cinch  an  accident  is  not  likely  to  occur  with  ether,  and
minor  operations  are  often  done  with  safety  during  the
first  stage  of  aneesthesia  (primary  ansesthesia)  when  con-


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303


scioiisness  aud  wenaation  are  lost  and  tlie  mnscles  begia  to
relax.
Shock  from  hemorrlif^e,  or  prolonged  and  severe  sur-
gical operatiuns,  maj  lead  to  fatalities  during  aufestliesia,
and  it  bo  me  time  a  occurs  when  au  operation  is  begun  before
the  patient  is  fully  under  the  influence  of  an  anasathetic —
particularly  chloroform — as  described  above.  In  practice,
these  causes  o!  danger,  i.e.,  respiratory  failure,  circulatory-
depression  and  shock,  are  usually  combined.
We  have  already  seen  that  asphyxia  leads  to  circulatory
disorder,  and  both  may  be  associated  with  surgical  shock.
The  following  embraces  the  proper  treatment  of  all  these
conditions,  aud  should  be  followed  in  every  case  where
danger  threatens  during  itnassthesia :

1.  Remove  the  anre'^thetic  and  allow  pleutj'  of  fresh  air.
2.  See  that  there  is  no  mechanical  obstruction  to  the
movements  of  the  chest,  or  to  the  free  entrance  of  air.
Pull  forward  the  tongue  and  lower  jaw  and  extend  the
bead.
3.  Invert  small  nniuials,  particularly  with  chloroform,
to  allow  blood  to  flow  to  the  brain.
