* Exceptional cases occasionally occur in which, after a very copious use of chloroform, a state of depression of certain functions continues for a considerable time, which appears to he a prolongation of the direct effect of the medicine. Dr. C. Happoldt, of Charleston, S. C, relates two cases, in one of which the patient kept himself under the almost constant influence of the medicine for forty hours, during which he inhaled about twenty ounces; and in the other about four ounces were inhaled at one time. In both, the sense of taste was perverted, and that of smell nearly or quite abolished; the bladder and lower bowels lost in a considerable dein some very rare instances, with more or less of the comatose condition, tonic spasms occur, or hysterical agitation, with screaming, laughter, etc., and now and then relaxation of the sphincters.

Three stages more or less distinct may be observed in this action of chloroform; 1. a preliminary stage of slight cerebral confusion; 2. an anaesthetic condition, or insensibility to painful impressions, which comes on before consciousness and the power of motion are lost; and 3. deep sleep or coma, with complete muscular relaxation.

The insensibility may begin so early as fifteen seconds after the commencement of inhalation, and is very rarely postponed longer than two minutes. it continues from five to ten minutes; but may be kept up for several hours, by a careful repetition of the inhalation, at each period of commencing subsidence.

Poisonous Effects from inhalation. When the effects of inhalation exceed those above mentioned, they may be considered poisonous, and death not unfrequently results. in this event, the respiration may become slower, the face and surface pale or livid, and the pulse more and more feeble, until respiration ceases, and the heart can no longer be felt to act. Under such circumstances, the fatal event is ascribable to an over-dose of the poison, which, by completely paralyzing the respiratory nervous centre, suppresses the function of the lungs, and secondarily that of the heart. But there appears to be another mode of fatal termination, which occurs in general very speedily, and without warning, and often proceeds from very small quantities of the poison, much less than those frequently used with entire impunity. Thus, in at least two recorded instances, death has occurred from the inhalation of only thirty drops. in these cases, it is apparently the heart which first ceases to act. it is asserted that this organ has been observed to become quite quiescent, while respiration still continued.* in the first method of poisoning, the patient dies of asphyxia or apnoea, in the latter of syncope. in the one instance, death is the result of an excess of the ordinary action of the gree their sensibility, so that the necessity of micturition and of defecation was not duly felt; and either the sexual propensities were abolished, or the capacity of indulging them was greatly impaired. A strong effort of the will was necessary for the evacuation of the bladder; and energetic cathartics were requisite to keep the bowels open. This condition lasted in one case about two months, and in the other still longer, before it was completely removed. [Charleston Med. Journ. atid Rev., xi. 60.) - Note to the second edition.

* A case of this kind is recorded by Mr. James Paget, in which respiration continued several minutes after the pulse could no longer be felt at the wrist, though the heart beat feebly; and afterwards artificial respiration was maintained for twenty minutes, without any return of the pulse. it is obvious that the patient died through the influence of the poison on the heart. (Med. Times and Gaz., March, 1857, p. 236.) - Note to the second edition.

poison; in the other, of an extraordinary and apparently direct influence either on the heart itself, or on those nervous centres through which its functions are regulated. Against the latter result it does not seem that any care is sufficient to guard. The greatest precautions, both as to the size of the dose and its administration, have been taken without effect. The patient dies almost as if his heart had been paralyzed by a stroke of lightning.

The quantity of chloroform which has been employed in fatal cases has generally been one or two fluidrachms, though in some instances much larger, and in a few, as already mentioned, even smaller. The fatal result has repeatedly occurred in less than one minute from the beginning of inhalation, and has been postponed for an hour or more. in a table of 33 cases published in the New York Journal of Medicine (N. S., x. 400), 3 are stated to have died instantly, 2 in a minute, 10 in from two to ten minutes, 1 in a quarter of an hour, 1 in half an hour, 1 in three hours, and the remainder at indefinite or unknown periods, but most of them very soon, and some almost immediately.

Appearances after Death from Poisoning by inhalation. The most prominent morbid appearance is venous congestion, which is generally very obvious in the lungs, and sometimes in a less degree in the brain; but, in the greater number of cases, the brain is healthy, and sometimes freer from blood than ordinarily in health. The heart is often, but not invariably, soft and flaccid. The blood is almost always fluid, and sometimes dark-coloured.*

* in reference to the anatomical characters of poisoning by chloroform inhalation, Dr. B. W. Richardson, of London, has performed numerous experiments on animals of different species, amounting to not less than 93, with the following results, which were the same in all.

The blood undergoes no organic change. The corpuscles are unaltered, but, upon exposure on the glass of the microscope, have a tendency to become crenate at the border, owing to the more rapid escape of the moisture with the chloroform vapour. The coagulating power is in no degree modified; the same rule holding as in death from asphyxia. if the vessels are closed, coagulation is slow. in large animals the blood may remain fluid for two days. The colour of the blood is little changed. Any arterial blood in the left cavities of the heart may have a slight tint of purple; but it is very faint. There is always a little chloroform in the blood immediately after death, but its presence is transitory, and the quantity variable. The proportion is not more than one part in sixteen thousand, and this can never be detected after a few hours.