Anesthesia in the Field.
W. C. ABBOTT, M. D., CHICAGO, ILL.
(When you read this glowing praise, remember: W. C. Abbott was rather involved in Abbott's Alkaloidal Company, who manufactured H-M-C. -Henriette)
[image:13631 align=left hspace=1]During the past year a number of articles have appeared in the medical journals treating of the administration of the ordinary volatile anesthetics. The trend of these papers, without a solitary exception, has been to urge the limitation of these powerful agents to the hands of specially skilled administrators. Good! That is as it should be.
Dr. Littig, a distinguished surgeon of Iowa, in a detailed hunt for H-M-C mortality (which he did not find) last year, collected and published a list of seventy deaths occurring in that state from the use of these anesthetics. The occurrence of thirty-nine deaths out of about 100,000 administrations at Guy's Hospital, as reported sometime since, has led the British authorities to insist that the volatile anesthetics be restricted to professional specialists in their application. Certainly this can only be because the authorities consider these remedies perilous. While this is a mortality of but one in 2564, it is too large provided any of these patients could have been saved by the substitution of any other anesthetic.
My mail this morning brought me the following items from a clipping bureau: At Muskogee, Okla., F. V. Burtis died on the operating table while having a broken leg reset. At Minot, N. Dakota, a chambermaid died from chloroform and the doctor was held to the district court on his own testimony. Prosecutor Heney at San Francisco was reported as suffering a setback due to the effect of the anesthetic on his kidneys. At Columbus, Ohio, Catherine Bobb, a child of eight years, died in the doctor's office shortly after the administration of an anesthetic preparatory to an operation. The doctor testified: "Death was due to anesthesia, which is apt to occur in the experience of any surgeon. There are many such cases on record, it is said, in which, for some unexplainable reason, the human organism yields to the anesthetic." At Sloan, Iowa, Mrs. A. M. Fecor died in the dentist's chair after having had teeth extracted under chloroform administered by a physician.
In addition, a Chicago paper states that two physicians of that city attended a woman for some ailment of the hand; they desired to employ an anesthetic which she refused, being afraid of it; and not availing themselves of the peculiar adaptability of the H-M-C tablets in just such emergencies, the results were such that the doctors are now defendants in a $20,000 malpractice suit.
These are a few of the stray items that occasionally creep into the newspapers (not into the J. A.M. A. and her fearsome brood of course) and illustrate the true state of affairs that prompts this demand that these anesthetics, ether and chloroform, should be exclusively administered by skilled specialists. But—while this may do for the big city hospitals and college clinics, what is the real doctor to do? He cannot lug a special anesthetist about with him on the chance that there may be an accident some day. When he is called to an accident he must grab his emergency bag (as his regular practice-case always should be) and run. It may be that a man has fallen against the circular saw at the sawmill; or a tree has fallen on somebody and crushed him; or the doctor may have on his hands a carload of wounded from a railway accident. Anyway, he is called on to give relief and that at once. The man may die of pain while being transported to a hospital—and after all is the American doctor so weak in professional attainments that he has to send all his surgery to the hospital? What shall he do?
Take the railway accident with a number of injured, all suffering, dying, clamorous for instant attention. Is the doctor to wait till he has a special anesthetist for each case? Not much—he takes out his hypodermic syringe and his vial of H-M-C tablets, and he gives every patient a "shot" that puts him at his ease; then he takes up the work, beginning with the worst cases while the rest wait contentedly now that they are relieved from pain and apprehension. He finds that the objections to whatever operative measures he counsels have subsided; there is no dread of anesthesia, or terrified protests against "the knife;" no life-destroying delays.
The preeminent fitness of this anesthetic resource for accidental or emergency surgery is established by thousands of witnesses, men who have tried it themselves and are not to be scared away from a useful remedy by others who have not tried it but presume to speak from a priori reasoning that may or may not be correct. But—is the H-M-C safe?
Judge for yourselves. The Abbott Alkaloidal Company has placed in the hands of the medical profession more than six millions of these H-M-C compound anesthetic tablets. These have not gone largely to the skilled anesthetists, although many are using it to excellent satisfaction, but to the rank and file of our profession, the men who do its real live emergency work, men whose qualifications you all know to be pretty well mixed, but who meet the emergencies pertaining to our profession as creditably as those of any other, to say the least. Well, out of these millions of anesthesias, used for pain, etc., we have been able to collect just five instances in which deaths have occurred that have even been attributed to the H-M-C, and four were stoutly combated by some of the physicians connected with the cases, who maintained that the H-M-C had nothing to do with the deaths.
However, admitting for argument that all five were due to this agent, we have a mortality of one for every 1,200,000 tablets. That's (little) enough for all practical purposes, as Howard Rand said, when somebody told him the world was coming to an end in thirty thousand years. But where is the dreadful mortality predicted by young Wood and insisted upon by Simmons and his ilk? His estimate, based on the European use of scopolamine, not hyoscine, was one death in 221 cases. This calls for about 27,000 deaths from the six millions. Please Mr. Editor, I have no such private graveyard about my premises. Instead I have over 25,000 recorded users who have written me reams of encomiums with no word of kick except what was largely to be explained on the basis of faulty technique by the user.
This is not the only time in which Wood's propensity to theoretical a priori reasoning has led him into error, greatly to the detriment of his trustful, unthinking followers. Some years ago the claim was advanced that atropine was a valuable hemostatic. Wood at once said it was not true, because atropine increases vascular tension. Appeals made to the profession at large elicited numerous reports showing that atropine was a powerful, prompt and sure hemostatic, in every form of hemorrhage to which humanity is liable, with one exception, but including traumatic cases, Only two exceptions were found, both relating to cases where the bleeding was due to ulcerative erosion of large arteries. Now, Sollman, a member of the Council of Pharmacists and Chemists, tells us in his work on Pharmacology, that atropine is only occasionally and slightly a vascular contractor, and this action is evanescent; while large doses strongly relax the arterial tension. Clinical testimony proved our contention to be correct, and then—the laboratory acknowledged it had made a mistake. Wood, so far as I know, (and as is the manner of the weakling positioned in so-called places of authority by chance) says nothing. If he has, if he has come out squarely and acknowledged his error, as his able father would have done, and will "show me," I will apologize.
When you know you are right, when you know you know and know why you know, stick to it, and the other fellow will have to come in time or wear the brand. Atropine, rightly used, is a valuable physiological hemostatic and H-M-C is a winner.
H-M-C is a winner! 1. As a relief for pain and spasm, giving the maximum of desired morphine effect, with no disagreeable after-effect, and therefore efficient in much less than usual morphine dosage.
2. As a preliminary sedative and quieter of nervous apprehension when complete anesthesia is to be obtained with chloroform or ether, effectually preventing nausea and producing anesthesia in far less time and with much less anesthetic than is usually (otherwise) required.
3. To produce complete anesthesia, properly used, which effected is easily sustained for operative hours and q. s., followed, without nausea and vomiting, by hours of restful sleep and quiet.
4. To quiet apprehension and relieve the pains of "labor," properly used, rendering the process without essential suffering and with greater safety to both mother and child, the mother thus humanely treated expressing delight beyond compare.
This is H-M-C—what it does cito tuto et jucunde. It is purposefully criticized by theorists without experience and certain purposeful hypocrites who would impede, but cannot stop, its progress, while it is loved by those who, using and knowing, have faith in and satisfaction from its use that comes to the doctor and his patient all too seldom.
The profession is awakening. Right, truth and justice will presently prevail, and the real working doctor will in time come into his own.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.