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JANUARY, 1915

J. J. TAYLOR, M.D.

FOUNDER
THOS. S. BLAIR, M.D.

EDITOR

PHILADELPHIA, PA.

VOL. XX.

NO.1

Published montbly by The Medical Council Co. Mrs. J. J. Taylor, Proprietress.
Entered as second-class matter Feb. 13, 1896, at the post office at Philadelphia, Pa., under Act of March 3, 1879.

Address all communications and make all funds payable to
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 sublime."

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. POCKET-CASE ŞURGERY, though

9

The psychology of anesthetic-induced frowned upon, is just as necessary sleep is the same as that of the inducas hand-extinguisher fire-fighting Field

tion of natural slumber, that is, the conwork anesthesia is just as imperative as is scious and sub-conscious elements and the operating-room anesthesia. Indeed, to

focus of attention are involved equally most of us the rough-and-ready methods

in both. Therefore, when attempting to are so imperatively necessary that any sug

anesthetize a patient, do not distract his gestions by means of which field-work attention by bright light, novel or unusual efficiency and exactitude may be furthered surroundings, or any disquieting sights or are of greater moment than the most elab- sounds. Have him alone with the anesorate technic.

thetist in a simply furnished room, not Nearly all doctors are called upon to give

even a nurse being present at first. Do anesthetics; but most of us are, of late,

not permit the presence of relatives if it discouraged by the highly elaborated can be avoided, and if any are present do methods urged upon us as so necessary

not permit them to touch th“ patient after methods none but a specialist can apply, having started the anesthetic. and which take a roomful of apparatus.

First of all get the confidence of the Is there a simple and safe method re

patient; but do not do so by misrepresencently advocated ? Several men are work

tation. Rather, tell him frankly that taking out the problem. What is here said ing an anesthetic is somewhat disagreeable is based upon the methods pursued by Dr. at first, but that the more deeply and reguRobert H. Ferguson, East Orange, Ń. J., larly he breathes the more quickly will the whose clinical demonstrations have inter- disagreeable sensations disappear. Most ested us greatly, owing to the simplicity patients will sensibly face what they are and safety of his methods.

led to expect. 29-1983

Uppermost in the minds of persons be- and, by the method to be outlined, a miniing anesthetized are these two thoughts: mum amount is effective. that some terrible but undefined thing may Special ether containers are unnecessary, happen, and that they may be cut before the ordinary 14-pound can being the most fully under the anesthetic. A person par- handy. Prepare the can as follows: Cut tially anesthetized is in an attitude of de- a piece of gauze (20 strands to the inch) fense, and any unexpected, though harmless, about a foot long and 1/2 to 2 inches wide; handling, may make him struggle. There- lay it flat and even upon a table; catch it fore, do not permit any handling except up in the center, where two lines, each where necessary on account of haste, the drawn from diagonal corners would cross, scrubbing up of the site of operation, and just as one would pick up a handkerchief have this begun before the anesthetic is in its center; hold the gauze firmly between started, so the patient may know what to the thumb and index finger of the left expect. Do not restrain the patient, hold hand; with the right hand stroke the his hands or distract his attention by any fabric downwards, like compacting an umform of unnecessary handling.

brella held by its tip; now, with both hands, Preliminary Medication.

firmly twist it into a wick, clipping off

the two tip ends. Now lay it aside and The preliminary administration of morphin is seldom necessary, exceptions metal seal, carefully removing all lead;

prepare the can as follows: Cut out the being the alcoholic, the user of cigarettes, insert the wick, extending it to the bottom the habitual and excessive smoker of pipe of the can; insert a good cork, pressing it or cigars, the person of very athletic build

down tightly against the side of the wick, with strong abdominal muscles, the exces

which is allowed to project an inch or so. sively nervous, and a few neurotics. These

This can, after being wicked, can be classes may be put into a more nearly normal state by a dose of morphin, and with dropped in any position without any ap

proximate waste of ether; yet it will drop them it is not apt to interfere with the

the ether just as nicely as will any elabpupillary action characteristic of anesthesia. But most persons should not have morphin depending upon the angle at which the can

orate apparatus, the rapidity of dropping because it may produce shock and con

is held. ceals the signs of impending danger. Even though, the anesthetist be very experienced,

The Position of the Patient. he needs le sign-posts of danger quite as It is important that the head be slightly much as does the experienced engine driver extended, but not hyper-extended. Placing of a fast train the signals along the way. a folded towel under the shoulders will acAlso, and this is important, an anesthetized complish this, thus allowing the head to person who has had a dose of morphin is drop slightly back. Hyper-extension will unable to swallow well and rarely can so displace the epiglottis that blood clots cough at all, and blood or mucus collecting may drop into the trachea instead of into in the larynx or pharynx can not be re- the esophagus, giving rise to all sorts of moved by swallowing or coughing.

trouble. On the other hand, a preliminary dose After the patient is properly placed, begin of atropin may be given almost as a matter the ether very gradually, talking to him the of routine. A hypodermatic dose of 1/120 while. At first instruct him about breathgrain will stimulate the center of respira- ing the ether in, but keep telling him that tion, support the heart and restrain the "everything is all right.” As he begins to secretion of mucus. For some reason, a "go under," and his attention is less easy woman with a short and thick leg almost to fix, shorten the sentence to "all is right, always secretes a great amount of mucus, or "everything is well." Later on, still and may require 1/60 grain of the drug. further abbreviate to "all fine” or “all

In obstetrics, the so-called "twilight well;" , and finally to single reassuring sleep," while not wholly condemned, should words, as “fine," "well” or “good.”

Renot be used if it is expected also to ad- member, don't touch him in any way to minister ether, as the danger is too great. give the all-but-anesthetized man the idea How to Use Ether.

that the knife is to be used. When "comEther is almost always to be preferred ing out,” also reassure him.

The Inhaler. over all other anesthetics, using it by the dropping method. It is comparatively safe A wire-frame inhaler is to be used (Dr.

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Ferguson has devised a good one), and Twilight Sleepin the Light of Day. see that it fits accurately to the face, bending the wire slightly if necessary. Cover the frame with nine layers of 26-strandsSOME VERY EXCELLENT lay maga

zines and some equally good profesto-the-inch gauze-more layers if gauze is

sional ones have been taking somewhat coarse, less if finer-and clip, evenly in opposite sides in a discussion of “painless place.' Then cover the outer frame with childbirth” according to rules laid down by the canton-flannel outside wall.

Never

Drs. Kroenig and Gauss, physicians-inallow an air-space between the rim of the charge of the maternity clinic, Baden Uniinhaler and the face and do not fold a

versity, Freiburg, Germany. towel around the device, nor cover the eyes.

The treatment is practically an adaptaSuch an inhaler is devised to evaporate

tion to obstetrics of Crile's anoci associathe ether and hold the heavier-than-air tion, that is, it is partly psychologic and vapor within the confines of the area

partly the administration of drugs to the through which the patient breathes; and it does not waste ether. Be sure the patient point of semi-narcosis with the aim of elimi

nating the memory of pain. can breathe freely through it before begin

Absolute quiet and very soft light in the ning the anesthetic.

lying-in chamber is insisted upon. One Regulating the Ether.

hypodermatic injection of narkophen, which Drop, not pour, the ether upon the gauze is claimed to be less toxic than morphin, is surface, very gradually at first, but never given, and an hour later a first injection of any faster than it evaporates. Remember, scopolamin into the muscles of the lumbar the gauze surface is meant simply to evap- region. Small doses of scopolamin are reorate the ether and that you want to give peated at intervals, according to the length the patient ether vapor, not liquid ether. of the labor, usually about five doses being Don't be in a hurry, and give the matter given. Advocates of the method claim reyour whole attention.

markable results. A few institutions which If you food the gauze surface of the in

are properly equipped for the work in the haler with ether, part of the ether evap- United States have given it sufficient trial orates and that chills the remainder of the to demonstrate that "twilight sleep" does ether so that it will not evaporate, but act to abolish memory of pain and may be simply becomes intensely cold. That chills practiced without marked danger to mother the air and endangers the patient, and it

or child, but only with every institutional does not properly anesthetize him. This precaution. Gentlemen who have tried out is very important to remember. The the German technic do not recommend it as amount of ether vapor the patient gets is a safe procedure under the usual conditions regulated by the extent of area over which of a general obstetric practice. Except for you drop the liquid ether; but even then do

the abolition of the memory of pain, and as not drop the ether too fast. Slow but

a luxury to women in confinement, there is, sustained dropping is the best practice; but

thus far, no sustained claim that the method keep your eyes on the gauze so it is not presents any tangible advantages in the drenched.

average case of obstetrics. Simplicity and Safety.

On the other hand, opponents are severe Now all of this seems very simple; that in their condemnation, claiming danger of is why it is so safe. In practice, by this the child being asphyxiated, prolongation simple method, it is surprising how little of labor, and excessive hemorrhage. But ether is required for a long operation, and perhaps the question of medical ethics inhow little trouble one has. Even patients volved as regards the kind of publicity emwith bronchitis or nephritis can be safely ployed in exploiting the method had some anesthetized by this ether-minimum bearing upon opinion rather sharply exmethod, except in exceptional cases. But pressed. remember, this is a system, not a series of Despite the fact that medical journals gensuggestions, and one must carefully observe erally were quick to denounce the methods every step, just as outlined. Now, Doctor. of Kroenig and Gauss, the same journals turn back and read this over, fixing every were equally prompt in commending the point in mind; and we beg to assure you made-in-America “twilight sleep,” as recthat you will get over that erstwhile fear ommended to be placed in the hands of you have had of giving ether after you every doctor who cares to purchase tablets have mastered and applied this method. of morphin and hyoscin.

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