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ARTIFICIAL RESPIRATION
74
pitant is emotional, but there seems to be a group in which a particular sound or musical note will induce a fit. This was true of the man who had his fits in response to the first word of the declaration " Here is the news ’.’ 8 it came over his radio ; such also is the case in the mice who have fits in response to a high-pitched note. These days the news may well induce a change in emotion, and Lindsley5 showed that the mice with sonogenic epilepsy became excitable and hyperactive before the onset of the fit. It may therefore be the stimulus which arouses the required emotion which is specific and not the direct relationship of the stimulus to the fit. Much of the experimental work on epilepsy based on changes in the E.E.G. now makes use of the tendency of some people to respond to highly specific situations with epileptic outbursts. These cases are sufficiently rare to excite the clinical collector, but when they are recognised they also excite the experimental worker, for they provide a stereotyped train of events which can be repeated at will, in a disease where progress is restricted by the uncertainty of its manifestations. ADDICTION TO AMIDONE
EXPERIMENTS in animal and human subjects have led Isbell et al.6in the United States to class ’Amidone’
drug of addiction. This synthetic analgesic, dl-2-dimethylamino-4 : 4-diphenylheptane-5-one, which is also known under its original German name amidon, and its trade namesPhyseptone,’ ’‘ Miadone,’DolophineLilly,’ and ’Methadon,’ suppresses the morphine abstinence syndrome and will take the place of morphine in morphine addicts. Apart from its effects in addicts, amidone does not produce euphoria, and cancer patients given the drug for periods of 3 weeks to 6 months showed either no symptoms or mild, ones after it was withdrawn. Nevertheless Isbell and his colleagues believe that, unless the manufacture and use of amidone are controlled, addiction to it will become a serious public-health problem ; and, as announced in our news columns, the drug has now been brought under the Dangerous Drugs regulations in Great Britain. ’Metopon,’ the other addition to the D.D.A. list, is at present unobtainable in this as
a
country.
,
ARTIFICIAL RESPIRATION THE late war brought a quickened interest in the methods and results of artificial respiration, and in an address last week to the anaesthetics section of the Royal Society of Medicine Dr. E. A. Pask was able to describe notable advances. When placed in an atmosphere of helium or nitrogen, and thereby deprived of oxygen, a man first hyperventilates, and thus reduces the carbondioxide tension of his blood. But experimentally it has been found that animals dying under such conditions have a high carbon-dioxide tension, the reason being that respiration has gradually failed before death. With asphyxiation, Dr. Pask said, artificial respiration should continue for at least half an hour. In most emergencies carbon dioxide plainly has no place in treatment during apncea ; but once the patient starts breathing again there is much to be said for having him breathe deeply, especially in carbon-monoxide and carbon-tetrachloride poisoning. All the common methods of artificial ventilation have been shown to give satisfactory ventilation, and the method should perhaps depend on the environment and on the training and intelligence of the person administering it. No method seems to be much better than others in dealing with a sluggish circulation, and probably no patient can recover after effective cardiac beats have stopped for a couple of minutes. Nevertheless experiments on deeply anaesthetised subjects have shown that with some methods the oxygen uptake is very much greater than with others ; indeed, even where ventilation 5. Lindsley, D. B. J. Neurophysiol. 1942, 5, 185. 6. Isbell, H., Wilder, A., Eddy, N. B., Wilson, J. J. Amer. med. Ass. 1947, 135, 888.
L., Moran, C. F.
is greatest, oxygen uptake may be least. These differences in Dr. Pask’s opinion are probably attributable to, some
effect
on
the circulation.
NEW YEAR HONOURS A LIST of medical recipients of New Year honours appears on another page. It is headed by the name of Sir Edward Mellanby (G.B.E.), who not only holds one of the most important posts in medicine but remains Lieut.a distinguished investigator in his own right. General T.0. Thompson (K.C.S.I.) and Major-General Robert Hay (K.C.I.E.) were respectively the last director of medical services, India, and the last direotor-general of the Indian Medical Service : it was their task to write the end of a long and fine chapter, and we are glad to know that General Thompson has gone back to India as Red Cross commissioner to help in opening a fresh one. A third Indian knighthood is that of Colonel David Clyde, late surgeon-general with the government of Bengal. Nearer home,, special pleasure will be felt at those bestowed on Dr. John Parkinson of the London Hospital, and Prof. Harry Platt of Manchester. Dr. Parkinson has lately made great efforts to improve the management of the rheumatic child : esteemed far and wide as an outstanding representative of British cardiology, he has a more private reputation for skill in water colours and gardening. Professor Platt, like Dr. Parkinson, is well known in the United States, and he brings both sense and imagination to many subjects besides orthopaedics. He is adviser in that subject to the Ministry of Health, and a member of the Spens Committee on the remuneration of consultants. We are glad to be given an opportunity of congratulating these and other colleagues on the good work which is now formally recognised.
COMPULSORY RECRUITMENT TO THE FORCES THE Central Medical War Committee has been notified by the Ministry of Health of changes, from Jan. 1, in the arrangements for calling up doctors. Compulsory recruitment of practitioners as general-duty medical officers is now confined to those under the age of 26, unless the committee agrees (or has already agreed) to postpone call-up beyond the 26th birthday on the ground that the doctor is undergoing or is about to undergo training for the purpose of acquiring further qualifications or special experience. In this event the doctor is liable for compulsory recruitment as a general-duty officer until he has reached the age of 30. The compulsory recruitment of doctors for service with the Forces as specialists or graded specialists is now confined to those under the age of 35. CHOLERA IN EGYPT IN a leading article on Nov. 27, objecting to some of the measures taken by various countries to prevent the spread of cholera from Egypt, we said : " It was also unfortunate that there was delay on the part of the British military in notifying the Egyptians of four cases in the Canal Zone." We have now ascertained that though there was considerable delay before the news of these Canal Zone cases reached the World Health Organisation’s epidemiological bureau at Geneva, there is no reason to suppose that the British authorities were responsible for it ; and we are in fact assured that inthese cases the interval between diagnosis and notification to the Egyptian public-health service was never more than four days. We are glad to publish this correction, and to add that during the whole epidemic close liaison was maintained locally between British military hospitals and civil health authorities, and centrally between the medical directorate, M.E.L.F., and the Egyptian ministry of public health.
Major-General NEIL CANTLIE has been appointed Director-General of Army Medical Services in succession to Sir Alexander Hood, who retires on April 1.
pitant is emotional, but there seems to be a group in which a particular sound or musical note will induce a fit. This was true of the man who had his fits in response to the first word of the declaration " Here is the news ’.’ 8 it came over his radio ; such also is the case in the mice who have fits in response to a high-pitched note. These days the news may well induce a change in emotion, and Lindsley5 showed that the mice with sonogenic epilepsy became excitable and hyperactive before the onset of the fit. It may therefore be the stimulus which arouses the required emotion which is specific and not the direct relationship of the stimulus to the fit. Much of the experimental work on epilepsy based on changes in the E.E.G. now makes use of the tendency of some people to respond to highly specific situations with epileptic outbursts. These cases are sufficiently rare to excite the clinical collector, but when they are recognised they also excite the experimental worker, for they provide a stereotyped train of events which can be repeated at will, in a disease where progress is restricted by the uncertainty of its manifestations. ADDICTION TO AMIDONE
EXPERIMENTS in animal and human subjects have led Isbell et al.6in the United States to class ’Amidone’
drug of addiction. This synthetic analgesic, dl-2-dimethylamino-4 : 4-diphenylheptane-5-one, which is also known under its original German name amidon, and its trade namesPhyseptone,’ ’‘ Miadone,’DolophineLilly,’ and ’Methadon,’ suppresses the morphine abstinence syndrome and will take the place of morphine in morphine addicts. Apart from its effects in addicts, amidone does not produce euphoria, and cancer patients given the drug for periods of 3 weeks to 6 months showed either no symptoms or mild, ones after it was withdrawn. Nevertheless Isbell and his colleagues believe that, unless the manufacture and use of amidone are controlled, addiction to it will become a serious public-health problem ; and, as announced in our news columns, the drug has now been brought under the Dangerous Drugs regulations in Great Britain. ’Metopon,’ the other addition to the D.D.A. list, is at present unobtainable in this as
a
country.
,
ARTIFICIAL RESPIRATION THE late war brought a quickened interest in the methods and results of artificial respiration, and in an address last week to the anaesthetics section of the Royal Society of Medicine Dr. E. A. Pask was able to describe notable advances. When placed in an atmosphere of helium or nitrogen, and thereby deprived of oxygen, a man first hyperventilates, and thus reduces the carbondioxide tension of his blood. But experimentally it has been found that animals dying under such conditions have a high carbon-dioxide tension, the reason being that respiration has gradually failed before death. With asphyxiation, Dr. Pask said, artificial respiration should continue for at least half an hour. In most emergencies carbon dioxide plainly has no place in treatment during apncea ; but once the patient starts breathing again there is much to be said for having him breathe deeply, especially in carbon-monoxide and carbon-tetrachloride poisoning. All the common methods of artificial ventilation have been shown to give satisfactory ventilation, and the method should perhaps depend on the environment and on the training and intelligence of the person administering it. No method seems to be much better than others in dealing with a sluggish circulation, and probably no patient can recover after effective cardiac beats have stopped for a couple of minutes. Nevertheless experiments on deeply anaesthetised subjects have shown that with some methods the oxygen uptake is very much greater than with others ; indeed, even where ventilation 5. Lindsley, D. B. J. Neurophysiol. 1942, 5, 185. 6. Isbell, H., Wilder, A., Eddy, N. B., Wilson, J. J. Amer. med. Ass. 1947, 135, 888.
L., Moran, C. F.
is greatest, oxygen uptake may be least. These differences in Dr. Pask’s opinion are probably attributable to, some
effect
on
the circulation.
NEW YEAR HONOURS A LIST of medical recipients of New Year honours appears on another page. It is headed by the name of Sir Edward Mellanby (G.B.E.), who not only holds one of the most important posts in medicine but remains Lieut.a distinguished investigator in his own right. General T.0. Thompson (K.C.S.I.) and Major-General Robert Hay (K.C.I.E.) were respectively the last director of medical services, India, and the last direotor-general of the Indian Medical Service : it was their task to write the end of a long and fine chapter, and we are glad to know that General Thompson has gone back to India as Red Cross commissioner to help in opening a fresh one. A third Indian knighthood is that of Colonel David Clyde, late surgeon-general with the government of Bengal. Nearer home,, special pleasure will be felt at those bestowed on Dr. John Parkinson of the London Hospital, and Prof. Harry Platt of Manchester. Dr. Parkinson has lately made great efforts to improve the management of the rheumatic child : esteemed far and wide as an outstanding representative of British cardiology, he has a more private reputation for skill in water colours and gardening. Professor Platt, like Dr. Parkinson, is well known in the United States, and he brings both sense and imagination to many subjects besides orthopaedics. He is adviser in that subject to the Ministry of Health, and a member of the Spens Committee on the remuneration of consultants. We are glad to be given an opportunity of congratulating these and other colleagues on the good work which is now formally recognised.
COMPULSORY RECRUITMENT TO THE FORCES THE Central Medical War Committee has been notified by the Ministry of Health of changes, from Jan. 1, in the arrangements for calling up doctors. Compulsory recruitment of practitioners as general-duty medical officers is now confined to those under the age of 26, unless the committee agrees (or has already agreed) to postpone call-up beyond the 26th birthday on the ground that the doctor is undergoing or is about to undergo training for the purpose of acquiring further qualifications or special experience. In this event the doctor is liable for compulsory recruitment as a general-duty officer until he has reached the age of 30. The compulsory recruitment of doctors for service with the Forces as specialists or graded specialists is now confined to those under the age of 35. CHOLERA IN EGYPT IN a leading article on Nov. 27, objecting to some of the measures taken by various countries to prevent the spread of cholera from Egypt, we said : " It was also unfortunate that there was delay on the part of the British military in notifying the Egyptians of four cases in the Canal Zone." We have now ascertained that though there was considerable delay before the news of these Canal Zone cases reached the World Health Organisation’s epidemiological bureau at Geneva, there is no reason to suppose that the British authorities were responsible for it ; and we are in fact assured that inthese cases the interval between diagnosis and notification to the Egyptian public-health service was never more than four days. We are glad to publish this correction, and to add that during the whole epidemic close liaison was maintained locally between British military hospitals and civil health authorities, and centrally between the medical directorate, M.E.L.F., and the Egyptian ministry of public health.
Major-General NEIL CANTLIE has been appointed Director-General of Army Medical Services in succession to Sir Alexander Hood, who retires on April 1.