It is to be remembered that in operations about the face ether anesthesia is not practicable, owing to the repeated lifting of the mask which allows the patient too much air. It can only be given by specially constructed inhaling devices, which are more easily used with chloroform or the mixed anesthetics. Their specific use and construction will be referred to later. COMBINED ANESTHESIA It is often desirable to get the patient as quickly as possible under anesthesia and still overcome the depleting effects of chloroform narcosis. A common method to accomplish this is to give chloroform to the point of relaxation and with a change of inhaler continue with ether. In this way anesthesia can be kept up safely a long time with a minimum amount of ether. There are, however, a number of mixtures used in place of this interchange of anesthesia, all having their particular merit. Some of the best known are: =Alcohol-Chloroform-Ether= (_A. C. E. Mixture, English Formula_, 1:2:3).—This induces rapid anesthesia without the danger of syncope or the other objections to chloroform or ether when used alone. =Chloroform-Ether-Alcohol=, in the proportion of 3:1:1, and known as Billroth’s mixture, is extensively used in the same way. =Chloroform-Ether.=—This mixture, in equal proportions, is known as Tillman’s mixture, and has been employed by many well-known surgeons. NITROUS OXID Nitrous oxid, as advocated by Sir Humphrey Davy, is a safe product, but the anesthesia produced thereby is of too short duration to be of practical value in plastic surgery. Its employment is resorted to only for such operations as the opening of abscesses or the removal of small cysts, etc. ETHYL BROMID While ethyl bromid is a product that cannot be said to be absolutely safe, Terrier, of Paris, has used it largely to induce anesthesia, following it up with chloroform. It should be given freely with deep inspiration, the sixth inhalation producing total loss of consciousness. A moment after complete muscular relaxation is attained, with congestion of the face and dilated pupil. The average time necessary to accomplish this is about one minute, in which about three to five grams are used. In this way the stage of excitement is overcome and immediate narcosis is obtained. As the chloroform is substituted it must be given fairly strong, reducing it gradually. The facial congestion slowly diminishes and the pupillary dilation gives way to contraction. About sixteen grams of chloroform are required to keep up anesthesia for fifteen minutes. The after-effects of chloroform are entirely overcome by the above method. ETHYL CHLORID