FATAL ANÆSTHETICS.

Oamaru Mail, Volume XXXVIII, Issue 10543, 26 August 1910, Page 6

FATAL ANÆSTHETICS.

A CASK FOR LKGISLATIOX. i.M.ii.. in the London Daily Mail.) 'Whatever the cause may be, deaths under a aesthetics are becoming more frequent. Last week alone fqiix inque.sts were held 011 persons wli(rs had died under an ana>stlietic. In 1886 there wore five such deaths; in 1900, liij; in 1905 there were 155; last year, *35. One thins '"s certain, and tnat is that the use of anaesthetics should be' eontrolled bv legislation. At present they mav he administered hy anybody. ' If I sell a glass of beer to another the law will punish me; but 1 nlay drug my friend to my heart's content and the law will ignore mo. Moreover, if I (.supposing, as an illustration, that 1 am an unregistered practitioner) call in a medical man to administer an anaesthetic to my patient while I, let mc say. am setting his broken bone —bonesetters are numerous —that medical man will be punished liv his professional authorities; hut if I call in my cools to a inesthoiise my patient, then liothinp will be ;1 scl hy anyone. Seeing that an enormous number of minor operation' are cairk-d out under anaesthetics !>> uni ■ •gi-.t.or'-d and unqpaliiied men, h tin re not here at least one ground foi these deaths:' Let me consider for one momcnl v, hai placing a patient under an ana's thclic really means. It means nothing more or less than that 1 am going t( poison my patient to the verge o .safety. I. am administering; to him : deadtv poison. and only knowledge care, 'and skill will make that ad minis tration safe. If my "patient dies fron the anaesthetic I administer —not mere ly' under the ame'sthetic. is i very diiVe: I vnt pair of shoes —then I have killed him. and it remains for ire ti justify my action. Consequently, it i of -the utmost importance not only * th:i my (iose of poison should be the r.gn (lose, that the administration should b skilful, and any complications that ma; a:ise should he promptly and propcrl; met. but. above all. that the aiuestheti I have chosen should be the right on in tiie circumstances. For. unquestionably, many ol th deaths recorded have been due to 'th administration of a drug which may b harmless to one person but deadly t another, or of a drug of which so littl is knov.ii that it should be avoided alt< •Tether. Thus I come to the secon point—certain drills must be forbidde co certain practitioners. Which, then, is the safest of tlies poisons, some of which arc inevitable Y To answer this question it is liecei sary to consider for one moment th action of the amestlietie. This, in tli case of the respirablc kind —such ; nitions oxide (laujrhinji) {fas, ethe: chloroform, and mixtures of tlie tv. 'last—may be .said to be the inhalatio ■>; vapor into the lungs which passi thence to saturate and intoxicate il blood ilowi'ij.'. to the brain and tin j:;;i-.- the' '.Milter nerve centres v.iii Ihe heart. Both the blooi ! ;nul the breathing inachini are at aifceted. The effect of II I and d iagerous "local" amesthetii | ->-r.ia-h a- e: eain. stovain, eucain, an j ;:i- like—-:■= '■■■< paralyse at once tl'.e in ! mediate i'aaidy and ol'u il. subsequent pi-i.f!:;:-e a general condition wlr.; i :-.f ' 1,..!-!" dangerous or deplorabt i; : d:;-'s being equal, unquestio! a',; .• t eniesthetie is uitroi ; ■■ Lu over a milli< : ' : "aiiiistrations of this lias in c.-.-iirred. The diKadvainaj. .1, r*ii< vai...r is that it lasts for so shoi :: :a: e i' 1 .. l. it is generally only use- : • =■.■;<• d. i-tal operations: but it ' : -,v .v. ionised ;!e,i. when mixed wit gen. !.:.:--:-vr operations—lasting o»*< ■ d: : t; - ceil be performed uiua in order of general safety conn . r. Of the advantages of ether, t! is.i-x o'.' its stimulus on the heart is nut fhy. Its chief disadvantage i ;> • c.:,i • distressing preliminai : .- .; L on the patient. 15ut some tli ; liuiiiiHi-.-d anaesthetists who preii l .iii :' ..-hvi.ite this by he<rinniu<{ wit 1 !iiii<>.f •• xdio. Alter ether come mi: ,a; as of eihar and chloroform, the etlu : In.'gely • pirdfiininatinji: the niixtui • ACK. v. hi'-h means alcohol, chloroi'orn oil".;' in proportions of i. 2. an j ft: fi.h.'.l chloride, and lastly chloroforis i" v;r :ia -, dl.e r hloroi'orm is the Hi"' deadly ;>■' diiese amestlietie partly hi e; : e? . its dejiressiuL; qualities an paiiiy. i„'i I'laps. on ac'eoun: of its lu i: iti so e. ■a-■i: diy ]:rejerred by ior L-.;:' <r.;i ratior.s. and the lon'yer . j putiwu !•, pi a state of aiiicsthesi l j the a,i i- ii>e risk. Of 132 deaths ( r j maic aadri' iiesesthetics last year. 7 ! ! ocired .njiier chloroform, four ur.de . | ACr'.' i:-: : ; :;dier ether, two uinler ethe ■ eid:;:oTdr:n. one under ethyl chloi ! ide. one under nitrous oxide, and i j iorty-:<iid;t*oase-: where the tlruji is no [ t ;eiiorted tlie j/reat majority almost eel [ tainly ji'.vee under chloroform. | Of the !'.: v. la. a! ana'stiietie 1 -. ce.caii i is the lea-.L danueimis. but ill nuiiiy con i ditions it ma.v be fraught with seriou - J risK, whlie ste.vain. eucain. novocain j a::d : ';;dia;' new anfi highly danizeroti ! dru.L's «ho:dd he only used by highl; J qualiriei: /)ersons. and then under ox ! eoptioaai eivcurastances. : At any rate, the use of -stovain anc I similar ( ! ri!;zs for iiiira-spina! injectioi should he forbidden to every practi tioner bur. a specialist. They have re suited in many deaths, and have frequently produced the most serious anc unexpected ai'tor-elfeets —such, for cx ample, as general paralysis. -Next, no operation, not even a denta operation, under amostheties should la conducted by an operator unaided b\ an anaesthetist. Of thirteen fatal case; cau'-fuily examined into, twelve oc riirrcd when the two functions were disclr-iLce;.' by a single person. Xothiiif. is p.noe dangerous than this. The operator has to attend to his own serious work, and the ainesthetist must watch wiiii unremitting attention the elfect of the dru.u' on the patient's condition. end. i-i particular, on his breaih- ! inir. and be ready to act ii>vtantaiiei o-isly. j Third!;.", n:: dentist should be allowed i lo ;-tic but nitrous oxide i s;as, Uidess he has a registered medical i prsci.il ioncr actiuu' a.s ana?sthetist: and. | fourthly, the ordinary medical practij lioni i' hnnseif must be better equipped .| in the future for the amestlietie operaj ".ion. A practical course in the subject | should be compulsory on all medical i students in order to qualify, and greater facilities should be provided fm I ihe creation of a. special class oi i anesthetists. | One encouraging word in conclusion, i ! believe that the proportionate injeicare in the .-number of deaths under ai'aestheti:-. will not continue. There is alreadv in existence a tendency among ;he last aua'sthetisis to produce as ligni a ionn of ana'slhesia as in compatible v. it'i the need —that is to say. to obtain liie painless state with the | miiHaoiin oi unconsciousness. This in i rrf-tii makes ior a iar greater degree oi .sa.rety. And. further, the invention oi a most ingenious apparatus by which tiie exact proporuan of vapor given may be accurately known and immediately controlled—a difficult and often impossible matter by the "open mask" method—has enormously reduced the risk of chloroform. With such an apparnj tiis in use. Sir Victor Horsley has declared that he knows of jio -death due to chloroform, and he does not hesitate to give chloroform with it- to anybody. But legislation is needed to ensure the presence of aiieesthetist in addition l to the operator; that that anesthetistI shall be, except in The case of nitrous j oxide gas. a qualified medical mail ; and i the. abandonment of all intra-spinal in- | jections of stovain, eucain. and the j allied drugs except under the strictest ' conditions and at the hands of quali- ; lied .specialists.