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ON ANAESTHETICS 71 
was employed. This may have been a mere coincidence, but it seemed to 
indicate that the milder atmosphere, though more tedious in operation, was 
the safer. But in cases which must be expected from time to time to arise, 
in which the system is unusually tolerant of chloroform, when several minutes 
have passed without any apparent effect being produced, there can be no 
objection to making the cap somewhat larger, provided the administrator bears 
distinctly in mind that he increases the strength of the chloroform atmosphere 
in proportion as he enlarges the cap. 
To return for a moment to the last case mentioned, I have to add that, 
although she required more chloroform than the average of patients for the 
production of anaesthesia, yet when this had been effected, it was maintained 
by the steady use of a comparatively small amount. Thus on one occasion 
she was kept perfectly tranquil for 12 minutes during what would have been 
very painful procedures by the use of 2? fl. drachms of chloroform, giving a per- 
centage of 3-75 by weight or -89 by volume, which is certainly an exceedingly 
mild atmosphere. 
This method is a little more troublesome than our old plan of holding a 
folded towel over the face, and replenishing it with chloroform at considerable 
intervals; but the constant attention which it necessitates is an additional 
element of safety. During the last five months I have proceeded on these 
principles, and I have been much pleased with the results. The gradual manner 
in which the chloroform is applied in the first instance makes the administration 
extremely comfortable to the patient ; respiratory obstruction has been markedly 
less frequent than formerly, even the falling back of a relaxed tongue being of 
rare occurrence ; there has been, as a rule, remarkable immunity from vomiting 
or after-sickness, and, except in one instance, no serious depression. 
This exceptional instance deserves detailed mention on account of the 
illustration which it affords of an important point in the preliminary manage- 
ment of the patient. I operated on a delicate boy, twelve years of age, on 
account of the dislocation of the upper end of the radius forwards of many 
years’ standing, removing the head of the bone and returning what remained 
to its natural position, an operation of short duration, and attended with scarcely 
any haemorrhage. Splints having been applied to keep the bone in position, 
the chloroform was discontinued, when some tendency to vomiting showed 
itself. While in this condition he was lifted into bed, and immediately on this 
being done he fell into a state of collapse, which was for a short time sufficiently 
alarming. The explanation of this most unusual occurrence appeared to be 
afforded by the neglect of my orders that he should sleep the previous night at 
the house where the operation was to be performed at nine a.m., and have a cup 
