872 TRANSACTIONS OF SECTION I. 



7. Surface Tension as a Factor in the Distribution of Salts inside the 

 Living Cell, By Professor A, B, Macallum, F.R,S, 



8. The Prevention of Deaths under Ancesthetics. 

 By FiiEDEiac W. Hewitt, M.V.O., M.A., M.D. 



Owing to the steady increase in the number of deatlis in connection with 

 the use of anresthetics for surgical operations, the prevention of these distressing 

 accidents constitutes one of the most pressing questions of the day. 



In order that the risk? incidental to generalised anaesthesia may be reduced, 

 it is obviously lirst necessary to study the conditions and circumstances under 

 which anaesthetics are now administered. At the present moment (1) the law 

 permits any person to produce general anaesthesia ; (2) many of the examining 

 bodies permit their candidates to qualify without producing evidence of having 

 received instruction in anaesthetics ; (3) the anassthetic dgpartments at our 

 hospitals are in many instances imperfectly and inadequately equipped both in 

 personnel and in other respects ; (4) anaesthetics, in both hospital and private 

 practice, are frequently entrusted to comparatively inexperienced practitioners ; 

 and (5) most of our hospitals publish no records of the anaesthetics administered 

 within them. 



Experience has conclusively shown that though anaesthetics are powerful 

 poisons, they may be safely administered provided that those who undertake their 

 administration have been properly educated and trained, and that the principles 

 under which they work, and the methods which they employ, are based upon 

 scientific data. The author referred to the valuable physiological researches of 

 Professor A. D. Waller, and to the work of other pliysiologists in the direction 

 of regulating the percentage composition of anaesthetic atmospheres. While 

 fully admitting that by percentage metliods the risks of ana3?thetics may be 

 reduced, it was submitted that the ground must first be cleared by better and wider 

 education, and particularly by instilling into students the absolute necessity of 

 securing a perfectly' free and unembarrassed air-way during anaesthetisation. 

 There is no single principle, indeed, the faithful observance of which will ensure 

 safety in every case. It was contended that there are three main principles which 

 must collectively be observed, viz. : (1) the selection of appropriate an;iesthetics ; 

 (2) the adjus*.ment of the percentage of the anaesthetic gas or vapour to meet the 

 requirements of the case ; and (3) the avoidance of the slightest obstruction to 

 the free entry and exit of air throughout the administration. The author dis- 

 cussed the relative importance of the second and third of these principles, and 

 suggested that a considerable step towards the solution of the main question 

 might be achieved if arrangements could be made whereby a committee of physio- 

 logists might observe, clinically, the usual modes of onset of difficulties and dangers 

 under anaesthetics. Such a committee would soon appreciate the difi'erences 

 between naso-oral and tracheal anaesthetisation, and the asphyxial effects which 

 may arise in the human subject as the result of naso-oral methods. The author 

 regards the third principle as the most important of the three ; for his whole 

 clinical experience, and the examination of the records of a large number of 

 recent fatal cases, kindly placed at his disposal by Dr. F. J. Waldo and 

 Dr. Freyberger, convince him that in the great majority of fatalities under 

 anaesthetics some obstruction to breathing above the trachea has been the imme- 

 diate cause of death. 



The following reforms are urgently needed : — 



(1) To make it a penal offence for any person other than a legally qualified 

 medical practitioner to administer an anaesthetic ; 



■ (2) To improve and extend the anaesthetic departments of our hospitals by 

 appointing experienced men of the highest academic ivnd professional attainments 

 tQ the various offices of such departments ; 



