MEDICAL NOTES.

Auckland Star, Volume LXI, Issue 103, 3 May 1930, Page 17 (Supplement)

MEDICAL NOTES.

A NEW ANAESTHETIC. " exaggerated SLEEP." (By PERITUS.) As long ago as March, 1929, two London surgeons reported upon the use of a new German anaesthetic (administered by injection) and advised its general use. Now, a year later, a doctor, a postgraduate pupil of the German sJirgeons who had proved the hew anaesthetic to ,oe safe and useful, reports upon a number of cases in which it has been used in Australia. The report is of public interest inasmuch as the medical profession in New Zealand has set its face against the routine use of chloroform (the trusted servant of the old school) and has given almost unlimited, approval to. etlier, wlnc-h, whilst safe as Tegards the patient's heart, has many drawbacks, its* administration being often, followed' by distention, vomiting, bronchitis and pneumonia, beside small discomforts. says the doctor, "produces a condition akin to exaggerated sleep. • After operation during the first 24 hours the patient is more asleep than awake; during the next 24 hours is more, awake than sleepy. On the fourth, fifth and sixth, days experiences a feeling of restfulness, and on the seventh day is quite alert. The absence of violent -vomiting, or retching, nausea and distention is of real advantage to the patient, and the absence of lung complications also. The period of actual unconsciousness lasts from two to four hours. Unconsciousness is produced quickly and quietly without excitement, or any unpleasant sensation. Respiration is slow and easy and the pulse rate unaffected. Avertin produces its effect in about four minutes, and the patient is heavily asleep in four to eight minutes." Sometimes the inhalation of ether, five parts, to chloroform one part, is needed in severe operations, but only for a short time and at a certain stage of the manipulations. Avertin has been used in some thousands of cases—twenty "thousand in Germany before the drug was issued \ for trial in England. The -Royal Society of Medicine (Eng.), issued a report, upon, two hundred cases last year, and Guv's Hospital reported upon 19S in March of that year,,. The English doctors did not keep strictly to the German instructions aluLih one case (fatal) gave an overdose, but considering their lack of. experience and familiarity they did well and reported favourably thus: "There appeal ~o .be no contra-indication to the use, of avertin on the score of age, Basil Hughes" speaks enthusiastically of its use for children, combined with infiltration anaesthesia, and some of our own most satisfactory experiences have been with aged persons. Nor does any state of bodily health, except rectal disease, apparently forbid its use. Feeble persons suffering from cancer have undergone avertin anaesthesia with, complete success. We would not use the drug if the liver or kidneys were known to be seriously diseased. "We believe .that its use has especial value: (1) For patients who dread the "anaesthetic, or have suffered after former anaesthetics; (2) for the subjects of exophthalmic goitre, or others in whom the psychic aspect of the matter is of real import; (3) for patients who have to undergo long operations not requiring very deep anaesthesia —e.g., long operations on bones, plastic operations, laryngectomies; (4) for injections for neuralgia; (o) for patients who suffer from any pulmonary complaint; and (6) in prolonged operations about the head and neck. We do not think avertin should be.used for operations likely to cause rapid; fall of blood pressure. We consider avertin to be a valuable addition to tfie drugs at the disposal of the anaesthetist, and that if used with due care and moderation its advantages can be taken, advantage of with perfect It is obvious that avertin is unsuitable as a, routine substitute for ether mixtures and must, at present, be con"sidered. as* a useful substitute in selected cases. It has promising features. •' Deatfis of Children. "Medical" statistics are more often alarming than instructive* but deathrate statistics are off value when they point the way .to prevention. The English Health Department has collected a "total of over thirteen thousand deaths of children between the ageß of 5 and 15. Not only are the results remarkable, but in at least three directions we are, given a hint of what should be done to avoid this waste of lite. Of the 13,000 the greater number (2173) died from consumption and most astonishingly "violence" caused the next greatest numbtr. .Then comes diphtheria (although the death rate has fallen from 30 per cent to 3 per cent since 189 a), and next again, diseases; of the chest. Tuberculosis calls for attention to milk supply and general satitation, and improved ways of living; "violence, meaning mostly street traffic accidents, demands such sheltering of pedestrians (young and old) that one sees the day comm„ when the only permitted method of crossinf the road will be by overhead bridge,"subway, or under the care of a traffic officer, and when children will be escorted to and from school and locked within school precincts durmgs school and play,hours. Diphtheria can best be met by wholesale immunisation (95> per cent of the young respond safely to this) until the disease is killed by lack of contacts. Diseases of thejbrain and nervous svstem come fifth on the list with I lib, or 8.4 per cent of the whole number. Herein "education," as we know it, has something to answer for. To b "uneducated" is less unpleasant than being blind, deaf or. lame,: poor, or out of fashion, and is not such a most parents imagine. Truly the "uneducated" cannot look forward to being imprisoned in an office, or a shop, but "they can enjoy to the full all the natural beauties of the e and sound appeal as strongly to the noncollegiate as to the learned professor. -A nervous child should .run wild," and pveri if dustpan- and brush or pick and shovel should loom ahead the freedom and the absence from the list of education's dead-are payment m advance for future toil.