170 REPORTS ON THE STATE OP SCIENCE. 



ease of highly nervous subjects, as well as in other special circum- 

 stances, the loss of consciousness in from three to ten breaths, which 

 may be relied upon, for example, in the ' gas-and-ether ' sequence, is a 

 great boon to the patient. But the anaesthetist who uses rapid methods 

 of induction will often find himself unable to provide his surgical 

 colleague with the best possible conditions for operating. The nervous 

 system does not like to be taken by storm ; it prefers to be gradually 

 invaded. If taken by storm, as when some rapidly acting sequence is 

 used, its quiescence during operations, and particularly during certain 

 operations, is likely to be interfered with, so that various inconvenient 

 reflex phenomena are liable lo arise and to cause difficulties. On the 

 other hand, a nervous system which has gradually been invaded by an 

 anaesthetic will generally be found to tolerate surgical stimuli even in 

 sensitive areas without inconvenient reflex response. The general 

 result, therefore, is that it is usually possible after a slow induction 

 method to work with a lighter anaesthesia than that required when a 

 rapid induction has been employed — a distinct gain to the patient. 

 These important differences in the eventual type of anaesthesia are often 

 well exemplified in abdominal surgery. Whilst most patients who have 

 been anaesthetised slowly will be found to remain tranquilly relaxed and 

 with almost inaudible breathing during abdominal manipulations, those 

 who have been subjected to rapid induction methods will be very liable 

 to display laboured breathing, laryngeal spasm, or persistent abdominal 

 rigidity — all of which may be highly inconvenienKo the operator. 



Whilst we are undoubtedly indebted to the chloroform-balance and 

 to other appliances for the possibility of reducing the risk of chloroform 

 anaesthesia almost to a vanishing point, it is questionable whether, in 

 view of recent developments in ether administration, we shall ever wit- 

 ness that widespread adoption of the more potent of these two agents 

 which some writers have regarded as inevitable. During the past year I 

 have given a very thorough trial to so-called ' open ether,' a term now 

 generally employed to indicate a method of administering this anaes- 

 thetic, the chief characteristic of which is almost continuous drop- 

 ping of ether upon one or more layers of gauze, domet, or flannel held 

 together by some kind of wire frame which by means of additional 

 gauze or pads is kept more or less closely and continuously applied to 

 the face. We are indebted, I believe, to America for this simple but 

 exceedingly satisfactory method. I have employed it very extensively, 

 and with such results as to justify me, I think, in predicting a long 

 and successful reign for the method. It will be remembered that 

 Professor Waller in Appendix I. to last year's report of this Com- 

 mittee referred to certain experiments which he had conducted with 

 the object of ascertaining the percentage of ether generally inhaled 

 during the use of the open method. Since that report the Committee 

 has gone a step further. Having satisfied myself that the best results 

 clinically were obtainable by the use of a Skinner's mask covered with 

 two thicknesses of flannel, and surounded by oval ' horse collars ' of 

 gauze, the Committee instituted a series of experiments with the object 

 of ascertaining the precise percentage of ether inhaled when ether was 

 fully dropped upon this simple contrivance. The results obtained were 

 remarkably constant, thus confirming the clinical observation that with 



