148 MATER i A MEDIC A AND THERAPEUTICS. 



extensive disease of the lungs or respiratory passages. Nitrous 

 oxide gas or ether must be preferred in such subjects, according 

 to the length of the operation. Valvular disease of the heart 

 with compensation suggests special care, but is not a contra- 

 indication. Operations on the mouth, nose, throat, attended by 

 possible bleeding into the glottis, demand special precautions, 

 whether by great expedition, special postures of the patient, or 

 even previous tracheotomy. It must never be forgotten, 

 however, that when an operation is absolutely necessary, it can 

 always be more safely performed with anaesthetics than without 

 their aid ; and that before the days of ether and chloroform, 

 many persons died under an operation, from fear, f aintness, and 

 shock, the danger from which is completely removed or greatly 

 diminished by anaesthetics. 



b. Preparation of the patient. Insensibility is more rapid 

 when the stomach is empty. No solid food should therefore be 

 given for at least six hours before the operation, which should, 

 if possible, be performed early in the morning' when digestion 

 has been completed and the anaesthetic is rapidly absorbed. If 

 the patient feel faint under these circumstances, a small quan- 

 tity of brandy and water may be given before operation. 

 Artificial teeth must be removed. The respiration and pulse 

 should be carefully noted before commencing inhalation. 



c. Selection of the anesthetic : purity of the same. The 

 anaesthetic agents in general use at the present time are chlo- 

 roform, bichloride of methylene, ether, and nitrous oxide gas. 

 Of these, ether and nitrous oxide are unquestionably to be 

 preferred, unless there be some special reason to the contrary. 

 The purity of the drug is best insured by purchasing it from 

 well-established makers, and not by attempting to test it for 

 oneself ; and the same manufacture should always be used, if 

 possible. It may be advisable to commence with one anaes- 

 thetic, and then, as circumstances alter during the operation, 

 to change it for another. 



d. Selection of the apparatus. This will depend on cir- 

 cumstances arid on the taste and experience of the administrator. 

 Whilst elaborate inhalers are used in hospitals, it is satisfactory 

 to know that the simplest apparatus is equally safe, such as a 

 handkerchief or towel made into a cone, care being taken that 

 chloroform vapour is mixed very freely with air, but that with 

 ether, on the contrary, the atmosphere is excluded as com- 

 pL't'-ly as possible. A few capsules of nitrite of amyl and a 

 straight polypus forceps should be ready at hand. 



e. Position of the patient. The administrator must accom- 

 modate himself to the convenience of the operator, whose eye 

 and hand must never be interfered with. If possible, the 



