ADMINISTRATION 
OF 
CIjMorm bj Dtghitition. 
BY 
JEROME COCHRAN, M.X>m 
Of Mobile, Alabama. 
©cnn.: 
UNIVERSITY MEDICAL PRESS—W. H. P. LIGON, PRINTER. 
1867 PRELIMINARY NOTE. 
Backwoodsman No. One. What might your name be, 
stranger ? 
Backwoodsman No. Two. It might be Sampson, but it aint. 
That particular use of Chloroform, which I have here called 
its administration by deglutition, has been named by some 
writers “administration by the mouth,” and by others “'internal 
administration.” But neither of these last two names seems to me 
to be sufficiently definite. Against the first of the two it may 
be urged that the taking of the liquid Chloroform into the mouth 
is only the first step, and by no means the most important one 
of the somewhat complicated process of deglutition; and that 
the Chloroform vapor may also be taken into the mouth in the 
process of inhalation. And if any curious critic, with laudable 
anxiety for the perspicuity of the Queen’s English,.say after the 
manner of our Backwoodsman, “Administration by the mouth, 
and what might that mean, Doctor ?” What answer would be 
possible but this ? “ My Dear Sir, it might mean the simple in- 
troduction of the medicine into the oral cavity and its absorp- 
tion thence through the buccal membranes into the interior of 
the organism, but it don’t.” 
Against the other, against the phrase “ internal administra- 
tion,” it may be urged that the administration by deglutition is 
not more truly an internal administration than is the adminis- 
tration by inhalation. In neither case does the medicine reach 
the interior of the organism until it passes through the mucous 
membrane. The mucous membrane lining the cavities of the 
stomach and intestines, and the mucous membvane lining the 
cavities of the lungs—the pulmonary tubes and vesicles, are but 
modifications, more or less profound, by involution, and evolu- 
tion, and structural and functional differentiation, of the skin, 
which forms the common integument of the body. They are all 4 
membranes of limitation, that is to say external membranes, 
membranes intervening between the organism and the environ- 
ment. Neither food, nor medicine, nor any tertium quid can 
find its way into the organism without passing through some 
part of this general membranous envelope. And no product of 
normal or of abnormal disintegration or metamorphosis can be 
excluded from the system without passing along the same route. 
In ultimate anatomical and physiological analysis, then, any- 
thing simply enclosed in a mucous cavity is as absolutely out of 
the organism as when in simple contact with the skin. As the 
differentiation of the structure in these membranes is incomplete, 
so also is the differentiation of function incomplete ; and each 
one of them can discharge vicariously, and with more or less 
efficiency, the proper office of each of the others. The skin is 
an important organ of respiration and of depuration, of the 
elimination from the organism of effete and redundant materials, 
and of the introduction into the organism, under certain contin- 
gencies, of both medicine and food. The intestinal mucous 
membrane is about equal in superficial extent to the skin. As 
an organ of elimination and depuration it is not, perhaps, of 
greater importance than the skin or the lungs ; but it is of far 
greater efficiency than either, or even than both of the others as 
a medium of nutrition ; and it is also the most common medium 
for the introduction of medicines into the system, as is most 
natural, inasmuch as medicines are but an other kind of food. 
For is it not evident that therapeutics bears the same relation 
to hygiene that pathology does to physiology ? The pulmo- 
nary mucous membrane is of far greater superficial extent than 
is commonly imagined, being estimated by Lindenan at not less 
than 2G42 square feet—an estimate almost exactly coincident 
with a calculation made by myself while a student of medicine. 
It is the great medium of inspiration, of the introduction of 
oxygen into the system and the elimination of carbon ; but it is 
.also instrumental in many other offices. Through it can be 
brought into the system all medicines that assume the form of 
vapors or gases ; and I believe that it is also the principal .me- 
dium for the introduction of those specific poisonous miasms 5 
which engender the long catalogue of infectious maladies that, 
flesh is heir to. 
The comparative influence on the organism, alimentary’-, 
medicinal and toxicological, of various agents when brought in 
through these different mediums is a matter of curious and sug- 
gestive inquiry, but too extensive to be even glanced at in a note. 
SECTION I. HISTORICAL SKETCH OF CHLOROFORM. 
Chloroform, as is well known, was discovered in the year 1831, 
almost simultaneously by Guthrie, in the United States, by 
Sauberein, in France, and by Leibig, in Germany. It came into 
medical use very slowly ; and to the great majority of the pro- 
fession remained almost unknown until the discovery, in 1847, of 
its marvellous anaesthetic properties. The anaesthetic power of 
sulphuric aether was d scovered the year before, namely, in 184G ; 
and South in his encyclopaedic edition of the System of Surgery 
of Chelius, calls it the annus mirabilis—the wonderful year of 
Surgery. The first publication of the anaesthetic power of Chlo- 
roform was made in the Pharmaceutical Journal for February, 
1847, by Mr. Jacob Bell, but does nut seem to have attracted 
much attention. In March, of the same year, Flourens pub-, 
lished a series of experiments on the inhalation of Chloroform 
by dogs. And in November, of the same year, Professor Symp- 
son, at the suggestion of Mr. Waldie, and apparently unacquain- 
ted with Mr. Bell’s recommendation, employed it to relieve the 
pains of parturition. The authority of his great name imme- 
diately brought it into general use. In the twenty years that 
have elapsed since then its reputation has grown apace ; and it 
is not too much to say, that it is at once the safest, the most 
powerful, and the most pleasant of the entire family of anes- 
thetics. 
But while in reference to the administration of Chloroform by 
inhalation we have facts and theories in embarrassing abun- 
dance, its a Iministration by deglutition has received far less at- 
tention. As a comprehensive summary of what is known of this 
method of exhibition I quote from the United States Dispensa- 6 
tory all that it contains• under the head of “Internal Adminis- 
tration of Chloroform.” 
“ When taken internally, Chloroform acts as a sedative nar- 
cotic, probably operating through the nervous system, indepen- 
dently of vascular action or congestion. In 1848 Dr. Henry 
Hartshorne tried its physiological effect in the dose of seventy- 
five drops on himself, an J found it to produce drowsiness, and a 
general diminution of sensoiial power, without exhilaration, or 
acceleration of the pulse. Since then he has used it internally 
in a number of cases, and finds it a safe anodyne and soporific, 
altogether free from the dangerous effects which sometimes fol- 
low the inhalation of its vapor. In the dose of a fluid drachm 
its soporific effect is about equal to that of thirty-five drops of 
laudanum. Dr. Hartshorne has given it in doses of from fifty 
to seventy-five drops every half hour for several hours together. 
“ Chloroform, as prepared by Mr. Guthrie, was used internally 
as early as 1832, by Professor Ives and Dr. Nathan B. Ives, of New 
H iven, in asrhma, spasmodic cough, scarlet fever, and atonic 
quinsy, with favorable results. It was employed by Dr. Formby, 
of Liverpool, in hystciia in 1833 ; by Mr. Tusan, of London, in 
cancer and neuralgic affections in 1813 ; and by M •. Guillot, of 
Paris, in asthma, in 1811 Antiperiodic properties have been 
attributed to it by Dr. Deliaux, of R ndiefort, who proposed it as 
a remedy for intermittents, given during the apyrexia, in cases 
in which bark and quinine foil to effect a cure. Its powers as 
an antiperiodic have been confirmed by Dr. L Dalton, of L >gan, 
.Ohio. Dr. Aran has employed it for four years in lead colic, 
administered by the nouth and rectum, and applied to the ab- 
domen. In these cases it probably acts by relieving the intesti- 
jiil spasm. One of the authors of this book has frequently used 
it with advantage for the relief of neuralgic and other painful 
affections, in the dose of from forty to eighty drops, suspended 
m water by means of gum arabic or yolk of egg. This dose may 
be repeated, if necessary, at intervals of one or tvvo hours, or 
until some effect on the system is produced. Chloroform has 
been used internally with benefit, by Dr. Orsbony, of Dublin, 7 
and by Dr. Gordon, Physician to the Hardwicke Fever Hospital, 
to allay nervous irritation and procure sleep.” 
This summary was written by Dr. George B. Wood, for the 
Dispensatory of 1850 ; and has been retained in all the subse- 
quent editions, including the revised edition of 1865 ; a conclu- 
sive testimony that no additional knowledge of the remedy has 
been gained which is esteemed worthy of special note. 
SECTION II.—NOTES OF CASES. 
My own attention was first called to the administration of 
Chloroform by deglutition by an article in the Memphis Bulle- 
tin, addressed to Surgeons in the army, by Dr. A. P. Merrill. 
My knowledge of Dr. Merrill led me to place some confidence in 
his recommendations. Among other things I knew him to be 
an indefatigable worker. He was a Physician in full practice in 
the city of Memphis ; was, at the same time, Professor of the 
theory and the practice of medicine in the Memphis Medical 
College ; editor of the Memphis Medical Recorder ; superinten- 
dent of the public schools ; a member of the board of aidermen, 
and a frequent contributor, on matters relating to public health, 
to two or three daily papers. He is also the man to whom La 
Roche dedicated his big book on Yellow Fever. From the 
article I mention I copied into my note book the following sug- 
gestive paragraph : 
“ It appears to be nature’s favorite remedy for pain. Taken 
into the stomach its influence over the nervous system is truly 
wonderful, relieving chill, spasm, sunstroke, concussion and neu- 
ralgic pain, and without the evil effects on the cerebral and 
digestive functions which follow the use of opium. Adults may 
safely take it in doses of one teaspoonful.” 
This was in 1861. Since that time I have administered 
Chloroform by deglutition very frequently, and in various kinds 
of diseases—in tetanus ; in spasmodic convulsions of the extrem- 
ities, or of the whole system ; in epileptic convulsions of children 
and adults; in hysterical convulsions; in every form of enteral- 8 
gia not acutely inflammatory, such as spasmodic colic, bilious 
colic, and lead colic ; and in several cases cd Asiatic cholera. 
Case I —A young soldier in the Military Hospital at Marion 
Station, Mississippi, in the summer of 1863, had an attack of 
tetanic convulsions. Some years before he had received a blow- 
on the head which had fractured the skull, and he had been sub’ 
ject to these attacks at uncertain intervals ever since. It seemed 
impossible for any man to suffer more than he did. Cramps 
seemed to have seized on every separate muscle in his entire 
body. The opisthotonous was so great at times that only his 
head and his heels seemed to touch the bed. The spasmodic 
contortions and the groans of dreadful agony were horrible to see 
and hear. I gave him at first a large teaspoonful of Chloroform; 
and repeated it in ten minutes, but with very little effect. Feel- 
ing that the case belonged to that desperate class which is said 
to require desperate remedies, and that the man must be relieved 
at any risk of danger, I gave in ten minutes more, for the third 
dose, using a tablespoon as a rough measure, about half an ounce 
of the medicine. In a few minutes the patient fell into a quiet 
sleep, slept for hours, and waked up well. No nausea nor other 
unpleasant results of any kind were noticed. The whole amount 
of Chloroform administered in the space of twenty minutes 
could not have been less than three-fourths of an ounce. 
Case II.—June 1st, 1866, Jeff. Taylor, a strong, athletic 
negro drayman, black as his African ancestors, and whose veins 
were evidently innocent of any admixture of Caucasian blood, 
had a severe attack of bilious colic. I found him rolling and 
tumbling, now on his back and now on his belly, and doubling 
himself up in every variety of eccentric positions, covered with 
sweat, groaning with agony, and praying for relief. One-third 
of an ounce of Chloroform produced some amelioration of the 
symptoms, and another dose of the same size, making two- 
thirds of an ounce in all, sent him off to sleep. His waking up 
was followed by copious bilious vomiting ; he had no more 
severe pain, but was kept four days longer under treatment with 
purgatives and quinine. Nearly a. year has transpired and he 
Jhas not been sick since. 9 
Case III.—On the afternoon of the 23rd of August, 1866, 
Mr. H. S. had an attack of cramps and pains, which commenced 
in the calves of both legs and gradually worked their way up 
until they involved the whole abdominal region. When I saw 
him, at 9 o’clock in the evening, he was suffering such intense 
agony that he prayed to die if there was no other means of re- 
lief. The pulse v/as full and a little fast, but gave no evidence 
of either fever or inflammation. Paroxysms of cramp racked 
him every few minutes : and in the little intervals between them 
he complained that he was burning up. He drank ice water 
with insatiable appetite, and had a towel wrung out of ice 
water spread over the stomach and bowels. Half an ounce of 
chloroform in three doses fifteen minutes apart eased him of all 
his troubles, in an hour after entering the house I left him 
asleep. When I called the next morning he was up and dressed 
had taken a light breakfast and felt tolerably well. 
Case IV.—Diana White was named to illustrate the theory of 
contrast. She was not white at all, but so black that she could 
not be any blacker. If not beautiful exceedingly according to 
the Greek ideal of the chaste goddess whose name she bore, she 
was at any rate unmistakably great according to the scales of cubic 
measure and avoirdupois weight. I was called to see her about 
noon on the 17th of July, and found her almost frantic with pain. 
She kept continually exclaiming, in most piteous tones, “ Oh ! 
my God, what shall I do ? Mr. White, my head will split open I 
Oh I my belly ! my belly ! I shall die ! I shall die !” She sat 
up in the bed ; she swayed to and fro ; she tumbled her huge 
body from side to side. She swallowed eagerly great draughts 
of cold water, which were thrown up again in a few minutes. 
The skin was hot, and wet with sweat; the pulse full and fast. 
She had a raging fever ; she was tormented with headache ; she 
was racked with colic. The seven devils of malaria had taken 
possession of her, How to drive them out, that was the ques- 
tion. Cold wrater and chloroform did it. I deluged her head 
with the water ; and gave her four teaspoonfuls of chloroform, a 
teaspoonful every twenty minutes. The vomiting ceased, the 10 
pain subsided ; she went to sleep, and waked up comparatively 
easy. That night and the next day she took quinine. bhe re- 
covered promptly. 
Case V.—I was called on the 24th of August, 1866, 8 o’clock 
in the evening to see Moses Thomas. The scene that met my 
astonished eyes when I entered his room baffles description. 
Not Dickens himself could do it justice. There, stretched on 
the floor, because he could not be kept on the bed, rolling, 
tumbling, groaning, and filling the startled air with clamo- 
rous invocations, was a son of Ham, cast in the mould of the 
giants, six feet two in his socks at the least, and evidently as- 
sailed by the whole mythology of furies at once. The room was 
swarming like a hive with men and women called together by 
his cries. The most of these, with blank, impassive faces in 
which no emotion took visible shape, stood helplessly about, 
speaking idle commonplaces in low tones one to another. But 
two or three old women, who called to mind the witches in Mac- 
beth, were piling hot bricks about him as opportunity offered3 
benevolently trying to drench him with some villainous decoction, 
which he sensibly refused to swallow. And one priggish fellow, 
with the legs of his blue breeches stuffed daintily into the legs 
of a pair of shining boots, and no beard on his face, was discours- 
ing grandiloquently on the vanities of this world, and energetic- 
ally endeavoring to impress the hoary old sinner on the floor, 
who heard never a word of all that was said, with a becoming 
sense of his exceeding great wickedness. I found that my pa- 
tient had been sick two or three days. He had eaten but little, 
and had taken some domestic remedies, hoping to wear out the 
disease without the aid of the Doctor. He had no fever. It 
was clearly a case of bilious colic. His sufferings were horrible, 
and the mind suffered in sympathy with the body. He was de- 
lirious from mere excess of pain, and paid no intelligent atten- 
tion to any thing about him. Nature to him had been liberal of 
her gifts. With the frame of Hercules he had inherited also the 
voice of Stentor. And with this great voice at its loudest pitch he 
called continually for the Doctor : “ Folks, why don’t you send 11 
for the Doctor? The Doctor can give me something to ease 
me I” When told that the’ Doctor had already come he would 
he quiet for a moment, and then break out again, “ Send for the 
Doctor ! Send for the Doctor I” I gave him at one dose a full 
half ounce of chloroform. When he was lifted up to take it I 
found that his entire vertebral column was as stiff as a board. 
After swallowing the chloroform the spasm rapidly relaxed, his 
consciousness of things about him returned, in a few minutes he 
was led to the bed, and in a few minutes more he fell asleep. 
Purgatives and quinine followed, as a matter of course, and he 
got well. 
Case VI.—I was called a little after midnight, July 9th, 
1866, to see Mr. P. Vv . He had attended to business the day 
before, but had not felt well. He stated that he had eaten but 
little during the day, and particularly that he had eaten no sup- 
per at all. The bowels were constipated, and he had slight 
fever, and some trouble about the head ; but he complained 
chiefly of intense abdominal pain. He drank a great deal of 
water, which was soon thrown up again without much change. 
I gave him a teaspoonfid of chloroform. This also was thrown 
up in a few minutes, and I gave him another teaspoonful with 
the same result, but doubtless some part of each dose was ab- 
sorbed. I now gave him still another dose of the same size, 
which was retained. Symptoms of alarming import quickly fol- 
lowed. The face became violently congested, the breathing grew 
stertorous, profound coma supervened, the tension of the muscles 
relaxed, and, to make use of a familiar phrase my patient was as 
limber as a rag. Soon after this he commenced vomiting, and dis- 
charged a large amount of undigested food, which must have been 
lying in his stomach for many hours, and which, strange to say, 
had not been disturbed by all the emesis, nor washed away by 
the water he had taken so profusely and thrown up again. 
The congestion, the stertor, and the coma now passed away ; 
consciousness returned, and the abdominal pains were felt no 
more. But some gastric irritation remained, and the constipa- 
tion continued. The subsequent treatment consisted, as usual, 12 
of purgatives and quinine. The case was discharged on the 11th 
—the third day—convalescent. 
Case VII.—Sept. 2nd, 1866. Mr. E. D. This was a charac- 
teristic case of congestive chill—febris intermittens maligna. 
The patient was comatose, the surface cold, the features collapsed, 
the pulse feeble and slow, the expired air cool, and all the senses 
blunted. At an earlier stage of the paroxysm there had been 
vomiting and purging. I gave half an ounce of chloroform in 
three doses twenty minutes apart. The good effect of the reme- 
dy was rapidly and unmistakably manifested. Warmth returned 
to the skin, the circulation rallied, the respiration improved, the 
coma subsided. The fever was short, and quinine prevented a 
recurrence of the chill. 
Case VIII.—Child of Mr. P. B. This was probably a case 
of congestive intermittent. The child was about six months old, 
exceedingly frail and delicate, and had had several chills. The 
bowels were loose, and the head stopped up with cold. When I 
saw it, it had been in convulsions for about an hour, with no dis- 
tinct intervals of ease, and was cold, pale and almost pulseless, 
and seemed indeed to be in articula mortis. I had but 
little hope of doing any good, but ventured anyhow to give 
at one dose a half a drachm of chloroform. The effort to 
swallow the medicine brought on a frightful spasm, but in five 
minutes after the child was asleep. The circulation was rapidly 
reestablished, warmth returned to the surface, and there were no 
more convulsions. A few doses of quinine completed the cure. 
Case IX.—Mr. L. M. had several attacks of intermittent 
fever during the summer »He was feeble, anaemic, and 
in general bad health. His mental faculties were observed to be 
impaired, particularly his memory. On the 25th of December, 
1866, he was suddenly seized with tonic convulsions. These 
grew more and more violent, and in three or four hours profound 
coma supervened. He had locked-jaw, opisthotonos, and sterto- 
rous breathing. It was at this stage of the case that I saw him. 13 
He was totally unconscious. The convulsions were extremely vio- 
lent, and involved the muscles of the arms and legs as 
well as those of the body. By forcing a strong iron spoon be- 
tween his teeth I managed to give him about three drachms of 
chloroform. This caused a temporary relaxation of the spasm, 
and a decided improvement of the respiration. Subsequently he' 
had an emetic of sulphate of zinc, was purged with croton oil, 
and was blistered, but all to no purpose. There was no restora- 
tion of consciousness, no subsidence of the coma. He died in 
about forty-eight hours from the commencement of the attack. 
The only noticeable amelioration of the symptoms was that pro- 
duced by the Chloroform. The malady was no doubt ingrave- 
scent or serous apoplexy. 
Case X.—W. M., a youth of eighteen years of age, small deli- 
cate organization, and nervous temperament, convalescent, from 
pneumonia, ate cabbage for dinner, and the night following had 
an attack of colic. He was vomited and purged, but the colic 
instead of subsiding grew worse ; and the next day, March 13th, 
1867, at three o’clock p. m. he sent for me. I ordered him a 
drachm of chloroform, but did not see him until four o’clock. 
He had thrown up the medicine, and with it a small quantity of 
some dark substance, which had not been kept, and I was con- 
sequently not able to determine its exact nature. The colic was 
still giving him a good deal of trouble. I gave him at a single 
dose two drachms of the medicine, which was retained, and in a 
few minutes he fell into a quiet sleep. He slept soundly a deep, 
quiet sleep, all the afternoon and all night, slept as though he 
could never sleep enough ; and when at last did wake up, he felt 
like a new man. 
Case XI.—Sept., 1866. This was a negro girl aged about 
fifteen, who had been afflicted with epilepsy from childhood. 
The paroxysms had never been frequent nor severe ; and neither 
the body nor the mind had been injured to any perceptible de- 
gree. In the particular instance in which I saw’ her, the attack 
was provoked by acute suppression of the catamenia, and w’as of 14 
far greater violence than usual. The convulsions were of the 
characteristic tonic type, with deep coma, stertorous respiration, 
chewing of the tongue, frothing at the mouth, and the full train 
of attendant symptoms. They succeeded each other very rapid- 
ly, and when I reached the house, at 8 o’clock in the evening, 
she was in a state of almost’ continuous spasms. I gave her 
Chloroform by the teaspoonful, until she had taken three doses, 
at intervals of fifteen minutes, before the subsidence of the convul- 
sions and the supervention of the chloroform sleep. The sleep 
was heavy, restless, and unsatisfactory, and was disturbed towards 
morning by occasional slight spasms for which another dose of 
the remedy was given. The epileptic passion was held in check 
but not thoroughly subdued. I put her the next day on twenty 
grain doses of bromide of potassium, and she had very little more 
trouble. 
Case XII.—I was called at seven o’clock in the afternoon of 
the 26rh of October, 1835, to see Air. J. D., a young man who 
was just convalescent from a long spell of bilious fever, compli- 
cated with facial neuralgia, who sought my assistance, in the 
absence of his attending physician, for an intercurrent attack of 
some kind of abdominal pain from which he had been suffering 
since the middle of the day. The day before at the same hour 
hi had an attack of similar nature, only of much less severity, 
which had been relieved by extract of ginger, paregoric, castor 
oil, and a mustard poultice; and the same remedies had been 
tried in the present paroxysm, but without the slightest mitiga- 
tion of the symptoms. I saw at once that I had no easy case to 
deal with. The pain was intensest agony involving the whole 
abdominal region, but most severe about the umbilicus. The 
face wore amanxious, troubled look. The pulse was slow and 
full. The skimwas wet with sweat, and cool to the touch; but the 
patient complained of feeling hot and threw off the cover. He 
did not vomit, nor complain of nausea ; but occasionally belched 
up mouthfuls of semifluid brownish matter, which although it 
had no’, distinctly stercoraceous smell or appearance, I supposed 
might be modified chyme from the duodenum after 15 
the passage of the pylorus. I ordered a fluid ounce of chloro- 
form, and gave the whole of it at three doses, the first at half 
past seven, the second at a quarter before eight, and the third at 
at a quarter past eight, measuring time by the clock that stood 
on the mantle in the patient’s room, and making an interval of a 
quarter of an hour between the first two doses, and an interval 
of half an hour between the last two doses. The result was such 
as to dissappoint all my expectations. Only a very slight alle- 
viation of the pain followed the first dose. After the seeond 
there was a slight and evanescent disposition to sleep, but the 
pain very soon grew worse again, and the man insisted that he 
must die if he were not speedily relieved. The third dose pro- 
duced no appreciable effect, and the pain grew steadily more and 
more intense. Ten or fifteen minutes after the last dose there 
was a tolerably copious discharge of urine smelling strongly of 
the drug. During all this time the pulse and respiration re- 
mained about the same, and there was very little change in any 
of the symptoms except that the skin g-ew dryer and warmer. 
The choloroform had occasioned no nausea, nor any sensation 
of burning in the stomach, nor any other unpleasant symptom 
whatever. As well as I could judge it had simply failed to re- 
lieve the pain, and that was all. 
What to do next was a matter of anxious consideration. It 
did not seem expedient to give more chloroform under the cir- 
cumstances. The amount already used was large beyond all 
precedent, and the system was already saturated with it as was 
evident from its rapid elimination by the kidneys, and, as I had 
also reason to believe, by the skin and the lungs. I ordered a 
solution of sulphate of morphine, five grains to one ounce of rose 
water. I gave about three fourths of this at three doses between 
nine and ten o’clock. Ten o’clock, brought the blessed release 
from pain ; and with it tired nature’s sweet restorer, balmy 
sleep. When I left at half past ten the patient was sleeping 
soundly and quietly ; and neither the circulation nor the respi- 
ration, nor any of the great functions, gave warning of approach- 
ing danger. I saw the case no more, but I learned that he slept 
well through the whole night and waked up spontaneously 16 
the next morning ; that the attending physician prescribed cro* 
ton oil ; that the man died before noon ; and that the sexton’s 
report gave intussusception as the cause of his death. 
Case XIII.—One day towards the end of August, 1866, the 
boy who attended to my gray horse Fooshee, went to the stable 
after breakfast to harness him up, and found him sick. Great 
was the excitement that followed the publication of the fact. 
For it must be understood that Fooshee is a great favorite in 
the family, as he well deserves to be. Because he is a good honest 
horse ; and was bred and raised by an honest man, which can’t 
be said of every body’s horse ; and, most of all, because of the 
honored name he bears—that of one of my best friend’s, who 
bought and trained him for me. As I proceeded, with sedate 
professional step, towards the stable to investigate the matter, 
I was met by half a dozen separate messengers, all at full speed 
.as if shot out of a catapult and running over with the same 
'dreadful intelligence, “ Fooshee is sick!” Last of all, because 
his little feet were not able to run as fast as the rest, came tod- 
dling breathlessly up, a fl ixened haired two-year old, who rejoices 
in the name of Bowling, exclaiming like the others, but in im- 
-perfeetly articulated baby speech, “ Papa, Fooshee sick”. When 
I entered the lot Fooshee too came meeting me, as if I did not 
make haste enough ; and looked into my face with his great 
brown eyes; an I seemed after his dumb, brute fashion to be 
pleading for human sympathy and the assistance of human 
science. The diagnosis of the case was not difficult. It was 
easy to see that the horse, like so many of my human patients, 
had the colic. His belly was tense and tympanitic ; he walked 
restlessly about ; he swayed to and fro ; he lay down, and got 
up, and lay down again, and stretched out his legs ; and rolled 
over; and groaned a little; and put his mouth to his belly as if to 
show where the pain was. In short he acted as much like a man 
as he could, only he sufered with a great deal more of dignity and 
fortitude. I gave him, at once, half a fluid ounce of chloroform. 
The effect was wonderful. No talismanic elixir of Eastern fable 
ever wrought so powerfully or promptly. In five minutes he 17 
was eating hay with evident apetite ; and in half an hour he was 
hitched to the buggy, and drew me as usual through my usual 
round of morning visits. 
SECTION HI.—METHODUS MEDENDI. 
The precise nature of the action of chloroform on the human 
organism has not been certainly determined. Professor Wood, 
as we have seen, gives it a place among the sedative narcotics, 
and believes that it acts immediately on the nerves, and through 
the medium of the nervous system upon the rest of the body. 
This seems to me the only tenable theory. Other authorities 
however, maintain that it acts directly upon the blood * and that 
it produces narcosis indirectly, by virtue of a property which it 
shares with all the other narcotics, of diminishing the power of 
the organic constituents of the blood to combine with oxygen an 1 
to give off carbonic acid. This theory is applied to the whole 
family of aethers by Dr. Charles A. Lee, the American editor of 
Copland,s Dictionary. It is also advocated by Mr. Sansom in 
his recent book on “ Chloroform and its Administration.” The 
facts from which Mr. Sansom make s his deductions are not devoid 
of interest, and as I have not read the book, I quote here a sum- 
mary statement of them from the Westminster Review for Oc- 
tober, 1865 : 
“ By microscopical examination of the capillaries of the frog’s 
foot when Chloroform had been administered to the animal by the 
mouth, he has found the effects of it, as of other anaesthetics, 
upon the circulation, to be, in the order of their sequence, first, 
an increase of the flow of blood through the arterial system ; sec- 
ondly, a decided contraction of the arteries, the current maintain- . 
ing its original force ; thirdly, a sluggishness of the flow of 
blood in the capillaries ; and, fourthly, dilatation of the artery, 
with an increasing sluggishness of the flow of blood that may 
pass to actual stasis. A state of anaesthesia does not then, as 
has been commonly thought, imply hyperaemia of the brain ; 
but the quantity of blood in the vessels is diminished, as i is 
now also known to be in natural sleep. This has been actually 
seen in the case of a patient in America, who had suffered a 18 
fracture of the skull that exposed the brain ; when he was fully 
under the influence of Chloroform, the brain was remarkably 
pale, but its surface became florid and injected as the anaesthesia 
passed off.” I give these facls for what they are worth ; and 
with the highest respect for the one indubitable fact that there are 
more false facts than false theories in the world. Certainly they 
afford no presumption, not even the faintest, against the doc- 
trine that Chloroform, by virtue of elective affinity, or by virtue 
of some other inexplicable attraction, exerts its specific influence 
immediately on the nervous system, and mediately through ner- 
vous instrumentality on the rest of the organism, blood, muscles, 
viscera, etc. But if it is indeed true that there is a smaller 
amount of blood in the brain during natural sleep, than at other 
times ; and if it is also true that the amount of blood in the brain 
is diminished under the anaesthetic influence of Choloform, it is 
evident that these facts are of immense importance in relation 
to practical therapeutics. They afford apriori presumption, 
for example, of the propriety of the use of Chloroform in the 
treatment of the various forms of cerebral congestion and cere- 
bral apoplexy ; and furnish means for at least the partial expla- 
nation of its hypnotic and anaesthetic efficiency. 
Choloroform is of somewhat complex chemical constitution ; 
and, so far as I know, no attempt has been made to trace in 
its influence on the human system, the specific effect of any of 
its proximate constituents. It is a terchloride of formyle. Chlo- 
rine, I believe, is not used in medicine except as a disinfectant; 
and formic acid and formyle are not used medicinally at all. 
Yet there is some reason to believe that the formyle is the active 
anaesthetic principle of Chloroform. Formyle is the hypothetical 
radicle of formic acid. Formic acid was original y derived, by 
some process of distillation, from the large red ant, the formica 
rufa of Linnaeus, whence its name, and is the substance that 
gives to that enterprising little animal its peculiar penetrating 
odor. It is a theme of curious speculative interest that while 
neither formyle nor formic acid has ever been used medicinally, 
the red ant itself the formica- rufa, has an unwritten therapeu- 
tic history. Thereby hangs a tale. 19 
An acquaintance of mine had, many years ago, an old negro, 
man who had been brought from Africa. This man was the sub- 
ject of frequent and very distressing attacks of cramp colic, 
which, in blissful ignorance of the therapeutic opulence of Cau- 
casian civilization, he was accustomed to treat with a remedy he 
had learned the use of in his native country—the land of Obi and 
Fetish. The remedy in question was the formica rufa. When- 
ever he came across a nest of these creatures he would mark the 
place so that it could be found when wanted ; and whenever he 
was visited by a paroxism of his habitual malady he might be 
seen rushing with breathless haste to one of his nests, tearing 
away the earth that covered it with impatient hands, eagerly 
cramming the living animals into his voracious mouth, and 
crushing and swallowing them as fast as he could -without any 
preliminary employment of the art of Soyer and Francatelli. 
This singular medicine always gave him relief. I take it for 
granted that it owes its efficacy to the formic acid it contains ; 
and that African therapm’ics can thus plausibly lay claim 1) 
the first practical anticipation of the great anaesthetic. 
SECTION IV. MODUS ADMINISTRANDI. 
When Chloroform is applied to the skin in such way as to 
prevent evaporation, vesication is rapidly and certainly pro- 
duced when it is left free to follow its natural tendency to pass 
into the state of vapor, its cutaneous influence is simply refrige- 
rant. When Chloroform is held in the mouth, it causes a sen- 
sation of burning in the mucous membrane, which is, however, 
less intense than that produced on the skin, for the reason, pro- 
bably, that the mucous membrane is protected by the mucus 
with which it is covered ; and the Chloroform vapor finding its 
way into the air passages gives rise to cough and strangulation. 
But if Chloroform is rapidly swallowed, only a warm and sweet- 
ish taste is excited, and none of these unpleasant sensations are 
induced. 
Various preparations have been devised to facilitate its ad- 
ministration. It has been proposed to hold it in watery solution 
by means of alcohol or glycerine ; and there is an officinal emu]- 20 
sion in the French Codex. Bat the best vehicle is simple cold 
water. It is true that the Chloroform is not dissolved, but the 
water envelops it in the act of deglutition, and washes it down 
without any trouble to the patient. The amount of water used 
ought to be small, so as to be taken at a single swallow, say 
about a tablespoonful to each dose ; and the patient ought to be 
raised to the sitting position if the state of the case allows it. 
But it is not necessary to use any vehicle at all. The unmixed 
Chloroform can be swallowed without difficulty ; and particu- 
larly if the sensations subservient to deglutition are much blunted. 
In some cases, indeed, where the prostration of the system is so 
great that the nerves and muscles of deglutition are insensible 
to the familiar stimulus of cold water they will still respond to 
the more powerful influence of the Chloroform, and the Chloro- 
form can be swallowed when the water cannot. 
I have been most accustomed to make use of Chloroform in 
cases requiring the most prompt and energetic treatment. In 
these cases I give it in doses ranging from one fluid drachm to 
half a fluid ounce, repeated at intervals ranging from ten to 
thirty minutes. I know that this kind of practice smacks of the 
heroic. But when some tremendous pathological influence 
threatens to subvert the very foundations of life, or when some 
great pain is clamorous for relief, there is neither rhyme nor’ 
reason in any treatment which is not heroic ; and in such cases I 
am certain that the doses I have mentioned may be prudently 
and safely given. 
Although I have not been much in the habit of giving Chlo- 
roform in small doses, in slight maladies, nor in combination 
with other medicines, there is one somewhat complex formula 
which I have used with good results, in cases of gastric and in- 
testinal irritation, and as a general antispasmodic and carmina- 
tive. It is this : Recipe—Spiritus Ammonias Aromatici; Spir- 
itus Cinnamoni ; Spiritus Caraphoraa ; Tincturaa Opii ; Chloro- 
formyli, aa f’5j« Misce. Of this one to two teaspoonfuls is 
added to a glass of water-—ice water if most agreeable—and 
from a teaspoonful to a tablespoonful of this solution, accoiding 
to the age of the patient and the urgency of the symptoms, is 21 
to be given every lew minutes, so that the whole of it may bo 
taken in one or two hours. It is pleasant to the taste, and com- 
bines a good many valuable properties. 
One remarkable property of Chloroform, which must not be 
overlooked, is its emetic power. It is not an emetic per se. 
Indeed, in many cases it is found to be a very efficient remedy 
for gastric irritability. If the stomach is empty at the time of 
its administration it produces no emesis, and even no nausea ; 
but whether given by inhalation or by deglutition—by the lungs 
or by the stomach—if there is in tire stomach any accumulation 
of food, digested or undigested, or of chyle or bile regurgitant 
from the duodenum, it is a prompt and certain emetic, and what- 
ever the stomach may happen to contain is inevitably thrown off. 
When the stomach has been effectually emptied, any subsequent 
dose of the medicine is retained without difficulty. This pro- 
perty is well illustrated in my case six, above. The half-digested 
food with which this man’s stomach was oppress 1, which had 
resisted the expulsive efforts of several hours of severe v( miting, 
was removed in a few minutes by a little Chloroform. Another 
illustration will be found in the inefficiency of the emetic of 
sulphate of zinc given after the Chloroform in case nine. The 
emetic draught was too potent not to be rejected itself, but the 
gastric load it was expected to dislodge was not forthcoming. 
Professor Wood’s retention, without alteration or addition, in 
the last edition of the Dispensatory, of the scanty summary on 
the internal administration of Chloroform, written fifteen years 
ago, affords suggestive evidence of the slowness with whicn this 
method of exhibiting the medicine is coming into use. It ap- 
pears from this that but little is known on the subject, and that 
this little does not increase ; a condition of things which admits 
of but two explanations. Either the trials that have been made 
of it have not yielded favorable results, because of the inherent 
unfitness of the medicine for this kind of use ; or else the results 
have not been favorable, because the common impression of the 
dangerous character of the remedy has stood in the way of its 
efficient employment. Or, which is still more probable, both of 
these causes have acted in combination ; the apprehension of 22 
■danger leading to its timid administration, and this, in turn, 
leading to unsatisfactory consequences. That the doses in which 
it is sometimes given are too small to do much good, I am well 
satisfied. I am also well satisfied that its poisonous energy is 
far less than is generally believed. During the last four years I 
have given it a great many times, and I have never known any 
bad consequences to follow' its use, of a more serious kind than 
sick stomach, or occasional vomiting. It is not true in any 
■sense that Chloroform is one of the most energetic of poisons. 
On the contrary, there are very few medicines that can be given 
so safely in doses so large and so frequently repeated. 
The common tincture of opium is not commonly considered to 
be a very dangerous dru<r; and yet common tincture of opium 
is a far more powerful agent of evil than Chloroform. I have 
already quoted from the United States Dispensatory the state- 
ment that a fluid drachm of chloroform is equ il in soporific effl ct, 
to thirty-five drops of laudanum. Now' a fluid diachm of 1 u- 
<danum contains a hundred and twenty drops, which would make 
a drachm of laudanum equal to three drachms and a half of 
chloroform, or almost halt a fluid ounce, whence it seems to fol- 
low that half an ounce of chloroform may be given with as little 
hesitation as a drachm of laudanum, and with as little dread of 
subsequent danger. And if -there are cases in which a drachm 
o;' laudanum would not be considered an extravagant dose, as 
there certainly are, it seems fair to conclude that there are also 
cases in which half an ounce of chloroform could be prudently 
and safely given. 
Dr. Hartshorne, as we have seen, speaks of Chloroform taken 
into the stomach as a safe anodyne and soporific, altogether free 
from the dangerous effects twhich sometimes follow7 the inhalation 
of its vapor. And Dr. Copland, in the article on poisons in the 
third volume of his great Dictionary, says of the whole class of 
aethers, “I am not acquainted with any dangerous effects which 
have occurred from swallowing any of these aethers ; and I be- 
lieve that they may be taken in larger doses than are usually 
prescribed, and be productive, in certain states of disease, of 
much benefit. 23 
Some very suggestive views bearing on this point of doses are 
very well expressed by Sir Henry Holland, in his discussion of 
the use of opium in his Medical Notes and Reflections. He says : 
“Its use is not to be measured timidly by tables of doses, but 
by fulfilment of the purpose for which it is given. A repetition 
of small quantities will often fail, which concentrated in a single 
dose, would safely effect all we require. On this subject,” he 
continues, “we must refer to a faff regarding opium, singular in 
itself, and affording many curious inferences. I mean the fre- 
quent absence of its ordinary effects in producing constipation, 
headache, and nervous symptoms, when given for the relief of 
acute pain or spasmodic actions in some part of the system. It 
would seem (however vague the expression) that the medicine, 
expending all its specific power in quieting these disorders of the 
nervous system, loses at the time every other influence on the 
body. Even the sleep peculiar to opium appears in such in- 
stances to be wanting, or produced chiefly in effect of the release 
suffering. Though certain analogies may be quoted in illus- 
tration of these facts, nothing like explanation of them is fur- 
nished by our present knowledge. Their reality, however, can- 
not be doubted as a matter of practical experience ; and the in- 
stances are further remarkable in the large doses which may fre- 
quently be given in such cases, with impunity as to all the ordi- 
nary effects of the medicine.” 
The principles here noted by Sir Henry Holland, are not to 
be restricted in their application to opiates alone ; but are equal- 
ly true, I imagine of the whole class of sedative remedies ; and 
not alone of sedatives either, but, in strictest logic, of all the 
medicines of the pharmacopeia. To express the doctrine in its 
most general form, there is always, in disease, a certain abnor- 
mal tension of the nervous system to be overcome—a certain 
abnormal polarity to be altered. And as this nervous tension is 
greater or less, as this vital polarity is in a state of greater or 
less deflection, so is a larger or smaller quantity of antagonistic 
influence necessary to overcome it and bring it back to its natural 
healthy condition. The greater the tension, the greater the dose 
necessary to relieve it. And the amount of powerful drugs that 24 
can sometimes be borne with impunity is not a little astonish- 
ing. I myself know an opium-eater who has assured me that 
he has taken an entire drachm of morphine at a single dose. 
Dr. Alonzo Clark relates a <a<e of puerperal fever treated by 
him in Bellevue Hospit; 1, in wh’ch there was given during 
the first twenty-six hours, sixty-eight grains of opium, and 
seven grains of morphine ; during the next twenty-four hours 
one hundred and forty-eight grains of opium and eighty-one 
grains of morphine—equivalent to four hundred and seventy- 
two grains of opium, or to two drachms of morphine. On the 
the third day, two hundred and thirty-six grains of opium. On 
fourth, one hundred and twenty grains. In reference to this case, 
Dr. Clark says : “ This woman was not addicted to drinking, 
and after her recovery, she assured me repeatedly that she did 
not know opium by sight, and had never taken it, or any of its 
preparations, unless it had been prescribed by a physician. This 
is, perhaps, ‘horrible dosing,’ and only justifiable as an experi- 
ment on a desperate disease. Yet this woman is alive to tell 
her story, as are several others who took surprising quantities of 
this drug. But later observations have shown that the tenth to 
the twentieth part of this maximum is efficient in controlling 
the disease. So this case is referred to, not for imitation, but 
because, with similar cases, it is a medical curiosity; and may, 
perhaps, open some new therapeutical views.” 
Cases of this kind in which immense quantities of medicine have 
been taken without injury, might be multiplied almost without 
limit—and might, also, be extended so as to include a large 
number of drugs belonging to several classes of materia medica, 
but it is not necessary to my purpose to increase the list. 
The theory of doses is a part of the general theory of the tole- 
rance of the organism for different kinds of food and medicine, 
under the special conditions of age, sex, race, constitutional idi- 
osyncrasy, and the correlative influence, of concurrence or of an- 
tagonism, of different agents acting at the same time, in health 
and in disease. What is called tolerance is itself included in the 
reciprocal relations of action and reaction, physical, chemical, and 
vital, between the organism and the environment. And these 25 
relations are found in the last analysis to be only special phases 
of the great law of Polarity. Here we reach the utmost limit of 
speculation. Polarity is the ultimate fact of the natural world, 
and is therefore, of necessity, the last word of all natural science. 
Polarity, in the most abstract and general statement, is the 
equilibrium of differences—Swedenborg’s doctrine of correspon- 
dences, and Emerson’s law of compensation from a different 
point of view. 
I will close this somewhat desultory essay with a summary 
statement of the conclusions which seem to me to be warranted 
by the facts which I have detailed. 
1st. Chloroform may be administered by deglutition, with rea- 
sonable expectation of benefit, in all cases where the paramount 
indication is the relief of pain. 
2d. In all adult cases it may be given in doses of from one to 
two drachms frequently repeated ; and where the pain is exceed- 
ingly severe and obstinate half a fluid ounce may be given at a 
dose safely and prudently. 
3d. Chloroform passes into the system with great facility, and 
is with equal facility eliminated from the system. The organs 
of elimination are the lungs, the kidneys and the skin. 
4th. Whether any part of the drug is decomposed in the sys- 
tem, I am not able to conjecture ; but it is certain that at least 
a part of what is given is eliminated without change. 
5th. The rapidity of its absoption and elimination, and the 
promptness of its action on the organism indicate that where 
more doses than one are needed they should follow each other in 
rapid sucession, so that the anaesthetic effect of each additional 
dose may be added to the anesthetic effect of the doses that 
have gone before, until the pain is overpowered. 
6th. I believe that Chloroform does not act immediately on 
the blood and by the arrest of molecular change, as Mr. Sansom 
and Dr. Lee, and some others have taught ; but that the more 
common opinion that it acts primarily on the nervous system 
through some power of elective affinity, is nearest the truth. 
7th. Although somewhat foreign to the subject of this essay, 
I may be allowed to add here, that for the production of anees- 26 
thesia by inhalation, pure Chloroform is in my opinion, more 
pleasant, more prompt, more powerful and at the same time 
safer than sulphuric aether, or than any combination of the two. 
8th. By any method of administration by inhalation or by 
deglutition, it is not by any means so dangerous a poison even 
in the medical profession as it is commonly believed to be. 
9th. Professor Merrill is right. It is nature’s favorite remedy 
for pain by whatever means produced. It combines in itself 
more good qualities and fewer bad ones than any other article of 
the Materia Medica which approaches it even remotely in power 
and in range of application. And I can not share in Mr. Bow- 
man’s sanguine anticipation that “in the sure progress of our art 
some other anaesthetic shall be found without even the slight 
inconveniences of Choloroform.” 
Note—This Essay, with the exception of a part of the cases which have occured 
since, was read before the Mobile Medical Society on the day of April, 1866.