Mixed narcosis by means of chloroform and morphine, or, to a less degree, chloroform and chloral, has frequently decided advantages. Dur ing the stage of excitement or even of toleration, an hypodermatic injec tion of morphia may be administered to quiet the psychical disturbances, to shorten the period of excitement, and then but small amounts of chlo roform are needed for prolonged anesthesia, which is a great desideratum in confinements and during plastic operations! The method of inducing anesthesia is sufficiently well known. For many operations deep anesthesia is not requisite, but in case of very pain ful procedures, as, for instance, the introduction of the entire hand into the rectum, it is.
In addition to general anesthesia, there are a number of means for the production of local insensibility. Owing to the risk and unpleasant consequences of general narcosis, it would be advisable to substitute local, wherever possible; but in gynecology this must be limited to minor meas ures, such as the opening of abscesses, and to localities where the applica tion of the means is possible. Among these means we mention: the ap
plication of ice, of evaporating lotions, the ether spray by means of Richardson's apparatus, and the chloroform vapor method of Hardy. Scanzoni and Veit have often used this method, and in my hands chloro form has rendered valuable service for the alleviation of hyperesthetie conditions, such as pruritus, and in one instance of neuralgia of the pudic nerve. Aran's suggestion of using chloroform vapor in the uterus has not been adopted. Simpson, Demarquay, Churchill, have advocated the use of sulphurous acid vapor for the relief of the pain accompanying carcinoma. Scanzoni noted one death and Bernard toxic effects from the procedure, and it is, therefore, not to be counselled.
The application of narcotics locally is not marked in its effects. Cocaine, which has latterly proved of such utility in ophthalmology, ap pears to be also of value in gynecology.