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being then applied, either during the intervals of the operation, or 

 as manifestations of pain or resistance may present themselves. 



8. Hare-lip. — With this operation may be included others upon 

 the nose and mouth, fauces and trachea. It has been presented as 

 the type of such operations, because it embraces several particulars 

 of interest. An operation in this region is often a dissection, and of 

 the parts concerned in inhalation. It is, therefore, impossible to 

 continue this process during manipulation. If, then, in such a case, 

 the patient is to remain insensible, the surgeon has two alternatives; 

 one of profoundly narcotizing the patient in the first instance; the 

 other of re-administering the ether; often at an inconvenient mo- 

 ment, and when the operation is materially interfered with. Of 

 these alternatives, the former seems to me the least objectionable. 

 Another important feature in these operations, is the liability of the 

 blood to accumulate in the trachea, which is no longer irritable or 

 conscious of its presence. When a tracheal rale gives indication of 

 the collection of a considerable quantity of blood or other fluid in 

 this region, the patient should be made to lean forward, to facilitate 

 the natural expulsive efforts of the expiration or of the cough, as 

 consciousness returns. In general during operations upon the face 

 and jaw, under the influence of ether, the patient should be sustained 

 in a position inclining somewhat forwards, and care should be taken 

 to prevent, as far as possible, by sponges or otherwise, the recession 

 of blood into the buccal cavity. Protracted operations upon the 

 fauces are difficult, if not impractiblc, with the use of ether. On 

 the other hand, the admission of instruments to the trachea, espe- 

 cially from the outside, is, without doubt, thus facilitated. 



4. In dislocation, it is obvious that ether inhaled, can be of no 

 avail unless continued to the relaxation of the muscles. 



It is well known with what facility dislocation is reduced upon 

 the dead subject ; and it is quite probable that all recent and favour- 

 able cases in the living subject may be reduced with almost equal 

 facility, when muscular relaxation is completely effected. This is 

 confirmed by one or two cases of dislocated shoulder, which have 

 fallen under my notice. I have met with no case of recent dislo- 

 cated hip since the introduction of the anesthetic agents. It would 

 be desirable, in such a case, that an attempt should be made com- 

 pletely to annul muscular resistance, before efforts are directed to 

 the replacement of the bone. 



It is equally evident that the reduction of hernia can be facili- 

 tated only by muscular relaxation, and that anything approaching 



