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 ---.--2. 
 
 REPORT ON A HUNDRED CASES 
 
 — OF — 
 
 ETHER ANjESTHESIA BY CLOVER'S INHALER. 
 
 BT 
 
 G GORDON CAMPBELL, B.Sc, M. D. 
 
 {Reprinted from the Montreal Medical Journal, April, 1893.) 
 
i 
 
 ' 
 
REPORT ON A HUNDRED CASES OF ETHER 
 ANESTHESIA BY CLOVER'S INHALER* 
 
 By G. Gordon Campbell, B.Sc., M.D. 
 
 As thg title of my paper suggests, my object is to bring be- 
 fore the Society a report of the results obtainable by the u«"e of 
 Clover's inhaler in ether anaesthesia, rather than a discussion of 
 the subject of anaesthesia in general. There are, no doubt, 
 many members who are not acquainted with this form of 
 inhaler, so I will exhibit the instrument. The following des- 
 cription is copied from Mill's article on Anaesthesia in Treve%' 
 Manual of Surgery : 
 
 " The inhaler consists of a face-piece with an indicator which, 
 by rotation, may be made to point to 0, 1, 2, o, and F on the 
 circumference of a metallic vessel containing fluid ethor ; and 
 of a bag into and from which the patient breathes. It is so 
 constructed that when the indicator is at the expired and in- 
 spired air passes to and from the bag, v«ic^out in any way com- 
 municating with the ether chamber. If the indicator stands at 
 F, the whole of the expired air must pass through the ether ves- 
 sel to the bag, and at inspiration return from the bag through 
 the ether vessel. When the indicator is at 2, half the respired 
 air passes to and from the bag direct, the other half passes 
 through the ether vessel, and so on for the other numbers. 
 The air does not pass through the ether but simply through the 
 vessel containing it, and this is sufficient to carry ofi^ a large 
 amount of its vapour." 
 
 On commencing the administration I pour an ounce and' a 
 half of ether into the vessel and rotate the cylinder so that the 
 indicator is at 0. The pillows are then arranged so that the 
 patient's head lies as nearly as possible in a line with the body, 
 that is, as it would be held in standing. The eyes being closed 
 the inhaler is then placed on the face and tilted away from the 
 uhin so that the mouth is left free. I then direct the patient to 
 take several deep breaths and lower the face piece in time to 
 catch each expiration, raising it again at inspiration, and thus 
 
 * R«ad before the Medico-Chirurgical Society of Montreal, l>eo. 9, 1892. 
 
't 
 
 fill the bag with the expired air. The usual result of taking 
 several deep breaths now follows, the succeeding ones are much 
 shallower than normal, and I now turn the cylinder so that the 
 indicator stands at about a quarter way between and 1, which 
 means that the patient is getting about five per cent, of ether 
 vapour in the air breathed. 
 
 I think it a good plan not to require the patient to take deep 
 breaths at first, as ether always causes more or less irritation to 
 the respiratory tract, and by beginning with a very small 
 amount the percentage of vapour may ofcen be rapidly in- 
 creased without producing much distress. If the vapour 
 causes no discomfort the reservoir is now slovly rotated, moving 
 only a short distance at a time and giving a breath of pure air 
 when necessary. At the first sign of intolerance, such as swal- 
 lowing or raising the hand to remove the inhaler, I give a breath 
 of pure air, and if this fails to quiet the breathing I turn the 
 reservoir back some distance. Very soon a stage is reached at 
 which the patient seems to fall asleep and regular, deep breath- 
 ing ensues, enabling the ether to be turned on more rapidly, and 
 complete anaesthesia, shown by loss of the corneal reflex and 
 snoring breathing, follows without any further trouble. At the 
 moment full anaesthesia is produced the muscles all over the 
 body relax, the chin falls, and the advantage of having the neck 
 straight is now seen, as where the head is raised too high on 
 the pillows the chin, as it falls, allows the glottis to become 
 closed and the passage of air into the lungs to become more or 
 less completely blocked. If, however, the neck is not bent, 
 placing one finger behind the angle of the jaw and raising it up 
 at once allows of the free passage of air through the larynx. 
 In a few cases of obstruction to the breathing this procedure is 
 unsuccessful and attention should then be turned to the nostrils, 
 which, in many people, under the complete relaxation of deep 
 anaesthesia, collapse at the beginning of each inspiration. In- 
 serting a small piece of stiff rubber tubing of the proper size 
 into each nostril, until the muscles have regained their tone, will 
 remedy this condition. It occasionally happens that instead of 
 relaxation a state of iiQuic oQntractiou or spasm, affecting the 
 
whole body, follows full anaesthesia The cause of this rigidity 
 I cannot explain, but by experience I have found that with- 
 drawing the ether altogether, until it passes off, is the best plan 
 of treating it, as on recommencing the administration it is not 
 likely to recur. Pushing the ether seems to prolong the spasm. 
 The condition has occurred eight times in the hundred cases, 
 but in only three of these was it at all marked. Very much 
 less ether is required to keep up than to induce anaesthesia, 
 hence I now turn the indicator back to midway between 1 and 2, 
 and in Bfteen minutes or so it can again be moved back, giving 
 less and less other as time goes on. At the beginning, too, the 
 patient may get one inspiration of air to every three from the 
 bag, gradually increasing the proportion of pure air. 
 
 I will now take up in order the various points of which 1 have 
 kept a record, first, 
 
 The length of Time required to produce complete anaesthesia. 
 — The average time for the whole hundred cases is 5.21 min- 
 utes, the longest being 1 1 and the shortest 2^ minutes. This, 
 however, does not f irly represent the time usually necessary, 
 as over 60 per cent, were under five minutes. It must also be 
 noted in considering this average, that the time was calculated 
 from the moment the inhaler was applied to the patient's face 
 until she was ready for operation, as I consider that, from the 
 point of view of both patient and surgeon, the actual time taken 
 up after the inhaler is applied until the patient is ready for 
 operation, is of more practical importance than the number of 
 minutes it takes to induce anaesthesia, when once the breathing 
 of ether vapour has begun. A great many persons will not 
 breathe properly at first, and some time is spent in allowing 
 them to become accustomed to the apparatus before the ether 
 can be turned on to any extent ; and I have included this time, 
 although it will be seen that all cases of over six minutes dura- 
 tion were due to this cause and there are twenty of such. 
 Furthermore, it must be remembered that the main point kept 
 in view during the administration is to give the ether with as 
 little discomfort to the patient as possible, and although this 
 lengthens the time somewhat I have not had a single case in 
 
e 
 
 which there was struggling or the patient required any restraint. 
 My rule is, on the patient showing any resistance or crying out, 
 to endeavour to reassure her and at the same time diminish the 
 strength of the vapour. If this fails and atruggling and scream- 
 ing commences, I at once remove the inhaler from the face and, 
 speaking sharply, order her to take the ether quietly, saying I 
 will wait until she ^oes so , and in all hut one case this has had 
 the desired effect, perhaps by the substitution of one emotion 
 for another, the fear, or whatever caused the excitement, being 
 replaced by a feeling of resentment at my want of sympathy. 
 The failure referred to is worth alluding to. The jiatient, after 
 a few breaths, began to scream, and on my removing the inhaler 
 was so excited she could not be induced to commence again for 
 a full hour. The idea had become firmly fixed in her mind that 
 she had entered on what she called the " terrors of death," and 
 that I had recognised her danger in time to remove the inhaler 
 and save her life. Finally, however, she went under in four 
 minutes without a cry, although she was trembling with excite- 
 ment. Where a second operation has to be performed, the 
 advantage of using no force in the first administration, and of 
 having the patient look back on it with as little dread as pos- 
 sible, is very great. 
 
 Percentage of Ether Neceamry to Produce Ancestheaia. — 
 In fifty of the cases reported I have kept a record of the pro- 
 portion of ether vapour, as registered by the indicator, in the 
 respired air, at the moment of full anaesthesia, on the supposi- 
 tion that the air passing through the ether vessel becomes com- 
 pletely saturated with vapour. Estimating the proportion from 
 this basis, I find that the average is 60 per cent; that is, that 
 the patient becomes fully ansBsthetised before the air breathed 
 contains two-thirds of its bulk of ether vapour. The old idea, 
 then, that ether vapour needs to be given as nearly pure as 
 possible must be abandoned. 
 
 Amount of Ether Consumed. — The next point I have 
 worked out is the amount of ether consumed during an 
 administration, and this I have obtained by noting the amount 
 of ether used and the length of the administration in 73 
 
 
 

 
 oases, of which the shortest was 20 minutes and the long- 
 est was 8^ hours. The average length of administration 
 is 91 minutes, or 1} hours ; and the average amount of ether 
 used, four ounces and six drachms by measure (f^iv f3vi), 
 that is considerably less than a quarter pound tin. The ether 
 in a 100 gramme tin, which measures just five fluid ounces, will 
 suffice for an administration lasting an hour and thirty minutes. 
 About four fluid ounces are required the flrst hour, and two the 
 next, and so on. There is too, rou^^hly speaking, a relation be- 
 tween the body weight and the amount of ether used, but this 
 is often disturbed by other causes which I am unable to de6ne, 
 but perhaps individual idiosyncrasy is a prominent one. 
 
 Vomiting during the Operation. — Vomiting on the operation 
 table occurred four times in the 100 cases: once owing to the 
 ether being withdrawn too soon, and Once in an extremely 
 nervous subject. The other two instances were in the same 
 patient on two separate occasions, and were attributed to a large 
 dose of whiskey and water taken just before beginning the 
 ether. 
 
 After Vomiting. — I have kept a record of the vomiting 
 occurring while the patient was recovering from the anaesthetic 
 in the last forty cases. Fifteen of these, or over one-third, 37 
 p.c. were not sick at all, seven were very sick and the others 
 vomited from one to four times. Absence of vomiting does not 
 necessarily mean absence of nausea, but as in most cases 
 lausea is accompained by vomiting, we can get some idea of 
 the relative frequency of after sickness from these figures. 
 The amount of vomiting occurring after the patient comes out 
 of the anaesthetic is also of practical importance in many laparo- 
 tomies where tension on the abdominal walls from within is 
 desired to be avoided as far as possible. 
 
 During the induction of anaesthesia the pulse as a rule becomes 
 very rapid, running up to 1 20 or 140 ; at the end of ten 
 minutes, however, it will be found to have quieted down con- 
 side»'ably, and it finally falls to between 80-100, and is 
 generally much fuller and stronger at the end of the administra- 
 tion than just before the commencement. On discontinuing 
 the ether, however, the rate rapidly increases agaiu. 
 
Tho retpiratioiifl are full nnd strong and average 25 to 35 to 
 the minute. Quicker respirations mean that more ether is 
 being given than necessary, and ulower, that the anaesthesia 
 i» on the point of passing off. The rate, therefore, of the breath- 
 ing, can be used as an indication of the degree of anaesthesia 
 present. 
 
 The pupils at the outset dilate, but soon contract, and 
 remain moderately contracted thioughout. The presence of the 
 light reflex is seen where the anaesthesia is not very profound ; 
 and contraction may thus be produced in one eye from repeated 
 exposure when the other pupil is moderately large. 
 
 Sighing is often very marked, it occurs every 45-65 respira- 
 tions, and seems to have very little sigiiiBoance. 
 
 As stated before, I find that patients breathe much more 
 easily when the head is not raised on a pillow in such a manner 
 as to bend tho neck. In persons with short thick i.eoks no 
 pillow at all is to be preferred. Closure of the glottis is at once 
 relieved by making <<xtrome extension of the neck, while at tho 
 same time the angles of the jaw are drawn forward away from 
 the neok. I have never had to use tongue forceps. 
 
 Stiff mucus collecting in the throat and interfering with 
 respiration is easily removed by a small sponge on an old 
 fashioned sponge holder. 
 
 In giving the anaesthetic I consider it is absolutely necessary, 
 in order to get good results, to have a quiet room to boji,in in. 
 Success, both as regards time and comfort, depends upon not 
 exceeding the tolerance of the patient, and the noise made by 
 the air going to and from the bag is what the anaesthetist de- 
 pends upon to guide him. Any noise which would prevent one 
 from hearing when there is some obstruction to the breathing, 
 will prevent the proper precautions being taken in time to avoid 
 struggling, etc. Moreover, it is found that patients who pass 
 into unconsciousness without excitement and without a struggle, 
 bear the anaesthetic much better during the operation than 
 when there is a stage of excitement. The behaviour of each 
 individual case to the an esthetic is noted while the patient is 
 going under, and the afte. conduct of the case is governed by 
 
« 
 
 4 
 
 the knowledge thus gained. Whin it is at all poaiible ,then,the 
 adnainistration shmld be boguii by tho one who is to oarry it on. 
 It is claimed that tho effect prOdiiued by thij form of inhaler 
 is, to a great extent, duo to asphyxia induced by reduction, in 
 the amount of oxygon and re breathing of expired air; and, 
 moreover, that tho breathing of the respired air has a deleteri- 
 ous effect, owing to the poisonous matters eliminated in it. In 
 order to determine as far as possible what portion of the anoas- 
 thetio effect was duo to asphyxia, I gave the ether in ten oaeas 
 in the following manner : one respiration of air ; inspiration of 
 air ; expiration into tho bag ;. one respiration from, and to the 
 bag ; that is, in avery three breaths two are pure air, and then 
 tho air in the bag is replenished each time by an expiration 
 containing tho amount of pure air in the rtose and respiratory 
 passages at the end of inspiration. The foul air in the bag. is 
 thus dilated with a certain amount of good air before it is drawn 
 'into the lungs. As two breaths of pure air are taken to every 
 one from the bag, the effect produced by asphyxia under such 
 circumstances must be almost nil, when we remember that the 
 patient is breathing at double tho normal rate. Now, compar- 
 ing these ten cases with ten others having respectively corres- 
 ponding durations, I found that in the cases where the possible 
 effect due to asphyxia was eliminated, the amount of ether used 
 only increased half a drachm in five ounces. Consequently 
 asphyxia cannot be a factor of any practical ' importance in the 
 ansestlu'sia induced and kept up in the manner described, 
 although by allowing the patient to breathe very much less pure 
 air in proportion to that from the bag. than is my practice, it 
 may become of importance. 
 
 In concli;sion let me sum up briefly the advantaiges claimed 
 for this form of ether inhaler. 
 
 Rapidity in the production of anaesthesia combined with' but 
 little discomfort to the patient. 
 
 The small amount of ether used and the slight escape of 
 ether vapour into the room. 
 
 The extremely slight liability to vomiting while under the 
 influence. 
 
10 
 
 The advantage to the anaesthetist Of having the exact state 
 of the breathing constantly evident to him through his sense 
 of hearing, and the prime importance of this now that the 
 respiration is admittted on all sides to bo the most trustworthy 
 evidence of the patient's condition, and the first function to 
 show the approach of danger. 
 
 It is necessary to state for a proper estimate of the value of 
 the foregoing statistics that the patients were, with three or 
 four exceptions, all adult females, and the most of them in a 
 private hospital where all precautions are taken to ensure 
 success. The operation is done between nine and ten in the 
 morning, and no food, except beef tea allowed for twelve hours 
 before. The absence in this report of such after effects as 
 bronchitis, suppression of urine, etc., which are usually attri- 
 buted to ether, is because none were observed, although the 
 patient was always under observation for at least ten days. 
 
 I have appended to the report a table of the individual cases 
 from which my statistics are compiled. 
 
 
 £ ^^ 
 
 <D 
 
 T3 
 
 -t~» 
 
 
 
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 J3 
 
 CO 
 
 ai 
 
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 •9 
 
 3 
 
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 ^1 
 
 
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 m 
 
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 Remarks. 
 
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 ^2 
 
 tt.S 
 
 CT- 
 
 ^b 
 
 
 a 
 
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 'S 
 
 Ur 
 
 B 
 
 H 
 
 5 a 
 
 
 11 
 
 |5 
 
 
 1 
 
 4 
 
 56 ' 80 
 
 ;i2 
 
 
 Profound anaemia, sighing 48-65, quiet. 
 
 2 
 
 9 
 
 100 200 
 
 ( 
 
 61 
 
 
 Talked and cried out just bel'ore going under, but no 
 forue necessary : ether very cold. 
 
 3 
 
 4 
 
 70 140 
 
 40 
 
 
 Stopped giving ether too soon ; patient vomited on table 
 
 4 
 
 6 
 
 75 
 
 140 
 
 44 
 
 
 Large woman. 
 
 6 
 
 4^ 
 
 1(K) 
 
 ■ . • • 
 
 
 Ether very cold. 
 
 6 
 
 7 
 
 75 
 
 as 
 
 20 
 
 Rigidity of whole body 1 miiiute after abolition of cor- 
 neal reflex. 
 
 7 
 
 6 
 
 62 
 
 
 
 S 
 
 i\ 
 
 45 
 
 25 
 
 20 
 
 
 
 9 
 
 63 
 
 70 
 
 28 
 
 • • ■ • • t 
 
 Aged 76. 
 
 10 
 
 1 
 
 61 
 
 80 
 
 24 
 
 
 Very weak ; required very little ether. 
 
 11 
 
 lU 
 
 75 
 
 110 
 
 40 
 
 
 Rigidity and moving hand alter abolition of corneal 
 
 reflex. 
 Kept a finger under mouth- piece going under. 
 
 12 
 lis 
 
 10 
 6 
 4 
 
 70 
 50 
 62 
 
 90 
 
 36 
 
 
 14 
 
 
 • * • • 
 
 
 Sighing very marked. 
 
 15 
 
 7 
 
 HI 
 
 iii 
 
 
 
 L .rge woman ; 5 p. o. ether last 40 minutes. 
 
 1R 
 
 4 
 
 50 
 50 
 
 
 
 
 i: 
 
 .... 
 
 
 
 
 18 
 
 S 
 
 50 
 
 
 
 
 Hiccough at times, stopped by pushing ether. 
 
 19 
 
 8 
 
 
 .... 
 
 
 
 I 
 
V 
 
 11 
 
 
 i 
 
 s 
 a 
 
 a 
 
 ^-•i 
 
 ^ 
 
 
 1 
 
 , 
 
 
 11 
 
 1 
 
 3 
 
 s 
 
 s 
 
 a 
 g 
 1!. 
 
 • 1 
 
 
 a 
 
 Ss 
 
 0) 
 
 ao 
 
 5 
 
 > 
 
 
 ,• 
 
 «•! 
 
 a 
 
 1^ 
 
 V 
 
 ;■ 
 
 
 & 
 
 A (^ 
 
 ♦3--^ 
 
 V 
 
 9S 
 
 
 o 
 
 a 
 s 
 
 a 
 
 ■| 
 o 
 
 a 
 
 ^1 
 11 
 
 V a 
 
 OS 
 
 n 
 
 — 73 
 
 o-S 
 
 XI 
 
 1 
 
 a 
 
 5 
 
 1-2 
 
 Remarks. 
 
 ao 
 
 21 
 
 11 
 
 10 
 
 70 
 
 
 
 
 Increased strength of vapour too rapidly causing spasm. 
 Reinuving stitobes. 
 
 IV 
 
 • ■ ■ 
 
 ■ < • • 
 
 
 22 
 23 
 
 4 
 
 
 
 
 
 
 5 
 
 '56' 
 
 
 
 
 
 24 
 
 3 
 
 70 
 
 145' 
 
 '48' 
 
 
 Less than 5 p. c. most of time. 
 
 25 
 
 8 
 
 75 
 
 55 
 
 32 
 
 
 
 26 
 
 11 
 
 .... 
 
 200 
 
 68 
 
 
 Vomited going under, just before anaesthesia complete: 
 6 p. c. ether after anaesthesia piodueed. 
 
 27 
 28 
 
 3 
 7 
 
 50 
 
 
 
 
 
 
 
 • • t > 
 
 
 
 29 
 
 ao 
 
 81 
 32 
 33 
 34 
 
 5 
 
 
 
 
 
 
 f 
 
 5 
 
 
 
 
 
 Vomited on the table. 
 
 . ... 
 
 " " 
 
 
 
 T VUllbOM \IU mUv hOiWIO. 
 
 45 
 
 
 . . * • 
 
 
 
 4 
 
 5 
 
 6,3 
 
 
 
 
 
 56 
 
 140 
 
 44" 
 
 
 
 35 
 
 4 
 
 45 
 
 140 
 
 21 
 
 
 Very slight ; emaciated ; breathing stopped by mucus 
 in throat ; relieved by turning on side ; no ether re- 
 quired at all last hour, except an occasional breath. 
 
 36 
 
 5 
 
 45 
 
 50 
 
 24 
 
 
 
 37 
 38 
 
 7 
 
 50 
 
 
 
 
 
 3i 
 
 82 
 
 "75" 
 
 44' 
 
 
 Large woman ; used more ether than usual. 
 
 39 
 
 5 
 
 50 
 
 120 
 
 48 
 
 
 
 40 
 
 41 
 
 45 
 
 90 
 
 40 
 
 
 Ether given on side ; elbow used. Kidney case. 
 
 41 
 42 
 
 11 
 
 63 
 
 
 
 
 Mouth-piece not fit the face. 
 
 Reflex from perinaeum after corneal absent- 
 
 4 
 
 56 
 
 'i-i' 
 
 24" 
 
 
 ^ 
 
 5 
 
 62 
 
 85 
 
 50 
 
 • • • i ■ 
 
 Vomited six times at intervals while completely anaes- 
 thetised ; given brandy and water just before admin- 
 istration. 
 
 44 
 
 6 
 
 62 
 
 , , , 
 
 > ■ • • 
 
 
 
 45 
 
 7i 
 
 75 
 
 105 
 
 48 
 
 
 Inhaler not fit the fa«e— No 41, 
 
 46 
 
 8 
 
 • • • • 
 
 50 
 
 32 
 
 
 • 
 
 47 
 
 5 
 
 60 
 
 60 
 
 26 
 
 
 "' , 
 
 48 
 
 3 
 
 > > . • 
 
 i-> 
 
 24 
 
 
 - ' • . . 
 
 49 
 60 
 51 
 
 1' 
 
 3 
 
 50 
 
 180 
 
 64 
 
 
 
 '.".'. 
 
 is" 
 
 24 
 
 * t > * 
 
 Gave 25 p. c. ether all the time. 
 
 62 
 
 5 
 
 • • • • 
 
 75 
 
 28 
 
 • • ■ • » 
 
 
 53 
 
 4 
 
 • I * • 
 
 55 
 
 28 
 
 
 Very anasmio. 
 
 54 
 
 3i 
 
 75 
 
 40 
 
 26 
 
 
 bb.^e as 43; vomited once during administration; 
 spii'.*" and water just before. 
 
 55 
 
 5 
 
 • • i • 
 
 20 
 
 8 
 
 
 Examinai'.-'n abdomen : umbilical hernia. 
 
 56 
 
 4i 
 
 
 60 
 
 32 
 
 
 Saiue case as i.5 • operation- 
 
 57 
 
 5 
 
 '76" 
 
 60 
 
 36 
 
 
 i 
 
 58 
 
 5 
 
 * • • * 
 
 • * • • 
 
 • . • . 
 
 
 Male. Dental case. 
 
 59 
 
 4i 
 
 50 
 
 60 
 
 32 
 
 < • ■< • 
 
 
 60 
 
 4 
 
 
 • . .. 
 
 * • • . 
 
 
 Same case as 59. 
 
 61 
 
 5 
 
 .... 
 
 120 
 
 44 
 
 "s ' 
 
 
 62 
 
 6 
 
 .... 
 
 150 
 
 48 
 
 3 
 
 
 63 
 
 10 
 
 ... 
 
 120 
 
 44 
 
 1 
 
 Mouth-piece not fit ; remedied by turning end for end ; 
 pulse very slow, 52- 
 
 64 
 
 3 
 
 50 
 
 110 
 
 41 
 
 
 
 Qave 2 breaths air to 1 ether all through. 
 
 65 
 
 5 
 
 62 
 
 9) 
 
 36 
 
 
 
 2 air to 1 ether; kept indicator at U = 38 p. 0, 
 Thick mucus in throat ; relieved oy pulling out the 
 
 66 
 
 4i 
 
 • • • • 
 
 15. 
 
 32 
 
 1 
 
 
 
 
 
 
 
 pillow. 
 
 67 
 
 5 
 
 • ■ • * 
 
 115 
 
 40 
 
 2 
 
 2 air to 1 ether. 
 
 68 
 
 5 
 
 , , 
 
 45 
 
 20 
 
 
 
 
 6U 
 
 2i 
 
 < • ■ • 
 
 150 
 
 56 
 
 
 
 
 70 
 
 4| 
 
 .... 
 
 110 
 
 44 
 
 
 
 
^ 
 
 i 
 
 12 
 
 
 1 
 
 ^A 
 
 tt 
 
 ■3 
 
 5 
 
 J; 
 
 !■ ' . ■ ■. •.':;' 
 
 
 fl 
 
 M S 
 
 QQ 
 
 
 o 
 
 
 
 "a 
 
 
 9i 
 
 
 
 *; ; '"'^'" '^ [ 
 
 
 
 
 is 
 
 .9 
 
 OS 
 
 JS 3 
 
 M 
 
 "a 
 
 .L 
 
 Rbharks. 
 
 Cm 
 
 M 
 
 »f 
 
 ti.s 
 
 »^ 
 
 ■sfc 
 
 
 
 a 
 a 
 
 5a 
 a « 
 o a 
 
 11 
 
 
 
 
 71 
 
 10 
 
 , , , 
 
 70 
 
 26 
 
 
 
 Goinor under commenced to scream ; removed inhaler 
 and waited until she agreed to breathe quietly. 
 
 
 
 
 
 
 
 72 
 
 4i 
 
 . .f . 
 
 120 
 
 40 
 
 6 
 
 2 air to 1 ether ; kept at 25 p. c. 
 
 73 
 
 6 
 
 . . . . 
 
 85 
 
 41 
 
 1 
 
 Very large woman. 
 
 74 
 
 5 
 
 . . . . 
 
 fio 
 
 80 
 
 Many 
 
 2 air to 1 ether. 
 
 75 
 
 4 
 
 
 9C 
 
 36 
 
 3 
 
 2 air to 1 ether. 
 
 76 
 
 8 
 
 . . . . 
 
 90 
 
 52 
 
 
 
 Large woman ; 2 air to 1 ether ; large amount used. 
 
 77 
 
 4 
 
 • •■• 
 
 m 
 
 48 3 
 
 2 air to 1 ether. 
 
 78 
 
 ?i 
 
 
 45 
 
 24 Many 
 
 Very nervou" woman ; spasm of glottis at beginnings 
 
 79 
 
 7 
 
 « * ■ • 
 
 90 
 
 40 
 
 s 
 
 1 ether to 2 air. 
 
 80 
 
 6 
 
 t •• ■ 
 
 135 
 
 48 
 
 2 
 
 2 air to 1 ether. 
 
 81 
 
 4 
 
 ■ . * * 
 
 120 
 
 48 
 
 3 
 
 
 82 
 
 4 
 
 • ••• 
 
 30 
 
 16 Many 
 
 Vomited on the table. Very nervous. 
 
 83 
 
 % 
 
 • ■ ■ • 
 
 5i» 
 
 24 
 
 3 
 
 Same as 81. 
 
 H4 
 
 • • • t 
 
 30 
 
 16 
 
 3 
 
 
 85 
 
 4 
 
 . . • . 
 
 45 
 
 20 
 
 4 
 
 
 86 
 
 3J 
 
 * • • > 
 
 95 
 
 34 
 
 
 
 Some spasm end rigidity. 
 
 87 
 
 3 
 
 . . *. 
 
 90 
 
 48 
 
 Many 
 
 Same case as 82 : mucus in throat. 
 
 88 
 
 5 
 
 50 
 
 lOO 
 
 42 
 
 
 
 2 air to 1 ethr. 
 
 89 
 
 3 
 
 * t • . 
 
 85 
 
 48 
 
 2 
 
 Cxnsiderable mucus durinit operation. 
 
 90 
 
 4 
 
 
 105 
 
 52 
 
 Many 
 
 During admini> ration, spacm lusting so long the pati- 
 ent almost regained consciousness 
 
 91 
 
 4 
 
 
 95 
 
 51 
 
 6 
 
 
 92 
 
 4 
 
 • ••. 
 
 185 
 
 88 
 
 2 
 
 
 u3 
 
 4 
 
 50 
 
 135 
 
 44 
 
 
 
 Case described ; screaming and refusal to go on for an 
 hour. 
 
 94 
 
 5 
 
 . • . . 
 
 20 
 
 8 
 
 
 
 Openii:g absoei'S. 
 
 9S 
 
 4 
 
 • ■ • • 
 
 120 
 
 44 
 
 1 
 
 No mucus. 
 
 '.<6 
 
 3J 
 
 46 
 
 120 
 
 44 
 
 , 1 
 
 Some sighing ; pulse 82 from 120. 
 
 97 
 
 3 
 
 5i 
 
 511 
 
 24 
 
 Many 
 
 Urin-, X oz. 1010.: urea li griiinx to o«. = 12 srnins 
 
 98 
 
 3i 
 
 45 
 
 90 
 
 36 
 
 
 
 Urine ioz.; loaded urates : ureii 11 grs. to oji. = 6i grs. 
 
 99 
 
 ^ 
 
 60 
 
 HI) 
 
 34 
 
 
 
 Abdominal case ; urine i oz.; urea 5 grains. 
 
 101 
 
 5 
 
 
 110 
 
 44 
 
 
 
 Excision of the oreast. 
 
 .V2I 
 
 60 
 
 91 
 
 38 
 
 3i 
 
 Peropnt. without after vomiting. 
 
 i 
 
 I