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GAS AND OXYGEN ANÆSTHESIA.
921 ovary accounted for 27-8 per cent. of all the deaths from cancer of this organ. The corresponding figure for cancer of the uterus was 26.3 per cent., and for cancer of the breast, 27 per cent. There was thus at the age between 50 and 60 a death-rate from cancer in these organs which was much higher than the corresponding death-rates in any other decade in life. But when the deaths from cancer of the stomach in women were investigated, it was found that the peak was not reached till the decade 70-80, in which decade 31-4 per cent. of all the deaths from cancer of the stomach in women occurred. Dr. Gade finds similar observations in the posthumous work of Clemens v. Pirquet (Allergie des Lebenalters. Die bosartigen Geschwulste) published in 1930 and based on the cancer death-rates of England and Wales in the period 1911-1926. Dr. Gade is inclined to support the theory according to which the lower incidence of cancer of the stomach in women, as compared with men, is due to so many cancer-predisposed women having been killed by cancer of their reproductive organs before the disease had had time to develop in the stomach. He sees in the high cancer-rate in the reproductive organs of the woman after the climacterium a biological law, senile changes in these organs promoting cancer therein, just as senile changes in general seem to favour the development of cancer in other parts of the
body.
the very patients for whom gas and oxygen alone is not effective enough. We allude, of course, to patients undergoing operations on the upper abdomen. In these people Dr. Macklin claims good results in only a third of the cases and obviously that is not enough. An anaesthetist must be sure of a much higher proportion of good results for any method which he recommends. The important practical question is how to make gas- and oxygen, without ether or chloroform, perfectly effective for upper abdominal operations. The best answer we believe is barely considered by Dr. Macklin. It is to be found in the much more frequent use of local injections for the production of relaxation. The surgeon who desires the best possible condition of his patient after operation will expect of the anaesthetist a perfectly quiet induction of unconsciousness and a maintenance of that state without deleterious effect on the patient. For perfect relaxation he will aid and abet the anaesthetist by local means. In no other way can the complete exclusion of chloroform and of ether be secured. Endotracheal use of gas and oxygen, and the proper employment of basal narcotics, can help, but they cannot of themselves always ensure perfect relaxation of the upper abdomen with no other anaesthetic than gas and oxygen. Allied with skilled use of local infiltration however they can certainly do so. Dr. Macklin believes that to render gas and oxygen effective by employing secondary saturation is no less safe than to achieve the same object by addition of ether or chloroform. Theoretically he makes out a good case, particularly from the point of view of the patient’s
____
THE PRESCRIBER. WITH the October number the Prescriber completes its little jubilee. From a modest origin 25 years ago as an aid to prescribing," with an issue of 1000 copies, it has grown to maturity as a journal of cosmopolitan outlook and catholicity of content. We offer our congratulation to Dr. Thomas Stephenson, who has been its creator, pilot, and inspiration. Originality has been throughout the keynote of the journal and it has provided contact for the practitioner, specialist, and bench-worker with the literature of drugs and their actions. Original articles and summaries prepared by qualified abstractors have been grouped month by month to form a compact review of modern teaching and practice. The busy practitioner has had good reason to appreciate the monographs dealing with recent advances in endocrine and spa treatment, as well as the systematic accounts of therapeutic progress, always combined with judicious criticism of newer remedies. The teacher has not had to look in vain for a survey of contemporary work, or for a reference to the original sources of information. The journal has never lacked charm and distinction. Observations and opinions have been set out with a judicial authority and without the premature praise or hasty condemnation which have blighted the career of so many remedies and methods. We wish our contemporary a continued popularity and
condition after
prosperity.
SIZE OF THE HEART IN CHILDREN. Dr. A. F. Hecht, of the University Children’s Clinic in Vienna, has carried out an extensive investigation1 of the size of the heart in children in the hos-
pital
or
attending
effects,
on
respiratory
or
gastro-intestinal systems,
are
a
special out-patient department
for heart affections. The children ranged in age from 6 to 14 years and in addition to having an orthodiagram made of the heart, each child was carefully measured as regards body-weight and height, sitting height, and breadth of thorax. Dr. Hecht used the Amsler planimeter to measure the actual superficial area of the heart shadow, a measurement found by Dr. Bedford and Wing-Commander Treadgold in our last issue (p. 838) to be less valuable than the transverse diameter, although they admitted that in the hands of a single observer the experimental error might be no greater. This area, stated in square centimetres, was used as the numerator of a surface-quotient" of which the divisor was the weight in kilogrammes reduced to the two-thirds power. Expressed as a formula this means that "
Surface
GAS AND OXYGEN ANÆSTHESIA.
SOME interesting questions are raised and to some extent answered in Dr. Macklin’s paper on gas and I oxygen anaesthesia which we publish at p. 897.i The questions affect both theory and practice. As regards the latter, no anaesthetist to-day, we imagine, disputes the proposition that whenever an operation can be perfectly carried out with no other anaesthetic than gas and oxygen, the gain for the patient is great. The trouble is thft those very patients for whom it is most desirable to avoid all inconvenient after-
Neither method, however,
____
I
____
operation.
appears to equal either in effectiveness or harmlessness the conjunction of basal narcotics, gas and oxygen and local analgesics.
"
quotient = Weight23
In order to avoid unnecessary decimals the result is multiplied by 100. Based upon nearly 400 observations a normal group is first described by Dr. Hecht. He divides this group into three : (1) perfectly normal cases ; (2) those with a systolic murmur without any history of rheumatism or any evidence of heart disease; and (3) those with slight functional derangement of the circulatory system without obvious pathological lesions in the heart. In these three divisions the surface-quotient was 737, 761, and 781 1
Jahr. f.
Kinderh., 1931, cxxxiii., 26.
body.
the very patients for whom gas and oxygen alone is not effective enough. We allude, of course, to patients undergoing operations on the upper abdomen. In these people Dr. Macklin claims good results in only a third of the cases and obviously that is not enough. An anaesthetist must be sure of a much higher proportion of good results for any method which he recommends. The important practical question is how to make gas- and oxygen, without ether or chloroform, perfectly effective for upper abdominal operations. The best answer we believe is barely considered by Dr. Macklin. It is to be found in the much more frequent use of local injections for the production of relaxation. The surgeon who desires the best possible condition of his patient after operation will expect of the anaesthetist a perfectly quiet induction of unconsciousness and a maintenance of that state without deleterious effect on the patient. For perfect relaxation he will aid and abet the anaesthetist by local means. In no other way can the complete exclusion of chloroform and of ether be secured. Endotracheal use of gas and oxygen, and the proper employment of basal narcotics, can help, but they cannot of themselves always ensure perfect relaxation of the upper abdomen with no other anaesthetic than gas and oxygen. Allied with skilled use of local infiltration however they can certainly do so. Dr. Macklin believes that to render gas and oxygen effective by employing secondary saturation is no less safe than to achieve the same object by addition of ether or chloroform. Theoretically he makes out a good case, particularly from the point of view of the patient’s
____
THE PRESCRIBER. WITH the October number the Prescriber completes its little jubilee. From a modest origin 25 years ago as an aid to prescribing," with an issue of 1000 copies, it has grown to maturity as a journal of cosmopolitan outlook and catholicity of content. We offer our congratulation to Dr. Thomas Stephenson, who has been its creator, pilot, and inspiration. Originality has been throughout the keynote of the journal and it has provided contact for the practitioner, specialist, and bench-worker with the literature of drugs and their actions. Original articles and summaries prepared by qualified abstractors have been grouped month by month to form a compact review of modern teaching and practice. The busy practitioner has had good reason to appreciate the monographs dealing with recent advances in endocrine and spa treatment, as well as the systematic accounts of therapeutic progress, always combined with judicious criticism of newer remedies. The teacher has not had to look in vain for a survey of contemporary work, or for a reference to the original sources of information. The journal has never lacked charm and distinction. Observations and opinions have been set out with a judicial authority and without the premature praise or hasty condemnation which have blighted the career of so many remedies and methods. We wish our contemporary a continued popularity and
condition after
prosperity.
SIZE OF THE HEART IN CHILDREN. Dr. A. F. Hecht, of the University Children’s Clinic in Vienna, has carried out an extensive investigation1 of the size of the heart in children in the hos-
pital
or
attending
effects,
on
respiratory
or
gastro-intestinal systems,
are
a
special out-patient department
for heart affections. The children ranged in age from 6 to 14 years and in addition to having an orthodiagram made of the heart, each child was carefully measured as regards body-weight and height, sitting height, and breadth of thorax. Dr. Hecht used the Amsler planimeter to measure the actual superficial area of the heart shadow, a measurement found by Dr. Bedford and Wing-Commander Treadgold in our last issue (p. 838) to be less valuable than the transverse diameter, although they admitted that in the hands of a single observer the experimental error might be no greater. This area, stated in square centimetres, was used as the numerator of a surface-quotient" of which the divisor was the weight in kilogrammes reduced to the two-thirds power. Expressed as a formula this means that "
Surface
GAS AND OXYGEN ANÆSTHESIA.
SOME interesting questions are raised and to some extent answered in Dr. Macklin’s paper on gas and I oxygen anaesthesia which we publish at p. 897.i The questions affect both theory and practice. As regards the latter, no anaesthetist to-day, we imagine, disputes the proposition that whenever an operation can be perfectly carried out with no other anaesthetic than gas and oxygen, the gain for the patient is great. The trouble is thft those very patients for whom it is most desirable to avoid all inconvenient after-
Neither method, however,
____
I
____
operation.
appears to equal either in effectiveness or harmlessness the conjunction of basal narcotics, gas and oxygen and local analgesics.
"
quotient = Weight23
In order to avoid unnecessary decimals the result is multiplied by 100. Based upon nearly 400 observations a normal group is first described by Dr. Hecht. He divides this group into three : (1) perfectly normal cases ; (2) those with a systolic murmur without any history of rheumatism or any evidence of heart disease; and (3) those with slight functional derangement of the circulatory system without obvious pathological lesions in the heart. In these three divisions the surface-quotient was 737, 761, and 781 1
Jahr. f.
Kinderh., 1931, cxxxiii., 26.