"5. Should loud snoring occur, force up the chin. This manipulation, by straightening the air passages from the nose to the larynx, makes easy breathing. The forcible elevation of the chin is far better in every respect than pulling out the tongue. It is easier of application, more quickly done, requires no instrument, and is much more efficient in removing the impediment to respiration.

"While operating, I have constantly in view both the color of the face and the respiration of the patient, which I consider even more important for the surgeon to observe than to feel the pulse." ( See "Chloroform" for further directions and precautions to be observed during the administration of this agent.)

Dr. H. A. Hare states that if during anaesthesia, respiration stops, he has found that in a large number of instances, both in man and in the lower animals, the free use of ether poured upon the belly causes so great a shock, by the cold produced by its evaporation, as to cause a very deep inspiration, which is often followed by the normal respiratory movements.

Dr. H. I. Neilson gives the following conclusions concerning the pupil as a guide in the administration of chloroform:

1. The first effect of chloroform narcosis on the pupils consists in a dilatation which varies in intensity and duration in different individuals. As the anaesthesia becomes more profound the pupils begin to contract and finally become very small and immovable. If now the chloroform is pushed still further, a sudden dilatation occurs, which is the result of asphyxia, from which the patient seldom recovers.

2. As long as the pupil is observed to dilate in response to sensory stimuli, such as pinching the skin, the anaesthesia is not yet sufficient to allow the commencement of the operation.

3. As soon as the pupil becomes strongly contracted and immovable, the administration of the anaesthetic must be suspended, until a commencing dilatation is observed, and the patient must be held at just this point as long as the operation continues.

4. Vomiting causes a dilatation similar to that occurring as the patient emerges from the narcotic condition, but it is usually more sudden in the former case. The contraction of the pupils does not appear to begin until the blood-pressure is somewhat reduced, and the dilatation proceeds pari passu with the increase in the blood-pressure. He therefore regards the appearance of the pupil as a very reliable guide for the administration of chloroform, as he is enabled to judge accurately concerning the condition of the patient.

When ether or chloroform is administered for the extraction of teeth, the operation should be performed in a dental chair so constructed as to admit of the patient being placed in as horizontal a position as is possible to operate successfully, and every instrument it is necessary to use should be within reach of the hand of the operator. As soon as the operation is completed the head of the patient should be gently inclined to the side, so as to permit the blood to run from the mouth and not pass down the throat. Any considerable change in the position of the patient should be avoided until recovery has taken place. Fresh air should be admitted by lowering the window, and the patient freely supplied with it by means of a fan.

The vapor from a mixture composed of equal parts of chloroform and alcohol has been combined with the nitrous oxide gas. This vapor from two or three drops of the chloroform and alcohol mixture is used with each gallon of gas, the anaesthetic effect of which, it is claimed, is more lasting, and at the same time less dangerous, than from either of the two agents alone. An apparatus for combining these two agents is in use, which is attached to the gas cylinder, in place of the ordinary connection. (See the combinations of oxygen and air with nitrous oxide, under Nitrous Oxide.)

The administration of anaesthetics through the nose has been suggested by Dr. B. C. A. Windle, of England, a peculiar instrument being employed for pumping the vapor of the anaesthetic through a tube which passes into one nostril; wings, to close the outer surface of the nostril containing the tube and the opposite surface of the septum nasi, are attached to the tube, so that air may pass through the passage unoccluded by the tube. The inventor of this method claims that by its use perfect anaesthesia can be maintained throughout an operation about the face, of any length, without interfering with the operator's actions; also, that in operations about the mouth and palate the patient can be maintained at that point of anaesthesia which may be considered desirable, and that the supply can be regulated.

Dr. Axel Yversen, of Copenhagen, suggested etherization by the rectum, the vapor being conducted to the rectum by a rubber tube (attached to a bottle containing the ether, in a water bath of 120°), terminating in a recurrent catheter, the free or recurrent end being closed by pressure of the thumb during the inflation of the bowel; the expiratory act being performed by removing this pressure and the water bath. The principal advantage this method appears to possess is that it permits operations on the face without the ordinary obstacles of the common method.

Dr. Thomas Fillebrown suggests a new apparatus for maintaining anaesthesia without a face-piece, and with the mouth open. The apparatus consists of a bellows, connected by rubber tubing with the long tube of a 12-ounce wash-bottle, with a stopcock to regulate the flow of air. From the bottle extends a half-inch rubber tube to the patient. The bellows is inflated, and the stop-cock opened so as to allow the air to bubble up freely through the ether, and to become saturated with ether vapor. The etherized air is then discharged through the second tube a few inches from the patient's face. It is claimed that such an application of ether will maintain complete anaesthesia for any length of time, and not interfere in the least with any operation in or about the mouth; nor will the surplus vapor discharged into the air sensibly affect either the operator or the assistants; also, that the anaesthesia can be maintained from one-half hour to one hour and a half without intermitting the operation at all on account of the anaesthesia; that this method is not wasteful.

The Dangers Of Anaesthesia

The conditions rendering general anaesthetics dangerous are fatty degeneration of the heart (a prominent contraindication); previous alcoholic habits; brain tumors and degenerations; respiratory obstruction from swollen epiglottis, enlarged tonsils, oedema glottidis, laryngeal paralysis, thoracic tumors or aneurism; emphysema and obstructed pulse circulation from engorgement of right heart and deficient heart power; valvular lesions; incomplete anaesthesia during painful surgical operations, causing death from shock, as the result of peripheral irritation. Muscular debility and weakness from exhaustion, if otherwise uncomplicated, are considered to be rather aids to anaesthesia than contraindications.