A plan commonly adopted is that which was first recommended by Dr. Simpson. A clean white handkerchief is to be folded funnel-shaped; into this the liquid is to be poured; it should at first be placed near the mouth of the patient; and, after a few respirations, over the mouth and nose. It is a good plan to allow the patient to hold the handkerchief, unless we desire to produce a deep state of narcotism, as it will fall from the hand when sleep commences. Another mode of adminis-tmtion proposed by Dr. Moir* and approved by Dr. Simpson, is to lay one single layer of a towel or handkerchief over the patient's nose and mouth, taking care not to cover the eyes, and to drop on this layer Chloroform drop by drop, until anAesthesia is sufficiently marked.

It may be doubted, however, whether when complete anaesthesia is to be produced, these "simple" modes of administration are sufficiently safe for adoption. Dr. Snow proved that patients cannot breathe an atmosphere containing more than 5 per cent. of Chloroform without danger. He objected strongly to the use of the handkerchief, and the recent Committee of the Royal Medical and Chirurgical Society} state that 3 1/2 per cent. should be the average amount, and 4 1/2 per cent. the maximum proportion It is true that the above-named committee state that an apparatus is not essential to safety if due care be taken in giving the Chloroform. Free admission of air with the anaesthetic is the one thing necessary, and guaranteeing this, any apparatus may be used. But Dr. Sansom§; has shown that of eighty cases of death from Chloroform seventy-eight occurred alter its administration on a towel, napkin, or sponge. There have been in all rather over 150 deaths from Chloroform; in only about a dozen were precautions taken to insure the proper dilution of the vapour. It is difficult to guarantee accurate dilution, except by using an inhaler, constructed expressly for that purpose.

835. The Adrantages Of Chloroform In Surgery Have Been Ably Enumerated By Prof

Miller,|| of Edinburgh. 1. It permits the performance of operations, which, either from mental agitation or extreme bodily pain, would otherwise-be inexpedient. 2. It permits the performance of operations which would otherwise be impracticable, e.g. deep-seated tumours of the neck, which require great nicety of manipulation, and much steadiness on the part of the patient. 3. It affords great relief to the operator as well as to the patient. 4. It affords the operator time for deliberate action - he has now no reason or excuse for hurrying over an operation. 5. It not only does not favour. but tends to save haemorrhage, both during and after t!>e operation. 6. It renders delicate dissections more simple and safe. Excepting the flow of blood, the anatomy is as plain as in a dissecting-room. 7. It lulls pain after opera: and may advantageously be employed, although inexpedient during the operation itself. 8. In operations on the skull and brain, anaesthesia is not contra-indicated. 9. Besides the above, there are other obvious advantages to-the patient; viz., absence of alarm and of excitement and of shock, previous to the operation; freedom from pain during it, and during the arrangement and dressing of the wound; a greater readiness to undergo an operation, rendering this, therefore, because early, the more likely to prove successful; and the prospect, at all times, of a better recovery. 10. In the examination of Injuries, in the operation of Sounding, in Irritable Stricture, in Dislocation, in the reduction of Hernia, and in many other cases, anaesthesia is of the greatest benefit, not only to the patient, but to the surgeon.

* Edin. Med. Journ., Dec. 1861. Med. Times, Nov. 20, 1847. Lancet, July 9, 1864.

§ Med. Times & Gaz., Oct. 17, 1863. || Surgical Experience of Chloroform, 8vo, 1848 (R).

. Directions for its employment are thus ably given by Pr. Snow: * - When voluntary motion is no longer apparent, in order to become informed respecting the state of the patient, the eyelid should be gently raised, touching its free border. If he look up, it is evident that narcotism has not ex-

1 the second stage. If no voluntary motion be excited, the third degree is probably attained; and, if the eye be turned up, this is pretty certain. But, notwithstanding this, if involuntary winking be occasioned by touching the edge of the eyelid, it is necessary to continue the vapour a little longer, before the operation is commenced In doing so, however, if the narcotism have already reached the third degree, and there is no particular rigidity or struggling, the vapour may be given in a more dilute form, or the inhalation may be intermitted fur two or three inspirations at a time. In this way Insensibility of the nerves is obtained, without increasing the narcotism of the nervous centres. As soon as the sensibility of the conjunctiva is abolished. or so far blunted that the free edge of the eyelid, or the eye itself, be touched without decided winking, the operation may be commenced, with confidence than there will be no pain, and no involuntary flinching to interfere with the operation. When there is struggling or great rigidity in the third stage, it is requisite to continue the vapour a little longer, till this state subside. If thore be any approach to stertorous breathing, the inhalation should be at once suspended. Stertor, however, never commences till the patient is perfectly insensible. The time occupied in the inhalation is, usually, from two to three minutes. The operation having been commenced, the medical man having charge of the Chloroform should carefully watch the patient's countenance, and if there be any sign of returning sensibility, a little more vapour should be given during the short time occupied in removing the limb. After the amputation is completed, the vapour need not be repeated until there is decidea evidence of sensation. When the arteries to be tied are not numerous, it is sometimes unnecessary to repeat the inhalation. Generally, however, it is requisite to give a little Chloroform at intervals, and if cold water have to be applied to stop the oozing of the blood, or the flaps have to be united by sutures, it is advisable to keep the patient insensible until this is done. The following are the rules for the use of Chloroform in surgical operations lately laid down by the Committee of the Royal Medical and Chirurgical Society.