I 
From the Chicago Medical Examiner. 
‘‘POSITION” IN THE TREATMENT OF CHLORO- 
FORM POISONING.—CARBOLIC ACID IN THE* r 
TREATMENT OF CONJUNCTIVITIS. 
By E. L. HOLMES; M.D., Lecturer on Diseases of the Eye and Ear in Rush 
Med. Col., and Surgeon to the Chicago Charitable Eye and Ear Infirmary. 
The subject of anaesthetics does not fall specially within the 
province of your Committee on Ophthalmology; and yet, there 
are a few points, which I consider of some interest in connec- 
tion with the administration of ether and chloroform in ophthal- 
mic surgery. 
I have observed a few facts, in operating upon the eye, which 
I deem of very great importance, as bearing upon the treat- 
ment of patients presenting alarming symptoms daring the in- 
halation of chloroform. It is not my object to discuss the 
comparative danger in the use of chloroform or ether, nor the 
circumstances upon which the danger depends. It has been 
my fortune to observe the administration of both agents in a 
very large number of cases, under the care of many different 
and eminent surgeons. I have also administered chloroform 
more than 400 times myself. Till quite recently, I had never 
witnessed a single case in which there was any apparent dan- 
ger to the patient. 
Some time since, two male adult patients, to whom I admin- 
istered chloroform, suddenly ceased breathing, the pulse at the 
wrist becoming at once imperceptible, the sound of the heart, 
however, being audible to the ear placed upon the chest. The 
removal of the chloroform, alternate pressure and relaxation of 
the chest, and cold water thrown upon the face, speedily aroused 
the action of the heart and lungs. 
I may state that in administering ether to a patient 76 years 
of age, the respiration suddenly ceased, although the pulse, 
very much reduced in force, continued. The appearance of 
the patient was alarming, the countenance being somewhat 
livid, cool, and haggard in expression, and the eyes rolled 
upward. It required considerable exertion to restore the 
patient. Every surgeon has, not unfrequently, observed that chloro- 
form produces considerable pallor, prostration in the action of 
the heart, arteries, and lungs, apparently without any imminent 
danger. In all such cases, as well as in the two just described, 
the danger seems to depend entirely upon syncope. I have 
never witnessed a case in which there was turgidity of the ves- 
sels and redness of the face, in which there was not also a reg- 
ular pulse, and a regular, though often stertorous, respiration, 
causing, perhaps, a peculiar heaving motion of the head. On 
several occasions, as I observed this tendency to syncope, al- 
though I saw no reason for alarm, I directed, experimentally, 
my assistants to raise the foot of the table sufficiently high to 
place the patient with the head downward on an inclined plane 
of at least 40°. I found, invariably, that the pulse at once 
became fuller and more frequent, and that the color returned 
to the face. 
Subsequently, in administering chloroform to a patient at 
the Chicago Charitable Eye and Ear Infirmary, the breathing 
and pulse, almost without warning, suddenly ceased. Although 
the pulse and respiration had been quite good, there still had 
begun to be a peculiar “cold perspiration” upon the brow, and 
a cold, moist condition of the hands, which I attributed to the 
depressing influence of fear, under which the patient was labor- 
ing. I was watching the patient, most carefully, thinking in 
this' condition he should receive no more chloroform, when he 
ceased to breathe. His aspect was most appalling; the face 
and hands were cold and wet, the features pinched, muscles of 
the face relaxed, lids half opened, and the cornea turned up- 
ward. The foot of the table had not been raised 15 seconds, 
the tongue having at once been withdrawn, before the pulse 
reappeared at the wrist and the respiration was reestablished. 
Upon restoring the patient to the horizontal position, the pulse 
and respiration again ceased. The elevation of the foot of the 
table, however, again reestablished the action of the heart and 
lungs. 
Some time after this occurrence, precisely the same symp- 
toms appeared during the inhalation of chloroform. The pa- tient was a young, strong man. In this case the pulse, for a 
few minutes, was growing less frequent, although the breathing 
continued quite strong and regular, till, without further warn- 
ing, the pulse and breathing suddenly ceased. The appearance 
of this patient was as frightful as in the case of the other, just 
described. A similar mode of treatment restored, at once, the 
action of the heart, some seconds passing before the respiration 
was fully reestablished. 
I have had an opportunity, at the Infirmary, of demonstrat- 
ing, experimentally, to students and physicians, more than 
thirty times, in cases where there was no apparent danger, and 
yet where there was a tendency to pallor and weakness of the 
pulse, that, in the position I have described, the cheeks became 
instantly flushed and the pulse stronger. 
In administering chloroform, I always use a napkin, folded 
several times, upon which the anaesthetic is poured in small 
quantities at a time, care being taken that a free current of air 
can pass to the mouth under the napkin. The patients are 
always in a horizontal position. I watch, with great care, the 
condition of the pulse and respiration; and yet, it is sometimes 
somewhat difficult to 'distinguish the difference between the 
effects of fear and those of the chloroform. 
Whatever may be the obscure causes of fatal results from 
the use of chloroform, I believe the danger, in by far the larger 
proportion of cases, depends upon a tendency to death by syn- 
cope. To overcome this tendency, it is necessary to stimulate 
the nervous centres. This may be done by causing a column 
of blood to press upon the vessels of the brain. It is not suffi- 
cient to remove the pillow from the head and place it under the 
hips. It is necessary that the whole body be placed upon a 
steep, inclined plane, to force as much blood as possible, by 
gravitation, into the brain. I believe this is of more impor- 
tance than any of the methods usually described by writers on 
the subject. It should take precedence to the withdrawal of 
the tongue, artificial respiration, galvanism, or stimulants. 
This remedy can always be applied without delay, and can be 
followed by any others which may seem desirable. 
I have dwelt upon this subject of position, because so little 4 
•is said upon it. either in the best works upon anaesthetics, or in 
the reports of the treatment in fatal cases, as found in medical 
journals. We have reason to believe that very few surgeons 
or obstetricians have ever placed a patient in the position de- 
scribed, in cases which threaten to terminate fatally. 
I have employed large and frequent doses of bromide of pot- 
ash, as recommended by Dr. Stone, both before and after the 
administration of ether, as also of chloroform, to prevent nau- 
sea, but have not observed any beneficial result. It is highly 
desirable to possess some agent to prevent nausea and vomiting, 
especially in the extraction of cataract, since the vomiting may 
cause the expulsion of the vitreous humor, and protracted nau- 
sea, and consequent loss of appetite, may prevent union of the 
corneal wound, by impairing nutrition. 
CARBOLIC ACID IN THE TREATMENT OF CONJUNCTIVITIS, 
The valuable properties of carbolic acid, as an application in 
diseases of the throat and gums, has been shown by dentists, 
and physicians who give special attention to diseases of the 
throat. The good results of its use in these diseases, induced 
me to try it in diseases of the conjunctiva. I have found in 
about a dozen cases, at tbs Infirmary, both of acute and, espe- 
cially, of chronic inflammation, that the patients made a good 
recovery under its use. 
It is doubtful whether it possesses any advantage over the 
ordinary astringents, and yet it may be a desirable agent in 
cases where the usual applications fail. In two cases of puru- 
lent conjunctivitis, its use between the applications of nitrate of 
silver, after the latter had been tried two days, seemed to rap- 
idly overcome the excessive discharge of pus. Possibly, its 
antiseptic properties may aid in destroying any specific poison 
that may exist. 
When applied, in a saturated solution, to the conjunctiva, as 
also to the mucous membrane of the mouth, it produces an 
intense burning pain, which almost invariably subsides in a few 
moments. It produces a thin, white pellicle on the surface 
where it is applied, which is soon cast off, leaving scarcely any 
irritation.