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HUGH OWEN THOMAS
EVIPAN IN OBSTETRICS.—HUGH OWEN THOMAS
and that nitrous oxide is preferable from this point of view. Carlson’s paper is illustrated by tracings showing the experimental results on stimulating sections of jejunum, but these comparatively few pieces of evidence are hardly sufficient to override the opinions derived from years of clinical experience. EVIPAN
IN
OBSTETRICS
AFTER a review of the use of Evipan in general surgery, which discloses no experiences different from those of previous writers, E. Weber1 gives his opinions on its employment in gynaecology and obstetrics. He computes that evipan has been employed now some 800,000 times, of which 12,000 administrations have been in France, and he claims that only four deaths can be fairly attributed to the drug. In ordinary confinements there is no opportunity for advantageous use of evipan unless it is quite at the end of the second stage during the crisis of expulsion. On the other hand, for all operative procedures, such as forceps application and extraction of placenta, Weber prefers evipan to inhalation anaesthetics and he uses it regularly for Caesarean section and other major obstetric operations. HUGH OWEN THOMAS
SHORTLY before his death Sir Robert Jones discussed with Mr. Frederick Watson the publication of a centenary volume dealing with the life and principles of Hugh Owen Thomas, the famous descendant of a line of Anglesea bone-setters. They decided that the work should be done in two separate parts : one dealing with the environment and personality of the man, and one dealing with his methods and principles. We have here2 the former section, and it makes
topical
because, in addition
as
well
to the
as interesting reading biographical details, we
obtain information of a valuable sort as to how the craft of bone-setting arose, why it obtained its popularity with the public, and where it deserved from the beginning the attention of the medical profession. Hugh Owen Thomas was the son of Evan Thomas, a famous Welsh bone-setter, who was the son of Richard Thomas of the same calling, who was himself by ancestry connected with the craft. The passages of the book concerned with the practice of Evan Thomas set out the difficulties which were created by the fact that he had no legal qualifications or status, in consequence of which he became as well known for his conflicts with the medical profession as for his undoubted services to cripples, who at that period of surgery received no intelligent assistance from medicine. One cannot fail to see the shortsightedness of our professional predecessors, in that the gap in orthodox medical training was never filled, and indeed was hardly admitted to exist until comparatively recently. Evan Thomas was not an aggressive manipulator, was conservative in his methods, and, we learn, made allies of rest and time in the after-care of the patients who passed under his hands. His son,
Hugh Thomas,
a duly registered surgeon, was always only loyal to his father’s memory, but able to appreciate the value of his manipulative work. How he conducted his extraordinarily large practice has been well described by Sir Robert Jones from personal recollection of the work done at Nelsonstreet, Liverpool, in the 70’s. We see in Jones’s picture a small thoughtful alert man, quick in ques-
not
1 Rev. franç. de gyn. et d’obst., December, 1934, p. 1071. 2 Hugh Owen Thomas : A Personal Study, by Frederick Watson, author of The Life of Sir Robert Jones, etc., pp. 94. Oxford University Press. London: Humphrey Milford. 1934. 12s. 6d.
281
We hear of a day’s work, medical and orthopaedic, which seems almost fantastic for length and variety, work which recalls vividly Thomas’s own words that he hoped he would not be remembered as an inventor of splints ; yet, as Mr. Watson points out, it was and is principally through the splint which carries his name that universal fame has come to him. This sketch of a brave and distinguished man, whose work became of the widest importance, partly from its original merit and partly from its development under a famous disciple, contains a regrettable message. We can see that the good inherent in a branch of practical surgery was displayed to ouri predecessors with unusual clearness, but the message was not received by orthodox surgery. Consequently the proper study of orthopaedics was postponed for many years-almost to this century.
tion, tolerant of reply, impatient of dogma.
CARBON
MONOXIDE POISONING
recent review1 of a new work on Industrial Toxicology by Dr. Alice Hamilton of Chicago, it was remarked that her long experience enabled her to say much about carbon monoxide poisoning that would probably be new to the unspecialised reader. On the safety limit for carbon monoxide in the air that is breathed our review summarised Dr. Hamilton’s conclusions in these words: "Apparently 0-04 per cent. breathed for several hours causes malaise ; 0-1 per cent. causes 50 per cent. saturation of blood in 15 minutes ; 1 per cent. causes immediate unconIn the last clause we were however sciousness." not quite fair to Dr. Hamilton, for the statement on p. 122 of her book is that 1 28 per cent. causes "immediate effect; unconsciousness and danger of death in 1-3 minutes." A correspondent writes to say that 1 per cent. of carbon monoxide does not cause immediate unconsciousness, and he recalls Prof. H. Hartridge’s statement,2 that "there is no definitely fatal amount of carbon monoxide in air since pure carbon monoxide gas could probably be breathed for a very short time without causing any symptoms." Prof. Hartridge gives a table of the time for symptoms to develop when various percentages of carbon monoxide in air are breathed ; 01 per cent., he notes, produces mild symptoms in 10-30 minutes and severe symptoms in 30-60 minutes. These figures are in harmony with those given by Prof. J. S. Haldane who says 3 : " If there were 1 per cent. of CO in the air breathed, 50 per cent. saturation would be reached in 15 minutes, and 80 per cent., causing death, in 23 minutes." And they are at variance with those given by Dr. Hamilton. There should be no difficulty in deciding who is right. The blood has a CO-carrying capacity of about one litre. Therefore in round numbers 500 c.cm. of CO would have to be absorbed to produce half saturation. In a man at rest air-ventilation is about 7 litres a minute, of which perhaps 5 litres reach the lung. Five litres of air with 0-1 per cent. of CO would contain 5 c.cm. of that gas. If all this were absorbed, which it is not, 100 minutes would be necessary for the introduction of 500 c.cm. into the body. Unconsciousness is produced at about 50 to 60 per cent. of saturation. If there were 1 per cent. (not 01 per cent.) of CO in the air ten minutes would be required to produce 50 per cent. saturation, even if all the CO were absorbed. If the man were taking active exercise, e.g., shovelling coal, so that the total ventilation through his lung was greatly increased, IN
a
1 THE LANCET, 1934, ii., 1227. 2 Ibid, 1928, i., 1137. 3 Brit. Med. Jour., 1930, ii., 16.
and that nitrous oxide is preferable from this point of view. Carlson’s paper is illustrated by tracings showing the experimental results on stimulating sections of jejunum, but these comparatively few pieces of evidence are hardly sufficient to override the opinions derived from years of clinical experience. EVIPAN
IN
OBSTETRICS
AFTER a review of the use of Evipan in general surgery, which discloses no experiences different from those of previous writers, E. Weber1 gives his opinions on its employment in gynaecology and obstetrics. He computes that evipan has been employed now some 800,000 times, of which 12,000 administrations have been in France, and he claims that only four deaths can be fairly attributed to the drug. In ordinary confinements there is no opportunity for advantageous use of evipan unless it is quite at the end of the second stage during the crisis of expulsion. On the other hand, for all operative procedures, such as forceps application and extraction of placenta, Weber prefers evipan to inhalation anaesthetics and he uses it regularly for Caesarean section and other major obstetric operations. HUGH OWEN THOMAS
SHORTLY before his death Sir Robert Jones discussed with Mr. Frederick Watson the publication of a centenary volume dealing with the life and principles of Hugh Owen Thomas, the famous descendant of a line of Anglesea bone-setters. They decided that the work should be done in two separate parts : one dealing with the environment and personality of the man, and one dealing with his methods and principles. We have here2 the former section, and it makes
topical
because, in addition
as
well
to the
as interesting reading biographical details, we
obtain information of a valuable sort as to how the craft of bone-setting arose, why it obtained its popularity with the public, and where it deserved from the beginning the attention of the medical profession. Hugh Owen Thomas was the son of Evan Thomas, a famous Welsh bone-setter, who was the son of Richard Thomas of the same calling, who was himself by ancestry connected with the craft. The passages of the book concerned with the practice of Evan Thomas set out the difficulties which were created by the fact that he had no legal qualifications or status, in consequence of which he became as well known for his conflicts with the medical profession as for his undoubted services to cripples, who at that period of surgery received no intelligent assistance from medicine. One cannot fail to see the shortsightedness of our professional predecessors, in that the gap in orthodox medical training was never filled, and indeed was hardly admitted to exist until comparatively recently. Evan Thomas was not an aggressive manipulator, was conservative in his methods, and, we learn, made allies of rest and time in the after-care of the patients who passed under his hands. His son,
Hugh Thomas,
a duly registered surgeon, was always only loyal to his father’s memory, but able to appreciate the value of his manipulative work. How he conducted his extraordinarily large practice has been well described by Sir Robert Jones from personal recollection of the work done at Nelsonstreet, Liverpool, in the 70’s. We see in Jones’s picture a small thoughtful alert man, quick in ques-
not
1 Rev. franç. de gyn. et d’obst., December, 1934, p. 1071. 2 Hugh Owen Thomas : A Personal Study, by Frederick Watson, author of The Life of Sir Robert Jones, etc., pp. 94. Oxford University Press. London: Humphrey Milford. 1934. 12s. 6d.
281
We hear of a day’s work, medical and orthopaedic, which seems almost fantastic for length and variety, work which recalls vividly Thomas’s own words that he hoped he would not be remembered as an inventor of splints ; yet, as Mr. Watson points out, it was and is principally through the splint which carries his name that universal fame has come to him. This sketch of a brave and distinguished man, whose work became of the widest importance, partly from its original merit and partly from its development under a famous disciple, contains a regrettable message. We can see that the good inherent in a branch of practical surgery was displayed to ouri predecessors with unusual clearness, but the message was not received by orthodox surgery. Consequently the proper study of orthopaedics was postponed for many years-almost to this century.
tion, tolerant of reply, impatient of dogma.
CARBON
MONOXIDE POISONING
recent review1 of a new work on Industrial Toxicology by Dr. Alice Hamilton of Chicago, it was remarked that her long experience enabled her to say much about carbon monoxide poisoning that would probably be new to the unspecialised reader. On the safety limit for carbon monoxide in the air that is breathed our review summarised Dr. Hamilton’s conclusions in these words: "Apparently 0-04 per cent. breathed for several hours causes malaise ; 0-1 per cent. causes 50 per cent. saturation of blood in 15 minutes ; 1 per cent. causes immediate unconIn the last clause we were however sciousness." not quite fair to Dr. Hamilton, for the statement on p. 122 of her book is that 1 28 per cent. causes "immediate effect; unconsciousness and danger of death in 1-3 minutes." A correspondent writes to say that 1 per cent. of carbon monoxide does not cause immediate unconsciousness, and he recalls Prof. H. Hartridge’s statement,2 that "there is no definitely fatal amount of carbon monoxide in air since pure carbon monoxide gas could probably be breathed for a very short time without causing any symptoms." Prof. Hartridge gives a table of the time for symptoms to develop when various percentages of carbon monoxide in air are breathed ; 01 per cent., he notes, produces mild symptoms in 10-30 minutes and severe symptoms in 30-60 minutes. These figures are in harmony with those given by Prof. J. S. Haldane who says 3 : " If there were 1 per cent. of CO in the air breathed, 50 per cent. saturation would be reached in 15 minutes, and 80 per cent., causing death, in 23 minutes." And they are at variance with those given by Dr. Hamilton. There should be no difficulty in deciding who is right. The blood has a CO-carrying capacity of about one litre. Therefore in round numbers 500 c.cm. of CO would have to be absorbed to produce half saturation. In a man at rest air-ventilation is about 7 litres a minute, of which perhaps 5 litres reach the lung. Five litres of air with 0-1 per cent. of CO would contain 5 c.cm. of that gas. If all this were absorbed, which it is not, 100 minutes would be necessary for the introduction of 500 c.cm. into the body. Unconsciousness is produced at about 50 to 60 per cent. of saturation. If there were 1 per cent. (not 01 per cent.) of CO in the air ten minutes would be required to produce 50 per cent. saturation, even if all the CO were absorbed. If the man were taking active exercise, e.g., shovelling coal, so that the total ventilation through his lung was greatly increased, IN
a
1 THE LANCET, 1934, ii., 1227. 2 Ibid, 1928, i., 1137. 3 Brit. Med. Jour., 1930, ii., 16.