Page 341 - My FlipBook

CHLOROFORM. 339

feeling of warmth in the stomach, followed by coldness, similar
to ether, and if taken in large quantity, undiluted, it acts as an
irritant poison, inducing violent gastritis. It is diffused into the
blood, and affects remote parts. It increases the action of the
circulatory system, producing excitement of the brain, followed
by a deep, heavy sleep; and in poisonous doses, stupor and in-
sensibility.
The first effect of chloroform is upon the brain, then upon
the sensory portion of the spinal cord, then the motor part of
the cord, then the sensory parts of the medulla oblongata, then
its motor portion, thereby causing death through the failure of
the vaso-motor and respiratory centres, unless heart failure has
already taken place, which is not usually the case.
When locally applied, chloroform acts as an irritant and anaes-
thetic on the sensory and motor nerves, but when inhaled has
little or no effect on these nerve trunks. Recent investigations
have shown that " the primary action of chloroform on the vital
functions of circulation and respiration is greatly to depress the
vaso-motor system, thereby causing an extraordinary fall of
blood-pressure. Some cardiac enfeeblement and dilatation adds
to the fall of pressure." Chloroform has little or no effect upon
the blood when it is inhaled, but lowers the bodily temperature
by assisting in the dissipation of heat, and its action on the nerv-
ous production of heat. Owing to its great volatility, chloro-
form is rapidly eliminated by the kidneys and lungs.
Locally applied to the skin, it causes redness and burning and
if confined so that evaporation is prevented, will induce vessica-
tion. It is somewhat anaesthetic when locally applied, but is
also a powerful irritant. The vapor of chloroform when inhaled
produces symptoms similar to those of ether, except that the
sensations of choking are absent, and the stage of excitement is
of shorter duration and less violent.
Sabarth has divided chloroform-narcosis into three stages In
:
the first, the symptoms are similar to alcoholic intoxication.
The second stage is that of anaesthesia, consciousness and sensi-
bility are abolished, the muscles are relaxed, and perfect quiet
ensues. This is the surgical stage.