* It is now stated that Sir J. Y. Simpson recommends preferably the method of Dr. Moir, which consists in placing a single layer of towel over the mouth and nostrils, and applying the chloroform drop by drop, until the required effect is obtained. (Richmond Med. Journ., Feb. 1866, p. 127; from the Edin. Med. Journ.)-Note to the third edition.

Experience has suggested various cautions in conducting the process. in the first place, it is advisable, for all medical and obstetrical purposes, to stop short of the abolition of consciousness; and, even in surgery, profound coma should be avoided. Secondly, particular watchfulness should be directed by a competent person to the state of the symptoms, so that, upon the instant that slow or stertorous respiration is produced, or the pulse begins to fail, the chloroform may be withdrawn. Thirdly, restorative measures should be immediately resorted to, if called for by alarming symptoms; and for this purpose the requisite means should be provided beforehand. Life has, no doubt, often been saved by this precaution. Fourthly, it is generally thought advisable not to administer chloroform on a full stomach, or in cases of disease in which the heart is debilitated, whether functionally or organically, or in any case in which there is a disposition to syncope.

It seemed probable that combination with ether might serve as the best protection against the debilitating influence of chloroform upon the heart. The two medicines co-operate in the production of the anaesthetic state; while, as heretofore stated, theory at least would indicate that the depressing effects of the chloroform might be counteracted by the stimulation of the ether. This plan has been extensively adopted in the United States. Equal measures of the two liquids have been used; but it would be better very much to increase the proportion of ether, of which there should be four parts to one of chloroform. in Vienna six or eight parts are said to be employed. {Med. Times and Gaz., July, 1858, p. 89.) it is, of course, only as an anaesthetic agent that this combination has been recommended. When the object, as in many cases of disease, is to obtain the sedative effects of the chloroform, and there may be a contraindication of ether on account of its stimulant properties, the former medicine should be given unmixed. This mixture, however, has not met all the expectations of those who first employed it. An instance of death in a child, five years old, from the inhalation of a mixture of one part of chloroform and four of ether, has been recorded by Dr. R. Crockett, of Wytheville, Va., in which the anaesthetic seems to have been carefully employed, and in not undue quantity. (Am. Journ. of Med. Sci., July, 1857, p. 284.) Since the appearance of the second edition of this work, another death has been announced from the same cause. The preparation used consisted of two parts of ether and one of chloroform, and the second drachm had just been inhaled, when the heart and lungs suddenly ceased to act, and the patient died. As the brain was found very anemic on examination after death, there can be no doubt that the result was owing to the powerful depressing effect of the chloroform, before the ether had time to obviate it. (Med. Times and Gaz., Oct. 1866, p. 378.) The idea, therefore, must be abandoned of securing against the dangers of chloroform by the antagonizing influence of ether, administered in connection with it.

The late Dr. John C Warren, of Boston, was in the habit of using a mixture of chloroform and pure alcohol, in the proportion of one part of the former to two of the latter, under the impression that the narcotic power of the chloroform thus diluted might be less dangerously exercised. He originally used the impure product, obtained by the first distillation from the materials employed for preparing chloroform, called improperly chloric ether; but substituted the above preparation, as more definite in composition, and called it strong chloric ether. it is simply chloroform diluted with alcohol, and is probably safer, in surgical practice, than chloroform alone, both from the diluted state in which the vapour enters the lungs, and the counter-agency of the stimulating vapour of alcohol. Dr. Warren employed it frequently, and in no case with evil results. (Effects of Chloroform, etc., Boston, 1849.)

The topical application of chloroform is made in various ways. The simplest is to saturate with it a piece of soft linen, and, having placed this upon the surface, to cover it with oiled silk, in order to prevent evaporation. This, however, in general occasions at first a very disagreeable burning pain, with rubefaction, which, though often in itself useful, renders the method objectionable in many instances, particularly in persons of very sensitive skins. Another method, which I have frequently used, is to mix it with an emollient poultice, as of bread and milk for example. Or it may be made in the form of a liniment or ointment by admixture with olive oil or lard, in the proportion of one part of the chloroform to two or more of the oleaginous matter, and applied by inunction. Such a preparation has been adopted in the Pharmacopoeias, with the name of Liniment of Chloroform (Linimentum Chloroformi, U. S., Br.). in the U. S. process it is made by mixing three parts of chloroform with four of olive oil; in the British, equal parts by measure of chloroform and liniment of camphor. Chloroform may be used, too, as a lotion, simply diluted with alcohol, or added to the camphorated tincture of soap. it was at one time thought that its local anaesthetic property might be taken advantage of to prevent the pain of surgical operations; but the influence does not extend to a sufficient depth. in superficial operations, however, such as the opening of boils and abscesses, and incisions in cases of anthrax, etc., it may sometimes prove serviceable.

Another mode of topical application has been proposed, and promises to be advantageous under various circumstances. it was suggested by Dr. S. L. Hardy, of Dublin, in a communication to the Dublin Quarterly Journal of Medical Science (Nov. 1853, p. 306), detailing several cases in which the vapour was beneficially applied to the uterus, in painful affections of that organ. Dr. Hardy employed for the purpose a gum-clastic bottle, to the mouth of which was attached a small metallic chamber, having at its other extremity a pipe furnished with a valve. At the same end with the pipe, was a valve to admit atmospheric air for the working of the instrument, and, on the side of the chamber, a stoppered opening for the introduction of the chloroform, which was to be wholly absorbed by a piece of sponge contained in the chamber. The vapour was expelled by pressing the bottle. Any one can contrive a substitute for this instrument, who may possess an ordinary air-tight injecting syringe. The vapour may be directed from the mouth of the instrument, in a jet, upon any external part, or may be carried by means of a tube to any position where it may be required. it may be injected into the vagina, rectum, urethra, external auditory meatus, or morbid cavities. To the surface of the body, the vapour may also be applied by inverting over the part a hollow vessel, a tumbler for example, in which a sponge saturated with the liquid has been placed, sufficiently large to fill the bottom of the vessel, so that it may not touch the skin. The vapour produces the anaesthetic effect with only a preliminary sensation of warmth, which is scarcely inconvenient. Since the publication of his first communication, Dr. Hardy has very much extended this method of using chloroform. He has found it extremely useful in quieting the nausea of choleric diarrhoea when applied to the epigastrium; and enumerates among the affections in which it had proved useful, gout, rheumatic gout, anthrax, a painful stump after amputation, painful hemorrhoids, irritable bladder in which the vapour was introduced into that viscus by means of a catheter, painful menstruation, ulcerated os uteri, and carcinoma of the rectum. The catalogue might, no doubt, be greatly extended. (See Banking's Abstract, No. 21, p. 120.)

According to Mr. Charles Hunter, chloroform may be safely used hy-podermically in urgent cases. it quickly causes the cessation of existing spasm, and induces sleep. But its local effects are unpleasant. First it causes pain, then redness, swelling, and tenderness on pressure; in other words, it gives rise to inflammation. But Mr. Hunter states that this ultimately disappears, without any injurious result. in a case of fearfully painful neuralgia, from which the patient had been suffering for years, Mr. Hunter injected into the cellular tissue thirty minims of chloroform. Though the patient had been in the habit of inhaling and swallowing enormous quantities, yet this amount, slowly introduced, caused almost instant relief and sleep in fourteen minutes. it was afterwards several times injected with similar results; but he finally omitted it in consequence of the inflammation induced. (Am. Journ. of Med. Sci., Jan. 1860, p. 241.)