Nontoxic solutions are indicated in this event; of these, hydrogen dioxid, three per cent, and boric acid, nine per cent, are most suitable. The solution is allowed to trickle gently through the wound and is led off by open tubes, that may be connected in such way as to empty into a receptacle placed beneath the bed. CHAPTER VII ANESTHETICS Anesthesia of the human may be accomplished in two ways: first, by the employment of a general anesthetic, and, secondly, by the local use of a narcotic agent. It is not the intention of the writer to dilate upon the nature and use of anesthetics, as their value and indication has been fully exploited. A concise review of these agents, however, will meet with the approval of the special surgeon, inasmuch as they have their particular use in individual cases. Local anesthesia is undoubtedly the most extensively employed, in the performance of the average plastic operation, yet in certain cases it is contra-indicated, and it is to further the proper selection of such that the following may be of value. GENERAL ANESTHESIA It must be understood that general anesthesia has its many advantages and equally its disadvantages. It necessitates the early preparation of the patient and a thorough physical examination as to the state of lungs, heart, and kidneys. Patients having cardiac affections or serious lesions within the lungs should be given the safest anesthetic obtainable; in fact, if the operation can possibly be done by local administration, it should be. It is to be remembered that in a majority of these cases the operation is undertaken to remedy a deformity, however caused, one that is not necessarily serious to health, and it would indeed be unwise to place such a body in jeopardy or to take undue chances if they can be avoided. Ofttimes several operations, a few weeks apart, must be done and the frequent repetition of a general anesthetic might impair the health of the patient—a condition not associated with local anesthesia. Neurotic subjects often insist upon the use of chloroform and the surgeon is frequently tempted to administer it, but little objection should be found with local narcosis, where it can be employed. PREPARATION FOR GENERAL ANESTHESIA The patient must not be allowed food at least six hours prior to operation. In neurotic and anemic subjects a full dose of strong wine or whisky should be given half an hour before operation. Habitual drinkers should be given one quarter grain morphin sulphate. All movable artificial teeth, or other foreign bodies, must be removed from the mouth. Observe the laws of asepsis as heretofore described. Loosen the clothing of the patient about the neck and chest. Only a single garment should be worn during the time of operation—a loose, sterilized night robe, as it may be necessary to move the patient about, and too much or tight clothing might prove to be dangerous in the delay occasioned by its removal.