in ano from which he had been suffering, the irritation produced by it appearing to have been the real cause of the incontinence.
We will now pass from reflex changes in the respiratory and intestinal tracts to reflex changes in the blood-vessels and heart. It is well known that, usually, irritation of a sensory nerve causes dilatation of the vessels in the part supplied by that nerve, and contraction of the vessels in the other parts of the body. This may take place without any alteration whatever in the beats of the heart itself; but if the irritation be very strong, or applied to certain nerves, the heart also may be acted upon. There seem to be certain nerves which act more readily upon the heart than others, and more especially is this power possessed by the fifth nerve, the roots of which are very closely associated with those of the vagus. On stimulation of the branches of the fifth nerve passing to the nose in animals—as, for example, by holding ammonia, strong acetic acid, or chloroform before the nose of a rabbit—the beats of the heart may be suddenly and completely arrested. To a similar arrest of the cardiac pulsations by irritation of the dental branches of the fifth, I attribute the numerous deaths which have occurred through the extraction of teeth under chloroform. It is probable that the extraction of teeth would, under all circumstances, be an exceedingly dangerous operation, were it not that in the waking condition irritation of the dental nerves sets in motion two pieces of mechanism, one of which, to a great extent, counteracts the effects of the other. As I have already mentioned in a former paper, I was once asked how it was that the application of ammonia or acetic acid to the nose of a fainting person was proved by experience to be beneficial, when theoretically it ought to be injurious by arresting the already enfeebled heart. The answer to this is, that ammonia or acetic acid, held before the nose of a fainting person, by irritating the branches of the fifth nerve, does not act upon the heart alone—it causes contraction of all the vessels of the body, and thus keeps the arterial system full, and the blood-pressure high, despite the diminished current poured into it by the flagging heart. So much is this the case, that I have found, in an animal in which the heart was weakened and the vessels dilated by shock, that the application of ammonia or acetic acid to the nose raised the pressure by one fourth of the whole. In the ordinary waking condition, the sudden stimulus of extracting the tooth has its effect upon the heart completely counteracted by the coincident contraction of the arterioles throughout the body which it also causes. In chloroform narcosis, however, these two reflexes are not influenced equally by the drug, and the reflex upon the heart may remain after the reflex action upon the vessels has been abolished, so that the heart may stop, and death will then ensue; for, the capillaries being no longer contracted, the blood at once drains out of the arteries into the veins, and circulation ceases. Another very important reflex upon the heart is that which is effected through the solar plexus and the sym-
