As long as the breathing remains unembarrassed and regular, the pulse is of good quality and a general, passive condition maintained, the patient is in the normal plane of surgical anesthesia and any interference would be meddling.
(1) Suprapubic prostatectomy and cystotomy after the skin incision is made.
(2) Nephrectomy in general, but especially in tuberculous and enfeebled women.
(4) Osteotomy and operations on the extremities.
(5) Curettage and obstetrical manipulations.
CASES REQUIRING ANESTHESIA OF MODERATE DEPTH.
(1) Trachelorrhaphy, Colporrhaphy and perineorrhaphy.
(2) Stretching of the sphincter and hemorrhoid operations.
(3) Resection of the rectum by the perineal or sacral route.
(1) Gynecological laparotomies: salpingo-oophorectomy and hysterectomy.
(2) Operations on the stomach or gall-bladder: gastro-enterostomy, cholecystectomy.
(3) Orthopedic manipulations necessitating complete muscular relaxation: reduction of congenital dislocation of the hip.
Anesthesia is a science which deserves more attention.
The extensive use of ether and the experience that its incautious administration is fraught with but little immediate danger, has gotten the hospital interne into reckless habits which cling to him in practice. There the anesthetist finds himself frequently compelled to use chloroform, a narcotic many times more powerful than ether. In the hands of the inexperienced, and above all, the inattentive, chloroform is certainly a dangerous drug. But this does not detract from its great value as an anesthetic and it would be illogical to condemn its use.
In the aged, we know that it is not so much the operation itself as the broncho-pneumonia that often follows the anesthesia which deserves grave consideration. Chloroform, or a chloroform-ether combination, such as anaesthol, is undoubtedly, in such cases, preferable to pure ether, because it causes less bronchial irritation. In the morphine-anaesthol-ether sequence which I have tried to outline, chloroform and ether are blended in a way most adequate for anesthesia, and the system is so flexible that it readily adapts itself to an anomalous case.
The difficulties in respiration so frequently encountered, even by the experienced anesthetist, find a natural solution; if he has been studying the case he will be able to judge whether the trouble is due to crowding or to a mechanical cause.