Whatever else might be said in regard to the physiological action of chloroform and ether, they undoubtedly act by arresting the activity of the nervous centers concerned in sensation. Given in excess, they destroy life by paralyzing the nervous mechanism concerned in the circulation or respiration, or possibly in both.

Any drug that is capable of depriving an individual of consciousness and rendering him insensible to pain is a poison, and should at all times be regarded as such. The use of chloroform and ether in the production of anesthesia, administered by inhalation, influences the nerve centers presiding over all bodily functions, and causes degenerative cellular changes in every organ and cell in the body. The toxemia produced in consequence of the administration of these anesthetics varies in severity in different patients, dependent on the amount of the anesthetic administered at a given time, the strength of the drug used, the length of time employed in anesthesia, and the quality of neuron structure in the complex mechanism of the entire physiological organism.

In by far the greater number of surgical patients there exists a general condition of physiological insufficiency or a marked degree of physiological incompetency. Aside from the gross pathologic changes in the local area to be relieved by surgical procedures, the cells of the entire organism do not properly perform their functions.

The predisposing factors which contribute toward fatal results are such conditions as sepsis, anemia, loss of blood, chronic wasting diseases, and any similar condition that lowers the resistive powers of the cells of the organism.

In all such cases less of the drug employed is required to produce anesthesia, due to the existing vulnerable condition of the protoplasmic elements of the organism.

Cells that are already engaged in mortal combat with pathogenic germs, or weakened from loss of blood, or struggling to eliminate toxic material from some of the various morbid conditions which give rise to surgical intervention, in the administration of anesthetics (especially when used in excess of the minimum amount required for anesthesia) are deprived of their fighting qualities, their function is inhibited, activity is arrested - stunned, benumbed, exhausted - poisoned to a degree that renders them unresponsive to internal or external stimuli; so no wonder the tendency to collapse, surgical shock, or death.

(c) Let us briefly consider the possibility of better results in surgical work where the minimum amount of the anesthetic is used.

The American text book of surgery, on page 1116, says: "Anesthetics act by producing paralysis of the cerebrospinal nerve centers. There is first a stage of cerebral excitement, followed by a stage of cerebral insensibility, then a loss of voluntary movement, followed by a loss of reflex action. Consciousness is lost before the paralysis of the muscles supervenes, and a patient is said to be fully anesthetized when the nerve centers are paralyzed, with the exception of those presiding over respiration and circulation."

It is conceded by the writers of the text books on surgery that the dangers from chloroform are chiefly in connection with the circulation, and are manifested by various degrees of circulatory depression; and that the dangers from ether are chiefly in connection with the respiration, and are manifested by various degrees of asphyxia.

The point that I desire to emphasize by these references is that ether and chloroform are dangerous poisons, and that they are regarded as such by all writers on surgery. The only logical conclusion, then, is that the least amount of the anesthetic administered to secure complete insensibility is most conducive to the safety of the patient.

But since it happens that death occurs with comparative frequency in trivial operations with incomplete anesthesia, it is supposed by most surgeons that the giving of too little of the anesthetic is attended with quite as much danger as, if not more than, the free use of the drug employed for the production of anesthesia.

The deaths that occur in the administration of anesthetics when given for trivial operations are due to the morbid psychic factor in those cases, which at the present time is not sufficiently appreciated by anesthetists and surgeons. Fear, an emotion which arises as a result of the analysis of consequences, has a most depressing effect upon the circulatory and respiratory centers, and this, in conjunction with the physiological action of chloroform and ether, given to a patient who becomes alarmed at the bare idea of taking an anesthetic, without the proper precautions to secure a favorable psychological attitude on the part of the patient, is likely to produce death in some instances, and in such cases the reason is ascribed to too little anesthetic.

It is possible that death may occur from purely nervous shock. Shock may be defined as a complete suspension of some and partial of others of the functions of the nervous system. The anesthetist who understands the technic of using suggestion in conjunction with the administration of anesthetics will not only avoid the danger from their use in trivial operations, but will minimize the danger from their use in excessive doses in all surgical work, and greatly increase the possibility of good results to the patient from the operation as well.

Success in surgery is determined by the benefit to the patient in consequence of the operation. In my opinion no anesthetist is justified in pouring a large quantity of ether into a closed inhaler every two to five minutes during the administration and placing this over the patient's face so as to exclude all air, as is so commonly done.

Since the anesthetic produces actual, organic, structural changes in the cells of the entire organism, and, in proportion to the amount used, exhausts the patient's reserved energy, the best results from surgery are impossible where the anesthetic is used in excess of what is actually necessary by its most skillful administration.