Surgery involves many controversial subjects which add interest to medical discussions and zest to meetings whenever doctors get together. Spinal anesthesia is a recent example, for no method has had stronger partisans ready to defend, on the one hand, or to condemn, on the other. As has been the case with most surgeons, we have been greatly interested in the question of the relative merits of this anesthetic and anxious to know the truth of the matter. On finding recently that sufficient material from which to draw conclusions had accumulated in our own clinic, we attempted to determine the nature of our own results. With no analysis having been made at the time and, therefore, without bias, we offered to read a paper entitled "The RelativeMerits of Spinal and Ether Anesthesia" before this section and so, with an open mind and with no attempt at prophesying what our conclusions would be, we set about making a comparative study of the results following the use of the two forms of anesthesia, ether and spinal, in a series of operations performed under closely similar conditions. It was with a sincere desire to determine the actual facts pertaining to the relative safety of spinal and ether anesthesias and with a resolve to steer a middle course between immeasurable enthusiasm, on the one hand, and unjustified condemnation, on the other, and to rely only on carefully collected data, that the study was made. The investigation was carried out on a series of major procedures all performed by one of us (H. L. F.), except for a few performed by an assis¬ tant, in the same hospital and operating room and with the same personnel ; 4,000 consecutive operations were performed, one half under ether anesthesia and the remaining half under spinal anesthesia. By ether anes¬ thesia we refer to ether, or ether plus nitrous oxide or ethylene, but in which no spinal anesthesia is used ; by spinal anesthesia, subarachnoid injection of procaine hydrochloride supplemented in a few cases by nitrous oxide and ethylene. Every anesthetic was administered by one of three trained anesthetists who had devoted many years exclusively to this work and who, there¬ fore, were experienced and skilled. We have not resorted to spinal anesthesia in closed fracture reduc¬ tion; hence, no such cases are included, while such procedures as cystoscopic examinations and other sim¬ ilar minor procedures, occasionally performed under spinal anesthesia, are, of course, not listed. All the procedures herein described come well within the cate¬ gory of major operations (table 1).The operations, whether with ether or spinal anes¬ thesia, were all consecutive and were all performed on structures below the diaphragm. Since the types of operation and the lesions for which they were per¬ formed were about equally divided between the two anesthetic methods, the study is fair and comparable.It seemed, therefore, that a review of the anesthetic results, the patient's reaction and condition during and after the procedure, with, especially, a comparative
