201 



after the appearance of the signs of etherization ; and partly from 

 the exertion, and partly from the inspiration of fresh air, he may 

 then recover sensibility. 



6. Lastly, the signs of insensibility having been manifested, the 

 operation is begun. In a few moments the patient partially regains 

 his consciousness, and exhibits the unequivocal appearance of suf- 

 fering, which may or may not be subsequently remembered; or 

 without being violent, is wild and uncontrollable. 



It will be observed, that in all these cases, ether was administered 

 for a comparatively short time. The result of such brief inhalation 

 is brief narcotism, either complete or incomplete. If inhalation be 

 arrested at this time, the period of subsequent insensibility to pain 

 varies from one to three minutes. This short or partial insensibility 

 is adapted to the operation of the dentist, which is usually rapid ; the 

 instrument is applied, and whatever be the demonstrations of the pa- 

 tient, it accomplishes its purpose. Here are no important nerves to 

 be severed, nor vessels to be wounded. But in a dissection, such as 

 occurs in many surgical operations, especially in one of a formidable 

 character, it is important that the subject of the operation should 

 not hazard his safety by being liable to sudden and convulsive move- 

 ments while the knife is dealing with the tissues. If the patient thus 

 partially revives, assistance is not unfrequently required to confine 

 him, and it is necessary to re-administer the ether ; the whole in- 

 terfering materially with the tranquillity of the operation, and the 

 comfort of those concerned ; perhaps endangering the welfare of the 

 patient. 



Although many operations were performed abroad, both in Eng- 

 land and upon the continent, and at no remote date, upon patients 

 yet capable of movement and resistance, yet there is an obvious 

 want of safety in operating under these circumstances. Decided 

 preference should be bestowed upon a condition of complete and 

 passive narcotism, provided it can be produced with equal certainty, 

 and is equally free from serious results. 



Such a condition is quite possible, and a short time suffices to 

 induce a train of symptoms indicative of it. Let the inhalation 

 be continued beyond the period, during which the patient exhibits 

 the earlier signs of narcotism. The muscles will be found gradually 

 and completely to relax under its influence ; and at a later period 

 the inspiration becomes a snore. The patient exhibits no sign of 

 consciousness, and is, in short, profoundly narcotized. 



In the symptoms hitherto detailed, two stages of the anaesthetic 

 14 



