In cases such as gastro-enterostomy, where the alimentary tract will be opened, the preparation must be a little more stringent. It is usual to allow no solids at all the day before. A saline enema may be given an hour or two before operation, when the soap and water has been evacuated. Preliminary Hypodermic Medication. This great improvement in anæsthesia was practised many years ago by a few surgeons, but it was only when open ether assumed its present position of pre-eminence that it was widely adopted. The present routine is to give morphia gr. ⅙, atropine gr. ¹⁄₁₂₀ to adult patients three quarters of an hour before operation. It has the following _advantages_:-- (1) The nervous fears of the patient give place to a feeling of bien-être. (2) The secretions of saliva and of mucous from the respiratory mucous membranes are limited. (3) A little less inhalational anæsthetic is required. (4) The after vomiting is lessened, and probably the liability to inflammatory respiratory complications also reduced. The _disadvantages_ can be met by proper care and dosage. They are as follows:-- (1) Morphia _plus_ chloroform depresses the respiratory centre at an early stage of anæsthesia. Respiration becomes infrequent and shallow, and cyanosis appears before the patient is really sufficiently anæsthetised for the purposes of the surgeon. (2) The larger the dose of morphia, the more troublesome is this premature failure of respiration. _The moral_ is obvious: give the small doses above recommended and induced with mixtures weak in chloroform, or better still with ether only (see page 86). Some years ago, before these facts were appreciated, there was a fashion for giving very large doses of preliminary narcotics. The combinations most favoured were as follows:-- SCOPOLAMINE-MORPHINE. Scopolamine is a form of hyoscyamine and is itself a powerful narcotic. Two or sometimes three doses of the mixed drugs were given at intervals of an hour, the last half an hour before operation. Scopolamine gr. ¹⁄₂₀₀, morphia gr. ⅛ was the usual formula: some surgeons added a dose of atropine or strychnine with the idea of stimulating the respiratory centre. The patients went to the operating or anæsthetising room so drowsy that they were unaware of their surroundings, and afterwards had no recollection of the actual beginning of the inhalation. So humane a method naturally attracted a good deal of attention, but the serious depression of the respiratory centre which seems inevitable in the method has gradually caused it to disappear from the practice of most surgeons and anæsthetists. At the present day, it is only to be recommended in midwifery practice; to the drowsy semi-conscious condition produced, the name of _Twilight Sleep_ has been given. OMNOPON AND OMNOPON-SCOPOLAMINE.