166 REPORTS ON THE STATE OF SCIENCE. 



anaesthesia carried out by the American School to refer to this method 

 of ether anaesthesia as the Boston method. The new expression ' open 

 ether ' is not justified by any novelty of procedure, and it is distinctly 

 misleading, inasmuch as it involves the use of a closely applied face- 

 piece. 



APPENDIX III. 



Six Months' Experience of the Use of a Chloroform-balance in the Out- 

 patient Department of St. George's Hospital. By G. R. Phillips, 

 M.R.C.S., L.R.C.P. 



Dr. Waller's chloroform-balance has been in use in the out-patient 

 theatre of St. George's Hospital for six months. It was found at once 

 that the machine could not deliver a sufficient volume for a normal 

 inspiration through a f-inch bore pipe. A 2-gallon gas-bag was there- 

 fore placed in circuit next to the face-piece. This was found to remedy 

 the defect, but in order to give accurate and even percentages through- 

 out an administration it was found necessary to have an inspiratory 

 and expiratory valve interposed between the bag and the face-piece. 

 (When there was an expiratory valve only, expirations escaped into the 

 bag and upset the mixture and introduced an element of rebreathing 

 unless the pressure in the bag was sufficient to keep a constant strong 

 outrush of chloroform-and-air. This was very wasteful of chloroform, 

 and the fan was much noisier when working at such a pressure. 

 Again, the chloroform was cooled much more rapidly, with a resulting 

 fall in the percentage given.) 



The apparatus should be placed in such a position that the adminis- 

 trator can both see the scale in the balance-case and make any altera- 

 tion in the setting of the taps. 



These points are of great importance, because in the use of the 

 instrument it is absolutely necessary that the face-piece should be 

 adjusted so that there is no leakage whatever, and that the percentage 

 should be raised or lowered very gradually and evenly. The great 

 advantage of the method in tine out-patient department is that patients 

 are quickly anaesthetised to the necessary depth, the average duration 

 of induction being six minutes. 



An extremely light anaesthesia or chloroform sleep can be main- 

 tained without the usual troubles of light anaesthesia for long periods, 

 and the patients are in a better condition and ready to go home sooner 

 than those anaesthetised by the mask and drop-bottle in ordinary hands. 

 When the apparatus was first installed it was most unpopular with the 

 nursing staff', but when they found that the patients were able to go 

 home so much sooner they forgave it. With regard to the safety of 

 the method, provided that the percentage is evenly and gradually 

 raised, the depth of anaesthesia required for any operation is much less 

 than by the Skinner's mask. The respirations are stronger, there is 

 less liability to vomit during light anaesthesia in the unprepared patient. 

 The airway is not interfered with to the same extent as it is when 

 chloroform is dropped suddenly on to a Skinner's mask at intervals. 



We have found frequently that when during a satisfactory light 

 anaesthesia the percentage has been suddenly raised or lowered (in spite 

 of the flywheel effect of the balance-case and reservoir-bag) vomiting 



