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DEATHS UNDER ANÆSTHETICS.
1103 Dr. Sven Hedin also visited 14 temple monasteries, of which at least ten were hitherto absolutely unknown. One of them was a monastery of female lamas. Altogether he made new in marches 81 absolutely country. Everywhere he was met by the Tibetan officials, as well as by the Nomads, with the greatest hospitality and kindness. There is no doubt, he says, that the friendly relations which they try to maintain with Europeans are due in a very high degree to the excellent understanding which was established with the authorities by Sir Francis Younghusband when he was in Lbassa. Dr. Sven Hedin does not say what his plans are for the future, but apparently he has no intention of returning to civilisa. tion for some time to come.
tables at
as
Guy’s
to anaesthetics should be kept by the authorities Hospital," a matter on which the coroner had
commented
freely.
The
jury found
that
no
blame attached
to the house surgeon who gave the anaesthetic. In view of the importance of the case we shall publish an
extended report of the medical evidence and the coroner’s remarks in a future issue. Less significance attaches to an held in the same court on the same day upon the death at Guy’s Hospital of another patient whilst under an anaesthetic. This was a case of cut throat, in which the A.C.E. mixture was administered and the patient died shortly after its commencement. The jury, on the advice of the coroner, returned a verdict of " Suicide whilst of unsound
inquest
mind." ___
AN UNSUSPECTED BREEDING-GROUND FOR MOSQUITOES. letter to the Times of India the Rev. H. Mould, chaplain of Colaba, calls attention to a breeding-place for mosquitoes which he believes has hitherto escaped observation. While going round the Colaba cemetery, which is in his charge, he noticed a small pipli" growing out of a hole in the trunk of another tree, a "karunj." He pulled it out and found the hole to be quite a foot deep and containing some inches of water at the bottom. Several mosquitoes came up out of the hole which he caused to be filled up with earth. During the next few days he found several other trees with holes in them containing water. In another "karunja" a branch had been lopped away and in the decayed stump there was a shallow cavity full of clear water "in which was quite a number of very lively mosquito larv2a." Mr. Mould brought his discovery to the notice of Colonel G. F. Gubbin, R.A.M.C., who at once gave orders to the assistant surgeon in charge of the Colaba Mosquito Brigade to examine all the trees and very soon reports were brought in of a large number in which water harbouring mosquito larvse existed. In the same connexion Mr. Mould mentions a previous experience of his in order to show the great length of time during which water can remain in hollow trees in considerable quantities. Some years ago when riding in the jungles of Meywar he noticed by the side of the road a huge mhava" tree, with a bamboo ladder some 15 feet long leading up to the first great fork. As he was wondering why it was there he saw a man ascend with a brass Iota tied to a long string. This he lowered down inside the trunk of the mhava " and when he drew it up again it was full of water. The man said that it was good and whole. some water and that the supply was perennial. IN
FASHION IN
a
DEATHS UNDER ANÆSTHETICS. THE adjourned inquest was held on Oct. 14th by Dr. F. J. Waldo, coroner for the City and Southwark, into the death of Minnie Colston Morgan, aged 29 years, who died at Guy’s Hospital on Oct. 5th whilst undergoing an operation A preliminary operation had for exophthalmic goitre. been performed on Sept. l0th at which the patient was safely ansesthetised with chloroform. On the day of the fatality an attempt was made to use eucaine locally but this was abandoned on account of the nervousness of the patient and chloroform, prepared from acetone, was administered ; shortly after the skin incision had been made she died. The post-mortem examination revealed a persistent thymus weighing 98 grammes and an enlarged thyroid gland weighing 202 grammes. The anesthetic was administered by a house surgeon in the ordinary course of his duties. The jury returned a verdict of -’Death from misadventure due to the administration of chloroform for a necessary surgical operation," with the rider "That in all operative cases of a serious nature anaesthetics should be administered either by a staff anaesthetist or by a resident under his immediate supervision ; and, further, that full statistical
I
DRUGS.
IN THE LANCET of Oct. 12th, p. 1060, we published an interesting note from our correspondent in Paris on the fluctuat,ions which have occurred in the consumption of drugs during the last ten years in the Paris hospitals and kindred institutions. The figures are of particular interest as indicating the drugs which are in favour now and those which have fallen into more or less disrepute and the results are instructive, inasmuch as they represent the observations gained by practical experience as to the merits or demerits of various remedies. Opium, cinchona bark, diachylon, tincture of iodine, glycerine, potassium bromide, bismuth subnitrate, sodium salicylate, silver nitrate, calomel, and leeches hold the field as "classics" in spite of the introduction of modern synthetics. Their demand is constant. There was a decline, however, in the amounts used of iodide of potassium and iodide of sodium, of the salts of quinine, and of antipyrin. Doubtless the inorganic iodides have been replaced by organic compounds of iodine, quinine by certain synthetics (acetanilide, for example), and antipyrin by less drastic and safer antipyretics. The use of poisonous antiseptics has declined, notably corrosive sublimate, biniodide of mercury, iodoform and carbolic acid, and a similar falling o;f of the intestinal antiseptics such as betaand benzo-naphthol and salol is shown. The demand for oxygenated water, however, appears to be increasing by leaps and bounds from 1000 to over 100,000 litres per year. This fact appears to show that peroxide of hydrogen is rapidly increasing in favour as an antiseptic. It is, of course, non-poisonous, non-corrosive, and unirritating, whilst it is a powerful germicide. On the whole there appears to be a reversion to old and well-tried drugs and there are many practitioners whose materia medica goes a very little further than opium, calomel, bismuth, the s3.licylates, quinine, and the bitters and the alkalies. Recent experience would seem to teach that with a few exceptions drugs outside this category, and more especially the complex synthetics, do not appear to enjoy the confidence which existed in them at the time of their introduction. If that be true the therapeutic pendulum obviously swings back. THE SPREAD AND PREVENTION
OF
PLAGUE.
Dr. J. Ashburton Thompson’s report on the spread and prevention of plague prepared for the International Congress of Hygiene and Demography at Berlin, an abstract of which we publish in this issue, is a valuable contribution to the subject. Dr. Thompson limits himself to the facts ascertained in the epidemics at Sydney, believing that the way in which plague spreads is one and the same everywhere, differences being casual and dependent on local circumstances. Careful investigation of the Sydney epidemics demonstrated that there was always a close association between plague in the rat and plague in man, that the one preceded the other, and that there was a chIonicity
tables at
as
Guy’s
to anaesthetics should be kept by the authorities Hospital," a matter on which the coroner had
commented
freely.
The
jury found
that
no
blame attached
to the house surgeon who gave the anaesthetic. In view of the importance of the case we shall publish an
extended report of the medical evidence and the coroner’s remarks in a future issue. Less significance attaches to an held in the same court on the same day upon the death at Guy’s Hospital of another patient whilst under an anaesthetic. This was a case of cut throat, in which the A.C.E. mixture was administered and the patient died shortly after its commencement. The jury, on the advice of the coroner, returned a verdict of " Suicide whilst of unsound
inquest
mind." ___
AN UNSUSPECTED BREEDING-GROUND FOR MOSQUITOES. letter to the Times of India the Rev. H. Mould, chaplain of Colaba, calls attention to a breeding-place for mosquitoes which he believes has hitherto escaped observation. While going round the Colaba cemetery, which is in his charge, he noticed a small pipli" growing out of a hole in the trunk of another tree, a "karunj." He pulled it out and found the hole to be quite a foot deep and containing some inches of water at the bottom. Several mosquitoes came up out of the hole which he caused to be filled up with earth. During the next few days he found several other trees with holes in them containing water. In another "karunja" a branch had been lopped away and in the decayed stump there was a shallow cavity full of clear water "in which was quite a number of very lively mosquito larv2a." Mr. Mould brought his discovery to the notice of Colonel G. F. Gubbin, R.A.M.C., who at once gave orders to the assistant surgeon in charge of the Colaba Mosquito Brigade to examine all the trees and very soon reports were brought in of a large number in which water harbouring mosquito larvse existed. In the same connexion Mr. Mould mentions a previous experience of his in order to show the great length of time during which water can remain in hollow trees in considerable quantities. Some years ago when riding in the jungles of Meywar he noticed by the side of the road a huge mhava" tree, with a bamboo ladder some 15 feet long leading up to the first great fork. As he was wondering why it was there he saw a man ascend with a brass Iota tied to a long string. This he lowered down inside the trunk of the mhava " and when he drew it up again it was full of water. The man said that it was good and whole. some water and that the supply was perennial. IN
FASHION IN
a
DEATHS UNDER ANÆSTHETICS. THE adjourned inquest was held on Oct. 14th by Dr. F. J. Waldo, coroner for the City and Southwark, into the death of Minnie Colston Morgan, aged 29 years, who died at Guy’s Hospital on Oct. 5th whilst undergoing an operation A preliminary operation had for exophthalmic goitre. been performed on Sept. l0th at which the patient was safely ansesthetised with chloroform. On the day of the fatality an attempt was made to use eucaine locally but this was abandoned on account of the nervousness of the patient and chloroform, prepared from acetone, was administered ; shortly after the skin incision had been made she died. The post-mortem examination revealed a persistent thymus weighing 98 grammes and an enlarged thyroid gland weighing 202 grammes. The anesthetic was administered by a house surgeon in the ordinary course of his duties. The jury returned a verdict of -’Death from misadventure due to the administration of chloroform for a necessary surgical operation," with the rider "That in all operative cases of a serious nature anaesthetics should be administered either by a staff anaesthetist or by a resident under his immediate supervision ; and, further, that full statistical
I
DRUGS.
IN THE LANCET of Oct. 12th, p. 1060, we published an interesting note from our correspondent in Paris on the fluctuat,ions which have occurred in the consumption of drugs during the last ten years in the Paris hospitals and kindred institutions. The figures are of particular interest as indicating the drugs which are in favour now and those which have fallen into more or less disrepute and the results are instructive, inasmuch as they represent the observations gained by practical experience as to the merits or demerits of various remedies. Opium, cinchona bark, diachylon, tincture of iodine, glycerine, potassium bromide, bismuth subnitrate, sodium salicylate, silver nitrate, calomel, and leeches hold the field as "classics" in spite of the introduction of modern synthetics. Their demand is constant. There was a decline, however, in the amounts used of iodide of potassium and iodide of sodium, of the salts of quinine, and of antipyrin. Doubtless the inorganic iodides have been replaced by organic compounds of iodine, quinine by certain synthetics (acetanilide, for example), and antipyrin by less drastic and safer antipyretics. The use of poisonous antiseptics has declined, notably corrosive sublimate, biniodide of mercury, iodoform and carbolic acid, and a similar falling o;f of the intestinal antiseptics such as betaand benzo-naphthol and salol is shown. The demand for oxygenated water, however, appears to be increasing by leaps and bounds from 1000 to over 100,000 litres per year. This fact appears to show that peroxide of hydrogen is rapidly increasing in favour as an antiseptic. It is, of course, non-poisonous, non-corrosive, and unirritating, whilst it is a powerful germicide. On the whole there appears to be a reversion to old and well-tried drugs and there are many practitioners whose materia medica goes a very little further than opium, calomel, bismuth, the s3.licylates, quinine, and the bitters and the alkalies. Recent experience would seem to teach that with a few exceptions drugs outside this category, and more especially the complex synthetics, do not appear to enjoy the confidence which existed in them at the time of their introduction. If that be true the therapeutic pendulum obviously swings back. THE SPREAD AND PREVENTION
OF
PLAGUE.
Dr. J. Ashburton Thompson’s report on the spread and prevention of plague prepared for the International Congress of Hygiene and Demography at Berlin, an abstract of which we publish in this issue, is a valuable contribution to the subject. Dr. Thompson limits himself to the facts ascertained in the epidemics at Sydney, believing that the way in which plague spreads is one and the same everywhere, differences being casual and dependent on local circumstances. Careful investigation of the Sydney epidemics demonstrated that there was always a close association between plague in the rat and plague in man, that the one preceded the other, and that there was a chIonicity