_Nasal operations._--If adrenalin is to be used, it must precede, not follow, chloroform--many fatalities have occurred from injecting or even packing with adrenalin in light chloroform narcosis. Some surgeons object to ether because of the bleeding, but this can be largely remedied by raising the head and shoulders, and by packing with adrenalin. Many surgeons prefer local to general anæsthesia. _Nasal insufficiency._--Don’t allow a patient to continue to make ineffectual attempts to breathe through a narrow nose. Establish mouth breathing, or use Silk’s tubes (_see_ Fig. 9). _Tonsils and adenoids._--Give ethyl chloride by the vapour method. _Tumours and inflammatory swellings obstructing respiration._-- Don’t use closed methods. Have tracheotomy instruments at hand, and a cylinder of oxygen. _Gôitres, especially exophthalmic gôitre._--Don’t use chloroform: it has caused many fatalities; morph-atropine, followed by open-ether is the safest. In bad cases, use rectal oil ether if intratracheal is not available. The “sitting up posture” is a great help (_see_ page 168). Use anoci-association if surgeon is willing. CHEST. _Bronchitis and pneumonia_ (_see_ remarks in chapter XVII). _Emphysema and rigid chest wall._--Patients take anæsthetics badly; they cyanose quickly, the abdominal wall cannot be made either lax or quiet, since the patient’s natural method of respiration is abdominal rather than thoracic. Lastly, there is frequently a dilated heart with degenerate cardiac muscle, giving an abnormal tendency to secondary syncope. Give a trickle of oxygen through a tube from a cylinder: don’t be tempted to overdose with anæsthetic in the vain hope of securing ideal relaxation of the abdominal wall. _Empyæma._--Be careful: a good many accidents have happened. Use chloroform with added oxygen: aim at an anæsthesia just deep enough to prevent straining which might rupture the empyæma into the lung and drown him in his own pus. Withdraw the anæsthetic as soon as the abscess is opened. _Phthisis._--Don’t use closed-ether: it may start hæmorrhage--open-ether rarely does any harm unless the condition is very acute. CIRCULATORY SYSTEM. _High tension, arterio-sclerosis, and aneurysm._--Avoid pure nitrous oxide: in severe cases, C.E. mixture and oxygen is the safest. _Heart._--Well compensated cases of _valvular disease_ take chloroform or open-ether well, provided a free air-way is maintained. Closed methods should be avoided. Cases of _myocardial disease_ with dilated cavities present special dangers. Open-ether with added oxygen meets the case better than any other anæsthetic. _Pericarditis_, both acute and chronic, has been found as the determining factor in many anæsthetic fatalities. ACUTE INFECTIOUS DISEASE.