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BARBITURATES AS BASAL HYPNOTICS.
670
BARBITURATES AS BASAL HYPNOTICS.
3. It may be confidently stated that the ultra- vary widely in their action on different individuals, violet-irradiated children showed no evidence of harm and nembutal is no exception. For this reason I in general health as compared with those of the believe it is unwise to attempt to obtain anything .screened lamp group, as judged by doctor and nurse, more than a pre-operative or post-operative sedative or by teacher and parent. action, and this can be obtained with comparatively It is justifiable to speculate on the explanation of the small doses. The definite production of basal hypnosis negative results. For instance, the ultra-violet with nembutal should be reserved for cases in which rays may be without effect in those particulars to intravenous injection is possible. If intravenous which the test was directed ; the doses used may have injection is impracticable or undesirable and basal been too small ; or they may have been too large, hypnosis is desired, it is better to use other agents so that any beneficial effect was masked by a harmful less variable in action. effect in the individual child ; or the response may The whole question of basal hypnosis is a matter have been such that the number of children benefited of increasing importance. The protection from physic was balanced by the number harmed. In my opinion trauma and the lessened amount of anaesthetic required we are not yet in a position to decide to which of these are advances which aid the scope of the surgeon. At present no single agent is capable of satisfying all - or other causes the negative results should be related. In view, however, of the claims of other workers with requirements, but by a careful contribution of various very varied doses, it is at least unjustifiable to agents it is already possible to produce satisfactory results in average cases. attribute them simply to overdosage. I am, Sir, yours faithfully, I aim, Sir, yours faithfully, I DORA C. COLEBROOK. Wimpole-street, W., March 16th, 1931. I. W. MAGILL, orthway, N.W., March 15th, 1931.
BARBITURATES AS BASAL HYPNOTICS.
I
CEREBRO-SPINAL FEVER.
To the Editor
of THE LANCET. SiR,—In connexion with the increasing incidence me to comment upon of cases of SiR,-Will you cerebro-spinal fever, I note in your issue your leading article last week (p. 595) entitled of March 7th (p. 555) a statement by Dr. Burton, Accessories to Anaesthetics. I have been, to a large medical officer of health for Ilford, that it is regretextent, responsible for the introduction in this country table that at the present time type meningococcal of Nembutal as a basal hypnotic in anaesthesia, and sera for diagnosis are not available in this country. I feel that the shadow of doubt cast upon the newer This statement is inaccurate as far as the Army is barbiturates in this article is not altogether justified. concerned. Type sera for purposes of are diagnosis It is true that the barbiturates, as a whole, are still manufactured at the Royal Medical College Army on trial in connexion with anaesthesia, at any rate, and have been constantly available for Army in Great Britain, but as pointed out by me in a bacteriologists. These sera have, of course, been previous article,l the clinical evidence already employed in the present outbreak. As an exceptional collected is sufficient to permit definite conclusions measure, owing to the emergency of the epidemic, to be drawn on the advantages and limitations of have in addition been issued to several supplies these drugs. laboratories. At the Mayo Clinic for example in the year 1929, civilian ’ I am, Sir, yours faithfully, barbiturates were employed in over 2000 anaesthetics,22 H. MARRIAN PERRY, .and the same figures hold good for the year 1930. Lieut-Colonel, R.A.M.C. I am informed on good authority that nembutal Pathological Department, R.A.M. College, Grosvenor-road, S.W., March 16th, 1931. - continues to be extensively used at that clinic. I have used nembutal consistently for the past six months whenever a basal hypnotic has been desirable " POISONING " IN ERODE. and intravenous administration capable of being To the Editor of THE LANCET. carried out. I continue to be pleased with the results, particularly in patients who have had previous SiR,—I notice in your issue of Jan. 31st under unhappy experiences before and after general Notes from India that an account in the Tixnes of Anaesthesia. To say that undesirable symptoms often India is quoted which describes " an extraordinary occur after nembutal is, to me, an exaggeration. case of poisoning in Erode." The " account," which ’The restlessness referred to may be observed after covers 12 lines in your paper, contains the following .avertin, or even after ether. A visit to the out-patient inaccuracies. It states: (1) That an outbreak of clinic of any general hospital during the recovery occurred recently in the London Mission, period of children operated upon for tonsils and poisoning That the outbreak was’ in connexion Erode. (2) adenoids will confirm this. I agree, however, in the with the London Mission High School. (3) That need for caution, and I pointed out in my article that 45 students died. (4) That the deaths occurred a drug of such potency as nembutal should be after a meal. (5) That a cook also died. employed to produce basal hypnosis by expert immediately That the outbreak was reported to be due to an (6) anaesthetists, and then only when indicated. It aranai in the students’ soup. (7) That the bite of the is obvious that if nembutal is followed by a badly is said, in the Tamil country, to cause instant aranai administered general anaesthetic, or possibly even by death. And in the paragraph following this account clumsy surgery, it is unfair to lay the blame for any you state, (8) that the sequel to this fatality has not untoward result on nembutal alone. been reported. The method of administration of nembutal seems to As to these statements, (1), (3), (4), and (5) are Tne to be of the greatest importance in arriving at merely untrue. (2) The school referred to is an correct dosage for basal hypnosis. Barbiturates upper elementary school. There is no Mission High School in Erode. (6) No statement was made 1 THE LANCET, Jan. 10th, p. 74. by any responsible person, or by any person who saw 2 Proc. Staff Meetings, Mayo Clinic, vol. vi., No. 2, p. 27. To the Editor
of permit
THE LANCET.
BARBITURATES AS BASAL HYPNOTICS.
3. It may be confidently stated that the ultra- vary widely in their action on different individuals, violet-irradiated children showed no evidence of harm and nembutal is no exception. For this reason I in general health as compared with those of the believe it is unwise to attempt to obtain anything .screened lamp group, as judged by doctor and nurse, more than a pre-operative or post-operative sedative or by teacher and parent. action, and this can be obtained with comparatively It is justifiable to speculate on the explanation of the small doses. The definite production of basal hypnosis negative results. For instance, the ultra-violet with nembutal should be reserved for cases in which rays may be without effect in those particulars to intravenous injection is possible. If intravenous which the test was directed ; the doses used may have injection is impracticable or undesirable and basal been too small ; or they may have been too large, hypnosis is desired, it is better to use other agents so that any beneficial effect was masked by a harmful less variable in action. effect in the individual child ; or the response may The whole question of basal hypnosis is a matter have been such that the number of children benefited of increasing importance. The protection from physic was balanced by the number harmed. In my opinion trauma and the lessened amount of anaesthetic required we are not yet in a position to decide to which of these are advances which aid the scope of the surgeon. At present no single agent is capable of satisfying all - or other causes the negative results should be related. In view, however, of the claims of other workers with requirements, but by a careful contribution of various very varied doses, it is at least unjustifiable to agents it is already possible to produce satisfactory results in average cases. attribute them simply to overdosage. I am, Sir, yours faithfully, I aim, Sir, yours faithfully, I DORA C. COLEBROOK. Wimpole-street, W., March 16th, 1931. I. W. MAGILL, orthway, N.W., March 15th, 1931.
BARBITURATES AS BASAL HYPNOTICS.
I
CEREBRO-SPINAL FEVER.
To the Editor
of THE LANCET. SiR,—In connexion with the increasing incidence me to comment upon of cases of SiR,-Will you cerebro-spinal fever, I note in your issue your leading article last week (p. 595) entitled of March 7th (p. 555) a statement by Dr. Burton, Accessories to Anaesthetics. I have been, to a large medical officer of health for Ilford, that it is regretextent, responsible for the introduction in this country table that at the present time type meningococcal of Nembutal as a basal hypnotic in anaesthesia, and sera for diagnosis are not available in this country. I feel that the shadow of doubt cast upon the newer This statement is inaccurate as far as the Army is barbiturates in this article is not altogether justified. concerned. Type sera for purposes of are diagnosis It is true that the barbiturates, as a whole, are still manufactured at the Royal Medical College Army on trial in connexion with anaesthesia, at any rate, and have been constantly available for Army in Great Britain, but as pointed out by me in a bacteriologists. These sera have, of course, been previous article,l the clinical evidence already employed in the present outbreak. As an exceptional collected is sufficient to permit definite conclusions measure, owing to the emergency of the epidemic, to be drawn on the advantages and limitations of have in addition been issued to several supplies these drugs. laboratories. At the Mayo Clinic for example in the year 1929, civilian ’ I am, Sir, yours faithfully, barbiturates were employed in over 2000 anaesthetics,22 H. MARRIAN PERRY, .and the same figures hold good for the year 1930. Lieut-Colonel, R.A.M.C. I am informed on good authority that nembutal Pathological Department, R.A.M. College, Grosvenor-road, S.W., March 16th, 1931. - continues to be extensively used at that clinic. I have used nembutal consistently for the past six months whenever a basal hypnotic has been desirable " POISONING " IN ERODE. and intravenous administration capable of being To the Editor of THE LANCET. carried out. I continue to be pleased with the results, particularly in patients who have had previous SiR,—I notice in your issue of Jan. 31st under unhappy experiences before and after general Notes from India that an account in the Tixnes of Anaesthesia. To say that undesirable symptoms often India is quoted which describes " an extraordinary occur after nembutal is, to me, an exaggeration. case of poisoning in Erode." The " account," which ’The restlessness referred to may be observed after covers 12 lines in your paper, contains the following .avertin, or even after ether. A visit to the out-patient inaccuracies. It states: (1) That an outbreak of clinic of any general hospital during the recovery occurred recently in the London Mission, period of children operated upon for tonsils and poisoning That the outbreak was’ in connexion Erode. (2) adenoids will confirm this. I agree, however, in the with the London Mission High School. (3) That need for caution, and I pointed out in my article that 45 students died. (4) That the deaths occurred a drug of such potency as nembutal should be after a meal. (5) That a cook also died. employed to produce basal hypnosis by expert immediately That the outbreak was reported to be due to an (6) anaesthetists, and then only when indicated. It aranai in the students’ soup. (7) That the bite of the is obvious that if nembutal is followed by a badly is said, in the Tamil country, to cause instant aranai administered general anaesthetic, or possibly even by death. And in the paragraph following this account clumsy surgery, it is unfair to lay the blame for any you state, (8) that the sequel to this fatality has not untoward result on nembutal alone. been reported. The method of administration of nembutal seems to As to these statements, (1), (3), (4), and (5) are Tne to be of the greatest importance in arriving at merely untrue. (2) The school referred to is an correct dosage for basal hypnosis. Barbiturates upper elementary school. There is no Mission High School in Erode. (6) No statement was made 1 THE LANCET, Jan. 10th, p. 74. by any responsible person, or by any person who saw 2 Proc. Staff Meetings, Mayo Clinic, vol. vi., No. 2, p. 27. To the Editor
of permit
THE LANCET.