undertaken. When I inhale chloroform my-narcotics act so differently on different indi-
self, I am sensible at this stage of a tremen-viduals. Enormous individual differences,
dous feeling of internal restlessness, vibra- in fact, exist as to sensibility to the action
tion and beating at the fingers' ends, and of of poisonous substances employed as medi-
an overpowering sense of the loss of all ca- cines. Thus, I am attending a lady in
pacity of will or action. So little tractable whom one-eighth or one-sixteenth of a grain
are most patients in this stage that we have of morphia excites such suffering, uneasi-
to carry them into the next-that of tole-ness, and vomiting, that, in spite of the se-
rance. The convulsions cease, and there is
muscular quietude. The mental disturb-
ances continue, but they have lost their
connection with the motory apparatus. The
condition of dreaming is set up, and, just
like in sleep, when the narcosis is slight,dered, after every spoonful was seized with
vivacious images are attended by move-
ments; when this is deep, all spontaneous
motion ceases. This condition of deep sleep
is the most favourable one for operations,
and the one we seek to maintain.

verest pain, she dares not take it; and yet
upon any of us such a dose would produce
scarcely any effect. Another patient, for
whom a mixture of half a drachm of iodide
of potassium in six ounces of water was or-

So

symptoms, we are powerless, although even
in these artificial respiration must not be
neglected. Much stress is laid upon the
purity of the chloroform employed, and
rightly so; but whether impurity produced
by products of decomposition is dangerous
has not been proved. Chloroform that has
been kept long and exposed to the light
always contains free hydrochloric acid and
chlorine, and although this may not be dan-
gerous, it should not be employed, for pa-
tients cannot inhale it, as it immediately in-
duces severe coughing, burning in the throat,
and constriction of the larynx. These symp-

aphonia and a splitting headache, and when I persuaded her to continue the medicine, after a few spoonfuls the entire head became erythematous, and weeping, discharge from the nares, with cough, etc., ensued. To this succeeds the paralytic stage, in belladonna, in the dose of ʊ grain, may which all traces of the power of movement induce symptoms of poisoning. In cases in have ceased; for while during the stage of which individuals manifest such excessive tolerance reflex movements are not infre-sensibility to chloroform that a few inhalaquently met with, now there is absolute tions prove fatal without any premonitory rest. Only breathing and the heart's pulsation continue, and if the narcosis be too prolonged even these will become paralyzed. The possibility of making a practical use of chloroform depends entirely upon the fact that the muscles of the extremities and of the trunk are first; and those of the heart and respiration last paralyzed. This paralytic stage is seldom resorted to for therapeutical purposes, and it is so chiefly for the reduction of old dislocations or the rupture of anchyloses. Between this paralytic stage and paralysis of the heart there is, however, always a large interval, the passage of the one into the other not usually taking place{toms, as well as one's own sense of smell, suddenly. The cessation of respiratory activity is announced first by stertor, and then by irregularity or incompleteness of the respiratory movements; and that of the heart by the gradually approaching feebleness and slowness of the pulse-the respiration ceasing prior to the action of the heart. Danger may arise in all the stages of The practical rules for the employment of chloroform-narcosis. During that of excitechloroform are founded upon the observation ment violent muscular efforts may give rise of these stages in thousands and thousands to apoplexy, especially in individuals with of cases. Yet there are individuals who, disease of the heart, rigid arteries, or emstanding apart from all such rules, after a physema. Of most consequence in this few inhalations quickly perish. It is said stage, however, are the contractions of the of such that they have an idiosyncrasy as muscles of mastication and the posterior regards chloroform. And there is no reason muscles of the tongue. By means of the why this should not be the case, or that all stylo-glossi and the glosso-pharyngei, the persona should be alike sensible to the ac-tongue is drawn spasmodically backwards, tion of chloroform, while the various other pressing the epiglottis down so as to me

lead us to reject it. Whether some material
that is specifically dangerous is generated
in chloroform by long keeping is unknown;
but that chloroform is very variable, both in
its smell and its effects, no one can doubt
who has had much to do with it.

chanically close the aperture of the larynx. the chloroform was continued, with the obSuch patients become blue in the face, and (ject of attaining the stage of tolerance. But

die suffocated, not through the direct action as soon as the convulsive movements had of the chloroform, but from the mechanical ceased, the patient assumed the appearance privation of air. Such cases have been often of a corpse. The mouth was opened, and observed in the Clinic, rendering it neces- the tongue drawn out in the belief that closary to force open the mouth with Heister's sure of the larynx had produced the effects speculum and draw out the tongue. When observed. This did no good, and the conthe narcosis is continued too long, there is traction of the stylo-glossi and the constricdanger of paralysis of the heart and sudden tores pharyngis prevented the passage of a collapse. It is a rule not to prolong the catheter into the larynx. Tracheotomy was narcosis when the upper eyelid allows itself at once performed, and a canula passed in, to be raised without any muscular resistance. but all in vain. The narcosis had lasted a Individuals in which this can be done only very short time, and, at the autopsy, there at a late period, or perhaps not at all, and in was scarcely any smell of chloroform. Eviwhom a paralytic condition of the respirationdently, a sudden collapse had occurred, his takes place simultaneously with muscular condition giving the impression of a deep quietude of the extremities (which happens swoon. It is a rare thing for a healthy man especially in drunkards), require to be to die during syncope, although this happens watched with the greatest care. There are with old people and during convalescence, subjects in whom complete muscular quiet- and especially after pneumonia. Death ude can never be attained. Before the utter from sudden collapse is also met with after stagnation due to paralysis of the heart and typhus. I am under the impression that the respiratory muscles is brought about, there present case was one of such collapse, ocare changes due to the paralysis of the mus- {curring during the narcosis, in consequence cles of the face to be observed. The jaw of anæmia. Generally there is not much sinks, the features become corpse-like, and learned from the autopsies of those who die the face pale, and we have the facies Hippo- from narcosis. The blood is pretty concratica before us; and so characteristic is stantly found not to be coagulated, and somethis change of physiognomy that, once seen, {times of a cherry-red appearance. This it can never be forgotten. It is therefore non-coagulation of the blood gives rise to of the greatest importance that the face of numerous consequences, which formerly the patient should be well watched. Ano ther warning sign is that the blood, during an operation, ceases to flow from the arteries or is of a dark blue colour.

were supposed to be characteristic of death from chloroform, such as hyperæmia of the posterior part of the lungs, kidney, and spinal marrow, etc., which are really postThe case we met with yesterday does not, mortem appearances due to the fluidity of in my opinion, belong to this category, as the blood. In the present case these ap. it did not give the impression so much of a pearances were present, although the heart case of intensely aggravated chloroform poi- and large arteries were strongly contracted, soning as of one of sudden collapse-a view and almost empty of blood. The heart is rendered probable also by the very anæmicfound in different conditions. In animals it condition of the individual. This man, is commonly dilated, especially the right twenty-six years of age, but looking much ventricle, but in the present case, as in all older, had, while drunk, cut his finger with anæmic subjects, it was strongly contracted. a china pot, and, according to account, lost There is no distinctive sign of death from a great deal of blood. At all events, when chloroform, and if an individual were killed he came to the hospital two or three days by it, and no other non-medical proof of after, his anæmic appearance was remarka- this existed, the anatomist would not be in ble, and this condition was further shown a position, from the condition of the body, by his excessive sensibility to pain, leading to declare that this had been the case. Even to the belief that one of the digital nerves (the odour of chloroform is a worthless sign, might be exposed. It was on this account for Rokitansky states that the brain espechloroform was given, and all at first went on as usual. Convulsive movements ensued, and, as during these, neither an examination nor operation can properly be performed,

cially sometimes gives out an odour exactly like that of chloroform without any ground for supposing that this substance had been employed.

one I ever saw. We must regard chloroformization as an operation by means of a chemical agent, as with arsenic, chloride of zinc, etc., and compare its results with those of other minor operations. I am convinced that the mortality statistics after the application of leeches, blistering, cupping, and

grene, tetanus, etc.), is greater than 1 in 12,500; but no one on that account has thought of prohibiting these means, and the use of chloroform cannot be prohibited because of these seldom-occurring fatal cases. The psychical impression which such a death produces is, by its very suddenness, a very powerful one, and exerts especial in fluence upon those who have not been ac

With respect to the administration of seconds become minutes and minutes hours chloroform, the employment of the chloro- Stimulating the phrenic nerve by means of form inhaler constitutes the best, the quick-electricity is undoubtedly a useful means est, and most convenient mode. The sin- for exciting the respiratory movements; but gular idea that a mixture of chloroform and unfortunately an apparatus is seldom ready ether is less dangerous than either of these when wanted. substances used separately has been aban. Fortunately, we may regard death from doned. Above all things, never adminis- chloroform as a very rare occurrence, and ter chloroform alone, but always have at one becoming more rare every year. Reckleast one assistant with you. When thereoning that, during my fifteen years of cliniis rattling in the throat, blueness of counte-cal teaching and the two last years of my nance, and irregularity of breathing, remove student life, I have been present at two the apparatus, and throw open the windows administrations of chloroform per diem and doors so that plenty of air may gain ac- (which is a low and certainly not an exagge cess to the patient, which is further to be rated estimate), I shall have witnessed 12,500 aided by forcing the mouth open and draw-cases of narcosis, and this is the first fatal ing forth the tongue-a manœuvre often attended with the best effects. Let the patient, and especially if there are not plenty of assistants at hand, always be in the lying, not the sitting, posture. The dashing the surface with cold water or applying ammonia can only be of service when the narcosis is slight enough to admit of the excitement { bleeding (through erysipelas, hospital gan-. of reflex movements; but in the paralyzed condition all such means are only a dangerous loss of time. Here artificial respiration must be at once resorted to, and executing this by mouth to mouth, with compression at the lower part of the thorax, is a preferable procedure to Marshall Hall's method. It is true that in this mouth-to-mouth procedure much of the air passes into the stomach; but the plan, with all its disad-customed to see men die before their eyes. vantages, is found practically useful, and, at Unfortunately, we have in surgery only too all events, resorting to it is better than do- often occasion to be convinced of the incoming nothing. The access of air may be pleteness and the impotence of our present facilitated by passing a catheter into the amount of knowledge. A mere cut of a larynx, which, in the paralyzed condition, is finger, especially if this opens into a joint as easy as after death. A great part of the or the sheath of a tendon, may give rise to air passes out again by the side of the cathe- phlegmonous inflammation, which during ter, but a considerable portion enters the the last twenty years has caused far more lungs in tolerable force. When the cathe-deaths than chloroform. Urged by the pa ter cannot be introduced, tracheotomy tient's vanity, we remove a small tumour should at once be performed, and a large from a man's scalp, and he dies of erysipecanula passed in. Artificial respiration las, or another dies from tetanus brought must be exercised in a regular rhythmical on by some slight injury-perhaps only the manner, and its efficacy as much depends prick of a thorn; and, as regards the cause upon the respiratory movements being forci- and action of these circumstances, we are ble enough as upon the admission of the as ignorant as we are regarding death from oxygen to the blood. In this case, artificial chloroform. respiration was continued for half an hour; But while such cases are sad to reflect but really after from ten to fifteen minutes upon, they should not, any more than the of inefficacious efforts all hope had ceased. one of yesterday, lead us to despair in our The duration of the asphyxia is not, how-art and means of investigation, nor to settle always easily estimated; for at such down in desponding resignation. Let them a time the watch is not looked at, and act as a great warning cry of nature, rousing

ever,

Accordingly having prepared himself with a number of bougies, to meet any contingencies, he says: 'I first attempted the passage with a No. 12 English bougie; but after using as much force as I deemed safe for fear of transverse laceration of the gut, I next introduced a conical-pointed wax bougie

Puerperal Convulsions.—Dr. FORDYCE BARKER, in a clinical lecture recently de-of the size of about No. 6, and pushed it in livered at Bellevue Hospital, summed up our knowledge on this subject as follows:First, That we have puerperal convulsions arising from uræmia, caused by Bright's diseases of the kidneys.

Second, That we have convulsions associated with congestion of the kidneys and albuminuria, but it is not yet proven that the convulsions and the renal congestion bear the relation of cause and effect.

the direction where I ought to find the upper portion of the rectum. This was carried up about two inches, or until resistance ceased. On withdrawing the instrument, only the colour of the meconium on its point showed that I had accomplished the object. I then introduced the larger bougie, which had failed before, and carried it up in the track of the smaller one, and, upon withdrawing it, I had the satisfaction of seeing a discharge of about four ounces of meconium with flatus. The passage was further distended by larger instruments, until a free passage was afforded. No further treatment was In relation to one point in the treatment, found necessary. The vomiting ceased viz., the delivery of the child, the principle and the child rallied from a condition so low which should govern us is this: Whenever as to give no sign of pain during the operadelivery by art can be effected with less tion. Some months afterward defecation irritation than would be produced by the was difficult, but not sufficiently so to warcontinuance of the child in the parturientrant interference, and when three years old canal, it should be resorted to.--Med. Record, it entirely disappeared.

Third, That we have convulsions that arise from reflex irritation and congestion of the true spinal system, without evidence of any renal affection.

Nov. 16, 1868.

Catalogue of the United States Army Case of Congenital Imperforate Rectum, { Medical Museum.—In a notice of this catasuccessfully treated without a cutting In-logue in the Med. Times and Gazette (Sept. strument.-Dr. J. D. B. STILLMAN (Cali- 26, 1868) the reviewer remarks: Never fornia Med. Gaz., July, 1868) was called to before has a government devoted itself with see a male child four days old, who had not so much zeal and with such liberality to the had an evacuation of the bowels, had wor-advancement of medicine and surgery. ried much, and was now almost continually We have already noticed from time to time vomiting. The point of a catheter could the very admirable reports which have isbe carried through a well-formed anus about sued from the Surgeon-General's Office at three-fourths of an inch, when its further Washington, and from the Sanitary Comprogress was arrested. An examination mission, and we have now before us the with the finger confirmed the nature of the catalogue of the Army Medical Museum, difficulty. There was a perfectly formed a rich storehouse of facts, which is unsurcul-de-sac, the fundus of which was firm, passed, and probably unequalled, in Europe. and resisted all the force deemed advisable The arrangement and classification of the to use. Its depth was not far from three-subjects reflect the highest credit upon the fourths of an inch. After careful consider-officers of the Museum, and especially upon ation of the case and the different ordinary Assistant Surgeon Woodhull, who has unprocedures, Dr. S. determined to employ{dertaken the arduous duties of editor. a blunt-pointed instrument, trusting to the When we inform our readers that the catastrength of the fibrous coat of the intestine logue forms a ponderous quarto volume, to retain the instrument within its walls, if containing nearly 1000 pages, they will apthere were any; and, in case there were preciate the labour involved in its producnone, it could not fail to reach the pouch {tion, and the impossibility of doing more

than merely indicating the general char- tic; and that the very various cardiac and acter of the contents in the limits of a vascular lesions which are found in different review."

cases are but accidents and complications. A system of treatment based on this prinDetroit Medical College.-This is the ciple proves greatly more successful than title of a new medical college recently or any other: the two remedies which have ganized at Detroit, Michigan. The faculty yielded him the best permanent results are consists of Edward W. Jenks, M.D., Prof. arsenic given by the stomach or by inhala of Obstetrics and Diseases of Women and {tion, and strychnia subcutaneously injected Children; Theodore A. McGraw, M. D., in doses of from 0 to 40 grains. The Professor of Principles and Practice of benefit produced by these remedies is very Surgery and Clinical Surgery; Geo. P. remarkable. The best palliative for the Andrews, M. D., Professor of Principles actual attacks is ether, in teaspoonful doses. and Practice of Medicine and Microscopy; -The Practitioner, Oct. 1868. Samuel P. Duffield, Ph.D., M. D., Professor of Chemistry and Toxicology; C. B. Gilbert, M.D., Professor of Materia Medica and Therapeutics; Wm. H. Lathrop, M.D., Professor of Physiology and General Pathology; J. F. Noyes, M. D., Professor of Ophthalmology; N. W. Weber, M. D., Professor of General and Descriptive Anatomy; J. M. Bigelow, M. D., Professor of Medical Botany; P. P. Gilmartin, M. D., Adjunct Professor of Obstetrics and Lec- Bromide of Potassium for the Sleeplessturer on Medical Jurisprudence; H. O.ness of Infants.-M. MOUTARD-MARTIN Walker, M. D., Demonstrator of Anatomy.

The Medical Bulletin.-This is the title of a bi-monthly journal published in Baltimore under the editorial direction of Dr. EDWARD WARREN, of which the first number was issued on the 16th of November last. Each number contains eight pages in small folio form. We shall be pleased to enter it on our exchange list, and wish it success.

Peroxide of Hydrogen in Diabetes.- Dr. B. W. RICHARDSON, in a recent interesting {lecture (Medical Times and Gazette, Dec. 12), stated that he had used this article in eleven cases of diabetes, and regretted to say that "at this moment there is no proof that the peroxide of hydrogen is of specific value in the treatment of diabetes."

has communicated to the French Academy of Medicine a memoir on "Some Applications of the Bromide of Potassium to the Medicine of Young Infants." Every one, he observes, admits the possession of sedative properties by the bromide, and in this direction it has become one of the most useful substances in the Materia Medica. Bearing in mind its hyposthenic action in erethism of the nervous system, and its innocuity, even in large doses, he believed OBITUARY.-Died, in Providence, R. I., that it might be employed with advantage Dec. 19, 1868, aged eighty years, USHER in some of the pathological conditions of PARSONS, M. D. Doctor P. was the last very young children. Among these sleepsurvivor of Commodore Perry's officers at lessness, alike mischievous to the infant the battle of Lake Erie. He was one of and wearying to the nurse, is one of very the founders of the American Medical As-common occurrence. The child does not sociation, and during its early years a con- seem otherwise ill, but has a very great instant attendant at its meetings. He was sufficiency of sleep both by day and night, the author of several medical works and aor only at night. Where a great variety contributor to various medical journals.

of means has failed to remove this sleeplessness, the bromide succeeds in a remarkSable manner, and M. Moutard-Martin adFOREIGN INTELLIGENCE. duces in his paper several cases in proof. Cardiac Neuralgia.-Dr. ANSTIE read a His conclusions are-1. The bromide of paper at the late meeting of the British potassium given in small doses (from five to Medical Association at Oxford, in which twenty centigrammes) is very well tolerated he endeavoured to prove that the essential by young infants. 2. By its sedative action pathology in a whole group of cases which it cures insomnia in these cases. 3. Adexhibit more or less typically the features of ministered to infants suffering from the acwhat is known as angina pectoris, are neuro-cidents of dentition, such as restlessness,