The reader must have been struck, in the preceding account of chloroform, with the remarkable difference, in the rapidity and degree of its action, as exhibited by the lungs and the stomach. in the latter, a much greater amount is required for a given effect, and this effect is much less quickly induced. I presume this difference arises from the two physical properties of great volatility and insolubility, the former giving it ready entrance into the system through the delicate pulmonary air-vesicles; the latter impeding greatly its absorption by the stomach. it is highly probable that, in the latter organ, the liquid chloroform, like the fixed oils, which it resembles in insolubility, is scarcely absorbed at all; and that it is through the vapour which must rise from it partially in the stomach, though necessarily with comparative slowness, that it finds entrance into the blood-vessels.*

3. Therapeutic Application

The first employment of chloroform medicinally was by the Drs. Ives, of New Haven, who gave it, as prepared by M.Guthrie, so early as the year 1832, both by the stomach and lungs, in asthma, spasmodic cough, etc. in 1838, it was used by Dr. Formby, of Liverpool, in hysteria; in 1843, by Mr. Tuson, of London, as a local anodyne; and in 1844, by M. Guillot, of Paris, in asthma. in 1847, M. Flourens made experiments with it upon animals, proving its anaesthetic powers. But it was not until after the determination by Dr. Simpson, of Edinburgh, of its extraordinary efficiency in relieving pain, when inhaled in the state of vapour, and of its applicability for this purpose in the practice of surgery and obstetrics, that it came into general notice. At present there are few medicines more employed.

The indications for the use of chloroform, deducible from its known physiological effects, are 1. to relieve and prevent pain, 2. to relax spasm, 3. to promote sleep, and 4. to calm nervous irritations not falling into either of the preceding categories. The contraindications are, 1. debilitated and disorganized conditions of the brain, as in the advanced stages of meningitis, cerebritis, or apoplexy, typhous coma, atonic convulsions, tumours, etc.; 2. debilitated states of the heart, as dilatation with or without valvular disease, softening or fatty degeneration of the organ, and all instances of abnormally feeble action;* 3. a constitutional tendency to syncope; 4. the existence of alcoholic intoxication at the time; and 5. considerable general debility from any cause. Besides, in cases of existing or threatened congestion in the lungs, brain, or indeed any of the great viscera, chloroform should never be pushed to the stage of coma, or that in which, through interference with the respiration, great venous congestion is induced; because the accumulation even of venous blood in these organs may prove highly dangerous, either by hemorrhage, by favouring the occurrence of low inflammation, or by immediately interfering with the function.

* The following are results obtained by a committee of the Royal Medical and Chirurgical Society of London, from their experiments on the subject of chloroformic inhalation. The first effect is to increase the force of the heart's action; but the effect is slight and transient; and, when complete anaesthesia is produced, the heart, in all cases, beats with less than its natural force. The strongest doses, freely admitted into the lungs, destroy life by arresting the action of the heart. By moderate doses the heart's action is much weakened before death; but generally, though not invariably, respiratory action ceases before that of the heart. To be administered with comparative safety, the percentage of chloroform vapour in the inhaled air should not be greater than 3.76; and the inhalation should cease at once when the desired degree of insensibility has been obtained. The committee agree, upon the whole, that ether is less dangerous than chloroform, yet are disposed to acquiesce in the British preference of the latter practically. The committee, however, recommend a mixture of the two, in the proportion of three of ether and two of chloroform, as safer when deep and prolonged anaesthesia is required. [Med. Times and Gaz., July, 1864, p. 74.) in reference to the increased force of action in the heart above mentioned, as characterizing the commencing operation of chloroform, I have only to state that it is by no means a uniform result, and, when it does occur, is probably ascribable,

For the various purposes for which it is indicated, chloroform may be used by the stomach, by enema, by inhalation, or as an external application.

From its employment by inhalation many persons are deterred by the numerous instances of death, which have resulted from its use as an anaesthetic agent in surgery. The question of its appropriateness for this purpose I shall discuss hereafter. At present I wish to direct attention to its use in this way in medicine. The existence of violent nervous excitement in any form, whether in that of pain, spasm, or delirium, is well known to oppose considerable resistance to the influence of anodyne or narcotic agents. The remark applies in some degree to chloroform. Hence, the same danger of fatal depression from its use by inhalation is not to be apprehended, when it is opposed to an already existing pain, as when it may be employed in a healthy system, at least in one not thus protected, in order to prevent future pain; and it is a remarkable fact, that almost all the recorded cases of death from the inhalation of chloroform have occurred, either in persons who have used it with a suicidal intent, or in those to whom it has been given in anticipation of a surgical operation. Even, however, with this consideration in its favour, I would not recommend the inhalation of chloroform in trifling cases, where life is not involved, and when other unequivocal remedies are at command; but, whenever a violent and dangerous case may occur, in which the symptoms may indicate the use of this measure, it may be resorted to, I think, with perfect propriety; as the risk of fatal conseeither to the very natural agitation of the patient on such an occasion, or to the sympathy of the heart with the first stimulant impression on the air-passages, and not to the direct action of the absorbed chloroform. I have also to observe that, in admitting the greater safety of ether, the committee have granted all that the advocates of the preferable use of that agent desired; for the preservation of life has precedence over all other considerations. (Note to the third edition.)