203 



A patient, thus partially etherized, is said quietly to criticise the 

 amputation of his own leg, or resists the dentist's instruments, and 

 to appearance suffers, and yet remembers nothing of it; or remem- 

 bers, but has not felt; or, which is unpleasant and fortunately rare, 

 has felt but could not move. Such occurrences, familiar to the early 

 history of etherization, have been somewhat less frequent, since the 

 subject has been better comprehended. Yet at a comparatively 

 recent date, partial consciousness of the patient during an amputa- 

 tion, for example, has been regarded as a circumstance of unfore- 

 seen occurrence, and not always amenable to ready influences. 



The inconveniences of partial consciousness have been alluded to ; 

 and I am now especially desirous of exposing the advantages of a 

 state of inebriation, during which the patient lies passive and 

 motionless, exhibiting only the phenomena of deep sleep. 



Second Stage. — Such is the second stage of anaesthesia, essen- 

 tially characterized and identified by muscular relaxation. Let the 

 subjects of the last mentioned experiments continue inhalation. The 

 arm, from time to time, when .raised from the side, resists. Soon, 

 however, it becomes flexible, and at last, falls passive and motionless. 

 The voluntary muscles are now relaxed ; and it is impossible at this 

 moment to rouse the patient. This stage requires for its induction a 

 considerable quantity of ether vapour, which may be presented to the 

 pulmonary surfaces either rapidly in the course of two or four mi- 

 nutes, or a more diluted vapour may be administered during a pro- 

 tracted inhalation of many minutes. In the former case, anaesthesia 

 is of rapid access, and in its most favourable form. But in the latter, 

 the dilute and protracted inhalation is often accompanied with the 

 annoyances of partial anaesthesia, and it will be stated in another 

 part of this paper that other symptoms, especially that of vomiting, 

 are quite apt to interfere with inhalation before the inebriation has 

 reached its second stage. The commencement of this state of nar- 

 cotism, characterized by passive flexibility of the arm, suffices for 

 any brief surgical operation, which is not likely to be impeded by 

 the movements of returning sensibility. Yet this insensibility at its 

 inception, though complete, is brief, and the revival of the patient 

 often sudden. 



A few additional inhalations so impregnate the system with the 

 vapour, that revival is deferred for some minutes after the inhala- 

 tion of pure air. Ether is this way cumulative in its effects. Be- 

 sides this, recovery is then generally not instantaneous, but gradual 



