Gases Administered in Artificial Respiration
Authors: K. W. Donald, W. D. M. Paton
Journal: BMJ (1955)

DISEASEBr 313 be done by air, and he made a transit of 9,850 miles by this means.A year later, except for a little weakness, he was keeping reasonably well.Case 29.-A girl of 19 was first seen in 1949, when she had an extensive rheumatic heart disease.The history sug- gested the possibility of pericarditis 18 months previously, and physical examination showed very great enlargement of the heart, auricular fibrillation, and systolic and diastolic murmurs at the apex.Broadbent's sign was positive in the interspaces behind on the left: The x-ray film (Fig. 3) showed that the heart was enormous; the transverse diameter of the chest was 23.5 cm. and that of the heart, by orthodiagraph, was 19.5 cm.In spite of the extent of organic change she has remained symptomatically remark- ably well, and flew with her father from San Francisco to Australia via the Philippines without symptoms.In recent years she has flown more than 13,000 miles.Case 30.-A woman aged 41 with mitral stenosis, normal rhythm, and pulmonary hypertension had had increasing shortness of breath with several attacks of severe parox- ysmal dyspnoea before her journey from Singapore to London.She was found to have a severe degree of narrow- ing, the mitral orifice measuring 1.5 by 0.5 cm. at the time of operation.She has now returned to her home in the Far East.Comment These examples from many different varieties of cases of organic heart disease would seem to show that flying is perfectly safe when the heart is well compensated, and that it is a reasonable risk in patients whose state of com- pensation is not perfect, provided that the journey is neces- sary, or provided it is of such personal importance to the patient that he is prepared to take what can accurately be described as a very moderate risk.Generalizations as to suitability or unsuitability for flying cannot be made.Every case must be considered on its merits.TIhis opinion is confirmed by figures obtained from a recent survey carried out by the Medical Committee of the International Air Transport Association, which includes figures from 13 different air lines.It seems that on a five- year average one cardiac death has occurred per 1,113,000 passengers carried, and that one cardiac death has occurred per 800,000,000 passenger miles. ConclusionsThirty individuals, all with organic cardiovascular disease, are shown to have been able to undertake journeys by air successfully.They comprised most of the common varieties of severe organic heart diseases.In all cases the state of cardiac compensation was good at the time of flying, and in no patient did such air travel deleteriously affect the heart or the hypertension, either at the time or subsequently.Adequate pressurization of the aeroplane must be assured in such cases.This point must be confirmed with the airport officials as an essential preliminary.The benefit of the short air journey must be set against the disadvantage of the longer sea transit in such patients as may require to be in close contact wi'th specialized medical care for therapeutic or other pur- poses, and who yet need, perhaps for personal reasons, to make a long journey.