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this "holding on" is because it is less volatile than ether, and can we not
here get a hint why chloroform is less deadly in the South than in the North?
The diffusibility of vapours or gases is in inverse proportion to the square of
their densities, and the vapour of chloroform would certainly diffuse itself
with far greater rapidity at 90° F. than at 70° F.
The comparative advantages and disadvantages of the two anæsthetics in practical medi-
cine are so well known that only one or two points seem to force themselves upon our present
attention. I cannot see that the surgeon is justified in putting the life of the patient to un-
necessary risk of chloroformisation, except under special circumstances. I believe, moreover,
that much of the unpopularity of ether is due to its improper administration. It is so easy to
embarrass the respiration seriously by the folded towel, as commonly used, that not only are
the struggles of mechanical asphyxia almost invariably produced, but probably death itself
sometimes caused, Especially is there danger of death being thus caused mechanically in the
advanced stage of etherisation, when the patient is too thoroughly etherised to struggle and
when the attention of the etheriser is, it may be, attracted by some novel and difficult operation.
I confess myself to once having nearly killed a patient in this way.
A proper apparatus is certainly preferable to the folded towel. Various have been in-
vented, but, as the time is short, I shall only mention one which seems to me a practically
perfect mechanism, although it is probably little known this side of the Atlantic.
The inhaler invented by Dr. O. H. Allis is based upon the theory that the patient to
be etherised should be supplied with a full abundance of air, saturated with the vapour of
ether. It consists essentially of a series of foldings of muslin on a wire framework, arranged
almost like the gills of a fish, so as to allow the air to pass freely through, but everywhere
come i n cont act wi t h et her. It shoul d be pl aced upon t he face of t he pat i ent dry, and t he
ether gradually poured on from a bottle with a tight cork, pierced by two small glass tubes,
one short for the entrance of the air, the other long. and reaching nearly to the bottom of the
bottle for exit of ether. When properly used the Allis inhaler practically does away with the
sense of suffocation, and the consequent struggles which have made etherisation alike so
repulsive to patient and surgeon.
In order to determine the rapidity with which etherisation can be produced by this
inhaler, Dr. M. H. Wilson kept for me notes of thirteen consecutive cases in the clinic of the
Jefferson Medical College Hospital in Philadelphia. The average time required for the
production of complete unconsciousness was 8 minutes, The average time during which
anæsthesia was fully maintained was 32 minutes; and the average amount of ether used
d u r i n g t h i s t i m e w a s 7 ½ o u n c e s . I n t w e n t y - o n e s u r g i c a l c a s e s o c c u r r i n g t h i s s p r i n g i n t h e
clinical service of Professor J. William White, of the University of Pennsylvania, the average
time for the production of complete anæsthesia with ether, used through Allis's inhaler
was 79/10 minutes. The results arrived at in these two clinics are so close that 8 minutes must
be considered as the average time required for full etherisation by this apparatus.
In discussing the treatment of the accidents of anæsthesia, the results obtained at the
bedside naturally press forward for careful consideration; but in going over the subject from