ANOCIATION 251 



where, thus increasing the amount of waste products 

 to be eliminated, laying a heavier task upon the 

 kidneys, and incidentally increasing the liability to 

 pneumonia, embolism and nephritis. In addition, 

 prolonged etherization causes striking histologic 

 changes in the brain, the adrenals and the liver. 



In the choice of the anesthetic, however, it should 

 be emphasized that the patient is the first consideration, 

 not the prejudice of the surgeon for a certain method. 

 If nitrous oxid-oxygen does not fully anesthetize the 

 patient, as may happen in some cases and frequently 

 happens with inebriates, then sufficient ether to attain 

 the desired end should be added. It should also be 

 borne in mind always that while nitrous oxid-oxygen 

 is the safest of all anesthetics in the hands of an expert 

 in the technique of its administration, it is perhaps the 

 most unsafe in the hands of the inexperienced and there- 

 fore should never be administered except by an anesthetist 

 specially trained in its use. In over 14,000 administra- 

 tions of nitrous oxid by the specially trained anesthe- 

 tists on my staff, there has been no death. 



With the increasing efficiency of the hospital organ- 

 ization and the growing knowledge of the wonderful 

 qualities of nitrous oxid, preoperative sedatives are 

 required less and less. 



The peace of mind of the patient having been secured 

 by management and, if needed, by sedatives, and uncon- 

 sciousness induced by inhalation anesthesia, the opera- 

 tion proceeds, each division of nerve-bearing tissue 

 being preceded by the injection of a local anesthetic 

 -novocain in 1-400 solution. The infiltrated parts 

 are subjected immediately to a firm but gentle pressure 



