* Arch. Gén., Sept. 1858, from Assoc. Med. Journ.

+ See a record of this case by Dr. James Williams, in the Medical Examiner, Philadelphia, Nov. 1856, p. 659.

‡ London Lancet, April 16, 1859, p. 400.

§ Am. Journ. of Med. Sci., Oct. 1856, p. 550, from London Lancet, Aug. 9, 1856.

|| B. and F. Medico-chir. Rev., Oct. 1864, p. 582.

Am. Journ. of Med. Sci., Oct. 1866, p. 571.

** See Med. T. and Gaz., May, 1862, p. 478.

‡† Am. Journ. of Med. Sci., Oct. 1856, p. 548, from the London Lancet of Aug. 9th, 1856; also Oct. 1857, p. 367; the case being recorded by Dr. Thomas Lawson, Surgeon-General of the U. S. Army.

‡ † Med. Times and Gaz., Dec. 1857, p. 615.

Treatment of Poisoning. if the poisoning has resulted from the swallowing of chloroform, the obvious indications are to evacuate the stomach and bowels, and afterwards support the actions of the system by external and internal stimulation; irritation of stomach, if it should follow the evacuation of the poison, being quieted by opiate enemata, and sinapisms or blisters to the epigastrium. When the respiration fails, it should be supported artificially, either by galvanism, Dr. Hall's method, or in some other way.

Poisoning by inhalation is unfortunately often so rapid that little time is offered for the intervention of remedies; and, when the poison attacks the heart especially, it is frequently rendered quite insensible to stimulant impressions. in most cases of apprehended asphyxia or syncope, it will be proper to try the effect of dashing cold water on the face and head; and a supply of fresh cool air should be kept up by fanning or otherwise. in order, moreover, to aid in rousing the sensibility of the nervous centres, spirit of ammonia, carbonate of ammonia, or other pungent volatile substance should be applied to the nostrils. Should the respiration have ceased, or seem about to cease, it should be maintained artificially, either until there is no doubt of death having occurred, or until the patient is out of all danger from this cause. Death has taken place after the restoration of respiration. A tendency to syncope must be counteracted by laying the body in a horizontal position, with the head low. Should the pulse begin to fail, the countenance become pallid, or the surface cold, stimulation internally and externally should be resorted to. Ammonia and wine should be given by the mouth if the patient can swallow, oil of turpentine or other stimulants injected into the bowels, and active rubefacients with friction applied to the skin; and, under these circumstances of threatened syncope, I should not hesitate to have recourse to the respiration of the vapours of ether, as the most powerful restorative, and most likely to counteract the depressing effects of the chloroform. This remedy, however, would be less obviously proper, in cases of threatened asphyxia, with well-marked venous congestion.

Besides the measures mentioned, galvanism or electro-magnetism may be resorted to, in order to excite the lungs and heart; the current being so directed as to pass through the nerves supplying these organs, and the nervous centres in the medulla oblongata. By placing the positive pole in the mouth or nostril, and the negative over the diaphragm, as suggested by Dr. Herapath, the natural route of impressions from without upon the respiratory function, through the fifth pair of nerves, may be followed by the galvanic current {Lancet, March, 1852, p. 303); or the diaphragm may be excited by direct irritation of the phrenic nerve, as suggested by M. Duchenne (see vol. i. p. 538). A case strongly illustrative of the propriety of employing restorative measures under the most unpromising circumstances, and at the same time of the remarkable efficacy of electro-magnetism, has been reported by Dr. John H. Packard, in the American Journal of the Medical Sciences (Jan. 1865, p. 271). The patient was a man of 49, who, when under the influence of the inhalation of chloroform, was suddenly seized with the most alarming symptoms, which soon ended in apparent death. The pulse and respiration had ceased, the surface was pale and livid, and the eyes glazed and turned upward. After a short and fruitless trial of artificial respiration in the ordinary mode, the electro-magnetic battery was employed; one pole being applied over the upper dorsal spinous processes, the other over the apex of the heart. in a short time the pulse returned at the wrist, and gradually increased in force and fulness, a deep sigh was drawn, respiration was restored, and the patient recovered.

In cases of asphyxia it is considered advisable, while performing artificial respiration, to pull forward the tongue, so as to prevent its falling back upon the glottis. This may readily be done by the finger passed into the fauces.* Dr. Hall's method has been employed in several cases successfully.

A new and very simple remedy, said to have proved efficacious in a threatening case of poisoning, is to slap the patient, with the flat of the hand, rapidly and strongly upon the exposed surface of the trunk and limbs; care being taken to keep the mouth open, and to draw the tongue forward. (Dr. J. Bullar, Med. Times and Gaz., July, 1865, p. 127.)

* Should all efforts at satisfactorily producing artificial respiration fail, recourse may be had to tracheotomy. Dr. Langenbeck, of Berlin, in a case of this kind, made an opening into the upper part of the trachea, and, having introduced a gum-elastic tube down to the bifurcation, performed artificial respiration through this, closing the lips of the wound against the catheter, and effecting expiration after each insufflation by pressure on the abdomen. The case ended favourably, though respiration had entirely ceased. [Arch. Gén., Juin, 1859, p. 730.)-Note to the second edition.

A case of death from chloroform has been recorded, in which the immediate cause of the fatal issue was the entrance of vomited matters into the trachea, producing suffocation. This case may with great propriety be adduced in favour of the operation of tracheotomy above proposed. (See Am. Journ. of Med. Sci., Jan. 1863, p. 257.) - Note to the third edition.