ANESTHESIA—KRANTZ 469 
the gas as it is carried by the blood to the central nervous system par- 
titions itself out of the blood into the lipids of the central nervous 
system producing narcosis. Induction is prompt, narcosis occurring 
within 1 to 2 minutes. Anesthetists have set forth the following effects 
from the inhalation of various concentrations of nitrous oxide: 
N20, 2 
Effect Percent Percent 
SUDCONSCIOUS /ANALSCS Take ee tees Cee ees es eee 80 20 
Conpletet analeesl ane ees Pee Re ee Cee eee eee 84 16 
hight anesthesia =.2- =. So aay Sere eyes ots ae ee ee 89 11 
Complete anesthesia) dangerous hypoxia with incomplete 
Relax alOnye ws wee ee ae ee a ee oe eee 94 6 
Like many other volatile anesthetics, nitrous oxide enters the body 
and leaves it unchanged. In other words, it is refractory to catabolism 
by biological processes. Its anesthetic action according to modern 
concepts is apparently due to the production of a reversible oxygen- 
want in the central nervous system. By means of drugs, hypoxia of 
the central nervous system can be produced by at least three 
mechanisms. 
1. Formation of carbonyl hemoglobin (carbon monoxide 
poisoning). 
2. Inactivation of the cytochrome oxidase in the cells (cyanide 
poisoning). 
3. Inactivation of the cytochrome reductase in the cells (narcosis- 
nitrous oxide, ether, chloroform, etc.) 
Substances used clinically as anesthetics affect the cells of the central 
nervous system according to the third concept but, in addition, they 
exhibit the property of affecting, first, the cells of the cerebral cortex; 
second, those of the spinal centers; and, last, the cells of the vital 
medullary centers. 
Inexplosibility, safety, and availability are factors which give 
nitrous oxide a place of pre-eminence among the volatile general 
anesthetics. 
ETHYL ETHER 
Crawford W. Long of Georgia used ether as a general anesthetic 
in 1842. He was familiar with some of the pharmacologic effects 
of ether and in Jefferson County there were many “ether frolics” 
which resembled modern parties of inebriates. He used ether also 
to deaden pain in the reduction of fractures and on James W. Venable 
to permit the surgical removal of a growth on the back of his neck. 
Unfortunate it is indeed that Long did not publicize his observa- 
tions for apparently the first paper published by Long on ether ap- 
peared in 1849, 5 years after Wells’ work with nitrous oxide, and 
3 years after Morton’s demonstration of the use of ether in Boston. 
In Boston, a chemist named Jackson suggested the use of ether 
to a dentist named W. T. G. Morton, who was a pupil of Horace 
