August 11, 1911] 



SCIENCE 



175 



that these changes are essentially different 

 from those we control in the laboratory. 

 If we wish to control a physical or chem- 

 ical change in the laboratory, we endeavor 

 to become familiar with all the factors and 

 conditions. If we seek to duplicate, we try 

 to duplicate the conditions. I know of 

 only one class of such changes over which 

 we have not as yet secured control, and in 

 that class belongs those processes which 

 we term radioactive. One of the essential 

 factors in controlling a chemical process 

 is the quality of the material with which 

 we are working. I can not, therefore, but 

 regard all published statistics as to the 

 mortality attributed directly to the anes- 

 thetic used as more or less worthless, and 

 that a large number of new cases must be 

 observed to secure knowledge of the real 

 physiological effect of the drug when cax'- 

 ried into the system by the pulmonary 

 route. 



Impure foods, sophisticated intentionally 

 or otherwise, may bring on disease. Im- 

 pure drugs, concocted or otherwise, fail to 

 produce the full effect planned by the 

 physician in curing disease. 



Idiosyncrasy has served to account in 

 large part for untoward after-effects of 

 anesthetics and certain disagreeable conse- 

 quences, as nausea; and interference with 

 some normal organic functions, as gly- 

 cosuria and albuminuria, have often been 

 regarded as natural results of anesthesia, 

 and taken for granted. They may now be 

 largely obviated and in many cases entirely 

 avoided by the use of anesthetics that are 

 free from impurities, and by improved 

 methods of administration. These state- 

 ments are based upon clinical evidence. 

 We now have records of 5,000 eases. 



The main objectionable impurity in 

 ether is acetaldehyde. American official 

 ethers call for three to four per cent, of 

 ethyl alcohol in accordance with an old 



and erroneous theory that alcohol pro- 

 tected the ether. Alcohol is practically 

 never free from water, and in the presence 

 of water and oxygen forms oxidation 

 products. The speeds of the changes de- 

 pend upon conditions. It has been shown 

 that the administration of moist ether, 

 free from aldehyde, at body temperature, 

 is rarely followed by nausea (less than ten 

 per cent.) and the usual strain upon the 

 kidneys is not observed. 



Chloroform was formerly made mainly 

 from alcohol and contained many of the 

 normal impurities of the alcohol used. 

 These were not removed by the methods of 

 piarification practised, nor are they totally 

 removable, except by elaborate methods 

 of purification. These impurities doubt- 

 less have had much to do with the feeling 

 of uncertainty in administering chloro- 

 form. Pure chloroform undergoes de- 

 composition when exposed under certain 

 conditions, such, for example, as the man- 

 ner in which anesthetic chloroform is dis- 

 pensed in some drug stores and hospitals. 

 A suitable amount of alcohol prevents this 

 decomposition, shunting the change in 

 composition to itself, hence anesthetic 

 chloroform should contain ethyl alcohol. 

 But the conditions of transportation and 

 keeping of this chloroform should be such 

 as to reduce the change of alcohol to alde- 

 hyde and acetic acid to the minimum. 



Nitrous oxide, ether and chloroform, 

 each exerts its specific physiologic effect in 

 producing anesthesia without asphyxia- 

 tion, provided the respiratory and cardiac 

 functions are approximately normal. This 

 may be and is being accomplished by ad- 

 ministering these gasified drugs with suffi- 

 cient oxygen not to interfere seriously 

 with the normal function of the hcemo- 

 globin of carrying oxygen to the capil- 

 laries and sustaining cardiac stimulation, 

 and by maintaining the usual concentra- 



