In most instances, therefore, we are compelled to have recourse to the use of obturators, and these are now made to accurately fit the opening without undue pressure on the sides. Two discs of india-rubber united by a central stem generally answer the purpose satisfactorily, and a plate may be worn fixed to one or more of the teeth. In hospital patients a piece of sheet india-rubber, which they fit for themselves, and maintain _in situ_ by suction, is a cheap and efficacious contrivance. ADDENDUM. RECTAL ANÆSTHESIA. The plan of inducing anæsthesia _per rectum_, which has recently been brought before the profession in this country by Dr. Dudley Buxton, was originally suggested by Pirogoff in 1847, ether being the agent employed; but the introduction of chloroform in 1848 led to the disuse of ether in any way for many years. More recently Pirogoff’s suggestion has been resuscitated, and made use of by Bull, Weir, and others in America, Ollivier and Molière in France, by Iversen and Wancher in Copenhagen, and by Dudley Buxton in this country. The last-named anæsthetist recommends an apparatus (supplied by Mayer and Meltzer) consisting of a receiver for the ether, which is placed in water at about 120° F. The vapour thus given off is conducted by a ¾-inch rubber tube, about four feet long, through a specially constructed intercepter to prevent any liquid ether bubbling into the rectum, and enters it by an anal tube. A special device maintains sufficient pressure upon the perineal pad to prevent the escape of flatus or ether from the bowel. Anæsthesia may be induced from the first in this manner; or, as a preliminary step, chloroform or ether may be given by inhalation in the usual way, and the rectal administration subsequently relied on. The disadvantage of this combined method is the difficulty of judging when the absorption by the rectum is sufficient to be trusted alone; otherwise the patient may regain partial consciousness, and struggle. When the rectal plan only is used, the patient is often twenty or thirty minutes becoming unconscious, although ether may be smelt in the breath within five of its commencement. There is no excitement or struggling, and fewer after-effects. Care must be taken to regulate the amount of ether used, or abdominal distension and rectal catarrh may result; particularly is this the case if the operation be protracted. The method may prove of value, when properly employed, in operations involving the tongue, lips, pharynx, larynx, palate, jaws, &c. There are, however, obvious dangers in connection with its use, and unfortunately these fears have been realised in America by the combustion of the vapour leading to rupture of the bowel and other disastrous consequences. FOOTNOTES [1] Trendelenburg, ‘Deutsche Chirurg.,’ Lief. xxxiii, Hälfte 1. [2] Rouge, ‘L’Uranoplastie et les divisions congénitales du palais.’ [3] Oakley Coles, ‘Deformities of the Mouth’ (Churchill).