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DEATH FROM SUFFOCATION AFTER A DENTAL OPERATION.
115 us unhesitatingly agree with’ those who advocate the appointment of a resident medicall officer. In our view, if there is no such officer, cases int extremis and requiring immediate tracheotomy must not beI Antitoxin will, we know, do muchi sent into the hospital. when used early in the disease, but it is not of such great value later when it is reasonable to assume that the! medical practitioner has applied the remedy and that it has already failed in its effect. We cannot decide between the rival statements in connexion with the Enfield Isolation Hospital, but we are in a position to affirm that the practice of sending in patients for operation is by no means unknown to us, and all hospitals which take in diphtheritic patients should, in our view, provide for such emergencies. We are, of course, perfectly aware that the children of the poor have not always a medical man at their immediate call -nor, indeed, have the children of the rich ; and it is clear that the provisions for obtaining medical aid at the Enfield Isolation Hospital are far better than those possessed by many of those who are likely to become inmates of the institution. Telephonic communication is as yet by no means
Isolation Hospital which makes
between patients and their medical adviser, and the family medical man may obviously be absent when a
common
message arrives. These things are alleged in defence of the arrangement by which telephonic communication with the medical officer of health takes the place of the services of a resident medical officer, but the conditions instanced
quite parallel. When as many as 50 patients, some of whom are suffering from diphtheria, are gathered together in an institution to which people are often induced to go, a resident medical officer should, we think, always be appointed. Other allegations made against the Enfield Isolation Hospital are, for instance, that no nurse is despatched with the ambulance which brings the patients from their homes, and that the patients, when discharged, have perforce Both these are to reach their homes as best they may. matters of detail which may well be considered by the management, but in regard to the ambulance, which, by the are
not
way, is
modern and well-constructed appears to accompany it, while in a
one.
an
attendant
to the latter
regard always point, that of discharge, the same allegation applies to the hospitals of the Metropolitan Asylums Board. As a general rule, patients when discharged from a fever hospital are quite capable of reaching their homes without danger or discomfort, and it has to be remembered that they have probably been much in the open air during their sojourn at the institution. Moreover, in rural districts during inclement weather the exercise of a little common sense in postponing, where necessary, the discharge, should go far to meet the difficulty raised, and in the
case of very young children or children in arms, some suitable provision for traversing long distances should naturally be made. As regards the future, the
hospital
committee have asked the medical
practitioners
of
the district to indicate upon the certificate of notification whether or not the patient is in a suitable condition to be
removed to hospital, and in furnishing this information regard will doubtless be had to the accommodation provided. This seems to us to be a very reasonable request, and it is to be hoped that there will be no difficulty in complying with it. Yet another cause of complaint is that parents are only informed of the condition of the sick in the event of their
becoming seriously ill, but such an inconvenience can easily be remedied by placing the hospital in telephonic communication with the district offices, and perhaps other convenient centres, in order that the not unnatural anxiety of
parents
without application to the hospital itself. We suggest to the management of the Enfield Isolation Hospital the desirability, in the interests of all concerned, of taking into serious consideration the points here referred to. may be
allayed
Annotations. " Ne quid nimis."
DEATH
FROM
SUFFOCATION AFTER OPERATION.
A
DENTAL
A PARAGRAPH of a appeared in several lay
distinctly misleading nature has contemporaries which states that a patient at Newport, Mon., died from the effects of laughing gas"during a dental operation. The facts of the
deplorable
case, of which
we
gave
a
brief account last
believe, correctly stated as follows. The patient, a healthy miner, went to a dentist’s rooms to have 11 teeth extracted under an anaesthetic. The dentist, a Licentiate in Dental Surgery of Ireland, administered nitrous oxide and ether, a nurse, but no medical man, being present. The removal of the teeth was successfully accomweek,
are,
we
sponges without attachment outside the mouth used to press on the gums to check the haemorrhage. The deceased sat listlessly in the dental chair for two or three minutes after the completion of the operation, then sprang to his feet, drew in a deep breath, and gasped for air. As signs of asphyxia were plainly evident the dentist felt digitally for any obstruction in the air-passages and finding none commenced artificial respiration. A medical man was sent for and on his prompt attendance he found the patient deeply cyanosed, lying upon the floor, and the dentist performing The pupils were widely dilated artificial respiration. and life appeared to be extinct. After pulling forward the tongue and again employing artificial respiration, the medical man examined the back of the throat with his finger and felt externally with the view of discovering if any foreign body was lodged in the air-passages. Remedies were used, but without effect. A necropsy was made on the following day and a sponge was found lodged below the vocal cords. The obvious lessons to be gathered from the above narrative are twofold. We have more than once urged the desirability of the presence of two qualified medical men when only a trifling operation has to be perIt is even more necessary formed under an anaesthetic. when the operator is a dentist not possessing a surgical qualification that a duly qualified medical man should be with him to give the anxsthetic. No man can with safety to his patient administer an anaesthetic and operate single-handed. But further, there is in every case in which an anaesthetic is given a liability to accident, and at any moment tracheotomy or some other purely surgical procedure may be required to meet emergencies arising as a result of the operation or of the anaesthetic. Is a dentist competent to deal with such emergencies ? We do not mean is he legally justified in giving an anaesthetic; that is a matter beside our present contention, but we ask, is he by his education and experience able to perform in a satisfactory manner the surgical operations which may be required as a result of a We submit that he is not. sudden emergency? His armamentarium will in nine cases out of ten not contain
plished and were
116 set of tracheotomy instruments, and it is not in the least that she had seen in a newspaper. She had been advieed to unlikely that he has never performed the operation. In the take the pills, she said, by a male relative who, having been case of ether or chloroform certainly, and we should add in duly cautioned by the coroner, decided not to give evidence. that of nitrous oxide, a dentist would be well advised if he The pills on analysis by Dr. Thomas Stevenson were found to refrained from giving the anxsthetic, and he should under contain iron or steel, aloes, colocynth, apiol, and strychnine, no circumstances undertake so grave a matter without the the majority of which ingredients, it will be remembered, aid of a surgeon. The second lesson is one of practice. As figured in several of the compounds analysed by us in our we understand the case, the man was apparently recovering inquiry into ° Quacks and Abortion,"1 Dr. Stevenson added from the narcosis and the sudden appearance of cyanosis in his evidence that the pills analysed by him were not with dyspnoea could point to only one cause-the occlusion such that, taken in accordance with their printed of the air-passages by a foreign body. The dentist label, they would be likely to produce miscarriage, but and the medical man appear to have recognised this, that taken as the deceased had apparently taken them although the latter as he came late upon the scene was they might have that result. It is always possible that possibly put off his guard by the absence of knowledge of legal proceedings may follow upon such an inquiry, and we the course which the symptoms had ran. Artificial respira- therefore withhold further comment. We note, however, tion was obviously useless as no air entered the lungs, and that the father of the deceased seems to have reproached tracheotomy was not performed. This operation might have the medical man who was called in by her when it was saved the man’s life if it had been done in time-that is, if too late to save her life, with not having at once informed the surgeon had been present from the beginning of the him of the cause of her condition. The coroner, Mr. and C. B. firmly supported the proceedings. Margetts, promptly medical man in the position which he had taken up, point. A SMOKELESS UNDERGROUND RAILWAY. ing out that as long as it was possible that the woman’s life THE proposal to adopt electric traction on the Metro- might be saved he was the custodian of her secret, amounting that she had committed a criminal act, politan District Railway has been thoroughly supported by to the confession far his having any duty to communicate and so from that, the shareholders of the company, and we are not surprised, since they must feel that all prospect of income is doomed this to her relatives, it might have been his duty to keep by the fact that better means of travelling underground it as a professional secret from the knowledge of everyone. On her death becoming imminent, the coroner added, the are at hand, while the public are sick of the experience man’s position changed, because it was then evident medical that is offered to them by the existing underground steam that an inquiry must take place into the causes of it; and and trains. These are exceedingly unhealthy exceedingly dirty, and apparently the attempts that have been made on such an occasion, when the patient can no longer suffer at ventilation have produced no practical results. The use, ’, by the divulging of her secret, publicity followed by the fullest therefore, of smokeless traction is the only chance, it seems inquiry makes for the public good and for the protection to us, of making the old underground railways wholesome ’, and warning of other women. and of saving the enterprise from absolute financial disaster. a
’
-
It cannot be denied that this system is the most useful line in London, and once wipe away the reproach as to the filthy state of its tunnels and railway carriages it will undoubtedly secure a big clientele. We cordially welcome the decision that electric traction is to be used, but at the same time we are curious to know how it is proposed to meet the difficulty of trains of other systems running upon the lines. Thus the Midland, the Great Northern, the London and North-Western, and the Great Western railway companies, all overground systems, have running powers on the underground railway. Would the steam-engine be detached somewhere and an electric engine be hitched on? This would, of course, mean delay.
QUACKS AND ABORTION. AN inquest concluded at Huntingdon on Jan. 2nd shows that the trade in quack medicines which are liable to be taken by pregnant women in the hope of procuring miscarriage has not yet ceased ; that newspapers are still, whether knowingly or not, the means of advertising such nostrums; and that thei compounds sold are apparently capable of causing the desired effect, subject to the reservation that they must be taken in very large quantities. That the death of the person so procuring abortion upon herself is a not unlikely sequel to’ her temerity also stands revealed. In the Huntingdon case the facts proved at the inquest differ in no materialL particular from those which have been brought out in many of the inquiries that were more common before recent prosecutions, and before our articles on the subject had called attention to the danger of selling would-be abortifacients and publishing advertisements of them. The woman upon whom the inquest was held had died from acute general peritonitis following miscarriage. Before death she had admitted taking constantly for about three weeks, with the object of procuring abortion, certain pills the advertisement of which she said
WHEN
IS AN IMPROVEMENT NOT AN IMPROVEMENT P
A CORRBSPONDENT writes from Bournemouth :-" Public opinion in this place has lately been greatly excited over an - Omnibus’ Bill which the corporation proposes to introduce during the next session of Parliament. Much of it is only of local interest, as it deals with such matters as but one clause is electric tramways, widening roads, &c. ; concerned with the acquisition by the corporation of a large open space, the Horseshoe Common, as a site for ’ municipal and other buildings.’ This proposition involves practically the destruction of one of the principalI lungs I of the town and is therefore of the greatest interest to all those medical men who have been in the habit of sending their patients to this really delightful health resort, as I hope I may call our town although I live in it. The plot of ground, 14 acres in extent, is well known to all visitors to Bournemouth. It is in the very centre of the town and is a bit of wild moorland, surrounded by fir-trees and covered with As far as I know, no gorse, bracken, and heather. such bit of unadorned nature exists in the centre of any other town in the kingdom. By an Act of Parliament, obtained by the corporation so recently as 1897, two acres of this ground at its lower end were given up to the corporation as a site for the municipal buildings, but it was expressly stipulated that the remaining 12 acres should (for 99 years) be reserved for gardens and pleasuregrounds.’L’appétit vient en mangeant,’ however ; and it has grown so rapidly that now the corporation desires to devour the whole of the space. What may be its immediate intention is not declared, but the clause in question would
-
———————————————————————————;————————————
1
THE LANCET, Dec. 10th (p. 1570), 17th (p. 1651), 24th (p. 1723), and (p. 1807), 1898, and Jan. 21st (p. 182), Feb. 4th (p. 327), March 11th 717) and 25th (p. 855), April 1st (p. 908), June 24th (p. 1739), July 8th 111) and 15th (p. 174), and Dec. 2nd (p. 1540), 1899
31st
(p. (p.
Isolation Hospital which makes
between patients and their medical adviser, and the family medical man may obviously be absent when a
common
message arrives. These things are alleged in defence of the arrangement by which telephonic communication with the medical officer of health takes the place of the services of a resident medical officer, but the conditions instanced
quite parallel. When as many as 50 patients, some of whom are suffering from diphtheria, are gathered together in an institution to which people are often induced to go, a resident medical officer should, we think, always be appointed. Other allegations made against the Enfield Isolation Hospital are, for instance, that no nurse is despatched with the ambulance which brings the patients from their homes, and that the patients, when discharged, have perforce Both these are to reach their homes as best they may. matters of detail which may well be considered by the management, but in regard to the ambulance, which, by the are
not
way, is
modern and well-constructed appears to accompany it, while in a
one.
an
attendant
to the latter
regard always point, that of discharge, the same allegation applies to the hospitals of the Metropolitan Asylums Board. As a general rule, patients when discharged from a fever hospital are quite capable of reaching their homes without danger or discomfort, and it has to be remembered that they have probably been much in the open air during their sojourn at the institution. Moreover, in rural districts during inclement weather the exercise of a little common sense in postponing, where necessary, the discharge, should go far to meet the difficulty raised, and in the
case of very young children or children in arms, some suitable provision for traversing long distances should naturally be made. As regards the future, the
hospital
committee have asked the medical
practitioners
of
the district to indicate upon the certificate of notification whether or not the patient is in a suitable condition to be
removed to hospital, and in furnishing this information regard will doubtless be had to the accommodation provided. This seems to us to be a very reasonable request, and it is to be hoped that there will be no difficulty in complying with it. Yet another cause of complaint is that parents are only informed of the condition of the sick in the event of their
becoming seriously ill, but such an inconvenience can easily be remedied by placing the hospital in telephonic communication with the district offices, and perhaps other convenient centres, in order that the not unnatural anxiety of
parents
without application to the hospital itself. We suggest to the management of the Enfield Isolation Hospital the desirability, in the interests of all concerned, of taking into serious consideration the points here referred to. may be
allayed
Annotations. " Ne quid nimis."
DEATH
FROM
SUFFOCATION AFTER OPERATION.
A
DENTAL
A PARAGRAPH of a appeared in several lay
distinctly misleading nature has contemporaries which states that a patient at Newport, Mon., died from the effects of laughing gas"during a dental operation. The facts of the
deplorable
case, of which
we
gave
a
brief account last
believe, correctly stated as follows. The patient, a healthy miner, went to a dentist’s rooms to have 11 teeth extracted under an anaesthetic. The dentist, a Licentiate in Dental Surgery of Ireland, administered nitrous oxide and ether, a nurse, but no medical man, being present. The removal of the teeth was successfully accomweek,
are,
we
sponges without attachment outside the mouth used to press on the gums to check the haemorrhage. The deceased sat listlessly in the dental chair for two or three minutes after the completion of the operation, then sprang to his feet, drew in a deep breath, and gasped for air. As signs of asphyxia were plainly evident the dentist felt digitally for any obstruction in the air-passages and finding none commenced artificial respiration. A medical man was sent for and on his prompt attendance he found the patient deeply cyanosed, lying upon the floor, and the dentist performing The pupils were widely dilated artificial respiration. and life appeared to be extinct. After pulling forward the tongue and again employing artificial respiration, the medical man examined the back of the throat with his finger and felt externally with the view of discovering if any foreign body was lodged in the air-passages. Remedies were used, but without effect. A necropsy was made on the following day and a sponge was found lodged below the vocal cords. The obvious lessons to be gathered from the above narrative are twofold. We have more than once urged the desirability of the presence of two qualified medical men when only a trifling operation has to be perIt is even more necessary formed under an anaesthetic. when the operator is a dentist not possessing a surgical qualification that a duly qualified medical man should be with him to give the anxsthetic. No man can with safety to his patient administer an anaesthetic and operate single-handed. But further, there is in every case in which an anaesthetic is given a liability to accident, and at any moment tracheotomy or some other purely surgical procedure may be required to meet emergencies arising as a result of the operation or of the anaesthetic. Is a dentist competent to deal with such emergencies ? We do not mean is he legally justified in giving an anaesthetic; that is a matter beside our present contention, but we ask, is he by his education and experience able to perform in a satisfactory manner the surgical operations which may be required as a result of a We submit that he is not. sudden emergency? His armamentarium will in nine cases out of ten not contain
plished and were
116 set of tracheotomy instruments, and it is not in the least that she had seen in a newspaper. She had been advieed to unlikely that he has never performed the operation. In the take the pills, she said, by a male relative who, having been case of ether or chloroform certainly, and we should add in duly cautioned by the coroner, decided not to give evidence. that of nitrous oxide, a dentist would be well advised if he The pills on analysis by Dr. Thomas Stevenson were found to refrained from giving the anxsthetic, and he should under contain iron or steel, aloes, colocynth, apiol, and strychnine, no circumstances undertake so grave a matter without the the majority of which ingredients, it will be remembered, aid of a surgeon. The second lesson is one of practice. As figured in several of the compounds analysed by us in our we understand the case, the man was apparently recovering inquiry into ° Quacks and Abortion,"1 Dr. Stevenson added from the narcosis and the sudden appearance of cyanosis in his evidence that the pills analysed by him were not with dyspnoea could point to only one cause-the occlusion such that, taken in accordance with their printed of the air-passages by a foreign body. The dentist label, they would be likely to produce miscarriage, but and the medical man appear to have recognised this, that taken as the deceased had apparently taken them although the latter as he came late upon the scene was they might have that result. It is always possible that possibly put off his guard by the absence of knowledge of legal proceedings may follow upon such an inquiry, and we the course which the symptoms had ran. Artificial respira- therefore withhold further comment. We note, however, tion was obviously useless as no air entered the lungs, and that the father of the deceased seems to have reproached tracheotomy was not performed. This operation might have the medical man who was called in by her when it was saved the man’s life if it had been done in time-that is, if too late to save her life, with not having at once informed the surgeon had been present from the beginning of the him of the cause of her condition. The coroner, Mr. and C. B. firmly supported the proceedings. Margetts, promptly medical man in the position which he had taken up, point. A SMOKELESS UNDERGROUND RAILWAY. ing out that as long as it was possible that the woman’s life THE proposal to adopt electric traction on the Metro- might be saved he was the custodian of her secret, amounting that she had committed a criminal act, politan District Railway has been thoroughly supported by to the confession far his having any duty to communicate and so from that, the shareholders of the company, and we are not surprised, since they must feel that all prospect of income is doomed this to her relatives, it might have been his duty to keep by the fact that better means of travelling underground it as a professional secret from the knowledge of everyone. On her death becoming imminent, the coroner added, the are at hand, while the public are sick of the experience man’s position changed, because it was then evident medical that is offered to them by the existing underground steam that an inquiry must take place into the causes of it; and and trains. These are exceedingly unhealthy exceedingly dirty, and apparently the attempts that have been made on such an occasion, when the patient can no longer suffer at ventilation have produced no practical results. The use, ’, by the divulging of her secret, publicity followed by the fullest therefore, of smokeless traction is the only chance, it seems inquiry makes for the public good and for the protection to us, of making the old underground railways wholesome ’, and warning of other women. and of saving the enterprise from absolute financial disaster. a
’
-
It cannot be denied that this system is the most useful line in London, and once wipe away the reproach as to the filthy state of its tunnels and railway carriages it will undoubtedly secure a big clientele. We cordially welcome the decision that electric traction is to be used, but at the same time we are curious to know how it is proposed to meet the difficulty of trains of other systems running upon the lines. Thus the Midland, the Great Northern, the London and North-Western, and the Great Western railway companies, all overground systems, have running powers on the underground railway. Would the steam-engine be detached somewhere and an electric engine be hitched on? This would, of course, mean delay.
QUACKS AND ABORTION. AN inquest concluded at Huntingdon on Jan. 2nd shows that the trade in quack medicines which are liable to be taken by pregnant women in the hope of procuring miscarriage has not yet ceased ; that newspapers are still, whether knowingly or not, the means of advertising such nostrums; and that thei compounds sold are apparently capable of causing the desired effect, subject to the reservation that they must be taken in very large quantities. That the death of the person so procuring abortion upon herself is a not unlikely sequel to’ her temerity also stands revealed. In the Huntingdon case the facts proved at the inquest differ in no materialL particular from those which have been brought out in many of the inquiries that were more common before recent prosecutions, and before our articles on the subject had called attention to the danger of selling would-be abortifacients and publishing advertisements of them. The woman upon whom the inquest was held had died from acute general peritonitis following miscarriage. Before death she had admitted taking constantly for about three weeks, with the object of procuring abortion, certain pills the advertisement of which she said
WHEN
IS AN IMPROVEMENT NOT AN IMPROVEMENT P
A CORRBSPONDENT writes from Bournemouth :-" Public opinion in this place has lately been greatly excited over an - Omnibus’ Bill which the corporation proposes to introduce during the next session of Parliament. Much of it is only of local interest, as it deals with such matters as but one clause is electric tramways, widening roads, &c. ; concerned with the acquisition by the corporation of a large open space, the Horseshoe Common, as a site for ’ municipal and other buildings.’ This proposition involves practically the destruction of one of the principalI lungs I of the town and is therefore of the greatest interest to all those medical men who have been in the habit of sending their patients to this really delightful health resort, as I hope I may call our town although I live in it. The plot of ground, 14 acres in extent, is well known to all visitors to Bournemouth. It is in the very centre of the town and is a bit of wild moorland, surrounded by fir-trees and covered with As far as I know, no gorse, bracken, and heather. such bit of unadorned nature exists in the centre of any other town in the kingdom. By an Act of Parliament, obtained by the corporation so recently as 1897, two acres of this ground at its lower end were given up to the corporation as a site for the municipal buildings, but it was expressly stipulated that the remaining 12 acres should (for 99 years) be reserved for gardens and pleasuregrounds.’L’appétit vient en mangeant,’ however ; and it has grown so rapidly that now the corporation desires to devour the whole of the space. What may be its immediate intention is not declared, but the clause in question would
-
———————————————————————————;————————————
1
THE LANCET, Dec. 10th (p. 1570), 17th (p. 1651), 24th (p. 1723), and (p. 1807), 1898, and Jan. 21st (p. 182), Feb. 4th (p. 327), March 11th 717) and 25th (p. 855), April 1st (p. 908), June 24th (p. 1739), July 8th 111) and 15th (p. 174), and Dec. 2nd (p. 1540), 1899
31st
(p. (p.