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CHLOROFORM. • 341

causes nervous excitement ; but the struggling and holding the
breath can hardly be avoided, and one or two whifFs of chloro-
form may be sufficient to produce complete insensibility. They
should always be allowed to inhale a little fresh air during the
first deep inspirations which follow.
In struggling persons, but especially in children, it is essential
to remove the inhaler after the first or second deep inspiration, as
enough chloroform may have been inhaled to produce deep
anaesthesia, and this may only appear, or may deepen, after the
chloroform is stopped. Struggling is best avoided in adults by
making them blow out hard after each inspiration during the in-
halation. The patient is, as a rule, anaesthetized and ready for
the operation to be commenced when unconscious winking is no
longer produced by touching the surface of the eye with the tip
of the finger.
The anaesthesia should never, under any circumstances, be
pushed until respiration stops ; but when once the cornea is in-
sensitive, the patient should be kept gently under by occasional
inhalations, and not be allowed to come out and renew the stage
of struggling and resistance.
As a rule no operation should be commenced till the patient is
fully under the influence of the anaesthetic, so as to avoid all
chances of death from surgical shock or fright. The administra-
tor should be guided as to the effect entirely by the respiration
;
and his only object, while producing anaesthesia, is to see that the
respiration is not interfered with. If possible the patient's chest
and abdomen should be exposed during chloroform inhalation, so
that the respiratory movements can be seen by the administrator.
If anything interferes with the respiration in any way, however
slightly, even if this occurs at the commencement of the admin-
istration, if breath is held or if there is stertor, the inhalation
should be stopped till the breathing is natural again. This may
sometimes create delay and inconvenience, but experience will
make any administrator so familiar with the respiratory functions
under chloroform, that he will in a short time know almost by
intuition whether anything is going wrong, and be able to put it
right without delay, before any danger arises. If the breathing