THE PRICE OF ANESTHESIA 623 



The procedure in hospital is (or would be) simplified by the 

 fact that the first step necessary in the case of animals, viz. 

 anaesthesia in a confined space, is not necessary for the human 

 subject. Obviously, also, tracheotomy is omitted ; all that is 

 required for the human subject is an open mask or face-piece 

 at the end of the delivery tube. For since the delivery of 

 chloroform to the patient is on the plenum principle, and such 

 pressure as exists in the mixing chamber and delivery tube 

 is positive, length of tube is immaterial, and does not place 

 any extra work upon inspiration by the patient. All the 

 apparatus required by the anaesthetist at the operating-table 

 consists of the tube itself, and the face-piece or other terminal 

 contrivance; the pump, the chloroform bottle, the mixing 

 chamber, and the chloroform balance are at a distance from 

 the operating-table, out of the way, but not out of sight. The 

 size of the mixing chamber (30 litres) ensures the continuous 

 and uniform supply to the patient of chloroform (or ether) 

 vapour at known and visible dilution. The indication of 

 percentage is easily verified, and is visible to all persons 

 present. The concentration, which, by reason of cooling of the 

 chloroform, automatically remains below 3 per cent., can be 

 varied at will with sufficient rapidity, as shown by the indicator, 

 and it cannot be suddenly augmented to a dangerous amount. 

 The attention of the anaesthetist is free to be wholly bestowed 

 upon the state of the patient, in accordance with which the 

 strength of vapour is raised or lowered, and seen to be raised 

 or lowered. (At the cost of a very trifling additional trouble, 

 a permanent record can be taken of the strength of vapour 

 employed during the whole time of its administration.) 



The apparatus in its laboratory form is not very portable. 

 And although, no doubt, it may be practicable to render it 

 more portable, I prefer at present to keep to the dimensions 

 with which I am familiar, and to advise its use chiefly as a 

 hospital fixture, set up in the operating theatre and in the 

 room or rooms in which patients are prepared for operation. 

 I am convinced that an installation of apparatus of this character 

 would go far to remove the possibility of prolonged series of 

 fatalities such as that mentioned in the footnote to p. 612, and 

 to allay an incalculable amount of anxiety in the minds of all 

 those who know. And as regards the general public, who at 

 present do not know, I am convinced that if the serious 



