Treatment of Untoward Manifestations. - Withdraw the ether if there be danger of respiratory or cardiac failure, lowering the head if there be indications of the latter, and if respiratory failure be threatened, as indicated by cyanosis, avoiding a prostrate position. Meanwhile other measures for the relief of cardiac or respiratory failure may be resorted to: artificial respiration, friction, or the electric current to excite respiratory action, one electrode being placed upon the larynx and the other upon the epigastrium. Hypodermic injections may be resorted to - of strychnine, or atropine, or, in desperate cases, of ammonia. Salt infusion may be used. Adrenalin is useful to restore blood-pressure.

Should nausea become too persistent, a hypodermic injection of morphine will usually suffice to quiet it.

Therapeutics. - Externally and Locally. - The local anesthetic properties of ether render it valuable in many diseases of the skin, such as pruritus, urticaria, etc. For treatment of these disorders it is usually combined with some aromatic.

A wet compress saturated with ether has been successfully applied to the forehead for the relief of epistaxis. The hypodermic injection of 15 minims (1.1 Cc.) of ether in close proximity to the affected nerve has been found valuable in neuralgia and sciatica.

The hypodermic method of administration has been also practised in the treatment of shock and in the threatened collapse following post-partum hemorrhage, as well as for the cure of sebaceous cysts.

Internally. - Ether is used as an antispasmodic in order to facilitate certain examinations, the reduction of dislocations, and to relieve pain in the general practice of surgery, obstetrics, and dentistry. It has been used as an anthelmintic against tapeworms.

The compound spirit of ether is a stimulant, antispasmodic, and anodyne. It is an efficient remedy for gastralgia and flatulent colic, and is used to allay many of the symptoms of hysteria, as well as restlessness and insomnia unaccompanied by fever. Palpitation of the heart and nausea due to the excessive use of tobacco are also greatly benefited by this preparation. In angina pectoris and hiccough it is an efficient remedy.

Contraindications. - Acute or chronic disease of the kidneys. Dilatation or fatty degeneration of the heart. Subacute bronchitis. Asthma sometimes. Tuberculosis with tendency to hemorrhage. Tumors of the brain or about the neck. Atheromatous condition of the arteries. Enlarged tonsils, chronic alcoholism, or aneurism.

It is necessary at times to give an anesthetic in the foregoing cases, and the surgeon is justified in the use of ether, but the administration should be extremely careful and conducted under skilful supervision whenever the above contraindications exist -particularly in conditions of dilated or fatty heart or chronic alcoholism. Any condition which might prove harmful by reason of the retching and straining, as hernia, etc., sometimes constitutes a contraindication.

Administration. - In administering anesthetics the following precautions should be taken:

The stomach of the patient should contain no food.

The clothing should be loose about the neck, thorax, and abdomen, allowing perfect freedom of respiration.

Artificial teeth should be removed.

It should be remembered that ether is inflammable, and, when its vapor is mixed with air, explosive; it should, therefore, not be used near a flame or an actual cautery, from which it may ignite.

The patient should be kept covered, in order that there may not be too great a reduction in temperature. He should, moreover, be watched for several hours after the administration, since there is always more or less danger until the effects of the ether have entirely disappeared.

Under proper methods the administration of ether occasions little inconvenience. In addition to the recommendations already given, it may be added that smearing the mouth and nose with oil prevents the excoriation frequently occasioned by contact with the anesthetic.

There are various means of administration, the simplest and in many cases the most efficient being a towel shaped into a funnel or hollow cone, with a piece of stiff paper laid between the outer folds to preserve the shape. Many other mechanical contrivances are in use. The Allis inhaler is widely used, although the tendency is to use more complicated inhalers.

In using the towel-cone the inner surface is saturated with about half an ounce of ether, the inhaler at first not being placed close to the mouth and nose, thus allowing the vapor to be sufficiently diluted with air. The effect of this method is to accustom the air-passages to the primary irritation of the anesthetic and graduate its effects. It should be borne in mind that poisoning occurs in both ether and chloroform anesthesias by reason of too concentrated a vapor. Ether should not be administered in more than 6-10 per cent. of vapor. Chloroform vapor should be much more diluted - 1 - 2 per cent. After this the towel may be pressed closer to the mouth and nose and the vapor of ether freely administered. In this manner a person may become completely etherized without nausea or resistance. The insensibility of the conjunctiva and complete relaxation of the muscles, accompanied by semi-stertorous breathing, indicate that the stage of desirable anesthesia is attained. The quantity of ether administered should now be reduced, further supplies being limited to the amount requisite to maintain complete anesthesia.

The symptoms incident to the primary effects of etherization -cerebral excitement, muscular activity, etc. - should not induce withdrawal of the anesthetic, but rather its continuance. Should vomiting occur at this stage, etherization should be suspended and the mouth thoroughly cleansed by means of a sponge or a towel.

Complete loss of consciousness marks the following stage of anesthesia, when total relaxation supervenes, accompanied by gentle, regular breathing. Should stertorous respiration attend further etherization, it is a warning of paresis, and the drug should be withdrawn.

Congestion of the facial muscles during anesthesia is quite normal, pallor, as a rule, indicating cardiac or respiratory debility. The practice of closely covering the face is thus to be discouraged, since it conceals important symptoms of the patient's physiological condition. The danger from asphyxia in complete etherization is shown by the entire muscular relaxation of the tongue, which is prone to drop backward, and the closing of the glottis, suspending respiration. In such an occurrence the jaw should be pressed forward, the head being well extended, and, if necessary, the tongue brought forward with the forceps.

The pulse, respiration, color, and pupillary reflex are the main points under observation by the anesthetist. At first the rate of the pulse is usually increased by reason of excitement; later it becomes slower and fuller, and when it becomes very slow and feeble, it is wise to ease the patient. The respirations, after the preliminary choking and gagging, become full, deep, and slower. As anesthesia progresses they become shallower and shallower, and should always be watched with a critical eye, especially if cyanosis develops. This indicates the danger-limit to which etherization may proceed. The pupils exhibit a variety of changes and differ in every individual. The usual rule is to have a preliminary dilatation, and during narcosis a moderate state of contraction. If marked dilatation occurs in deep narcosis, this is an indication of poisoning and for the withdrawal of the anesthetic.

Under favorable conditions, from five to twelve minutes are required to etherize the patient completely. The effects of anesthesia upon recovery vary with the temperament and character of the individual and the conditions under which the drug is administered. Great excitability may attend awakening from etherization, or the patient may return to consciousness as from a tranquil slumber. Nausea and vomiting frequently accompany rallying from the narcosis - not, however, such as may require especial treatment. Should somnolence be manifested, it is best not to rouse the patient, that the awakening may be easy and natural.

In etherizing a female patient the presence of a woman is always desirable, in order that her testimony may assuage certain sexual impressions to which women during anesthesia are prone. To the operator and attendants her presence is also of importance.

In collapse states hot applications, the internal administration by hypodermic of caffeine, strychnine, ergot, or adrenalin chloride are each, and may be all, called for. Artificial respiration is imperative; oxygen often helpful, and enteroclysis with hot saline, or infusion may be useful. Suprarenal extracts may be of service.

Great care should be taken to see that the patient is well covered and not exposed to drafts, in its relaxed condition the body being peculiarly susceptible to pneumonia or pleurisy. The anesthetic should be carefully examined before administration, and the character of the drug thoroughly known.