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SPREAD OF ANTIBIOTIC-RESISTANT BACTERIA
571 mether’sarms. The distraught mother, very young and travellingalone, told us that it was her first baby and he:nrst flight. She had travelled a long distance overnight before boarding the aircraft and the infant’s feeding schedule had obviously been upset by thejourney. I cried to examine the baby, which was a puny little thing only a few months old. Our aircraft was one of the more hear nothing of noisy types and, try as I would, I could what went on inside the infant’s chest. However, its colour was then quite good and it was breathing regularly if rather shallowly. It seemed more tired than anything else and fell asleep as I was looking at it. I was reasonably happy that nothing much was wrong and I tried to reassure the mother as I handed the baby back to her. She Accepted it unwillingly and stared at it as if it were some changeling. She could not convince herself that the child was indeed breathing, and within minutes her anxiety made her again cry out hysterically for the air-hostess. The latter, a most competent girl with a nursing qualification, then held the baby for a while, but she had many other jobs to do and could not nurse it indefinitely. The mother was obviously much too scared to look after it and the other female passengers regarded it somewhat askance. There seemed no alternative, so I took the child in my arms, much to the amusement of the other passengers, who were prepared to see the humorous side of the affair so long as it didn’t involve them. For the next four hours either the air-hostess or I held the baby. It stayed pale and listless but gave no real anxiety. I made two attempts to palm it off on a motherly looking passenger but she wasn’t having any. The mother and baby were supposed to continue their journey to Western Canada by another aircraft soon after our arrival in Montreal, and in the circumstances I felt that the baby should be properly examined under quiet conditions to see if it was fit to continue the journey. I asked the captain to radio ahead to Dorval and arrange for the airport doctor to meet the aircraft. As we came to a halt on the apron and the engines stopped there was an unusually prolonged silence. No-one seemed anxious to wheel the steps over to us, and the normally bustling officials hung back at a distance. I had reckoned without the quarantine regulations, and we were treated as outcasts until the airport doctor came to find out just what frightful illness we had on board. The unaccustomed silence woke the baby, who stirred in my arms. It smiled for the first time, and I could have " That was fun ! worn that it winked at me as if to say " didn’t I fool them ? *
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As the tram-car fibrillated its way along the High StreetI stole another glance at the pair sitting opposite ’;"’. The mother, tight-lipped and forbidding, stared dly into space. By her side, completely enveloped from head to waist in a large pillow-case, sat a small
Damy
Crockett had, I knew, been
consigned to the yesterday’s heroes ; space men were, on the thorityof my youngest, quite outre. What this latest costume was meant to resemble I couldn’t diagnoseKlu Klux Klan, perhaps. A grimy hand tugged at the mother’s dress. " Are we there yet, Ma ?" a plaintive wailed. No reply was forthcoming and the voice off into a dismal silence. Ghost riders of the sky, . thought, or Roy Rogers in disguise. ! as we came to our infirmary and at the same the little figure was jerked upright and hustled off uf
tram. The conductress didn’t look twice-the run was her regular route. As I walked up - drive I saw them ahead of me disappearing into the ’:.
entrance.
By chance .
. .:
-
.
I was called there a short time later. The stood grimly over a small boy, now divested of his while a perspiring house-surgeon and a nurse and tugged. As a utensil it had its uses, but head’was certainly not one of them. " He was playing at -aid the mother not without a certain sombre
Letters to the Editor THE MORTALITY OF ANÆSTHESIA
SIR,-It is easy to point out to Dr. Dunderdale (Sept. 1) that he need not be surprised that he has " never seen one obstetric case die as the result of the anaesthetic." I have produced evidence’- which suggests that in England and Wales the frequency of death from this cause in obstetrics is of the order of 1 for every 30,000 births. There is, therefore, a tendency to dismiss the personal experience of any one general practitioner as of little value in this respect, since the sum-total of an average doctor’s obstetric cases may not reach four figures in a life-time. However, the combined experience of numerous practitioners cannot be neglected. I have been allowed to study the records of maternal deaths in recent years in Birmingham and have shown that no death due to anaesthesia occurred in a series of 100,000 confinements (including 3048 forceps deliveries) conducted at home. There is no reason to doubt the accuracy of this. Deaths associated with childbirth do not go unrecorded, and the few deaths which did occur in the home were certainly not due to the anaesthetic. Since, during the same period, there were at least 8 deaths due to aspiration in hospital, I came to regard hospital methods, and in particular the anaesthetic machine, with suspicion, and I continue to believe that avoidable maternal deaths occur owing to inexpert handling of the machine. Until recently the open mask appeared blameless in respect of aspiration, but, Lock and Greiss2 record 4 cases, in a large series, in which fatal aspiration occurred during open-drop ether. It would be well therefore to keep an open mind, though Lock in a personal communication says : " Machines are often used by semiskilled administrators, with more difficulty developing than when ether or chloroform is used by a complete amateur "-i.e., on an open mask. Dr. Dunderdale implies that what we need today are " simpler and more direct methods in skilled hands." I prefer to leave " skilled hands " to choose the technique they prefer, but I would advocate the simple well-tried methods for the occasional anaesthetist. No shame need attach to the use of the open mask, if it gives the results I have quoted, in the home. Indeed I wonder if anything better (i.e., safer) can be taught to the student and houseman in hospital, provided he appreciates the dangers of chloroform. (Of the 29 deaths reviewed by Edwards et al.,3 2 were due to chloroform.) It may be assumed that he is already being taught the advantages of local anaesthesia over any other method, when it:can be used. R. B. PARKER. Walsall. SPREAD OF
ANTIBIOTIC-RESISTANT
BACTERIA
SIR,-In your leading article of Aug. 11 you used the words " Doctors should think twice about using antibiotics at all in most cases in which they are now given." The fantastic cost of antibiotics to the National Health Service resulted at the end of 1955 in my deciding on an experiment at the Royal Northern Hospital. I issued instructions that in my firm no antibiotic should be prescribed without my permission, unless the registrar considered that the patient’s life might be in danger by any delay in obtaining it. So far in 1956, antibiotics have been prescribed for my patients on three occasions only. London, W.1.
RAYMOND GREENE.
-
*
.
*
*
from -school.-My weight is 6 stone 6, my height is ’· ; I have very good eyesight and very good earshot.
’:
1. 2. 3.
Parker, R. B. Brit. med. J. July 7, 1956, p. 16. Lock, F. R., Greiss, F. C. Amer. J. Obstet. Gynec. 1955, 70, 861. Edwards, G., Morton, H. J. V., Pask, E. A., Wylie, W. D. Anœsthesia, 1956, 11, 194.
*
*
As the tram-car fibrillated its way along the High StreetI stole another glance at the pair sitting opposite ’;"’. The mother, tight-lipped and forbidding, stared dly into space. By her side, completely enveloped from head to waist in a large pillow-case, sat a small
Damy
Crockett had, I knew, been
consigned to the yesterday’s heroes ; space men were, on the thorityof my youngest, quite outre. What this latest costume was meant to resemble I couldn’t diagnoseKlu Klux Klan, perhaps. A grimy hand tugged at the mother’s dress. " Are we there yet, Ma ?" a plaintive wailed. No reply was forthcoming and the voice off into a dismal silence. Ghost riders of the sky, . thought, or Roy Rogers in disguise. ! as we came to our infirmary and at the same the little figure was jerked upright and hustled off uf
tram. The conductress didn’t look twice-the run was her regular route. As I walked up - drive I saw them ahead of me disappearing into the ’:.
entrance.
By chance .
. .:
-
.
I was called there a short time later. The stood grimly over a small boy, now divested of his while a perspiring house-surgeon and a nurse and tugged. As a utensil it had its uses, but head’was certainly not one of them. " He was playing at -aid the mother not without a certain sombre
Letters to the Editor THE MORTALITY OF ANÆSTHESIA
SIR,-It is easy to point out to Dr. Dunderdale (Sept. 1) that he need not be surprised that he has " never seen one obstetric case die as the result of the anaesthetic." I have produced evidence’- which suggests that in England and Wales the frequency of death from this cause in obstetrics is of the order of 1 for every 30,000 births. There is, therefore, a tendency to dismiss the personal experience of any one general practitioner as of little value in this respect, since the sum-total of an average doctor’s obstetric cases may not reach four figures in a life-time. However, the combined experience of numerous practitioners cannot be neglected. I have been allowed to study the records of maternal deaths in recent years in Birmingham and have shown that no death due to anaesthesia occurred in a series of 100,000 confinements (including 3048 forceps deliveries) conducted at home. There is no reason to doubt the accuracy of this. Deaths associated with childbirth do not go unrecorded, and the few deaths which did occur in the home were certainly not due to the anaesthetic. Since, during the same period, there were at least 8 deaths due to aspiration in hospital, I came to regard hospital methods, and in particular the anaesthetic machine, with suspicion, and I continue to believe that avoidable maternal deaths occur owing to inexpert handling of the machine. Until recently the open mask appeared blameless in respect of aspiration, but, Lock and Greiss2 record 4 cases, in a large series, in which fatal aspiration occurred during open-drop ether. It would be well therefore to keep an open mind, though Lock in a personal communication says : " Machines are often used by semiskilled administrators, with more difficulty developing than when ether or chloroform is used by a complete amateur "-i.e., on an open mask. Dr. Dunderdale implies that what we need today are " simpler and more direct methods in skilled hands." I prefer to leave " skilled hands " to choose the technique they prefer, but I would advocate the simple well-tried methods for the occasional anaesthetist. No shame need attach to the use of the open mask, if it gives the results I have quoted, in the home. Indeed I wonder if anything better (i.e., safer) can be taught to the student and houseman in hospital, provided he appreciates the dangers of chloroform. (Of the 29 deaths reviewed by Edwards et al.,3 2 were due to chloroform.) It may be assumed that he is already being taught the advantages of local anaesthesia over any other method, when it:can be used. R. B. PARKER. Walsall. SPREAD OF
ANTIBIOTIC-RESISTANT
BACTERIA
SIR,-In your leading article of Aug. 11 you used the words " Doctors should think twice about using antibiotics at all in most cases in which they are now given." The fantastic cost of antibiotics to the National Health Service resulted at the end of 1955 in my deciding on an experiment at the Royal Northern Hospital. I issued instructions that in my firm no antibiotic should be prescribed without my permission, unless the registrar considered that the patient’s life might be in danger by any delay in obtaining it. So far in 1956, antibiotics have been prescribed for my patients on three occasions only. London, W.1.
RAYMOND GREENE.
-
*
.
*
*
from -school.-My weight is 6 stone 6, my height is ’· ; I have very good eyesight and very good earshot.
’:
1. 2. 3.
Parker, R. B. Brit. med. J. July 7, 1956, p. 16. Lock, F. R., Greiss, F. C. Amer. J. Obstet. Gynec. 1955, 70, 861. Edwards, G., Morton, H. J. V., Pask, E. A., Wylie, W. D. Anœsthesia, 1956, 11, 194.