174 ON ANAESTHETICS 
ficial respiration. In it inspiration is effected by drawing up the arms above 
the head till they are in a line with the trunk, and thus raising the ribs through 
the medium of the muscles which connect them with the upper extremities ; 
while expiration is produced by lowering the arms and pressing the elbows 
firmly against the front and sides of the chest. I can testify to the great 
superiority of this method over the old plan of merely compressing the thorax 
intermittingly, and trusting to its expansile elasticity for inspiration. 
Inhalation of the vapour of a few drops of nitrite of amyl as a cardiac 
stimulant is stated to have proved useful in some cases of collapse under chloro- 
form. And in accordance with the exaggerated idea of the sedative influence 
of chloroform upon the heart to which I have above referred, the admixture 
of a small quantity of the nitrite of amyl with it has been suggested as a pre- 
ventive of cardiac depression. The proposal has not, however, met with accep- 
tance ; nor is it likely to do so, seeing that the nitrite, while a very potent agent, 
seems to be inconstant in its operation. 
The same dread of the depressing effect of chloroform upon the heart has 
led some surgeons to use it mixed with ether, together with some alcohol to 
produce complete blending of the two liquids. Deaths have, however, occurred 
under the use of such mixtures, and we have no evidence that they are really 
safer than undiluted chloroform carefully given. 
The hypodermic injection of morphia a short time before chloroform is 
administered has been recommended in Germany for some special operations, 
on account of the remarkable result, which certainly follows such practice, that 
the patient may be deprived of sensibility to pain, though still retaining con- 
sciousness and voluntary motion ; so that he is able to assist the surgeon by 
his own exertions. I understand, however, that a very serious depressing 
influence upon the nervous system has been sometimes found to result from this 
combination of the two narcotics. 
A favourite method with some London practitioners is to begin by giving 
nitrous oxide, and when anaesthesia has been rapidly produced in this way, 
maintain it by means of ether. The patient is thus saved the discomfort of the 
inhalation of ether, and I am not aware that any disadvantage attends the 
preliminary use of the nitrous oxide, except the inconvenience of the necessary 
apparatus, which practically must restrict this mode of procedure to dentists 
and persons who devote themselves specially to the administration of anaes- 
thetics. 
Ethidene dichloride, or ethidene, as it is often called for the sake of brevity, 
was recommended, as we have seen, by the Committee of the British Medical 
Association. It happens, however, that in the trials which it has received on 
