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ETHER—ANAESTHESIA. 261

The Dangers of Anaesthesia.—The conditions rendering
general anaesthetics dangerous are fatty degeneration of the heart
(a prominent contraindication); previous alcoholic habits; brain
tumors and degenerations ; respiratory obstruction from swollen
epiglottis, enlarged tonsils, oedema glottidis, laryngeal paralysis,
thoracic tumors or aneurism ; emphysema and obstructed pulse
circulation from engorgement of right heart and deficient heart
power; valvular lesions; incomplete anaesthesia during painful
surgical operations, causing death from shock, as the result of
peripheral irritation. Muscular debility and weakness from ex-
haustion, if otherwise uncomplicated, are considered to be rather
aids to anaesthesia than contraindications.
Preventive Measures Against the Dangers of Anaes-
thesia.—A thorough examination for sources of danger should
always be made previous to the administration of the anaesthetic.
An anaesthetic should never be administered on a full stomach,
as an anaesthesia of the glottis prevents the expulsion of vomited
matter from the larynx, in case it enters by regurgitation. An
anaesthetic should never be administered after long fasting, as
absence of nutrition may tend toward cardiac paralysis. One or
two ounces of whiskey should be administered immediately be-
fore the operation. All excitement should be avoided, to the
patient, from fear, sight of instruments, too many spectators, etc.,
all of which tend to induce shock. All appliances for resuscita-
tion should be at hand, and plenty of fresh air be available during
the inhalation. In using chloroform mix only three and a-half
per cent, of the vapor with air, to insure safety. In the admin-
istration of ether the respirations, according to some authorities,
alone need be watched : in chloroform, however, both the respi-
rations and the pulse should be carefully noted.
Treatment of Dangerous Symptoms of Anaesthesia.—
The suspension of the heart's action necessitates the immediate
withdrawal of the vapor and the immediate inversion of the
patient, according to Nekton's method. The failure of respira-
tion necessitates the forcing up of the chin, or the forcible draw-
ing out of the tongue to lift the epiglottis; the practice of arti-
ficial respiration by the Sylvester method, and by faradization of