisoning with anaesthetics is by artificial respiration.

By this means resuscitation may generally be accomplished after natural respiration has ceased, provided the heart continues to act; and it may sometimes be effected even after the cessation of the heart's action, but this result is exceptional. Galvanism resuscitates within the same limits as artificial respiration; it is, however, far less to be relied on than artificial respiration in equal cases. With either remedy it is found that animals quickly rendered insensible by a strong dose are more easily recovered than those which have been gradually narcotised, even by a small percentage of the anaesthetic."

Artificial respiration should on no account be delayed or suspended in order that galvanism may be tried.