" SOME DISAPPOINTMENTS IN SURGERY."

65 eye on," the manipulations of the surgeon, and if this is iits pathology, and its more characteristic clinical manifesta1 Dr. Buxton’s meaning it cannot be too strongly condemned, tions. Methylated spirit, as now allowed to be sold by the l Inland as it is acknowledged to be the most dangerous of all Revenue, consists of about 88 per cent. of alcohol, f over proof, 10 per cent. of wood naphtha, and about doctrines to preach. But the gist of the whole argument is 62 It 1 per cent. of petroleum oil. The addition of the mineral more fully disclosed in the second part of the statement. c was expressly added with a view to prevent its being is that the surgeon is no longer to be responsible for theoil safety of his patient, but the responsibility is to be sharedcdrunk, but spirit-takers soon discovered that by adding by the man who gives the chloroform or ether. In certain water to the spirit the petroleum oil was separated and 4 be removed. It generally retails at from 5d. to 6d. per eventualities the anaesthetist is to dictate to the surgeon, could and, containing as it does twice as much alcohol as the so that the surgeon becomes a mere operator, a subI pint 1 ordinate instead of the chief who under all circum- best whisky, the drinker is enabled to procure the alcoholic stances retains the supreme command and the entire iequivalent of half a pint of whisky for three-halfpence. It i quite obvious, then, that the one thing needful in order to responsibility in his own hands. This constitutes in is my opinion the tendency to the degradation of surgery Iobtain an unlimited supply of alcohol for a few pence daily i to acquire a taste tor the poisonous spirit, and this is against which surgeons should guard with all their is might. There is no doubt about its evil effects on the pro- iapparently readily cultivated, especially by those who have fession. I know of an operation in England where the long learned to seek in spirit a stimulant and not a bouquet. anaesthetist gave the patient a slight overdose of chloroform Cases, although they are numerous enough, where death The patient, a child, became has followed the use of methylated spirit have usually with a Junker’s inhaler. pallid, and the anaesthetist told the surgeon that he must been classed as due to some form of alcoholism, and even stop the operation as there was some shock. The burgeon men of considerable experience may be found to deny meekly obeyed this direction and sent the child back to bed that they have ever known of a fatal case, short of a with the operation unfinished. The proper course for the history of the habits of the individual. I do not know of surgeon obviously was that he should have noticed that the any post-mortem signs which would indicate that the methy. chloroform was being given a little too freely and have told lated and not ordinary alcohol had been used, but the wood the ansesthetist not to give so much. naphtha seems to affect the spleen more than is common in The writer of the article of Nov. 17th sheds crocodile cases of mere alcoholism, and the blood seems to stain the tears over the " potency" of chloroform, a phrase which serous membranes, as is found after many poisons. The heart must mean one of two things : either (1) it means that the muscle seems to become darkened and very friable, and the rank and file of our profession are not to be trusted to tendency to general arterio-fibro: is is apparent at a much employ a potent drug-e.g., chloroform-with safety ; or (2) earlier age than obtains even with alcoholics. Takers of that chloroform possesses a special potency for evil of its methylated spirit deny the habit with a persistency and an own. No one, least of all THE LANCET, could insult the ingenuity which are only equalled by those of a cocainoprofession by attempting for a moment to maintain the maniac, and which are infinitely more acute than the excuses first of these propositions, which is belied in practice in the of the opium-drinker, whose habits are generally marked on his person. They differ, too, from the mere drunkard in case of other drugs quite as potent as chloroform every day, and the second is only true in so far as faulty and unsafe this, that but a small quantity can be taken at a time, and methods of administration are concerned. Chloroform has no the effects pass away quickly-phenomena which have been particular or mysterious potency or action of its own apart already noted in the case of ether-drinkers. Many of the from overdosing, and overdosing can be avoided by anybody victims are poor students and literary hacks, and unlike who knows how to look after the breathing in the right way. purer alcohols methylated spirit does not seem so prone to I would venture to urge that if THE LANCET, instead of using produce somnolence. The impossibility of early morning its enormous power to restrict the employment of chloro- sleep and the craving for the spirit with the break of form, adopted the opposite tactics and exerted all its in- day are marked characteristics, but instead of being heavy, fluence to extend the benefit of the anesthetic it would be sodden, blear-eyed, stupid, and sick, the victims, even in doing the profession a service of the greatest possible magni- the earliest morning, are bright, keen, intelligent, active, tude, which it would be impossible to repay. Snow’s yet with a yearning for the spirit which might be described As methylated-spiritobsolete methods and teaching have had a fair and ex- rather as a hunger than a thirst. tended trial, with the result that of the men who pass out drinking is indulged in to the extent of probably 100,000 from the English schools the best are said to be ,. lament- gallons per annum, and has doubtless caused infinitely more ably ignorant" and the rank and file "deplorably deaths than arsenical beer, it might be fitting that it should incompetent"in the administration of anaesthetics. Let receive some notice at your hands. I am, Sirs, yours faithfully, Syme’s principles and the Hyderabad method of administraJ. C. MCWALTER, tion of chloroform now have an equally fair trial and the McWALTEB, B.A., D.P.H., F.F.P.S. Dublin, Dec. 26th, 1900. entire position of anaesthetics will be changed. I am convinced from careful observation that the students of the London medical schools, judging especially by the young men who are entering the fervices in India, " SOME DISAPPOINTMENTS IN SURGERY." are unsurpassed anywhere, and if properly instructed To the Editors of THE LANCET. are capable of giving chloroform with absolute safety. I Here we use chloroform for everything, and as a rule we SiRs,-May I add a few remarks to those of Mr. D’Arcy never even extract a tooth, in hospital or private practice, Power in reference to "mental disturbance following a without it, and none of our patients, as far as I am aware, surgical operation " in his interesting paper on Some DisIt would be absurd to contend appointments in Surgery in THE LANCET of Dec. 22nd ever runs the smallest risk. that what we do daily in routine practice the men of the (p. 1789) ?7 It seems to me that none of the three cases he English schools cannot do at all. So long, however, as they cites from his personal experience is an instance of "postare controlled and hampered by an unfounded fear of operative insanity," strictly speaking. His first is " prechloroform anaesthetics will remain in their present unsatis- operative," to far as the report shows. The second is factory state, and surgery will continue subjected to the most likely 11 post-anesthetic," and the third was probably also toxic and septic. In classifying cases, I think degrading and throttling thraldom of ether. I am, Sirs, yours faithfully. those whose "mental condition is clearly impaired from E. LAWRIE, M.B.Edin., the time of recovery from the anaesthetic," and also Lieutenant-Colonel I.M.S., Residency Surgeon, those who are evidently septic, should be differentiated from Dec. 10th, 1900. " Hyderabad (Deccan). post-operative " cases pure and simple, in which so far as can be ascertained, the mental disturbance is not due to either the ansesthetic or a septic condition. Sir W. M. THE DRINKING OF METHYLATED SPIRIT. Banks and Dr. Macphail have both referred in their recent papers to an article of mine on Post operative Insanity in To the Editors of THE LANCET. the Journal of Mental Science for January, 1897. The points SIRS,-May I be permitted to draw attention to the relating to the action of anaesthetics, sepsis, &c., are, ravages which the drinking of methylated spirit, now, however, more fully discussed in "Cerebral and Mental indulged in to an enormous extent by the poorer classes of Symptoms," from which book the article noted was largely all the great towns, brings about amongst its victims. I would taken. I am, Sirs, yours faithfully, also suggest that the time is now opportune to investigate J. CHRISTIAN SIMPSON. Cambridge, Jan. 1st, 1901.

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