I can spare the reader the ordeal of many words by beginning in a concrete way with the outline of a system of anesthesia that is now largely followed at the German Hospital, New York City.

The Schimmelbusch mask is used; this fits the face and is large enough to include the bridge of the nose and prominence of the chin. It is covered with a piece of thin flannel, and, over this, impermeable cloth in the center of which a lozenge-shaped fenestra (1½”×1”) has been cut. In the upper half of this little window with the flannel pane, on the inside of the mask, a small wad of gauze is fastened. The mask is then complete and can be used for administering any anesthetic by the drop method—chloroform, anaesthol or ether. In giving ether one makes use of the upper half of the fenestra with its separate ether pad; while chloroform and anaesthol are given to advantage through the lower portion. The chin, cheek and bridge of the nose are anointed with a little white vaseline at the line of contact with the mask, and then the latter is allowed to rest lightly on the face of the patient for a few moments, until he can reconcile himself to the strange procedure, and resumes his normal breathing. There must be absolute quiet. The anesthetist alone may speak when he deems fit.

The beginning is made with anaesthol or chloroform drop by drop. The slightest objection on the part of the patient that the vapors are too strong must be considered; irritation of the throat, slight coughing, all merely emphasize that the introduction must be very gradual. If the patient is solicitous about the efficacy of the anesthetic he should be assured that there is no hurry, and he should be enjoined to take deeper breaths, if he breathes too lightly. As long as the "Primary Anesthesia" patient is conscious he will respond to the injunction to take a deep breath; if he does not respond to this request he has reached the stage of unconsciousness—the state of primary anesthesia.

Sometimes a remarkable calm, a period of relative apnea, precedes the stage of excitement. At other times, this stage ushers the patient directly into the state of complete anesthesia. There need be no stage of excitement at all. This is especially true if morphine has been administered hypodermatically before narcosis, and if the induction of the anesthetic is cautious and gradual.

The surgical degree, the state of complete anesthesia, is announced by the respiration when it assumes the more or less well marked snoring character of one who is fast asleep.

In the German Hospital system the patient, male or female, is given a quarter of a grain of morphine sulphate hypodermatically half an hour before narcosis. The anesthesia is always induced with anaesthol or chloroform. Where much blood is lost or the operation is of very long duration one may at any time make the transition to ether by the drop method without changing the mask. As a rule, a morphine-anaesthol narcosis is given with a few drops of ether now and then (ether feeding), when a little stimulation is indicated. In a small number of cases, among them choledochotomies and other operations on the gall-bladder, particularly where there is jaundice, the morphine-anaesthol introduction is followed by the ether drop method.