death under nitrous oxide and ether during a dental operation

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appalling. It is fortunate that he did not substitute some-

thing worse, although even in the case of borax mischiefmight have been done. In a district not far off a pastry-cook was found premeditating the admixture of unsound con-- densed milk, which was totally unfit for the food of man,with certain other materials for the preparation of " pound "

cakes. Some of the tins were without labels and"blown." It is evident that the tricks of unscrupulouspersons have not been entirely suppressed, as some

would have us believe. It is for those forms of

fraud, which have now grown so ingenious, that the pro-visions of the new Act have been principally strengthened.The margarine fraud is one of them. The law very properlyrequires the seller to call margarine by its proper name, andto sell butter as everybody understands that term, withoutany admixture with foreign fats. No one can doubt thewholesomeness of margarine as a food, but when butter-is demanded pure butter alone should be supplied. The

margarine industry objects to certain clauses of the proposednew Act on grounds the logic of which we fail to see, andthis position is well defined by a writer in the Times of

April 2nd. -

THE SALE OF POISONS.

THAT the law is not always logical was very well illus- (trated in a prosecution at Heywood last week, when achemist and druggist was charged with selling poison-,namely, strychnine-to a person unknown to him, and whowas not introduced to him by a person of whom he hadknowledge. A woman asked for rat paste, but he could notsupply it, and instead gave her vermin killer. On her return

journey home by train the woman swallowed the prepara-tion, and death eventually took place. The defence was

that rat paste was quite as deadly as vermin killer, but itdid not come under the schedule of the Act. Thedefendant was convicted and fined ten shillings andcosts. It is the same old story. The Act, in attempt-ing to provide against the indiscriminate sale of poisonsfails in a great measure because it is not sufficiently compre-hensive or stringent. We have had more than enoughevidence lately to prove the necessity of placing severalpoisons within the meaning of the Act that are at present notso classed. Apart from the injury done to the community,these omissions make it unnecessarily difficult for the phar-maceutical chemist to conduct his business comfortablyand legitimately, since, there is reason to suppose, heis just as anxious to comply with the requirements ofthe law as any other erson. Still, in the present casethe druggist committed an offence by neglecting to sell ascheduled poison in the prescribed way. The rat pastewould have done the same mischief, but then he wouldhave been free from blame. Bumble surely would havebeen right in his opinion of the law in this case.

"GAS BACILLI" AND PUTRESCENCE IN UTERO.1 V

DR. G. W. DOBBIN reports a case of puerperal sepsis, duemainly, he considers, to the bacillus aerogenes capsulatus.1The patient, a multipara with generally contracted pelvis,had been in labour two days with a child of large size, andwas under the care of a midwife. On approaching the bed asweetish, offensive odour was perceptible and the maternalgenitals emitted a bubbling, crackling sound, whilst the

vaginal discharge contained many gas bubbles. Deliverywas accomplished with the Tarnier basiotribe, underchloroform. Immediately after it there was an explosive-escape of sickening foetid gas from the uterine cavity. Therewas as yet no tissue emphysema. Next mourning 11 gasbacilli " were found in the tissues of the foetus and

1 Johns Hopkins Hospital bulletin, February, 1897.

in the placenta, and the same evening the mother died.A few hours later the body was enormously swollen andemphysematous all over. The foetus and the placenta werelikewise infiltrated with gas, which burnt with a flame when

ignited, and was infested everywhere by the " gas bacilli"along with staphylococci and streptococci. The placentalbloodvessels contained gas cysts surrounded by a zone ofthese bacilli, cultures of which were made. A pigeonand a rabbit were inoculated and rapidly developed anoedematous emphysema. These observations are in accordwith those of Welch and Nuttal,2 who attributed manycases of supposed entrance of air into the uterinesinuses to this parasite. They also found that this bacilluswhen inoculated into rabbits was not usually fatal, butthat if the animal were then killed the micro-organismdeveloped rapidly with abundant formation of gas in all

organs. Dr. Dobbin argues that in his case the bacilliwere introduced by the nurse ; that they found in the deadfoetus, as in the dead rabbit, a suitable nidus, and filled theuterine cavity with putrid gas ; and that the mother died notinfected by the bacilli, but poisoned by the toxins producedby them, her own macerated vaginal tissues, moreover, actingas a seat of germ development. Whether this explanation bein all points correct or not, the case itself should serve toaccentuate the danger of delay in casea of prolonged anddifficult labour.

___

DEATH UNDER NITROUS OXIDE AND ETHERDURING A DENTAL OPERATION.

AN occurrence so unusual requires careful examination.Has the feeling of security which has grown with regard tothis combination since Mr. Clover first introduced it intocommon practice been a delusion, or is some explanation athand ? The report of the death from a lay contemporary 1states the facts as follows. The patient, a woman agedtwenty-nine years, had been a nurse and was an able-bodied woman free from organic disease, but as

she suffered from neuralgia the removal of several

stumps and teeth was considered advisable. Mr. ArthurVernon Evans, M.R.C.S., L.R.C.P., administered nitrousoxide gas and ether, and ’’ about one and a half drachms

"

of ether were used. We may presume that an inhaler

was employed. The dentist had removed three teeth,when Mr. Evans observed that the patient’s face changedcolour and that the pulse ceased. Prompt removal from thechair and the performance of artificial respiration withhypodermic injection of strychnine failed to restore anima-tion. Death, it was thought, took place three minutes fromthe appearance of collapse. A necropsy was made, whichshowed the organs to be uniformly healthy. It seems

hardly likely that ether played any part in the catastrophe.The inhalation of about ninety drops would produce analmost inappreciable effect. There appears little doubt thatthe case was one of simple cardiac syncope occurringduring the state of recovery from a light anaesthesia. Theassumption, which appears in the evidence, that nitrousoxide acts as a cardiac depressant is, of course, not generallyadmitted, and, as is well known, syncope under that agent ismost rare. What happens in some cases is that an impedi-ment to expiration exists-such, for instance, as the forcingback of the tongue during the extraction of lower teeth,dropping of the jaw, or the faulty position of the patient’shead, and this leads to the patient being unable to rid thecirculation of the gas which has been inhaled. This will

produce syncope and death. The danger of such a pro-ceeding has only to be pointed out to be avoided. It is no

exaggeration to say that nitrous oxide gas has been givenmany millions of times and with impunity, and is being

2 Ibid., August, 1892.1 The Windsor and Eton Express.

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so given thousands of times daily. Perfection in arms-thetics has yet to be found, but it may fairly beclaimed for nitrous oxide that it has stood the test

of time well and may still claim for its title " the

safest of ansesthetics." It must be understood that nitrousoxide anaesthesia is not asphyxia ; the one condition isassociated with increased vigour of the heart’s action, theother rapidly leads to paralytic distension of the blood-vessels owing to impeded circulation through the lungs.

THE PLAGUE ON BOARD A BRITISH

TRANSPORT.

THE Dil7vara, hired transport, bringing troops from India,arrived at Southampton on April 6th. This is the vessel onwhich a case of fatal plague occurred on March 18th. On

reaching Suez the persons who had been in immediate con-tact with the deceased child were landed at Moses’ Wells,disinfection was carried out, and the vessel was allowed to

pass through the Suez Canal in quarantine-that is to say,with guards on board to prevent communication with theland on either side. Before the arrival of the ship at

Southampton Dr. Bulstrode, of the Medical Depart-ment of the Local Government Board, went downto Southampton to confer with Mr. Harris, the portmedical officer of health, and to arrange with the naval and

military authorities as to the landing of some 1200 men,women, and children on board, and he remained there towatch the disembarkation of the troops, &c. All necessaryarrangements were completed before the arrival of the

vessel, and, in accordance with English practice, no personswere detained, since all were healthy on arrival. The

arrangements at Southampton, which are largely due toMr. Harris’s admirable initiative, sufficed for all purposes ; and since no fresh cases had occurred on board nothing butmedical inspection and certain measures of disinfection werenecessary. This case proves anew how easy it is, withproper sanitary administration and healthy conditions onboard, to deal with and to prevent recurrences of plague, iand it also justifies the action laid down by the LocalGovernment Board in dealing with this disease, which wasformerly subject to quarantine at our ports. This is the thirdvessel reaching an English port in which there has been

plague derived from Bombay, and in no case has there beenany extension of the disease.

A CLINICAL meeting of the Neurological Society of London will be held at the rcoms of the Medical Society, 11, Chandos-street, W., on April 22nd, at 8.30 P.M. Members wishingto show cases are invited to communicate with one ofthe hon. secretaries, Dr. F. W. Mott and Dr. J. S. Risien

Russell, as soon as possible, and are requested to send to4, Qacen Anne-street, W., very short abstracts dealing withthe salient features of the cases.

THE Hospital Reform Association will present its memorialagainst hospital abuse to the Royal College of Physicians ofLondon in a few days’ time, so that members of the pro-fession are invited to sign it without delay. At the meetingof the Council of the Association held on April 1st it wasdecided to prepare a memorial on hospital reform for pre-sentation to H.R.H. the Prince of Wales.

UNDER the auspices of the American Surgical Associationand the Alumni Association of the Jefferson Medical Collegeof Philadelphia the statue of the late Professor Samuel D.Gross, M.D., will be unveiled near the Army MedicalMuseum, Washington, D.C., on Wednesday, May 8th, 1897.

INFANTILE MORTALITY IN EGYPT.

A CORRESPONDENT, who has been examining the weeklystatistical returns issued by the Egyptian Sanitary Depart-ment, has tabulated a summary of the facts relative to thedeaths of children during each quarter of the year 1896;and the results, which are shown below, may be correctlydescribed as appalling.

The unavoidable inclusion of the cholera deaths in the

portion of the table referring to the provincial towns hasthe effect of making the infantile death-rate appear to bemore favourable than was actually the case, for judgingby Cairo and Alexandria the number of young childrencarried off by the epidemic must have been comparativelysmall ; but even as they stand the figures represent a terriblepreponderance of premature mortality, no fewer than sixtyout of every hundred burials having been of children underfive years of age. Compared with the births this slaughterof the innocents comes out in, if possible, a worse light, aswill be seen by the subjoined table.

Deat7is per 1000 Births.

In the former table one of the most noteworthy featuresis the progressive increase in the mortality up to the endof the third quarter. It is not until the Nile rises andwashes away the impurities that the death-rate begins todiminish.