Much has been written, and many discussions have taken place in recent years as to trouble with anæsthetics. Important research work has been carried out with the object of ascertaining the cause of:—1, Cyanosis in anæsthesia, and how it occurs; 2, the cause of respiratory trouble, and why it occurs; 3, the logical treatment of collapse under anæsthetic; 4, the cause of post-operative vomiting; 5, how best to avoid all these troubles and to safeguard the patient. Before proceeding to deal with the matters enumerated above, it is necessary to explain that chloroform and ether are manufactured from:—Alcohol and sulphuric acid in the case of ether (C₄ H₁₀ O) ;) alcohol and bleaching powder (calcium oxychloride, (Ca O Cl₂ ) in the case of chloroform (trichlormethane, CH Cl₃) or from acetone. In the investigations before us, the acids prove to be of no interest, all the interest centring around the type of alcohol used in manufacture. Alcohol has several distinct types, but the two types we are concerned with in anæsthetics are:--Methyl alcohol (industrial methylated spirits or wood alcohol obtained by distillation), and ethyl alcohol (obtained by fermentation from grain). It is now only necessary to examine the chemical formulæ of each before proceeding to answer the questions set above: Methyl alcohol, (CH₃ OH); ethyl alcohol, (CH₃ CH₂ OH) derived from entirely different sources. It should here be explained that the chemical actions and reactions involved in the manufacture of chloroform and ether are very complicated, and it is not proposed to give these in detail.

1. Cyanosis in Anæsthesia and How it Occurs.—Most anæsthetics at present in use are prepared from methyl alcohol, Methyl alcohol, in conjunction with sulphuric acid, produces a methyl ester. This methyl ester is present in solution, together with free methyl alcohol, oil of ether, and S0₂. Washing with milk of lime will eliminate most of these side-products of the reactions, but the methylic ester is not completely reduced, and methyl alcohol is still present. The latter, by oxidation, forms formaldehyde (CH₂ O). Formaldehyde has a strong toxic action on nitrogenous organic substances. Formaldehyde will further oxidize into formic acid in the human system. Formic acid has a marked action in the system, causing fatty degeneration of the sheaths of the choroid membrane and optic nerve. In both these last two reactions the oxygen is obtained from the only available place—the human system. This is a cause of cyanosis, and it occurs as a result of the absorption of oxygen as shown above.

2. Respiratory Trouble and Why it Occurs.—In anæsthesia, the quantity of free air in the patient’s lungs is of necessity restricted. Add to this the fact the absorption of oxygen by the decomposition product as shown above, and respiratory trouble is aggravated.

3. The Logical Treatment of Collapse under Anæsthetic.—The answer to this question becomes obvious from the answer to the two preceding questions, i.e., remove the mask and administer oxygen—the real object in resorting to artificial respiration.

4. The Cause of Post-operative Vomiting.—The now known presence in the system of formaldehyde , and later formic acid, and later still oxalic acid, successfully accounts for this.

Before dealing with the question No. 5, it here becomes necessary to consider ethyl alcohol (CH₃ CH2 OH). Ethyl alcohol, in conjunction with sulphuric acid, produces an ethyl ester, made up in accordance with the following formula:—C₂ H₅ OH plus H₂ SO₄ equal C₂ H₂ (HSO₄) H₂ O. The compound italicized represents the ethyl ester, or ethyl-sulphuric acid. The final ether product after elimination leaves only traces of ethyl alcohol and ethyl esters. The products of decomposition, however, only form water, carbon dioxide and sulphur dioxide. They are harmless, as the former escapes into the atmosphere, and the latter is eliminated by the subsequent washing with milk of lime, needing only the one atom of oxygen to final resolution into water. Formaldehyde and formic or oxalic acid are never formed at any stage.

5. How Best to Minimise these Troubles and to Safeguard the Patient.—It has been shown that the two principal ingredients employed differ very materially, and that in the case of an anæsthetic prepared from methyl alcohol, cyanosis, respiratory failure and post-operative vomiting almost invariably occur from the causes shown, whereas in the case of an anæsthetic prepared from ethylic alcohol, none of these factors are present: added to this, the experience of the use of the latter preparations amply demonstrates that the answer to this question lies in the use only of an anæsthetic prepared from ethylic acid.

Much has been written, and many discussions have taken place in recent years as to trouble with anæsthetics. Important research work has been carried out with the object of ascertaining the cause of:—1, Cyanosis in anæsthesia, and how it occurs; 2, the cause of respiratory trouble, and why it occurs; 3, the logical treatment of collapse under anæsthetic; 4, the cause of post-operative vomiting; 5, how best to avoid all these troubles and to safeguard the patient. Before proceeding to deal with the matters enumerated above, it is necessary to explain that chloroform and ether are manufactured from:—Alcohol and sulphuric acid in the case of ether (C₄ H₁₀ O) ;) alcohol and bleaching powder (calcium oxychloride, (Ca O Cl₂ ) in the case of chloroform (trichlormethane, CH Cl₃) or from acetone. In the investigations before us, the acids prove to be of no interest, all the interest centring around the type of alcohol used in manufacture. Alcohol has several distinct types, but the two types we are concerned with in anæsthetics are:--Methyl alcohol (industrial methylated spirits or wood alcohol obtained by distillation), and ethyl alcohol (obtained by fermentation from grain). It is now only necessary to examine the chemical formulæ of each before proceeding to answer the questions set above: Methyl alcohol, (CH₃ OH); ethyl alcohol, (CH₃ CH₂ OH) derived from entirely different sources. It should here be explained that the chemical actions and reactions involved in the manufacture of chloroform and ether are very complicated, and it is not proposed to give these in detail.

1. Cyanosis in Anæsthesia and How it Occurs.—Most anæsthetics at present in use are prepared from methyl alcohol, Methyl alcohol, in conjunction with sulphuric acid, produces a methyl ester. This methyl ester is present in solution, together with free methyl alcohol, oil of ether, and S0₂. Washing with milk of lime will eliminate most of these side-products of the reactions, but the methylic ester is not completely reduced, and methyl alcohol is still present. The latter, by oxidation, forms formaldehyde (CH₂ O). Formaldehyde has a strong toxic action on nitrogenous organic substances. Formaldehyde will further oxidize into formic acid in the human system. Formic acid has a marked action in the system, causing fatty degeneration of the sheaths of the choroid membrane and optic nerve. In both these last two reactions the oxygen is obtained from the only available place—the human system. This is a cause of cyanosis, and it occurs as a result of the absorption of oxygen as shown above.

2. Respiratory Trouble and Why it Occurs.—In anæsthesia, the quantity of free air in the patient’s lungs is of necessity restricted. Add to this the fact the absorption of oxygen by the decomposition product as shown above, and respiratory trouble is aggravated.

3. The Logical Treatment of Collapse under Anæsthetic.—The answer to this question becomes obvious from the answer to the two preceding questions, i.e., remove the mask and administer oxygen—the real object in resorting to artificial respiration.

4. The Cause of Post-operative Vomiting.—The now known presence in the system of formaldehyde , and later formic acid, and later still oxalic acid, successfully accounts for this.

Before dealing with the question No. 5, it here becomes necessary to consider ethyl alcohol (CH₃ CH2 OH). Ethyl alcohol, in conjunction with sulphuric acid, produces an ethyl ester, made up in accordance with the following formula:—C₂ H₅ OH plus H₂ SO₄ equal C₂ H₂ (HSO₄) H₂ O. The compound italicized represents the ethyl ester, or ethyl-sulphuric acid. The final ether product after elimination leaves only traces of ethyl alcohol and ethyl esters. The products of decomposition, however, only form water, carbon dioxide and sulphur dioxide. They are harmless, as the former escapes into the atmosphere, and the latter is eliminated by the subsequent washing with milk of lime, needing only the one atom of oxygen to final resolution into water. Formaldehyde and formic or oxalic acid are never formed at any stage.

5. How Best to Minimise these Troubles and to Safeguard the Patient.—It has been shown that the two principal ingredients employed differ very materially, and that in the case of an anæsthetic prepared from methyl alcohol, cyanosis, respiratory failure and post-operative vomiting almost invariably occur from the causes shown, whereas in the case of an anæsthetic prepared from ethylic alcohol, none of these factors are present: added to this, the experience of the use of the latter preparations amply demonstrates that the answer to this question lies in the use only of an anæsthetic prepared from ethylic acid.