GRACE, GATHERING, GROWING, GIVING, GOING - Finding and Following Jesus Together.
LIFE GROUP VALUES/PURPOSE & KEY MINISTRY LEADERS
SCC Core Values & the Goal of the PATH (an introduction to LIFE at SCC):
(8 week Orientation to Community LIFE at SCC): 1. The PATH makes is the rst 4 Steps for people to enter into the community LIFE at SCC. Answering the following questions: What is SCC all about? - What does it mean to have a personal relationship with Jesus Christ - What is a LIFE GROUP? - How do I begin to connect with others at SCC and/or nd the right LG for me? SCC Core Values: Step 1: Gathering (How We Follow Jesus), Step 2: Growing (Drawing Near
to Jesus), Step 3: Giving (Serving Others with Jesus) and Step 4: Going (Inviting Other to Follow Jesus).
What is my next step after the PATH? schedule 3 LG visits and attend a LG Connection Event 2. To establish a foundation for spiritual growth and the LG culture at SCC Grace, Gathering, Growing, Giving, Going 3. To help existing LG Leaders recruit new LG members and key LG ministry leaders for their group (also part of orientation/training for new LG Leader/Apprentices) 4. The PATH is a training, equipping, recruiting experience to grow existing LGs and start new LGs
Life Group Mission and Strategy What is a Focus Group?
Creating a safe, conversational environment where people can explore faith and grow in relationship around the Word of God. a short-term group of people for a specic ministry, study, service group, afnity group and/or support group (the PATH is our 8 week Focus Group to introduce people to Life Groups and the biblical values of Grace, Gathering, Growing, Giving & Going)

What is a Life Group?

a long-term group consisting of 3-12 people who have committed to regularly get together to challenge, serve and prayerfully encourage one another to nd and follow Jesus together.
THE PURPOSE OF LIFE GROUPS
are to build godly relationships in a safe place to know and grow in and through the Word of God. THE PURPOSE OF A LIFE GROUP LEADER is facilitate godly conversation, relationships and discipleship and create a safe place to find and follow Jesus together. THE PURPOSE OF A LIFE GROUP PASTOR is to know, encourage, instruct and pray for the Life Group Leaders.
rob@sccconnect.net - www.sccconnect.net - Wednesday, November 10, 2010
Life Group Leader Apprentice - a person (or persons) who
is an active member of a Life Group with the calling, equipping and character to start their own Life Group (helping the LG leader build their group with purpose of launching their own group). To be considered for a Life Group Leader Apprenticeship you must be nominated by a LG Pastor, Leader and/or staff member or elder of SCC and agree with the following:
I. How to Start a New Life Group
A. Attend LG Leader apprentice Orientation B. Take 101 & 301 C. Go through LG Ldr. Apprentice Training 1. Part I - 8 Habits (2 weeks) 2. Part II - Doing Life Together (from Purpose Driven Life) (5 weeks) 3. Part III - Partner with a LG Leader (nal week(s)/Connection Event.) D. Apprentice with a LG Leader in an existing group a) Attend 1 LG Summit and 1 LG Connection Event b) Assist in recruiting 12 group members & 5 key LG ministry leaders E. Recruit 3 of the 5 Key LG Ministry Leaders (in order to launch your own group) 1. Examples a) LG Leader Apprentice b) Growth Leader (201) c) Serving Leader (301)
(weekly connecting points for Life Pastor to ask Life Leader)

II. Life Group Values

A. Authentic Relationships 1. How do group members experience trust and acceptance, in a safe environment? B. Biblical Authority 1. How is scripture the basis for group discussion? C. Humble Leadership 1. How do you (Life Group Leader) value group members opinions and beliefs? D. Relevant Environment 1. How is your group appealing, engaging and helpful? E. Spiritual Growth 1. How are group members growing in their relationship with God? 2. How is life-change occurring?

III.LG Leader/Apprentice Qualications
A. B. C. D. E. F. Be in a growing relationship with Jesus Christ Be a member of SCC Be an active participant in a Life Group Communicate clearly and/or Submit a written testimony Attend a 7 week new Life Leader training/orientation Apprentice with an experienced Life Leader/Group
IV. LG Leader/Apprentice Characteristics
A. Character - is this person in a growing relationship with Jesus Christ? B. Competence - does this person have the skills and experience to lead a group? C. Calling - is this person passionate and willing to be a champion for Life Groups? D. Connected - is this person connected through membership and a Life Group? E. Chemistry - is this someone with whom youd like to be in a group?
V. Leader Expectations/Goals
A. Afrm SCC Statement of Faith and Life Groups strategy B. Recruit 12 Life Group Members C. Recruit 5 Key LG Ministry Leaders: 1. (1.) LG Leader Apprentice (101), (2.) LG Host, (3.) Discipleship/Prayer (201), (4.) Serving (301), (5.) Outreach/Missions (401), (6.) Worship (optional), (7.) 1st Connections (optional) D. Lead Doing Life Together (from Purpose Driven Life) (5 weeks) at least once a year 1. Either with Sunday morning BLT (Beginning Life Together) or with your own Life Group E. Shepherd your Life Group according to the SCC Life Group Values and Leader Essentials F. Connect weekly with your Life Group Pastor 1. Provide regular (preferably weekly) feedback for your Life Group Pastor G. Participate in ongoing training (e.g., spring and fall training/connections events) H. Lead your LIfe Group in participating in annual Church-wide events/community outreach/service/mission project(s) I. Provide & promote a Sunday Serving Culture 1. See SCC Ministries Quicklist J. Use only SCC approved curriculum and/or study material
VI. 5 Key LG Ministry Leaders (responsibilities):
A. LG Leader Apprentice (Step 1: GATHERING) 1. responsible for co-leading the group 2. help select/facilitate study/conversational material 3. help recruit/welcome new members (12 members/5 leaders) 4. help coordinate LG events/outreach 5. make sure all visitors/members have taken step 1 of the PATH B. LG Host 1. coordinate food/snacks for group gatherings 2. maintain/update group phone chain, current contact information 3. arrive early and help create a welcoming environment (candles, music, video clip, relevant books, magazines, etc.) 4. help with followup/weekly contact with group members (phone chain, FB, email, etc.) C. Growing (Step 2: GROWING) 1. lead/coordinate prayer at every group gathering (prayer needs, praises, etc.) 2. champion 15 min. accountability time at each group gathering (guys with guys and girls with girls) 3. make sure all LG members have taken step 2 of the PATH 4. Model/encourage consistent time in Gods Word and prayer a) www.mygodsightings.com & www.echoprayer.com D. Serving (Step 3: GIVING) 1. make sure all LG members have gone taken step 3 of the PATH 2. work closely with SCC staff and LG leader to help members nd their place of service at SCC 3. help coordinate LG events/outreach E. Outreach/Missions (Step 4: GOING) 1. facilitate awareness of existing missionaries that SCC supports 2. help coordinate missions events / pray for missionaries 3. partner with SCC Missions Team and champion missions events and group participation in annual church-wide missions events 4. make sure all LG members have taken step 4 of the PATH F. Worship Leader (optional) 1. Have an initial meeting with Worship Pastor 2. Coordinate songs with Worship Team / Lead songs during LG gatherings 3. Teach, communicate worship ministry values to LG 4. Participate in Worship Ministry workshops/training G. 1st Connections Team (optional) 1. Have a passion and gifting to meet new people and encourage to get connected to a Life Group and/or promote the PATH 2. Work with Connection Pastor to help visitors get connected: call 1st time visitors, register new people for the PATH 4 Steps, make a follow-up call to people who have completed step 3 and taken their SHAPE test. 3. Serve on Sunday rotation team at the Connections Bar: inform people about Sunday morning ministries, focus groups and church-wide events.

VOL. XXIX, No. 1

DENTAL SECTION
MINUTES OF SPECIAL COlMMITTEE MEETING October 15, 1936, Philadelphia, Pa. The Special Committee of the National Medical Associationi Executive Board met in Room 218 Y.M.C.A. Buildinig at 1 P.M. for the purpose of clearing up the unfinished business of the Philadelphia meeting. Letters, telegrams and proxies vere read from a large majority of the Executive Board members authorizing such a meeting and giving authority to the Special Committee. Proxies having been read anid verified by Dr. Givens, Secretary, D)r. Barnes asked for a reading of the minutes of the session of the E,xecutive Board held in Philadelphia in August. Presenlt at the meeting vere D)octors Bowles, Keninev, Biarnies, Givens, Turnier, BFurwell, Bluford, Tompkins, Fortune anid the auditor, Mr. Garlick. The minulltes of the Executive B3oard, ulpoIl the (lemald of l)r. Barnies wvere read. D)uring the readi'lg. Dr. Kenniey opposed the term, "rejection" of I)r. Barnes' bill of $653.00 alleged to have beeil paid by himl to Wrinstoni alnd Comipaniy, publishers of the N.M.A. souiveniir programs. l)r. Kenney poinitedl out that the Board did niot reject lDr. Barnes' bill, but simplv held it for the necessary detailed informlation. Mr. C. H. Garlick, the auditor niext made his report which shoved that there was a balanice oni hanid in the bank unider the control of the Treasurer, D)r. Johni A. Keniney, of $684.35, which showed the accoutints of the Treasurer to be in perfect balance.\s the most important item of this colmmiiiittee's activ'ities wvas all effort to reach ail adjustlmienit with Dr. WV. i-larry Bariies, Ex-Presidenit of the National
Medical Associationt, in-zconection -with his "frienidly" s11it against the National -Medical Associationi for $653.00, after mtuch discussion of the matter from the various atngles, it was agreed that ouit of the $817.85 which the auditor's report showed that Dr. Barnes had in his possession beloniging to the Nationial Mledical Association, D)r. Barnes would deduct the $653.00 for which he was suing and would senid to D)r. John A. Kenney, the Treasuirer, his personial check for the difference of $164.85, and that wvheil this was donie, anid wheni he had given legal niotice to the effect that the suiit was withdrawn, D)r. Kenony would theni givc to Dr. Barnes a receipt in full for such: moniies as he had had in his possession belonigitng to the Association dowon to date, and Dr. Barnes would receipt the N.MX4.A. for the amounlt for which he was stinig. In this special meeting also somiie members of the ILocal Committee made their reports, amonig them Dr. Tompkitns Treasturer of the Local Committee, who tuirnied over to Dr. Kentney $141.88, receiving receipt there for. Also D)r. Fortune, of the Boat Ride Committee reported that the total receil)ts of the Boat Ride were $1444.87 againist expenises of $948.58, leaving cash in his hanids of $23.70, and that the Boat Ride showed a real profit of $204.60, most of which amounit had been spenit in various authorized wvays. lie turnied over the $24.70 to Dr. Kenney. I)r. Barines wvas advised to communiicate with Dr. Rollo Wilson aind conie to an agreemeint with him oil the matter of the bill which vas presented as a discouniit oni the commercial exhibits. The variouis details of the Conimittee's arranigemincts have sinice been completed and all of the matters uinider dispuite or conisiderationi at that time have been adjiuste(d.

Dental Section

ED)WARD F.
DENTAL DECAY The tirst stage of dental decay manifests itself superficially, in the eniamel. The second stage, a deeper invasioni into the dentin. The third stage, still deeper and into the pulp chamber and the restilt, a noni-vital tooth. WVe dentists know all this and constanitly remind( our p)atients of the benefits to be derived by preventioIn. But wvhat are we doing about our owvn denital

JON1S, D.D.S.

(lenital magaziines. The second stage is characterized by a nion-initerest in text books or courses. The third stage is evideniced by a complete lack of desire to attelnd denital meetiings. Our group seemiis to have so maniy in this last stage. The fourth stage produces a non-vital or dead dentist. This delntal decay attacks three (3) classes of denitists: (1) Those who are at present doinig well anid feel they will always continlue to. (2) Those who are not doing well and( believe they will always continue so. (3) Anid those who are simply lazy anid indifferent-anid refuse to bruish their mental teeth. There is much hope for the first two classes. As for the last class, it may require a high potenitial vitality tester to stir them into activity.

decay.

Otur dental decay follows a different course and dloes not attack every dentist. Let us go ilnto symllptomatology. Its maniifestationis are: First stage, the (lentist canniiot lind the time or inclinationi to read
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION

FEBRUARY, 1937

The first group had better realize that if they wish to maintain their present prosperity, they had better keep pace with progressive dentistry. If they do not, they will find themselves more and more leisure time to think things over. They have to move along with dentistry or else they will soon find themselves on the wayside. The second group should realize that they alone are contributing to their failures. They must be optimistic and present a progressive attitude to those patients they have if they wish to.attract more. Are you developing dental decay?, Now that you know the symptoms it is a simple matter for correction. You know-"An ounce of prevention-"

DENTISTS DIMIINISHING*

It might be well to review briefly the question of dental education and the present status of the dental profession. In 1922, there were 14000 students in the dental schools of the United States. In 1932, 7000-an actual decrease of 54% in ten (10) years. There are retiring from practice each year because of death, age or more than 1900 dentists; the graduates from all the schools approximate about 1800. In 1922, there were approximately 62000 dentists in the United States, and in 1932, 58000-a loss of 4000 in teni (10) years. If this decrease should continiue unitil the year 2000 or 64 years hence, San Franicisco would have four (4) denltists, based on its presenit population. Your committee feels that it is time serious thought was giveni dental education lest we as a profession perish.

'disability,

For instanice, a muscular twitching is first manifested, then jactitation and convulsions will follow. Cyanosis may or may not be preselnt, as this is dependent upon the hemoglobini content of the blood anld not on the solution of gases in the serum. The anesthetic margin with Nitrous oxide oxygen is extremely narrow, but the anesthetic being so evanascent that a patient in profound aniesthesia, cani be lightened by means of oxygeni almost instantly. Remember that the manner of death from overdose should it occur, is by asphyxia only. These muscular twitchinigs, jactitations, coInvulsioIs, etc., of the patient; what do they really mean to us? They mean that through the media of certain muscular phenomena or manifestationis the patient is trying to describe or make us familiar with certain signs and symptoms characteristic of a particular plane or anesthesia. We now can see that as the patient eniters the different stages of aniesthesia that for each stage certaini characteristic signis and symptoms manifest themselves. These signs must then be our guide as to the percentage of mixture of gases to be adminiistered depending upon the depth of anesthesia, for instanice certain signls in profound anesthesia would indicate that an increase in oxygen is necessary, while oni the other hand a certain group of symptoms would inidicate that less oxygeni is required and more nitrous oxide should be added to the mixture. All that one must do to master the technique of gas, oxygen anesthesia would be to. master these true signs anld symptoms of the various stages of anesthesia; i.e., 1. Misinformationi concerning cyaniosis, and 2. Igniorance of the true signs and symptoms of anesthesia.
STAGES OF ANESTHESIA Gas anesthesia is genierally divided into four stages. 1st st(age, or the stage of anialgesia, the 2;td stage or the stage of excitement, the 3rd stage or the surgical stage which is divided inito Planes. First plane or light planie, second planie or normal plane, third planie or profound planie, anid the 4th stage, stage of overdose or asphyxia, where as in the properly executed induction for aniesthesia, the stage of analgesia and the excitemenit stages are so brief, it is hardly possible to detect aniy objective symptoms exhibited by the patienit, we will therefore go through these two stages briefly. ANALGESIA By the adminiistrationi of suitable mixtures of nitrous oxide and oxygeen, generally 75% niitrous oxide and 25% oxygen, this anialgesic stage is generally produced and may be mainitainied for somne time witl the addition of very little oxygeni to the mixture. In this stage the patienit is still coIIscious, but immunie to variable degrees of pain relief, sufficienit to excavate anid prepare cavities, scalinig of teeth, etc.
* Excerpts from minutes of the House of Delegates meetinig of A.D.A. in Sani Francisco, July 15, 1936.

NITROUS OXIDE AND OXYGEN ANESTHESIA Phillips Brooks, D.D.S., Historian for The Academy of Anesthesiology in Or al S'urgery, New Yor-k City. Nitrous oxide is an iniert gas, and its aniesthetic action produced by crowding out of oxygeni; owing to its greater solubility in the blood stream, and it is by the degree of oxYgen reduction to thte braini cells that the loss of conlsciousniess is produced. When we have ani extremne abnormiial reductionl of oxygen in the blood plasma, the body itself will exhibit certain signs or symptoms produced by this oxygen deprivation. Example: A good example of oxygen deprivation is seen1 in a chickeni whose head has just beeni severed from its body. The body will have a tenidenicy to flop about unitil by conitiniued diminiutioni of oxygeni contenit, death ensues.
The brain is stimulated, there is rapid flow of ideas, there is a feeling of warmth throughout the entire body, and a feeling of numbness in the extremities. Tinnitus is present, the sense of hearing is very keen, but sound becomes distant. There is often a disturbance of color vision, this finally becomes blurred and lost at the close of this stage. The sense of pain is obliterated to some extent in the analgesic stage, it is not advisable to attempt the extirpation of pulps, or any surgical interference whatsoever at this time. Towards the close of this stage and before we enter the second stage the patient may laugh or cry dependilng upoIn the mental attitude of the patient before the commencement of the induction.
SECOND OR EXCITE'MENT STAGE The patient during this stage loses consciousness, and may make efforts to perform rather complicated acts such as resisting the further administration of the gases by kicking, fighting, etc. No recollection of doing these things can be described by the patient. In these, erotic dreams or hallucinations may occur and it is for this reason that it is unwise to administer the anestlhetic without a third party for your protection. THE THIRD STAGE OR SUIRGICAL ANESTHESIA This stage is subdivided for our conveniienice into three Planes. 1. Light Plane 2. Surgical or Normal Plane 3. Profound Plane Each of these planes is characterized by definite sigins and symptoms which are characteristic of each l)lane. The characteristic signs and symptoms in this stage in order of their importance, are as follows: respiration, muscular manifestations, eye signs, circulatory and color. Remember that no single guide is infallible however important it may be.

1st Guidc-Respiration

As our respiration is the most importanit guide in aniesthesia it becomes expedienit for the anesthetist
to hear every breath of the patient. Notice the characer of the breathing and its change in rate as the anesthesia progresses. Let me take you through the planes of surgical anesthesia and compare the respirations in each plane. In light anesthesia it is well to remember that the inspirationis are long and the expirations are short. The breathing is superficial, slow and often irregular in character. At times, phonation due to reflexes of pain might occur. Breath holding and grunting are not uncommon in this plane. In some patients the breathing may be very rapid; this is due to nervousness and fear on the part of the patient. As we enter the second or surgical plane you will find that instead of the prolonged inspirations and the
short expirations, that both inspirations and expiratiotns are nearly equal, that they are full and machine like in character, that they are faster thani normal. Phonation is not present in this plane as the reflexes are abolished. The breathing is continauous and uninterrupted. These few signs in the surgical plane are sufficient to guide the operator. The patient will now stand surgical interference. If we allow the patient to go any deeper we will find that our patient is in profound anesthesia with the following signls to be observed. Instead of our machine like respirations as in abnormal anesthesia, they become irregular sobby in character and usually slower than normal. (spasmodic) The expirations become prolonged and the inspirations short. Phonation may be present in this stage due to muscular spasma (crowing or wheezing). At the enid of this stage if the demand for oxygen is not supplied, cessation of respiration occurs, usually due to spasma of the exhalation. So far we can readily see the importance of these sign1s in regulating the dosage of gases to produce the desired effects. Your patient is the compass; the anesthetist is the captain of a ship guidinig it safely through an anesthetic sea. MIuscular Manifestatioins All signls exhibited by the patienit be it breathing, eye sign1s, etc., are muscular phenomenia. Let us see what the action of the general muscles have to tell us concerniing our planes. In the light plane of the third stage, the muscles may be tense, exhibit purposeful movements. The facial expression may be one of pain or semi-consciousness. Nausea may occur, but very rarely occurs in this stage, reflex or purposeful resistance as a result of trauma. Entering the normiial or surgical plane, these muscles become immobile and relaxed, and still possess a niormal muscular ton1us. The patient exhibits an expressioni of normal sleep. Quiet and relaxed. As long as the required percenitages of gases are given the patienit, the patienit can be maintained in this stage for any desired lenlgth of time. Upon the patien1t enterinig the profound planie, again certain characteristic signsi of this stage present themselves. The first signi of anloexeniia presents itself in the form of a twitchinig of the upper lid, accompanied by a twitching of the

muscles of the finlgers, the movements are cloinic i-l character, and later develop inito the tonic type. The expression of the patient is wild looking. Swallowinig and retching or vomiting are common in this planie. Later, tetanic spasms become marked, rigidity is presenit, and in some cases opisthotonuls may occur.

Evc Signls

I see a great many beginners in gas oxygen work, pulling anid twisting the eye to pieces trying to determine the patienit's plane. I would like to impress
upon your minds that the reliability of the eye signis as a guide in anesthesia depends upon the length of time the patient has beeni anesthetized, and as the time progresses, the eye signs become more reliable. The eye signis in the first 15 minutes of an anesthetic are not reliable. The onily reliable sign during this time would be the extremely dilated pupil. In light anesthesia the pupils are moderately dilated and react to light actively. The upper and lower lids resist opening by the anesthetist. The corneal and conjunictival reflexes are still presenit. Eye ball rolls quite rapidly and may assume anly positioin. Enteritlg a normal surgical plane the lid reflexes and the reflexes of the cornes and conjunctiva are abolished. The pupils are small and usually the eyeball assumes the centre position. The eyeball may be fixed or slowly oscillatinig. Always note the size of the pupils before iniducing patient. Patient may be a druig addict in which case, the pupil would be pin point in size alnd a slight dilation of the pupil during the anesthesia, might meani profound anesthesia. In the case of atropin the pupils would be extremely dilated. A patient may have a glass eye or an Argyle Robertson pupil. The pupil of the eye of a child is always larger than that of an adult. Lids are often slightly open; approaching the profound plane, the pupils become fixed and enlarge progressivelv and finally become irregular in outline. The pupils become so large that the iris is almost completely obliterated. The eye ball is usually fixed in some position, usually downiward, in some cases they may jerk. The eyelids are stiff and often wide open. The eve becomes glassy in appearance and wild looking.

the gases in the serum. The degree of oxygeni unsaturation of the hemoglobin, therefore will determine the degree of cyanosis. In the anemic whose hemoglobin index is low, there is sufficient oxygen to saturate the patient's hemoglobin and the patient may remain pink throughout the narcosis; and the patient could meet with respiratory failure without a change in color, while on the other hand, the plethoric type of patient whose hemoglobin is plentiful may show signis of cyanosis before the surgical stage is eveni reached. A great many medical men who are accustomed to seeing their subjects pink in the case of extreme anesthesia, become alarmed where cyanosis l)resents itself. It would be a physical impossibility to anesthetize a Negro subject if we had to depend upoIn cyanosis. Those exaggerated symptoms are only reliable in short anesthesia.
7 hc Tcchniique of Inductiol I prefer the fast inductioni to the slow iniduictioni in
Circulatory Contditionis In light anesthesia, the pulse is accelerated and in normal anesthesia is usually slightly above the normal, while in the profound plane, it mav be rapid or very slow or sometimes irregular, dependilig u1poIn the condition of the patient. Blood Priessuri-e The blood pressure in light anesthesia is normal, in surgical anesthesia we ha-,e also a normal pressure, and in profound anesthesia, the pressure is sometimes increased slightly, but it usually drops below the niormal. Color M\uch misinformationi concerning color or cyanosis has caused a great many failures in nitrous oxide oxygen anesthesia. I feel if I tell you men to disregard color to the limit, I will be. doing you a great favor and helping you to become better anesthetists. Note your patient's color when in surgical anesthesia and if the color should deepen after that you can then regard it as a sign. Cyanosis depends upon the amount of hemoglobin unsaturated with oxygen and does not depend upon1
spite of the fact that this type of induictioni is used contrary to the maniy adherents of slow indtuctionl. I think the followinig reasons are sufficient to see why we adopt the fast induction. In the lirst place when administered 100%0 nitrous oxide, nine times out of ten, we'll experience no unpleasanit sensationis or dreams. This is quite possible because the subconscious minid does not have time to act before unconsciousniess is gained. By the fast inductioni the excitement stage is passed without activity upoIn the part of the patienit, preserving his physical economy by not allowing muscular activity, inicreased heart action or raised blood pressure. Before placing the nasal inhaler oni the patient's nose, examine the entire machine to see that it is funlctioning properly. See that your tanks have plenty of gases to safely carry you through an even anesthesia. If your subject is an adult, adjust your rebreathing bag to accommodate 300cc. of the patient's expired air and if in the case of a child, 200cc. will be sufficient. Of course, there are always exceptions to the rule. TIn cases where the patient's vital is in doubt, you can take it after the patient is leveled off. Next, see that the oxygen Vernier is at zero and the 1202 dial is at zero. The pressure dial will read OFF at this time. If the anesthetist has any preference, the patient should be seated in an upright position as in this position the respirations are embarrassed the least. This positioni will also allow the blood and saliva to collect in the floor of the mouth where it can be removed by means of an aspirator or sponges. When the patient is in the prone position there is a greater hazard for the patient to aspire oral secretion, blood,

Having already seated the patient in the chair, and with a few kind words of assurance that everything will be alright, the bite block is then inserted

Vof. XXIX, No. 1

in the patient's mouthi. There will be a case now anid theni of a patienit whose throat is very sensitive and upon placinig props, they will gag. This type of patienit will have to be iniduced before the prop is positioned. Adjust the pressure oni the nasal inhaler to 5mmli. Hg. pressure or if not the AMcKesson type, opeC1 a quarter of a turni anid then apply the niasal inihaler seeinig that the niasal inihaler is not attaclhed to the delivery tube at this time as the patienit will experienice a senise of suffocationi. It is important that the nasal 'inhaler be well adapted to the face as the slightest amount of air getting in under the niose piece will disbalance the mixture, tenidinig to initerfere with a smooth induction. Care should be taken that the nosepiece does not impinge upoIn the niares as this would interfere with the breathing anld might cause conisiderable trouble. The niasal inhaler beinig properly adjusted, the pressure gauge oni the machinie is turnied to zero and the delivery tube is theni attached to the Y upoIn the nosepiece. The clock controlling the flow of gases through the mouth cover should then be turnied oIn anid then the cover placed over the mouth. The anesthetist holding the cover anid nosepiece with his right hand and supportinig the chlinl. The left hanid should be free to chanige the mixture of gases on1 m1achlinle wheni necessary. The pressure oni the machinie is turnied to 5mmii. Hg. pressure anid the gases are ready to flow. 100%0 nitrous oxide is giveni to the patienlt unitil the first signls of ani exomeia presenit themiselves. These signs would be inidicated by a twitchinlg of the upper lid anid theni a slight twitchinlg of the mnuscles of the fingers. At the appearanice of these signls of depth, as much oxygeni is added to the mixture as the administrator considers sufficienit to correctly carry the patient inito surgical aniesthesia. The average mixture for the average patient is 93%,a nitrous oxide (N2) and 7% oxygeni. Continiue to observe your patienit. I f on this temporary mixture of 93 anid 7 he becomes light, a few breaths of 100% N20 are given and the mixture carried to 91 % N20 and 9% 02. On the other hand, if the patient becomiies too deep on1 the 93 and 7 a 100% breath of oxygeni should be delivered by pressinig on1 the direct 02 buttoni and the mixture is theni set at 92 anid 8'% After you are convinced that the patient is in surgical anesthesia, allow your patient to saturate. Increase the pressure on the inhaling valve to 10mm. Hg. likewise increase pressure oni machinie to 10mm. Hg. You will now find out if these pressures correspond to the pressure on the rebreathing bag, the rebreather will function. When you are ready for the operator, shut off the gases from mouth cover anid inisert the throat pack and watch the patienit. Do not be eager to change your mixture or increase your 02 for if your patient is leveled off properly he will carry for quite some time oni the mixtuire at hand. Allow the gases more opportunity to become absorbed inlto the blood stream

and distributed to the lymph cell tissues. AMany an anesthetic has been poor owing to the impatience of the operator. 1f ate-hiitg thle Chinl The chin at all times should be elevated, a depressed manidible will tend to interfere with the open air way by pressing oni the hyoid bone and cutting off the supply of gases to the air passage. The chin is ofteni neglected by the student and the patient will show signls of oxygen want, the student seeing his patient in this condition will attempt to force straight oxygen which will be of no avail to the patient as the gases cannot pass through the larynx. Upon elevation of the chin the patient resumes breathing. This we call a mechanical asphyxia, because the patent's breathing is interfered with through no fault of the mixture of the gases. Iniseirtinig the Orapharyngeal Pack Whenl you are ready to insert your pack, push the tonigue forward as you insert the pack posteriorly. Should you attempt placing your pack without pushing the tongue forward, the tongue and pack will be pushed backward and close to the orapharynx and cut off the supply of gases. Again a case of mechanical asphyxia. During some inductionis the tongue will have a tendenicv to fall back into the throat, causing an interference with the airway. In these cases it is best to grasp tongue with the forceps and prevent it from being swallowed, then after the patient is induced, introduce the pack in the correct manner and increase your pressure anid the tongue will stay forward. Do not allow the patient to swallow blood or mucous as this will cause vomiting. ReoxvYgenating the Paticnt When you are about ready to allow your patient to awaken, increase the oxygen gradually up to 100 as too rapid an oxygenation will cause them to vomit. After you have reached 100% 0. turn off your machine and force 02 into the lungs with direct oxygen button with the exhaling valve closed, this will bring them out very quickly.
Cauises of Nauisea 80%v of our nauseas are caused by too deep an anesthesia. Therefore, most of our nausea occurs
in depth, nausea never occurs in a normal anesthesia. Occasionally a patient will vomit in light anesthesia. Nausea may also be caused by the patient bending over too quickly after recovery. Inducing patients onI a full stomach will cause vomiting, 'but if handled very carefully the patient in a great many cases wrill not vomit. Do not remove your bite block until your patient has fully recovered consciousness as laceration of the lip and cheeks has been inflicted by patient's teeth while regaining consciousness.

Age Limit in N20 and 02

I have administered gas and oxygen to a patient 20 months old and carried the same patient for a period of 20 minutes without any ill effects. MIy oldest patient, a man of 85 presented himself for the extraction of a broken down central incisor. The patient was a cardiac and came to the office with his nurse. The tooth was removed, and the patienit went to his club for dinner. No ill effects. Indications antd Contraindicationts M\orbidity and ignorance on the part of the aniesthetist are the only contra-indicationis for this anes-

DENTAL BOOK REVIEWS

DENTAL PHARMACOLOGY AND THERAPEUTICS-Secontd Editioni-By J. R. Blayney, B.S., D.D.S., MlS. Professor of Denttal Pathology and Therapeutics, University of Illiniois, College of Dentistry. Illustrated:
thesia. Nitrous oxide and oxygen is indicated in those conditions which are the greatest risks for operations. In anemics, it does not increase blood dyscrasia (abnormal or poor state of blood and the Vitae 02 can be adequately met). Blood pressure can be maintained in cardiacs and the operative procedure made a rest period, instead of an exhausting ordeal. In diabetes, N20 and insulin are the essentials in preventing PLO coma. Nitrous oxide oxygen is not indicated in the weak and debilitated in the pulmonary and the cardiac and nephritis complications. In the anemics from old age. Pregnancy is no contraindication for the gas. I have administered N20 and 02 in cases up to 8 months, with no abortions. Nitrous oxide can be given to nursing mothers without endangering the baby.
340 pp. The C. V. Mosby Co., St. Loutis, Mo. Price $4.00. This volume, like the first editioni, presents a coIncise discussion of drugs of particular interest to dental practitioners. It constitutes a ready handbook and guide for those in practice and is most helpful to the dental student because of the compactness, and fine arrangement of its material. Names and compositions conform with those of the sixth editioln of the National Formulary and the eleventh editioin of the U. S. Pharmacopoeia. The author justly, does not claim for this volume the characteristics of a detailed reference, but this review finds his point well taken in that the book constitutes a summary which readily acquaints the student with the chief characteristics of those more important drugs with wvhich he must have a lasting knowledge and with which he must deal in the ultimate. The volume is a decided improvement on the first edition, in that it has been carefully revised and contains much new discussion and added information. It is in clear type, with fine plate illustrations, bound in cloth and is a worthy addition to dental literature for both student and practitioner. -S. J. L.

BOOK REVIEW

INTERNATIONAL CLINICS A Quarterly of Illhstrated Cliii ical Lecturies andi Especially Prepared Origil Articles oii Treatment, Medici,ie, Surgery, Neurology, Pediatrics, Obstetrics, Gynlaccoloqy, Orthopacdics,
P'at hology, Dermnatology, Ophthal;nioloayg, Otology, Rhiitology, Larvngology, Hygiene, anid Other Topics of Interest, by Leadinig Members of the Medical Pr-ofessioii Throu,ghontt the WForld. Edited by Loutis Hainanan, M.D., T 7sitibg Physician, Johlis Hopkiiis Hospital, Baltiiiorc, lid. IW'ith the Collaboration of a ANuntiber

of A4ssistaiits.

This, the fourth volume in 1936, is devoted almost exclusively to medicine, and covers an unusually large range of subjects; There is Gastroscopy, by Schloss of Bostonl; Postoperative Myxedema with Hypercholesteriniemia, Attacks of Angina Pectoris, Biliarv Cirrhosis with Jaundice, Hepatomegaly, Esophageal Varices and Anemia, by Keefer of Bostoni; A Case of Goniococcal Septicemia with Endocarditis and Hepatitis. by Blumer and Nesbit of New Haveni, Counii.; Specitic and Nonispecific Changes in Blood Protein Durinig Acute Rheumatismii with Carditis, by Coburn of New York City; Clinics of Dr. F. M. Hanes: 1. Trichniosis Complicated by Hypoproteinemia. 2. Sprue. 3. Two Instanices of Hyperparathyroidism Due to Parathyroid Adeniomas, by Hanes of Durham, N. C.; Xerostemia, by Beebe; Essenitial Thrombocytopenic Purpura, by Griffinl of Rochester, AIiinni.; anid Nutritional Edema, by Youmans of Nashville, Tennii.
We have also The M\edical Aspect anid Treatmiienlt of Chronic Gall-Bladder Disease, by Piersol of Philadelphia; The Bedside Recogniitioni and Treatmenit of Cardiac Irregularities, by Levine of Boston; Cliniic on Cardiovascular Diseases by -Major of Kanisas City, Kanisas; Certaini Observationis Concerninlg HypertellsionI anid izs Treatmenit, by Beardsley of Philadelphia; The Treatmenit of Ephysema, by Alexanider of St. Louis, -Mo.; Diagnosis and Treatmenit of the Fusospirochetal Type of Lunig Abscess, by Smith of Durham, N. C.; The Relation of Accidenit and Inijury to Pulmoniary Tuberculosis, by Hawes of Boston; Collapse Therapy in Pulmoniary Tuberculosis, by Lloyd