Observation has convinced me that the amount of the anesthetic employed in a given operation by different anesthetists varies considerably, and that the time required to anesthetize a patient varies even more.

From thirty to forty-five minutes in the administration of ether, the anesthetic most commonly employed at the present time, before complete anesthesia is produced is quite a common occurrence, if not the rule, in the majority of administrations; and when we take into consideration the fact that enormous quantities of ether are used in these prolonged administrations, administered in a closed cone or inhaler that unduly excludes the admixture of air, the wonder is that the mortality from the administration of anesthetics is not even greater than it is, to say nothing of the lasting injurious effects to a nervous organization, notwithstanding the benefit derived from surgery in the relief of a gross pathologic condition. But what is more important to be considered is the outcome of surgical work in cases of excessive employment of agents so powerful in their effects as to produce catabolism or destructive metamorphosis, with the consequent toxemia which follows, with its disastrous effect upon an already outraged nervous system, as occurs with the present method commonly employed in the administration of chloroform and ether.

However skilled a surgeon may be, or perfect in his operative technic, the results of his work are seriously handicapped where the functions of every cerebral and spinal center is seriously and permanently injured and the resistive power of every cell of the organism is weakened, as is done where an undue amount of chloroform or ether is employed.

Nor are the various compounds of morphin tablets administered hypodermatically to inhibit all functional processes, and, in a degree, to prevent the normal reaction of the patient from the anesthetic administered by inhalation, in my opinion justifiable, except in so far as the procedure is coupled with a suggestive influence that conveys to the patient the idea of safety, and in a measure secures a favorable psychological situation for the use of chloroform or ether. Administered in homeopathic doses, such combinations, while not essential, would be of unquestioned value as a means of suggestion.

(d) Let us now look into the facts bearing evidence of the value of the employment of suggestion as an adjunct in the administration of anesthetics and the safety of the method to the patient.

Alice Magaw, Dr. W. J. Mayo's anesthetist at Rochester, Minnesota, who has, with possibly one exception, anesthetized more patients than any other person in the world, has an unbroken record of approximately seventeen thousand surgical anesthesias without a single death directly from the anesthetic.

No other surgical clinic in the world has been so constantly witnessed by surgeons during the last several years and no other clinic presents a greater number of difficult cases to be operated upon, or those that are more unfit for favorable results from the administration of anesthetics.

At St. Mary's Hospital, in the personalities of Alice Magaw and Miss Henderson, the anesthetists of W. J. and C. II. Mayo, at Roch-ester, Minnesota, we see the results from the outcome of surgical work done with the minimum amount of the drug employed for anesthesia, and the free and intelligent use of suggestion as an adjunct to its administration.

It was with no small degree of pleasure that, upon a visit to Rochester during the month of November, 1907, I found these women actually putting into practice one particular phase of psychotherapy that I had so strongly urged upon surgeons during the eight years previous.

Both Alice Magaw and Miss Henderson were highly appreciative of that particular part of my lecture to the Physicians' Club of Rochester wherein I urged the importance of the employment of suggestion as an adjunct in the administration of anesthetics, and cited their every-day work as an illustration of complete surgical anesthesia with the use of but little ether, and the employment of suggestion to meet the requirements of the individual patient as an adjunct. Moreover, these women were free to say that they knew from every-day experience that what I had to say in reference to the use of suggestion as an adjunct in the administration of anesthetics was true.

In the Journal of Surgery, Gynecology, and Obstetrics of December, 1906, Alice Magaw says: "Suggestion is a great aid in producing a comfortable narcosis. The anesthetist must be able to inspire confidence in the patient, and a great deal depends on the manner of approach. . . . The secondary or subconscious self is particularly susceptible to suggestive influence; therefore, during the administration, the anesthetist should make those suggestions that will be most pleasing to this particular subject. Patients should be prepared for each stage of the anesthesia with an explanation of just how the anesthetic is expected to affect him - 'talk him to sleep,' with the addition of as little ether as possible.

By the employment of suggestion scientifically and earnestly, very little ether is required to produce surgical anesthesia, and even less chloroform, to keep a patient surgically anesthetized.

I do not exaggerate in the least when I assert that it is quite the common occurrence for an anesthetist who does not understand the use of suggestion to use from ten to twenty times the amount of ether in anesthetizing a patient that is used by Alice Magaw and Miss Henderson, who make use of suggestion in every possible way in a given operation.

Nor is the anesthesia where such enormous quantities of ether are employed one iota more satisfactory from the surgeon's point of view than is secured for the Mayos. On the contrary, there is no period of excitement, no struggling of the patient that demands restraint, comparatively little stertorous breathing, no feeling of the pulse, and no hypodermics administered in the course of the operation, and, more yet, an unbroken record of approximately seventeen thousand cases of anesthesia without a single death from the anesthetic.