the insensibility is total, just as in the last stage of chloroform. Thus intoxication by chloroform and intoxication by alcohol proceed along parallel lines, and we can distinguish a first period of intoxication, properly so called, and a second period of sleep or coma.
When a person takes chloroform, the first few inhalations make him dizzy; he is seized with a sort of vertigo and dimness of vision. This vertigo goes on increasing, and, as the patient continues to respire the toxic agent, his ideas become more and more exalted. He hears what is said to him and makes replies, but he does so after the manner of a drunken man, at first exaggerating his impressions and regardless of proportion. His judgment has already disappeared, and he utters the most insignificant replies with a theatrical accent, the effect being often grotesque. Next, his ideas grow more and more mixed: will and judgment being gone, ideation is disordered and delirious; in short, we have a state of sleep accompanied with dreaming, closely resembling ordinary sleep.
When the chloroform absorbed by the mucous membrane of the lungs has passed into the blood, active memory, which presupposes attention and will, has disappeared; still, the intelligence is not yet dead. Ideas are still conceived, old recollections persist, and sometimes even the memory of past events is strangely quickened. The patient will speak in a language he thought he had forgotten, and recall old stories that seemed to have passed into oblivion. This superexcitation of memory is all the more interesting because in sundry forms of mental alienation it occurs with the same characters—these, too, being accompanied by entire loss of active memory.
Though insensibility supervenes very soon after the administration of chloroform, commonly it occurs only after the loss of memory, and this circumstance leads to very singular results. Thus, if the surgeon begins the operation before perfect insensibility has been produced, the patient will cry out, and beg to have it delayed till the drug has had full influence. One might suppose, from his cries of pain and his contortions, that the chloroform had produced no effect, and yet on awaking he has no recollection of what has taken place.
Is that real pain which leaves in the mind no trace? The answer to this question is not so easy as one might imagine. Suppose an acute, penetrating pain, continuing only for about one minute. Undoubtedly the patient suffers real pain during that minute; but, if all memory of it disappeared at once, then the patient would deny that he had suffered at all, and would not hesitate to undergo the operation again. In short, he would have enjoyed the benefits of chloroformic anæsthesia.
In administering chloroform, we must take account of the patient's temperament. If he is a resolute, courageous person, all will go on well, and the insensibility will readily disappear; if, on the contrary, he has an unconquerable dread of the operation, great watchfulness
