Entered as second-class matter Feb. 13, 1896, at the post office at Philadelphia, Pa., under Act of March 3, 1879. The Medical Council, Commercial Union Building, 416, 418, 420 Walnut St., Philadelphia, Pa., U. S. A. 1915, A Happy New Year, is our wish for the world-peace for the Old World and prosperity for the New! May the balm of national healing come as a medicine to the warring Nations and the grace of patience as the prophylactic against involvement of the Ones at Peace! DOCTOR, we are in the dawn of a New Age-"an age on ages telling; to be living is sub lime." We need a new Abou Ben Adhem to say to the Recording Angel, "I pray thee then, write me as one that loves his fellow men." And: "The Angel wrote and vanished. The next night It came again with a great wakening light, And showed the names whom love of God had blessed, And lo! Ben Adhem's name led all the rest." May we, in 1915, love our fellow-men, our common profession, our country and our God! Then 1915 may be truly The Dawn of a Better Age. Safety and Simplicity in Anesthesia. DOCKET-CASE SURGERY, though frowned upon, is just as necessary as hand-extinguisher fire-fighting. Fieldwork anesthesia is just as imperative as is operating-room anesthesia. Indeed, to most of us the rough-and-ready methods are so imperatively necessary that any suggestions by means of which field-work efficiency and exactitude may be furthered are of greater moment than the most elaborate technic. Nearly all doctors are called upon to give anesthetics; but most of us are, of late, discouraged by the highly elaborated methods urged upon us as so necessarymethods none but a specialist can apply, and which take a roomful of apparatus. Is there a simple and safe method recently advocated? Several men are working out the problem. What is here said is based upon the methods pursued by Dr. Robert H. Ferguson, East Orange, N. J., whose clinical demonstrations have interested us greatly, owing to the simplicity and safety of his methods. The psychology of anesthetic-induced sleep is the same as that of the induction of natural slumber, that is, the conscious and sub-conscious elements and the focus of attention are involved equally in both. Therefore, when attempting to anesthetize a patient, do not distract his attention by bright light, novel or unusual surroundings, or any disquieting sights or sounds. Do Have him alone with the anesthetist in a simply furnished room, not even a nurse being present at first. not permit the presence of relatives if it can be avoided, and if any are present do not permit them to touch th patient after having started the anesthetic. First of all get the confidence of the patient; but do not do so by misrepresentation. Rather, tell him frankly that taking an anesthetic is somewhat disagreeable at first, but that the more deeply and regularly he breathes the more quickly will the disagreeable sensations disappear. Most patients will sensibly face what they are led to expect. 294983 Uppermost in the minds or persons beof ing anesthetized are these two thoughts: that some terrible but undefined thing may happen, and that they may be cut before fully under the anesthetic. A person partially anesthetized is in an attitude of defense, and any unexpected, though harmless, handling, may make him struggle. Therefore, do not permit any handling except where necessary on account of haste, the scrubbing up of the site of operation, and have this begun before the anesthetic is started, so the patient may know what to expect. Do not restrain the patient, hold his hands or distract his attention by any form of unnecessary handling. Preliminary Medication. of The preliminary administration morphin is seldom necessary, exceptions being the alcoholic, the user of cigarettes, the habitual and excessive smoker of pipe or cigars, the person of very athletic build with strong abdominal muscles, the excessively nervous, and a few neurotics. These classes may be put into a more nearly nor and, by the method to be outlined, a minimum amount is effective. Special ether containers are unnecessary, the ordinary 4-pound can being the most handy. Prepare the can as follows: Cut a piece of gauze (20 strands to the inch) about a foot long and 12 to 2 inches wide; lay it flat and even upon a table; catch it up in the center, where two lines, each drawn from diagonal corners would cross, just as one would pick up a handkerchief in its center; hold the gauze firmly between the thumb and index finger of the left hand; with the right hand stroke the fabric downwards, like compacting an umbrella held by its tip; now, with both hands, firmly twist it into a wick, clipping off the two tip ends. Now lay it aside and metal seal, carefully removing all lead ; prepare the can as follows: Cut out the insert the wick, extending it to the bottom of the can; insert a good cork, pressing it down tightly against the side of the wick, which is allowed to project an inch or so. This can, after being wicked, can be mal state by a dose of morphin, and with dropped in any position without any ap them it is not apt to interfere with the pupillary action characteristic of anesthesia. But most persons should not have morphin because it may produce shock and conceals the signs of impending danger. Even though the anesthetist be very experienced, he needs the sign-posts of danger quite as much as does the experienced engine driver of a fast train the signals along the way. Also, and this is important, an anesthetized person who has had a dose of morphin is unable to swallow well and rarely can cough at all, and blood or mucus collecting in the larynx or pharynx can not be removed by swallowing or coughing. On the other hand, a preliminary dose of atropin may be given almost as a matter of routine. A hypodermatic dose of 1/120 grain will stimulate the center of respiration, support the heart and restrain the secretion of mucus. For some reason, a woman with a short and thick leg almost always secretes a great amount of mucus, and may require 1/60 grain of the drug. In obstetrics, the so-called "twilight sleep," while not wholly condemned, should not be used if it is expected also to administer ether, as the danger is too great. How to Use Ether. proximate waste of ether; yet it will drop the ether just as nicely as will any elaborate apparatus, the rapidity of dropping depending upon the angle at which the can is held. The Position of the Patient. It is important that the head be slightly extended, but not hyper-extended. Placing a folded towel under the shoulders will accomplish this, thus allowing the head to drop slightly back. Hyper-extension will so displace the epiglottis that blood clots may drop into the trachea instead of into the esophagus, giving rise to all sorts of trouble. After the patient is properly placed, begin the ether very gradually, talking to him the while. while. At first instruct him about breathing the ether in, but keep telling him that "everything is all right.' As he begins to "go under," and his attention is less easy to fix, shorten the sentence to "all is right," or "everything is well." Later on, still further abbreviate to "all fine" or "all well;" and finally to single reassuring words, as "fine," "well" or "good." Remember, don't touch him in any way to give the all-but-anesthetized man the idea that the knife is to be used. When "com Ether is almost always to be preferred ing out," also reassure him. over all other anesthetics, using it by the dropping method. It is comparatively safe The Inhaler. A wire-frame inhaler is to be used (Dr. Drop, not pour, the ether upon the gauze surface, very gradually at first, but never any faster than it evaporates. Remember, the gauze surface is meant simply to evaporate the ether and that you want to give the patient ether vapor, not liquid ether. Don't be in a hurry, and give the matter your whole attention. If you flood the gauze surface of the inhaler with ether, part of the ether evaporates and that chills the remainder of the ether so that it will not evaporate, but simply becomes intensely cold. That chills the air and endangers the patient, and it does not properly anesthetize him. This is very important to remember. The amount of ether vapor the patient gets is regulated by the extent of area over which you drop the liquid ether; but even then do not drop the ether too fast. Slow but sustained dropping is the best practice; but keep your eyes on the gauze so it is not drenched. Simplicity and Safety. Now all of this seems very simple; that is why it is so safe. In practice, by this simple method, it is surprising how little ether is required for a long operation, and how little trouble one has. Even patients with bronchitis or nephritis can be safely anesthetized by this ether-minimum method, except in exceptional cases. But remember, this is a system, not a series of suggestions, and one must carefully observe every step, just as outlined. Now, Doctor. turn back and read this over, fixing every point in mind; and we beg to assure you that you will get over that erstwhile fear you have had of giving ether after you have mastered and applied this method. "Twilight Sleep" in the Light of Day. SME VERY EXCELLENT lay maga zines and some equally good professional ones have been taking somewhat opposite sides in a discussion of "painless childbirth" according to rules laid down by Drs. Kroenig and Gauss, physicians-incharge of the maternity clinic, Baden University, Freiburg, Germany. The treatment is practically an adaptation to obstetrics of Crile's anoci association, that is, it is partly psychologic and partly the administration of drugs to the point of semi-narcosis with the aim of eliminating the memory of pain. One Absolute quiet and very soft light in the lying-in chamber is insisted upon. hypodermatic injection of narkophen, which is claimed to be less toxic than morphin, is given, and an hour later a first injection of scopolamin into the muscles of the lumbar region. Small doses of scopolamin are repeated at intervals, according to the length of the labor, usually about five doses being given. Advocates of the method claim remarkable results. A few institutions which are properly equipped for the work in the United States have given it sufficient trial to demonstrate that "twilight sleep" does act to abolish memory of pain and may be practiced without marked danger to mother or child, but only with every institutional precaution. Gentlemen who have tried out the German technic do not recommend it as a safe procedure under the usual conditions of a general obstetric practice. Except for the abolition of the memory of pain, and as a luxury to women in confinement, there is, thus far, no sustained claim that the method presents any tangible advantages in the average case of obstetrics. On the other hand, opponents are severe in their condemnation, claiming danger of the child being asphyxiated, prolongation of labor, and excessive hemorrhage. But perhaps the question of medical ethics involved as regards the kind of publicity employed in exploiting the method had some bearing upon opinion rather sharply expressed. Despite the fact that medical journals generally were quick to denounce the methods of Kroenig and Gauss, the same journals were equally prompt in commending the made-in-America "twilight sleep," as recommended to be placed in the hands of every doctor who cares to purchase tablets of morphin and hyoscin. |