wly introduced into the rectum; this is repeated, if
necessary, during the operation, and at its conclusion. The
operating-room must be warm--not less than 70 F.--and the patient
should be wrapped in cotton wool and blankets, and surrounded by
hot-bottles. All lotions used must be warm (100 F.); and the operation
should be completed as speedily and as bloodlessly as possible. The
element of fear may to some extent be eliminated by the preliminary
administration of such drugs as scopolamin or morphin, and with a view
to preventing the passage of exciting afferent impulses, Crile advocates
"blocking" of the nerves by the injection of a 1 per cent. solution of
novocaine into their substance on the proximal side of the field of
operation. To prevent after-pain in abdominal wounds he recommends
injecting the edges with quinine and urea hydrochlorate before suturing,
the resulting anaesthesia lasting for twenty-four to forty-eight hours.
To these preventive measures the term _anoci-association_ has been
applied. In selecting an anaesthetic, it may be borne in mind that
chloroform lowers the blood pressure more than ether does, and that with
spinal anaesthesia there is no lowering of the blood pressure.

_Treatment._--A patient suffering from shock should be placed in the
recumbent position, with the foot of the bed raised to facilitate the
return circulation in the large veins, and so to increase the flow of
blood to the brain. His bed should be placed near a large fire, and the
patient himself surrounded by cotton wool and blankets and hot-bottles.
If he has lost much blood, the limbs should be wrapped in cotton wool
and firmly bandaged from below upwards, to conserve as much of the
circulating blood as possible in the trunk and head. If the shock is
moderate in degree, as soon as the patient has been put to bed, about a
pint of saline solution should be introduced into the rectum, and 10 to
15 minims of adrenalin chloride (1 in 1000) may with advantage be added
to the fluid. The injection should be repeated every two hours until the
circulation is sufficiently restored. In severe cases, especially when
associated with haemorrhage, transfusion of whole blood from a compatible
donor, is the most efficient means (_Op. Surg._, p. 37). Cardiac
stimulants such as strychnin, digitalin, or strophanthin are
contra-indicated in shock, as they merely exhaust the already impaired
vaso-motor centre.

Artificial respiration may be usefu