The Birmingham age-herald., 1910-12-04
MANY PEOPLE ARE
 KILLED BY DRUGS London Writer Cites Danger in Use of Anesthetics NEED OF LEGISLATION Declares That Only Registered Physi- cians should Be Permitted to
 Apply Opiates - some
 Startling Figures
NEED OF LEGISLATION
M. D., in the London Mail.


 under anesthetics are becoming more frequent. Last week alone four inquests were held on persons who had died un der anesthetics. In 1866 there were 5 such deaths; in 1900, 116; in 1905 there these deaths.
 One thing is certain, and that is that the use of anesth cities should be con- trolled by legislation. At present they may be administered by anybody If I sell a glass of beer to another the law will punish me; but I may drug my friend to my hearts content and the law will ignore me. Moreover, if (sup- posing, as an illustration, that I am an unregistered practitioner, call in a medical man to administer an anes- thetic to my patient while I, let me say, am setting his broken bone-boneset- ters are numerous-that medical men will be punished by his professional au- thorities; but if I call on my cook to anesthetize my patient, then nothing will be said by any one. Seeing that an enormous number of minor opera tions are carried ont under anesthetics by unregistered and unqualified men. is there not here at least one ground for these deaths?
 Poisons the Patient
 Let me consider for one moment what placing a patient under an anesthetic really means. It means nothing more nor less than that I am going to poison my patient to the verge of safety. I am ad- ministering to him a deadly poison. and only knowledge, care and skill will make that administration safe. If my patient dies from the anesthetie I administer not merely under the anesthetic, which is very different pair of shoes-then I have killed him, and 1t remains for me to justify my action. Consequently, it is of the utmost importance not only thai my dose of poison should be the right dose; that the administration should he skillful. and that any complications thai may arise should be promptly and prop. erly met, but above all, that the anesthet- lo I have chosen should be the right one in the circumstances.
 For unquestionably many of the deaths recorded have been due to the adminis- tration of a drug which may be harmless to one person but deadly to another, or of drug of which so little Is known that it should be avoided altogether hhus l come to the second point-certain drugs must be forbidden to certain practi tioners
 Which, then, is the safest of these poisons some of which are inevitable?
 Actions of Anesthetics
 To answer this question 1t Is necessary to consider for one moment the action of the anesthetic. This, in the case Of the respirable kind-such as nitrous ox- lde Laughing gas). ether. chloroform. and mixtures of the two last-nay be the lungs which passes thence to satur- ate and intoxicate the blood flowing to the brain and thus paralyze the higher nerve centers while depressing the heart Both the blood circulating and the breath ing machines are at once affected. The affect Of the law and dangerous ''local' as cocaine, stovain, eucain and the iike-is to paralyze at once the immediate locality and often, to produce a general condi- ton which may be highly dangerous or deplorable.
 Next in order of general safety comes ether Of the advantages of ether, the fact of the stimulus on the heart is most It's chief disadvantage Is the extremely distressing preliminary ef- feet on the patient. But some distin- guished anesthetists who prefer ether obviate this by beginning with nitrous oxide After ether comes mixtures of ether and chloroform, the ether largely predominating; the mixture, ace, which means alcohol, chloroferm, and ether in of l. and 3; ethyl chloride, and lastly chloroform.
 Chloroform Most Deadly
 Undoubtedly, chloroform is the most deadly of these anestbetics-partly be- cause of its depressing qualities and partly, perhaps. on account of it's being so generally preferred by surgeons for lon goperations. and the longer a patient is kept in a state of anesthesia the great CT the risk. Of 132 deaths of males under snesthetics last year, 70 occurred under under ace, 6 under ether, 2 under ether and chloroform, 1 under ethyl chloride, under nitrous oxide, and in E cases where the drug is not reported the great majority almost certainly took place under chloroform.
 Of the few local anesthetics cocaine is the least dangerous but in many conditions 1t may be fraught with seri- ous risk; while stovain, eucain, noyo- cain and similar new and highly dan gerous drugs should be only used by highly qualified persons and then un- der exceptional circumstances.
 At any rate, the use of stovain and similar drugs for intra-spinal injection should be forbidden to every prac- titoner but specialist. They have re- suited in many deaths and have ire quently produced the most serious and unexpected after efrects--such, for ex- ample, as general paralysis. <
 For Dental Operatfon
 Next, no operation, not even a dental tipn affcu ehntilA he conducted by an operator unaided by an anesthetist. Of 13 fatal cases care fully examined into 12 occurred when the two functions were discharged by 6 single person. Nothing is more danger ous than this. The operator has to at tend to his own serious work, and the anesthetist must watch with unremit- ting attenention the effect of the drug on the patients condition, and, in par ticular, on his breathing, and be ready to act instantaneously.
 Third, no dentist should be allowed to use any anesthetic but nitrous oxide gas unless he has q registered medical practitioner acting as anesthetist; md, forrthly, the ordinary medical practition- CT himself must be better equipped In the future for the anesthetic operation. A practical course in the subject would
 ~0-7 pplsorv on all medical students In order to qualify, and greater facilities should be provided for the creation of q srecial class of anesthetists.
 One encouraging word in conclusion. believe that the proportionate increase in the number of deaths under anesthetics "''' ro' continue. There is already in existence tendency among the best an- esthetists to produce as light form Of anesthesia as is compatible with the need--that is to say, to obtain the pain