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GAS AND OXYGEN IN OBSTETRICS.
139 to toxins, one of which acts on the nervous system, the other on the lower bowel. The excretion of the toxin causes exudation of lymph into the submucosa, later into the mucosa, leading to ulceration. If the intestinal membrane is produced by excretion of toxins, may not the vaginal be produced in the same way ?2 Another theory is that the infection may have been carried to the vagina by the blood stream. Cases of bacillary dysentery septicaemia have been reported. Of the cedema of the abdominal wall Dr. Lemann can give no explanation. He considers it analogous to the oedema frequently observed on the thoracic wall over empyemata and over abscesses of the liver.
DR. BEATTIE CROZIER: THOUGH it
was
MEDICAL PHILOSOPHER.
neither in the
practice
nor
in the
scientific advancement of medicine that Dr. Crozier achieved his fame, his training had a profound effect on his subsequent activities. While in his early youth he derived inspiration from the study of phrenology, his medical studies directed his reading into more scientific
channels, and the study of books by Darwin and Spencer altered his whole scheme of life. On his
qualification at the University of Toronto in 1872 he decided to leave Canada, where he was born and had always lived, for England, where he settled nominally as a medical practitioner. His real work, however, rose out of his search among the philosophers of all ages for a school of thought which would satisfy his own aspirations while harmonising with some of the then new teachings of Herbert Spencer, whose materialistic outlook he could never accept. The middle period of his life Crozier spent in the study of the history of intellectual development, and his book on this subject, published in 1897, was an attempt to show that the laws governing the rise and fall of philosophies could be interpreted, and that at least some guidance for the future could be obtained by their study. In his later years, though his failing eyesight made work difficult, he thought and wrote on political economy. His final publication in 1917 was a survey of the economic, intellectual, and religious movements brought into being or influenced by the war. Dr. Crozier had a definite position in a field of thought not generally entered by medical men, and his high ideals and laborious efforts to further on record in his works.
our
national progress remain
-
STEPS TOWARDS BIOLOGICAL STANDARDISATION. RECENT discussions on the best means of ensuring accuracy in dispensing have ignored the most important and probable source of danger in therapeutic agents administered to the public-that which is due to lack of standardisation and is beyond the control of the dispenser. Modern therapeutics has largely substituted for older drugs biological preparations, alkaloids, vaccines, and complex synthetic preparations which are not amenable to ordinary chemical tests. The need for the establishment of biological standards of measurement and of means for their ready application has been seen and emphasised by the Medical Research Committee since its formation in 1914. But the large amount of ultimate quantitative research required could not be undertaken in the war years except in so far as certain arbitrary standards of measurements had to be established at short notice, as, for example, those applied to salvarsan compounds sold in this country. At the end of 1916 the Committee issued a memorandum to the Government again urging the desirability of setting up official standards of value and authenticity for arsenical biological preparations, serums, and the like used in medical practice, and expressed the opinion that the absence of possibilities of control was not only discreditable to our national position in the world of science but a source of grave danger to the community. The Medical Research Committee urged strongly " the establishment of a Government laboratory for biological standardisation as needed for national purposes no less important than those of an
analogous kind fulfilled by the National Physical Laboratory." A fuller statement of the need for such a laboratory was issued early in 1919, and various research schemes in preparation for its establishment have been centralised at the National Institute for Medical Research at Hampstead. A special committee on Biological Standards and the Methods of Biological Assay, consisting of Professor W. Bulloch, F.R.S., Dr. H. H. Dale, F.R.S., Professor G. Dreyer, Sir Walter Fletcher, F.R.S., and Professor C. J. Martin, F.R.S., has been appointed by the Medical Research Council to advise them on the promotion and coordination of studies of this kind. Moreover, Dr. Dale has been appointed to represent the the Departmental Committee appointed last Counciltoonadvise the Minister of Health in the adminisApril and legislative measures that may be necessary. The report of this Committee should be issued shortly. Meanwhile, since the work in departments of bacteriology and pathology, biochemistry, and pharmacology at the National Institute is daily concerned with quantitative standards, the Council has invited Dr. Dale to serve as director of a Biological Standards Department. This department will have special relation to the central administrative organisation and supply of the separate departments of the Institute, and will, it is hoped, bring effectively into touch all the work likely to have a useful application to a national system of standardisation. For this the National Institute would seem to afford an appropriate permanent home.
trative
GAS AND OXYGEN
IN OBSTETRICS.
THE National Anaesthesia Research Society of America has issued a monograph on nitrous-oxide-oxygen analgesia and anaesthesia in normal labour and operative obstetrics. The publication is remarkable for several reasons. Its form is unusual, being more that of a presentation poetry-book than that generally associated with scientific productions; since this includes good paper, large clear type, plenty of space, and ornamental captions it is only to be commended. The matter is fairly comprehensive, including an account of the physiological actions of anaesthetics on pregnant animals and of blood changes due to various anaesthetics. At the same time there is a lack of definite practical details in the account of the applications of nitrous oxide analgesia to patients in labour. With the arrangements commonly in vogue in this country, where labour is conducted on a bed, and with the apparatus usually employed, nitrous oxide and oxygen is an extremely inconvenient anaesthetic. The patient’s head is some distance from the edge of the bed and half immersed in a pillow. Doubtless our American confreres, w ho have employed nitrous oxide in labour far more freely than we have, have found A description of them means to increase its facility. would greatly have enhanced the practical value of this monograph. It is claimed for nitrous oxide that, so far from lengthening labour as other anaesthetics are accused of doing, it actually shortens the process. This is owing to the fact that during analgesia the patient will effectively cooperate. She is to assist the contraction of the uterus, and since this is prevented from giving her pain, she finds no obstacle to bearing down. Although self-administration of nitrous oxide and oxygen for the purposes of analgesia is possible, and has been often permitted by some of the writers, yet it seems clear that the use of this anaesthetic for labour necessitates the presence of a second medical man. Certainly this is the case if all the advantage possible is to be got from this particular agent. It may well be, indeed, that, as is suggested in the monograph, an ideal labour would be conducted through the presence of a skilled anaesthetist supplying the analgesia of nitrous oxide and oxygen for the pains of the first and the early part of the second stage, and full anaesthesia by the same drugs for the rest of the process. The baby is unaffected in ordinary labours conducted under nitrous oxide and oxygen.
encouraged
1 THE LANCET, 1920, i., 974.
DR. BEATTIE CROZIER: THOUGH it
was
MEDICAL PHILOSOPHER.
neither in the
practice
nor
in the
scientific advancement of medicine that Dr. Crozier achieved his fame, his training had a profound effect on his subsequent activities. While in his early youth he derived inspiration from the study of phrenology, his medical studies directed his reading into more scientific
channels, and the study of books by Darwin and Spencer altered his whole scheme of life. On his
qualification at the University of Toronto in 1872 he decided to leave Canada, where he was born and had always lived, for England, where he settled nominally as a medical practitioner. His real work, however, rose out of his search among the philosophers of all ages for a school of thought which would satisfy his own aspirations while harmonising with some of the then new teachings of Herbert Spencer, whose materialistic outlook he could never accept. The middle period of his life Crozier spent in the study of the history of intellectual development, and his book on this subject, published in 1897, was an attempt to show that the laws governing the rise and fall of philosophies could be interpreted, and that at least some guidance for the future could be obtained by their study. In his later years, though his failing eyesight made work difficult, he thought and wrote on political economy. His final publication in 1917 was a survey of the economic, intellectual, and religious movements brought into being or influenced by the war. Dr. Crozier had a definite position in a field of thought not generally entered by medical men, and his high ideals and laborious efforts to further on record in his works.
our
national progress remain
-
STEPS TOWARDS BIOLOGICAL STANDARDISATION. RECENT discussions on the best means of ensuring accuracy in dispensing have ignored the most important and probable source of danger in therapeutic agents administered to the public-that which is due to lack of standardisation and is beyond the control of the dispenser. Modern therapeutics has largely substituted for older drugs biological preparations, alkaloids, vaccines, and complex synthetic preparations which are not amenable to ordinary chemical tests. The need for the establishment of biological standards of measurement and of means for their ready application has been seen and emphasised by the Medical Research Committee since its formation in 1914. But the large amount of ultimate quantitative research required could not be undertaken in the war years except in so far as certain arbitrary standards of measurements had to be established at short notice, as, for example, those applied to salvarsan compounds sold in this country. At the end of 1916 the Committee issued a memorandum to the Government again urging the desirability of setting up official standards of value and authenticity for arsenical biological preparations, serums, and the like used in medical practice, and expressed the opinion that the absence of possibilities of control was not only discreditable to our national position in the world of science but a source of grave danger to the community. The Medical Research Committee urged strongly " the establishment of a Government laboratory for biological standardisation as needed for national purposes no less important than those of an
analogous kind fulfilled by the National Physical Laboratory." A fuller statement of the need for such a laboratory was issued early in 1919, and various research schemes in preparation for its establishment have been centralised at the National Institute for Medical Research at Hampstead. A special committee on Biological Standards and the Methods of Biological Assay, consisting of Professor W. Bulloch, F.R.S., Dr. H. H. Dale, F.R.S., Professor G. Dreyer, Sir Walter Fletcher, F.R.S., and Professor C. J. Martin, F.R.S., has been appointed by the Medical Research Council to advise them on the promotion and coordination of studies of this kind. Moreover, Dr. Dale has been appointed to represent the the Departmental Committee appointed last Counciltoonadvise the Minister of Health in the adminisApril and legislative measures that may be necessary. The report of this Committee should be issued shortly. Meanwhile, since the work in departments of bacteriology and pathology, biochemistry, and pharmacology at the National Institute is daily concerned with quantitative standards, the Council has invited Dr. Dale to serve as director of a Biological Standards Department. This department will have special relation to the central administrative organisation and supply of the separate departments of the Institute, and will, it is hoped, bring effectively into touch all the work likely to have a useful application to a national system of standardisation. For this the National Institute would seem to afford an appropriate permanent home.
trative
GAS AND OXYGEN
IN OBSTETRICS.
THE National Anaesthesia Research Society of America has issued a monograph on nitrous-oxide-oxygen analgesia and anaesthesia in normal labour and operative obstetrics. The publication is remarkable for several reasons. Its form is unusual, being more that of a presentation poetry-book than that generally associated with scientific productions; since this includes good paper, large clear type, plenty of space, and ornamental captions it is only to be commended. The matter is fairly comprehensive, including an account of the physiological actions of anaesthetics on pregnant animals and of blood changes due to various anaesthetics. At the same time there is a lack of definite practical details in the account of the applications of nitrous oxide analgesia to patients in labour. With the arrangements commonly in vogue in this country, where labour is conducted on a bed, and with the apparatus usually employed, nitrous oxide and oxygen is an extremely inconvenient anaesthetic. The patient’s head is some distance from the edge of the bed and half immersed in a pillow. Doubtless our American confreres, w ho have employed nitrous oxide in labour far more freely than we have, have found A description of them means to increase its facility. would greatly have enhanced the practical value of this monograph. It is claimed for nitrous oxide that, so far from lengthening labour as other anaesthetics are accused of doing, it actually shortens the process. This is owing to the fact that during analgesia the patient will effectively cooperate. She is to assist the contraction of the uterus, and since this is prevented from giving her pain, she finds no obstacle to bearing down. Although self-administration of nitrous oxide and oxygen for the purposes of analgesia is possible, and has been often permitted by some of the writers, yet it seems clear that the use of this anaesthetic for labour necessitates the presence of a second medical man. Certainly this is the case if all the advantage possible is to be got from this particular agent. It may well be, indeed, that, as is suggested in the monograph, an ideal labour would be conducted through the presence of a skilled anaesthetist supplying the analgesia of nitrous oxide and oxygen for the pains of the first and the early part of the second stage, and full anaesthesia by the same drugs for the rest of the process. The baby is unaffected in ordinary labours conducted under nitrous oxide and oxygen.
encouraged
1 THE LANCET, 1920, i., 974.