After ascertaining that none of the contraindications mentioned above exist, the patient may be prepared for the inhalation of the anaesthetic vapor. The inhalation should not be proceeded with soon after a full meal. Vomiting, as the narcosis subsides, is usual, and, as the insensibility of the glottis persists for some time afterward, particles of food may be lodged in the chink, causing fatal suffocation. Several cases of this kind have been reported. On the other hand, it is bad practice to administer an anaesthetic after a prolonged period of fasting, for the exhaustion thereby induced may be an influential factor in determining a fatal result. Before the inhalation is begun, it is proper to administer an ounce or two of whisky or brandy. Much more important is the expedient proposed by Bernard and afterward by Nussbaum, to premise a subcutaneous injection of morphine. Bernard proposed to administer the morphine before beginning the inhalation; whereas Nussbaum used it after unconsciousness to pain had been produced. The advantages of the former method are obvious. When the morphine influence takes place, the inhalation will proceed quietly without the struggling and coughing, and spasmodic breathing, which so interfere with the administration of anaesthetics, especially of ether. The use of morphine subcutaneously also lessens materially, if not prevents entirely, the stage of rigidity and spasm. The quantity of the anaesthetic required is much less, and the stage of insensibility more prolonged, when morphine is thus given.

Besides the foregoing conspicuous advantages derived from the preliminary subcutaneous injection of morphine, there can be no doubt that this agent antagonizes the paralyzing action of the anaesthetic on the cardiac and respiratory centers, and prevents the subsequent shock due to the administration of the anaesthetic and the performance of a surgical operation.

The proposal of Bernard, as subsequently advocated by Nussbaum, was some time afterward strongly urged by the late Prof. William Warren Greene, M. D., of Pittsfield, Massachusetts, and Dr. J. C. Reeve, of Dayton, Ohio. Soon after the publication of Bernard's observations, the author, in his "Manual of Hypodermatic Medication," proposed the use of morphine and atropine combined as more perfectly realizing the object contemplated. Since this time, at Lyons, the combination of morphine and atropine has been largely employed preliminary to ether inhalation. The method is known as "anesthé-sies mixtes" or, anaesthesia by a mixed method (Aubert). The addition of atropine is to increase the forces of the antagonism against the depression of the cardiac and respiratory functions. The experience of the Lyons school is decidedly in favor of the method of mixed anaesthesia. Adverse reports from other quarters, however, have not been wanting, but the relevancy of their facts is doubtful.

When the anaesthetic is about to be administered, the operator should, by a cheerful and confident manner, remove the fears of the patient. None of the parapherna of the operation to be performed should be exhibited before the patient, and no remarks should be made in his hearing regarding his case, the anaesthetic sleep, or the surgical procedure. Only the physician having the administration of the anaesthetic in charge, and the necessary assistants, should be present in the apartment. An abundant supply of fresh air should be insured to the patient, and all the appliances required for resuscitation should be at hand, but not ostentatiously paraded before the patient.

The simplest apparatus only is required. Complicated inhalers have, as frequently as the towel or the handkerchief, been used in fatal cases of chloroform narcosis. A cone of stiff paper, lined with lint or felt, and large enough to cover the nose and mouth of the patient, is the best form of inhaler for the administration of ether. Lente's ether-inhaler consists of a cone of hard rubber lined with felt, and having attached to the apex a flexible rubber tube communicating with the ether-bottle. This is a very satisfactory apparatus. A similar but much less complicated and expensive inhaler is that of Dr. Allis, of Philadelphia. The utility and desirableness of this apparatus are much commended by Prof. William Goodell. When ether is inhaled, the atmosphere is, as far as possible, excluded, in order that the anaesthetic effect may be quickly induced. The important point in the administration of chloroform is to secure such an admixture of atmospheric air as that the amount of chloroform-vapor shall not exceed three and a half per cent. If this rule be regarded, the form of inhaler is of little importance. The original method of Simpson consisted in applying the vapor by dropping slowly chloroform on a piece of thin cloth laid over the mouth and nose, or by a linen handkerchief moistened with half a drachm. The mouth and nose should be protected from the irritant action of the chloroform by inunction with oil.

A cone made of a towel, having a large opening at the apex, and containing a suitable, very porous sponge, is now probably more employed than any other form of inhaler for giving chloroform. The typical method for administering it is that of Snow: in a bag of suitable size the vapor of chloroform is mixed with air in the proper proportion, and then given directly; but, obviously, such an arrangement is not often available.

In administering the vapor of chloroform by any of the modes in use, it should not be forgotten that it has a density and weight four times those of air, and that, consequently, when a cloth or handkerchief is held closely over the mouth, the air is displaced, and the patient may be breathing little more than chloroform-vapor. During the administration of ether, attention should be directed to the state of the respiration, for arrest of the respiratory movements is the only source of danger. When chloroform is being inhaled, the state of the circulation, as well as of the respiratory apparatus, must be regarded.