In my association with the physicians in the capacity before, mentioned I have been interested in all phases of surgical work, and have witnessed operations in many leading hospitals by some of the foremost surgeons of our country, as well as by those of lesser note, and have had the importance of the subject of suggestion to the general welfare of surgery impressed on me by many illustrations in both hospital and private work.

I invite the reader's attention to (a) the efficacy of suggestion to induce anesthesia; (b) the danger to the patient attending the administration of anesthetics; (c) the possibility of better results in surgical work where the minimum amount of anesthetic is used; (d) the efficacy of suggestion as an adjunct in the administration of anesthetics, and the safety of the method to the patient.

(a) As to the efficacy of suggestion to induce anesthesia, I have instructed physicians to follow a simple method of using suggestion to the extent that anesthesia was induced so that a pin was thrust through the fold of the skin in an individual's arm or face, or through his lip or neck, without the slightest evidence of pain. These tests were made under conditions of absolute fairness, the subject for each demonstration being taken at random from the streets, and had not the slightest idea that the results were other than the effect of a placebo (a bottle of medicine) which was used as a means of suggestion.

Among the first group of physicians to give me audience was a dentist, who, within less than an hour after our engagement, extracted teeth for two patients without pain or even the knowledge that the teeth had been removed, having used suggestion for the operation.

Since that time I have had occasion to demonstrate the efficacy of suggestion to induce anesthesia in dentistry many times, and would occasionally anesthetize a patient, where a favorable psychological situation presented itself, in the presence of one or more physicians in the removal of tumors, sewing up incised wounds, opening abscesses, setting a fracture, amputating a finger, resecting a rib, in operation for empyemia, where the use of ether or chloroform were not justifiable, in operation for adenoids, the removal of tonsils, and in obstetrics.

One physician, to my knowledge, had within five months used suggestion in minor surgery in not less than five or six hundred instances, and hundreds of physicians, who made effort to do so, had success in the application of this phase of psychotherapy far beyond what they had ever expected possible to obtain. Among these were some who had availed themselves of opportunities to witness the practical employment of suggestion in all parts of the world, and had implanted within them the conviction that suggestion was not of efficacy when employed by them.

Of the subjects used for demonstrations by the physicians 99 percent were amenable to suggestions, made by physicians with no previous experience, sufficient for anesthesia to be induced.

(b) Regarding the danger to the patient attending the administration of anesthetics, no satisfactory statistics are today obtainable in reference to the mortality from chloroform or ether anesthesia. Nitrous oxid is not yet practicable for general surgical work, however meritorious and free from danger this agent may be; so my remarks will be restricted to the use of suggestion as an adjunct to the employment of ether and chloroform in the production of anesthesia.

Statistics collected by Julliard show a mortality from chloroform in 524,507 administrations of 161 deaths - rate, 1 in 3,258; and from ether in 314,738 administrations of 21 deaths - rate, 1 in 14,987. Those collected by Gurlt in Germany from 1891 to 1897 show a death rate of 1 in 2,039 from chloroform, and 1 in 5,000 from ether.

My opinion is that the mortality is very much greater than is shown by statistics. Many deaths, no doubt, occur from the excessive administration of ether and chloroform that are ascribed in perfeet candor to the inadequate physical condition of the patient and not to the anesthetic, and my reason for this conclusion will be fully set forth.

In a city of my knowledge two deaths occurred on the operating table, a week apart, which were reported at the local medical society, and the cause ascribed was the administration of ether (not the excessive administration of ether).

In another city two deaths occurred, one each from chloroform and ether, in a period of less than sixty days apart. « These four deaths occurred upon the operating table and were directly the effect of the excessive administration of the anesthetic upon the centers presiding over the circulation and respiration.

In another instance of my knowledge an eastern expert was giving a lecture on the administration of ether, and at the same time demonstrating the technic of the method employed by him, before a body of medical men. He was urging the importance of profound anesthesia for the safety of the patient, and was pushing the anesthetic to its full physiological effect to secure the condition desired, when the surgeon in waiting modestly touched him, call-ing his attention to the condition of his patient - he was dead. This case went on the hospital records as "heart failure," and the magnanimous spirit of the physicians present did all they could to console their crestfallen visitor.

I have more than once asked in confidence the resident physician in a large hospital, "Do you ever have a death on the operating table from the anesthetic?" and received this or a similar reply, "Oh, yes, I am sorry to say that we do, more frequently than we feel is justified."

The immediate untoward effects of the anesthetic have been most strongly impressed upon me, and this leaves out of consideration the secondary effects or conditions likely to follow as a sequel to the administration of an anesthetic, more especially where used in excess, such as bronchitis, broncho-pneumonia, lobar pneumonia, renal congestion, nephritis and urinary suppression, jaundice, glycosuria, and insanity. These and other results are known to follow the administration of anesthetics.