b. Preparation of the patient. - Insensibility is more rapid when the stomach is empty. No solid food should therefore be given for at least six hours before the operation, which should, if possible, be performed early in the morning when digestion has been completed and the anaesthetic is rapidly absorbed. If the patient feel faint under these circumstances, a small quantity of brandy and water may be given before operation. Artificial teeth must be removed. The respiration and pulse should be carefully noted before commencing inhalation.

c. Selection of the anesthetic: purity of the same. - The anaesthetic agents in general use at the present time are chloroform, bichloride of methylene, ether, and nitrous oxide gas. Of these, ether and nitrous oxide are unquestionably to be preferred, unless there be some special reason to the contrary. The purity of the drug is best insured by purchasing it from well-established makers, and not by attempting to test it for oneself; and the same manufacture should always be used, if possible. It may be advisable to commence with one anaesthetic, and then, as circumstances alter during the operation, to change it for another.

d. Selection of the apparatus. - This will depend on circumstances and on the taste and experience of the administrator. Whilst elaborate inhalers are used in hospitals, it is satisfactory to know that the simplest apparatus is equally safe, such as a handkerchief or towel made into a cone, care being taken that chloroform vapour is mixed very freely with air, but that with ether, on the contrary, the atmosphere is excluded as completely as possible. A few capsules of nitrite of amyl and a straight polypus forceps should be ready at hand.

e. Position of the patient. - The administrator must accommodate himself to the convenience of the operator, whose eye and hand must never be interfered with. If possible, the patient's head should be placed in such a position on the edge of a pillow that the saliva may flow from the mouth instead of into the stomach, and that the tongue may not fall hack and produce dyspnoea. It is essential that the patient's chest and abdomen should not be compressed in the slightest degree by clothes or by the arms of the assistants, or confined by bandages. The most comfortable position for the patient is on the side, with one hand and fore-arm beneath the pillow; and as a rule it is better to induce insensibility in this position, and afterwards arrange the patient for the surgeon, than to aenasthetise him in the constrained attitude often required in operations.

f. Administration. - The confidence of the patient should first be gained by a few minutes' conversation, whilst he is reassured as to the result and instructed how to breathe. When inhalation has commenced, the administrator must not even for a single instant cease to watch the face, respiration, and pulse. The degree of insensibility necessary for different cases varies greatly, the least being required for uterine, the most for rectal operations. The loss of the corneal reflex, and stertorous breathing, are generally employed as tests of insensibility, but no single sign can be relied upon. The smallest possible quantity of the drug should always be given; and patients once thoroughly anaesthetised by ether may be kept under its influence for many minutes by rebreathing the air of expiration loaded with its vapour mixed with some fresh air.

g. Complications and unfavourable symptoms. - Vomiting is generally preceded by pallor of the face or a few deep inspirations. When it occurs, care must be taken that nothing is drawn into the larynx; the head should therefore be thrown forward, and the mouth opened by pressure on the symphysis of the jaw, or by inserting a pair of forceps between the teeth. Should vomited matter be inhaled into the respiratory passages and asphyxia threaten, laryngotomy must be immediately performed.

Lividity of the face and prolonged deep stertor should be checked by raising the shoulders so that the diaphragm may descend more easily, and by making the patient breathe fresh air.

The position of the head is to be changed until respiration is more easy; the vessels of the head and neck must be allowed to empty themselves well and quickly; and the mouth may have to be opened to its fullest extent, which induces a deep inspiration, the following expiratory effort often clearing the larynx and fauces of tenacious mucus which had been obstructing the entrance of air.

Pallor of the face is to be combated by lowering the head and shoulders; if severe, by dropping the head over the end of the table. If this should not succeed, the vapour of nitrite of amyl should be given.

Shallow breathing, especially if intermittent, should be anxiously watched; and if it increase, artificial respiration should be at once resorted to, on no account waiting for the respiration to cease.

h. After-treatment. - Absolute quiet and keeping the eyes closed often prevent sickness after an operation. The whole surface of the body being carefully covered to prevent chill, the room should be cleared of ether vapour as quickly as possible. Cough induced by ether is often attended by blood-stained mucus, which, with these precautions, is of no consequence. Food should not be given within two hours after the operation, and for the first twelve hours should be entirely cold, and consist chiefly of soups and jellies, milk being avoided. A tea-spoonful of burned brandy will often relieve the after-sickness, when all other measures have failed.

4. Remote Local Action

Chloroform is excreted in part, as such, by the kidneys, lungs, and skin; part is lost in the system. No use is made of its remote effects, although small doses given by the mouth are said to increase all the secretions.