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RECENT IMPROVEMENTS IN REGULATING CHLOROFORM INHALERS.
1555 Inhaler fitted with the feather respiration indicator attached a vulcanite face-piece, with the Dudley Buxton funnel for filling and tube for blowing chloroform vapour into the mouth or nostril. The vulcanite face-piece can be replaced by a flannel cap or piece of domette stretched across a metal frame. The latter is a safer and more cleanly form’ of mask and, as it is now supplied with little clips which enable the administrator to readily replace the domette or I flannel used in each case, it should commend itself to I those who study to eliminate infection through the use of dirty inhalers. Graduated Air. In Fig. 2 is shown a ball now supplied in place of the
dispensary medical officer in Ireland is in general overworked and underpaid. It is nothing short of a scandal that he should be compelled to go on working in many cases when quite broken in health or incapacitated by reason of the infirmities of old age. A suitably adjusted system of superannuation would be not merely an act of justice to a bard-worked class of meritorious public servants, but clearly to the advantage of the public. Work such as that devolving upon dispensary medical officers can only be discharged efficiently by men in good health and not too far advanced in years. The next and concluding article will complete our examination of the Bill.
The
to
,
FiG. 2.
RECENT IMPROVEMENTS IN REGULATING CHLOROFORM INHALERS. Definite Dosage. BASING all their efforts upon the principles enunciated by Snow, that 18 minims of chloroform contained in the circulation of an average adult sufficed to produce complete
FIG. 1.
FIG. 3.
anæsthesia, Messrs. Krohne and Sesemann have improved Dr. former round Junker’s inhaler and made various alterations in its struction of which the
following
is
an
account.
con-
Fig.
1
represents Messrs. Krohne and Sesemann’s improved Junker’s
one, allowing definite quantities of air to be pumped through the chloroform according as the admini strator compresses the rings marked 1, 2, 3, and 4. Fig. 3 shows the apparatus made for use in the tropics, the
1556 being confined to the tubes connecting the Fig. 4 shows the apparatus with vulcanite or metal air-pump face-piece and mouth-tube. It will be with Ecrew piston rod and nut. This arrangement ensures seen that by moving the stop the amount of chloroform is a rigid precision in the amount of chloroform administered, regulated by the air pumped through the liquid, and jr, , , even, it is claimed, to 1/100 of a minim. By its use, after or 1 minim is delivered at each compression of the bellow?. commencing the inhalation with a most minute quantity, a gradual and regular increase in definite quantities can be effected. Fig. 5 is to show how accurately the amount FIG. 4. of chloroform used can be measured. The eighth drachm is divided up into minims which can readily be read off use
of rubber
small bellows with
after each administration. It is asserted that with this apparatus 18 minims of chloroform will literally produce profound anaesthesia. For this to be the case of course there must be no waste, the quantity must enter the blood of the patient, and to do so in the best possible manner there is no doubt that Messrs. Krohne and Sesemann are correct in advising that it should be given in the most minute doses at a time so that the 18 minims are not absorbed for some minutes. It must be borne in mind that such an ideal result is only attainable in the case of patients who breathe easily and regularly. The data upon which Snow based his figures and those upon which Messrs. Krohne and Sesemann base theirs are derived from auto-inhalation (where the object of the individual is to inspire), whereas in actual practice patients are not always equally well affected towards the anesthetic and rebel against it if it is not sufficiently diluted. The extreme value of great dilution of the vapour is shown in such cases so that, although the 18 minims limit may be not always achieved, yet by means of a regulating inhaler such as the one under review a far better and infinitely safer result can be obtained than was possible with the older and more crude methods so long in use. As a rule profound anxsthesia is secured with from 1 to 1’5 per cent. of chloroform vapour in the respired air.
ANNUAL REPORT OF THE REGISTRARGENERAL ON BIRTHS, DEATHS, AND MARRIAGES IN ENGLAND (1896). FiG. 5. IN THE LANCET of May 21st we reviewed the RegistrarGeneral’s annual summary of births, deaths, and causes of death in London and other large English towns for the year 1897, and shortly after going to press we received the report now before us which has reference to the preceding year, 1896. To the uninitiated it does not clearly appear why the report cannot be published until a year later than the summary relating to the same year, we have therefore made inquiries in the proper quarter and have ascertained the following particulars. The annual summary is compiled from the weekly and quarterly returns of the local registrars and relates to the deaths occurring in the 100 principal towns of England and Wales ; it can therefore be issued shortly after the close of the year to which it relates and, as a matter of fact, it is generally published about the end of the first quarter of the ensuing year. But the annual report, which is based on the certified copies of the local death registers, cannot even be commenced until these copies have been received at the Central office from every registration district in England and Wales. As the deaths amount to as many as half a million annually and every one of these has to be classified according to age, cause, and locality by experts in the Statistical Department at Somerset House, it will be understood that a vast amount of clerical labour has to be expended before the 380 pages of tables can assume a form suitable for comment and comparison. In the annual report for 1896 several topics of statistical interest are dealt with, either for the first time or else more fully than in previous annual reports. To one of these topics, which deals with the question of coroner’s inquests in relation to uncertified deaths, we referred at length in our leading article of last week. The mortality of England and Wales in 1896 corresponded to a rate of 17’1 per 1000 living. With the exception of the year 1894, when it was lower by 0’5 per 1000, the rate of English mortality in 1896 was the lowest on record. At the several periods of life the death-rates in this year were with very few exceptions the lowest since the commencement of civil registration in 1837. Infantile mortality in 1896 was equal to 148 per 1000 births, and differed scarcely appreciably from the average in the preceeding ten years. In registration counties the mortality
dispensary medical officer in Ireland is in general overworked and underpaid. It is nothing short of a scandal that he should be compelled to go on working in many cases when quite broken in health or incapacitated by reason of the infirmities of old age. A suitably adjusted system of superannuation would be not merely an act of justice to a bard-worked class of meritorious public servants, but clearly to the advantage of the public. Work such as that devolving upon dispensary medical officers can only be discharged efficiently by men in good health and not too far advanced in years. The next and concluding article will complete our examination of the Bill.
The
to
,
FiG. 2.
RECENT IMPROVEMENTS IN REGULATING CHLOROFORM INHALERS. Definite Dosage. BASING all their efforts upon the principles enunciated by Snow, that 18 minims of chloroform contained in the circulation of an average adult sufficed to produce complete
FIG. 1.
FIG. 3.
anæsthesia, Messrs. Krohne and Sesemann have improved Dr. former round Junker’s inhaler and made various alterations in its struction of which the
following
is
an
account.
con-
Fig.
1
represents Messrs. Krohne and Sesemann’s improved Junker’s
one, allowing definite quantities of air to be pumped through the chloroform according as the admini strator compresses the rings marked 1, 2, 3, and 4. Fig. 3 shows the apparatus made for use in the tropics, the
1556 being confined to the tubes connecting the Fig. 4 shows the apparatus with vulcanite or metal air-pump face-piece and mouth-tube. It will be with Ecrew piston rod and nut. This arrangement ensures seen that by moving the stop the amount of chloroform is a rigid precision in the amount of chloroform administered, regulated by the air pumped through the liquid, and jr, , , even, it is claimed, to 1/100 of a minim. By its use, after or 1 minim is delivered at each compression of the bellow?. commencing the inhalation with a most minute quantity, a gradual and regular increase in definite quantities can be effected. Fig. 5 is to show how accurately the amount FIG. 4. of chloroform used can be measured. The eighth drachm is divided up into minims which can readily be read off use
of rubber
small bellows with
after each administration. It is asserted that with this apparatus 18 minims of chloroform will literally produce profound anaesthesia. For this to be the case of course there must be no waste, the quantity must enter the blood of the patient, and to do so in the best possible manner there is no doubt that Messrs. Krohne and Sesemann are correct in advising that it should be given in the most minute doses at a time so that the 18 minims are not absorbed for some minutes. It must be borne in mind that such an ideal result is only attainable in the case of patients who breathe easily and regularly. The data upon which Snow based his figures and those upon which Messrs. Krohne and Sesemann base theirs are derived from auto-inhalation (where the object of the individual is to inspire), whereas in actual practice patients are not always equally well affected towards the anesthetic and rebel against it if it is not sufficiently diluted. The extreme value of great dilution of the vapour is shown in such cases so that, although the 18 minims limit may be not always achieved, yet by means of a regulating inhaler such as the one under review a far better and infinitely safer result can be obtained than was possible with the older and more crude methods so long in use. As a rule profound anxsthesia is secured with from 1 to 1’5 per cent. of chloroform vapour in the respired air.
ANNUAL REPORT OF THE REGISTRARGENERAL ON BIRTHS, DEATHS, AND MARRIAGES IN ENGLAND (1896). FiG. 5. IN THE LANCET of May 21st we reviewed the RegistrarGeneral’s annual summary of births, deaths, and causes of death in London and other large English towns for the year 1897, and shortly after going to press we received the report now before us which has reference to the preceding year, 1896. To the uninitiated it does not clearly appear why the report cannot be published until a year later than the summary relating to the same year, we have therefore made inquiries in the proper quarter and have ascertained the following particulars. The annual summary is compiled from the weekly and quarterly returns of the local registrars and relates to the deaths occurring in the 100 principal towns of England and Wales ; it can therefore be issued shortly after the close of the year to which it relates and, as a matter of fact, it is generally published about the end of the first quarter of the ensuing year. But the annual report, which is based on the certified copies of the local death registers, cannot even be commenced until these copies have been received at the Central office from every registration district in England and Wales. As the deaths amount to as many as half a million annually and every one of these has to be classified according to age, cause, and locality by experts in the Statistical Department at Somerset House, it will be understood that a vast amount of clerical labour has to be expended before the 380 pages of tables can assume a form suitable for comment and comparison. In the annual report for 1896 several topics of statistical interest are dealt with, either for the first time or else more fully than in previous annual reports. To one of these topics, which deals with the question of coroner’s inquests in relation to uncertified deaths, we referred at length in our leading article of last week. The mortality of England and Wales in 1896 corresponded to a rate of 17’1 per 1000 living. With the exception of the year 1894, when it was lower by 0’5 per 1000, the rate of English mortality in 1896 was the lowest on record. At the several periods of life the death-rates in this year were with very few exceptions the lowest since the commencement of civil registration in 1837. Infantile mortality in 1896 was equal to 148 per 1000 births, and differed scarcely appreciably from the average in the preceeding ten years. In registration counties the mortality