^{page 311 note *} Boston Med. and Surg. Jour., 1874. Cf. Leonard Hill, Brit. Mid. Jour., April 1897.

^{page 311 note †} Thèse, Paris, 1879.

^{page 311 note ‡} Les Anesthétiques, 1890.

^{page 311 note §} Brit. Med. Jour., 1893, vol. i.

^{page 311 note ∥} Jour. Physiol., vol. xi. p. 97, 1890.

^{page 312 note *} Pflüger's Arch., vol. xliv. p. 596, 1889.

^{page 312 note ‡} Thompson-Yates Laboratories Reports, 1903, vol. v.

^{page 312 note ∥} Communication to the Physiol. Soc.; Jour. Phys., vol. xxix., 1903.

^{page 312 note ¶} Brit. Med. Jour., April 1902. Lancet, 1902.

^{page 312 note †} Jour. Anat. and Phys. vol. xiv., 1879, p. 495.

^{page 312 note §} Private communication.

^{page 318 note *} Dixon, Jour. Phys., vo1. xxx., p. 97, 1904. Also Brodie and Dixon, ibid., p. 476.

^{page 319 note *} Reflex constriction of bloodvessels can be obtained, on stimulating an afferent nerve, even if chloroform anaesthesia is very pronounced, showing that even in deep anæsthesia the vasomotor centre is still active, although its activity is no doubt lessened. Cf. Bowditch and Minot, op. cit. Further, chloroform does not diminish the excitability of the peripheral vasomotor nerves (Scheinensson, Gentralbl. f. d. med. Wiss., 1869, p. 105).

^{page 322 note *} Jour. Phys., vol. xiii. p. 860, 1892.

^{page 322 note †} Pflüger's Arch, vol. lxi. p. 201, 1895.

^{page 325 note *} Op. cit.

^{page 326 note *} The above tracings make it abundantly evident that the assertion of Lawrie (Lancet, 1890, vol. i. p. 1393), founded on the report of the Hyderabad Commission, “that sudden death from stoppage of the heart is not a risk of chloroform itself,” is completely erroneous.

^{page 327 note *} Dastre states that this increase of vagal excitability under chloroform was first noted by Vulpian (C. r. Soc. Biol., 1883, p. 243). According to François-Franck (ibid., p. 255), it disappears with increase of anæsthesia, but this is not in accordance with our experience so far as concerns direct excitation.

^{page 329 note *} See on this subject remarks by Crouch, H. C. and Brodie, T. G. in Trans. Soc. Anæsth., vol. vi. pp. 70 and 81, 1904Google Scholar. Harley, J. (Brit. Med. Journ., vol. ii., 1868, p. 320)Google Scholar recommended a dose of from grain to grain in man, Dastre (Soc. Biol., 1883, p. 242) states that a dose of atropine amounting to 0·0015 gramme ( = grain) is sufficient for the purpose indicated. Langlois and Maurange (Arch. de Phys., 1895, p. 692) recommend the employment of oxy-sparteine in place of atropine.

^{page 331 note *} An instance of the last-named complication is illustrated in fig. 20. In this animal the breathing was laboured, owing to obstruction of the air-tubes by mucus. There was marked dyspnoea, and the heart-beats were very slow and even arrested whenever the dyspnoea became intense. The violent respiratory efforts succeeded from time to time in clearing the air-passages, and this was followed by partial recovery. This pronounced inhibition was due to asphyxia, which, if more marked than in the instance given, may lead to entire arrest of the heart. Such inhibition from asphyxia does not occur with cut vagi. The condition is one which is not unfamiliar to anaesthetists, who are cognisant of its cause and danger. It is not liable to occur if a prior dose of atropine be administered, partly on account of the effect of this on the vagi and also because atropine tends to prevent the secretion of the mucus which causes the obstruction to respiration. This reason for the administration of atropine will apply equally to ether as to chloroform anaesthesia.

^{page 331 note †} Sherrington and Sowton (op. cit.) in the isolated and perfused cat's heart arrested by chloroform, obtained a renewal of the contractions on stimulation of accelerator nerves. But it is doubtful if this could be obtained with a strong dose of chloroform.

^{page 331 note ‡} Sherrington and Sowton.

^{page 333 note *} This mode of producing inhibition has been especially emphasised by Arloing (Thèse, Paris, 1879), who describes the effect of chloroform in producing heart failure in terms very similar to those which we have employed.

^{page 333 note †} Pitha (1861, quoted by Dastre); Harley, J., Brit. Med. Journ., vol. i., 1868, p. 320Google Scholar; Schäfer, , Brit. Med. Journ., vol. ii., 1880, p. 620.Google ScholarFraser, (Brit. Med. Journ., vol. ii., 1880, p. 715)Google Scholar, Brown-Séquard (C. r. Soc. Biol., 1883, p. 289), and Dastre and Morat (Lyon Méd., 1882, and C. r. Soc. Biol., 1883, pp. 242 and 259) have made a similar recommendation, but have suggested the addition of morphia, and this combination has often been used (first systematically by Aubert, C. r. Soc. Biol., 1883, p. 626). But morphia is in some ways antagonistic to atropine, and tends by itself to exalt the irritability of the cardio-inhibitory centre. Without atropine it would undoubtedly increase the danger of heart-arrest in chloroform administration.

^{page 335 note *} For references see M. Bourcart, Rev. méd. de la Suisse Romande, October 20, 1903.

^{page 335 note †} This is no doubt the condition referred toby Richet (Dict. de physiol., article “Anesthésie,” 1895, p. 523) when he avers that when cardiac syncope occurs artificial respiration never succeeds in effecting restoration; for the statement does not apply to the syncope caused by the secondary inhibition previously referred to.

^{page 335 note ‡} Arch. f. Path. u. Pharm., Bd. 37, p. 98, 1896. See also Biedl, Wien. klin. Wochenschr., 1896.

^{page 335 note §} Practitioner, vol. xxvi. p. 436, 1881.

^{page 338 note *} The addition of ammonia gas to the chloroform to be used for inhalation was advocated by Menzies, J. Duncan (Brit. Med. Jour., vol. ii., 1895, p. 871).CrossRefGoogle Scholar

^{page 340 note *} Cf. on this subject, Quinquard, C. r. Soc. Biol., 1883, p. 425; and Dubois, ibid., p. 441.

^{page 341 note *} To observe this condition of the liver and abdominal organs, it is necessary to open the abdomen before the thorax. For if the contents of the latter be first laid bare, and any of the great veins injured, the congestion of the abdominal viscera at once subsides, owing to the escape of blood from their vessels.

^{page 341 note †} Cf. on this subject the Report of the Committee on Suspended Animation, Trans. Med. Chir. Soc., 1904, Suppl., p. 63.