FIRST STAGE.--The first sign that some effect is being produced in the patient is usually the appearance of the movements of _swallowing_; the hyoid and thyroid can be felt or seen to be moving in conjunction with the muscles of deglutition. During this stage, the patient being still to some extent under volitional control, there should be no other movement noticed. The eyes are usually closed and the colour normal; the respiration may be hurried by excitement, but judicious handling of the patient will do much to minimise this. THE SECOND STAGE is really entered when volitional control is lost. It may be characterised by struggling and shouting by the patient, even if the anæsthetic is properly administered; but with a healthy patient and a good anæsthetist, all that usually occurs in the way of movement by the patient is some rigidity of the limbs and a slight attempt, perhaps, to lift the head from the pillow or a limb from the couch. The breathing tends during the first part of this stage to be light and is rarely entirely regular: slight pauses occur, usually after an inspiration, less commonly after expiration. Serious “holding of the breath” (after an inspiration) rarely occurs save in the type of patient who is also struggling; if it does occur to a degree which causes any blueness of the patient’s face (cyanosis), it usually calls for the removal of the anæsthetic for a moment until normal breathing has been resumed. The colour of the face rarely departs much from normal during the second stage, unless cyanosis from breath-holding intervenes. The eyes are usually opened, as the second stage progresses, and the eyeballs tend to rotate slowly in every plane. The pupils are usually large, but react sharply to light. Both conjunctival and corneal reflexes are brisk. THE ONSET OF THE THIRD STAGE is marked by the appearance of muscular relaxation. Any limb which the patient may have been holding rigidly up sinks down on to the couch, and it will be found that if an attempt be now made by the anæsthetist (as it should be) to turn the head of the patient to one side or another, the muscles of the neck no longer resist. _The respiration_ also alters in type, losing its tendency to lightness and irregularity, and becomes full, deep, and regular. In open ether anæsthesia particularly, expiration commonly assumes a “blowing” type very characteristic, and which to the trained ear is of itself an indication that full surgical anæsthesia is present or at any rate not far distant. _The colour_ varies somewhat with the anæsthetic in use. With ether it is usually somewhat higher than normal, and a trace of blueness may be present if the method is the “closed” one. Anything more than a trace, however, must be regarded as abnormal, whatever the method or anæsthetic may be. With chloroform the colour is perhaps a little paler than that normal to the individual.