168 REPORTS ON THE STATE OP SCIENCE. 



In these light stages of anaesthesia patients often have control of the 

 pharynx. They are able to swallow saliva or small drops of water 

 introduced into the mouth without any attempt at retching or coughing. 

 Some patients cannot be brought up to and kept at this light level, but 

 have to be taken through the surgical degree and gradually brought back 

 to it. Men and alcoholics usually require as much as 3 or 3'5 per cent, 

 to control them at first. 



The majority of healthy young adults do not require more than 2 - 5 

 per cent, for this light stage. 



The apparatus lends itself well to any sequence. A patient can be 

 anaesthetised with gas and ether or ethyl chloride and transferred to 2 

 or 2-5 per cent, direct. The initial struggling of the alcoholic is thus 

 aborted or more safely and easily controlled, and time is saved. 



In the case of small children and infants we have discarded the face- 

 piece and bag, preferring to play a stream of vapour over the patient 

 while they are partly covered over by a rug in a nurse's arms. The 

 effect upon children is even more marked than upon adults. Their 

 colour usually remains good instead of the pallor and feeble breathing 

 which often results from the Skinner's mask method with chloroform 

 or a mixture of chloroform-and-ether. 



The apparatus has not been used for any severe operation yet. 



APPENDIX IV. 

 By Sir Frederic Hewitt, M.V.O., M.D. 



The chloroform-balance introduced by Professor Waller, and at the 

 present moment installed at St. George's Hospital, has, since its 

 transference from the laboratory to the operating theatre, taught many 

 valuable lessons to clinical workers in the field of practical anaesthetics. 

 It has enabled us to disentangle, so to speak, the complex phenomena 

 of chloroform anaesthesia, to study these phenomena separately, and to 

 refer them, at all events in many instances, to their true causation. It 

 has indicated for us the lines upon which we should proceed if we wish 

 to obtain the best results in practice. It has, in particular, revealed 

 the origin and nature of certain of the difficulties and complications of 

 general anaesthesia, and has thus suggested to us the desirability of 

 modifying or abandoning certain methods of administration which, 

 though advantageous from some points of view, are disadvantageous and 

 possibly dangerous from others. The balance has thus thrown a new 

 and philosophic light upon general anaesthesia, and though it would be 

 wrong to claim for it that it has been wholly responsible for the funda- 

 mental change that is now taking place in this department of practice, 

 it has fully justified those who were responsible for the formation of 

 this Committee in the view that, by bringing the physiologist and the 

 clinical worker into closer association, considerable improvements in 

 anaesthetisation would result. 



In addition to the great lesson taught us by the chloroform-balance 

 and other appliances for the percentage administration of chloroform, 

 namely, that safe anaesthetisation may be secured provided the strength 

 of chloroform vapour does not exceed 2 per 100, there are certain 

 other lessons to which I would now specially direct attention. The first 



