A INFILTRATION ANESTHESIA BY WALTER W. BRAND, M. D., TOLEDO, OHIO FTER examining the statistics from year to year, the seriousness of general anesthesia is becoming more apparent and the wish greater to shrink the high mortality rate, and, when it is possible, to replace general anesthesia by a practical method of local anesthesia. To Schleich of Berlin belongs the honor of having been the first to devise a method which is not only safe, but also very practical, because of its wide range of usefulness and its being unattended by any of the accidents which sometimes accompany general anesthesia. The many dangers connected with general anesthesia have led some members of the medical profession to devise some method of local anesthesia that will answer the purpose for many of the minor operations of surgery, of which so many are seen in office practice. Among the various methods which have been devised and found wanting are: compression of the efferent nerves, the application of cold in the form of ice, or one of the many ethers and the chlorid of ethyl. More satisfactory than any of these has been the injection of narcotic substances into the tissues or painting them upon the mucous surfaces. These substances produce anesthesia because they are cell poisons and are always attended with more or less danger. When using these injections we always have to wait for the substance to diffuse before anesthetizing, thereby enlarging the field of operation, but during this stage of diffusion there is always an intense burning pain. Cocain and eucain have been used more extensively for this purpose than any other narcotics. After Leibrich had demonstrated the fact that most all substances give rise to pain upon injection before anesthesia took place, Schleich continued the experiments with various solutions from time to time. Instead of using subcutaneous injections he used intracutaneous injections. He demonstrated that a 1-50 percent solution of cocain would produce anesthesia without a preceding hyperesthesia, weaker solutions producing pain before anesthesia. After using these very weak solutions of cocain and finding that they produce anesthesia, he tried plain distilled water. The wheal produced by the injection first gave rise to intense burning pain, and later became insensible to needle pricks. Upon continuing his experiments he found that the physiologic 3-5 percent solution of sodium chlorid gave the opposite result. There was no pain after injection, nor was there anesthesia. Finally he used a solution of medium strength of the 3-5 percent sodium chlorid and pure distilled water, and found that there was no pain after injection, but it did produce anesthesia. Unlike the anesthesia of cocain, the anesthetized area was limited to the zone of edema produced by the infiltration of the Read before the Northern Tri-State Medical Association at Toledo, January 23, 1898 tissue with the injected fluid. Insensibility to pain is produced immediately and you do not have to wait, as is necessary when using cocain, carbolic acid or bromid of potassium. The result of the immediate insensibility to pain is explained by the ischemia due to compression of the vessels and nerves by the infiltrated tissue and by the fluid being of a lower temperature than that of the body. If the fluid is about 40° F., the anesthesia is more marked and extends over a longer time. In preparing the solutions for this method of anesthesia sodium chlorid is made the vehicle. If the tissues are inflamed and hyperesthetic, add from 1-100 to 1-50 percent cocain. To the solution of sodium chlorid and cocain add from 1-200 to 1-40 percent morphin hydrochlorate, which will reduce the pain after operation to less than what it is after chloroform. The solution I have used and found most practical is what he calls No. 2, or medium strength. It contains: Cocain hydrochlorate Sodium chlorid, sterilized 0.1 0.025 0.2 ..100.0 Add to this one drop of a solution of formalin, 40 percent. Of this solution, from 50 to 75 syringesful can be used without any danger attending its use. and the anesthesia produced by this method lasts from 25 to 30 minutes. 706 Madison Street CLINICAL NOTE Extract from the official report of the vaccinating of Battery A, First Light Artillery, O. N. G., March 16, 1898: "All the men of this command had previously been vaccinated, and one had had small-pox. These, with but one exception, bore each from one to four typical marks, which evidenced the fact that the objective effect in each had been successfully attained. Two had been vaccinated each within two years, and from that the time intervened among the men extending back to childhood. "The order not having been made compulsory, not all the men submitted to the operation. Out of the whole number (sixty-one enrolled) fifty were treated. Of these, among whom were the two who had been vaccinated within two years, and the one who had had small-pox, forty-six were decidedly successful, each arm showing the typical characteristics; and while probably six or eight were uncomfortably annoyed, so far as I have been able to ascertain none were wholly incapacitated, but continued to follow their accustomed vocation. J. J. ERWIN, Capt. Med. Dept. 1st Lt. Art., O. N. G." Cleveland Journal of Medicine THE OFFICIAL JOURNAL OF THE CLEVELAND MEDICAL SOCIETY AND OF THE UNION MEDICAL ASSOCIATION OF NORTHEASTERN OHIO PUBLISHED THE TENTH OF EVERY MONTH AT 512-515 NEW ENGLAND BUILDING, 129-181 EUCLID AVENUE, CLEVELAND One Dollar a Year in Advance Single Copies Ten Cents EDITORIAL HOSPITAL STAFFS SHOULD BE PAID T is a sad fact, but none the less a fact well recognized by all of us, that the medical profession of today in America does not as a whole receive that respect which is due it as a learned and philanthropic profession. It is also true that as a consequence of this deficiency of respect the profession finds it all but impossible as a whole to secure the remuneration for its services which would be in keeping with that of the other professions, let alone the true value of the services to the community. This lack of respect is not often spoken of among us, and yet each one of us sees more or less evidence of it every day. There is no need to specify the ways in which this is shown, as we all know them but too well. The cause and the remedy are the matters of importance. One great cause, if not the chief one, is, we believe, the lack of respect the profession shows for itself in bartering away its services for little or nothing and in submitting to freely presenting our knowledge to vast numbers of people. As an abstract humanitarian principle it is right for us to succor the sick poor without price, but as a sociologic act it is a grave question if our doing so is not a serious factor in promoting poverty, shiftlessness and weak dependence, as well as a great damage to ourselves. It is wholly and absolutely wrong and immoral, and should be considered unprofessional conduct, for any physician to give his services free of all charge to any hospital, dispensary or other corporation organized for the care of the sick and injured. If one of us chooses to give his services freely to a sick individual, all well and good, but it is a curious and sinful distinction that has arisen in our institutional work where nurses, superintendents, attendants and all other employees, except the physicians, whose work is the most important and essential, are paid for their labor. Charitable organizations should pay their physicians just as they do their nurses or their gardeners. There is no justification whatever for the present method of conducting these institutions. If the physicians attached to these institutions were paid as they should be we would hear no more of the superabundance of hospitals and dispensaries. Herein lies the true remedy for the "dispensary evil," which is being fought so hard now in the eastern cities. Here also is the only remedy for the lack of respect shown the profession. How can a sensible and hard-headed public be expected to regard as rational beings men who deliberately throw away their best services, not for the sick poor mind you, for we can do all that in our offices, but for some corporation organized to care for the sick in the easiest and most approved fashion—a corporation which expects to pay good wages to all its employees except those whose services are absolutely essential, its physicians. And why does not the corporation expect to pay its physicians? Simply because we are fools enough to think we can increase our private practice by borrowing something from the luster of the institution to which we are attached. It is purest mock-heroics to say we do it for charity, because it is not true and because charity is far better done in another way. Yet the nurse is said to give her life, or some years of it, to "charity," but she gets her week's wages, as does the clergyman whose whole time is thus taken up. Charity organizations can just as well raise money to pay their physicians as to pay their nurses, and if this resulted in fewer such organizations neither the profession nor the deserving poor would be the losers thereby. Until the medical profession grasps this fact, which should be self-evident and not even need stating to be accepted as true, just so long will the public look upon us, and more correctly than should be, as a set of harmless idiots of some use to the sick but whose opinions are to be received with a raising of the eyebrows and a compassionate aside. In our own hand lies wholly our attaining that respect which all acknowledge is due our calling, and the abatement of the overabundance of hospitals and dispensaries, which increase the number of paupers and render more helpless those already such, which sap the vitality and self-respect of the profession, which cause nine-tenths of intraprofessional strife and "politics," which detract from the dignity of the profession, and which rob the old as well as the young physician of the cases and remuneration that are his by right. An awakening is at hand, and the present generation of physicians will live to see steps taken to at least initiate the correction of these evils. T HE bill providing for labeling of all "patent medicines" which contain poisonous drugs, "poison," having failed to pass our State Legislature, a measure, the Bennett bill, has been proposed, which provides that "patent medicines" shall have their formulas printed on the label. This latter is much the fairer provision and the Legislature should pass it as being very directly in the interest of the general public, which yearly consumes great quantities of stuff of unknown composition with very frequently disastrous results. The Leader, in its issue of April 6, attacks this bill in an editorial entitled "Attacks Upon Business Men." It is impossible to lay aside the suspicion that the pressure which the "patent medicine” makers are known to be making on all the newspapers is the reason of the Leader's attitude. What other reason can there be? Its arguments are of a most surprising character. Absolutely the sole argument advanced against the proposed measure is that few "patent medicines" contain enough poison to be deleterious to health, and that "nearly every physician's prescription contains one or more poisonous ingredients, and the compounds made from these prescriptions would be as deleterious to health as any 'patent' medicine if taken in doses larger than are indicated by the directions." Passing by the obvious fact that the last sentence entirely begs the question and destroys the argument, and also the fact of its general misrepresentation, one can but wonder if the writer of the above was simply fatuous or deliberately intended to deceive when he neglected to state that the physician's prescription is always on file at the drug-store where it was filled, and hence the composition of the medicine made up therefrom is always readily ascertainable; when he further neglected to allow anything for the special training of the physician, taken for the purpose of learning how to use medicine intelligently, and further neglected to allow for the care of the physician under which the effect of the remedy is watched and the precautions taken to avoid ill consequences of overuse. If the opponents of the Bennett bill have only this style of "argument" to urge against its passage, even the Ohio Legislature would be promptly compelled to put the law upon the statute books. Unfortunately a much more potent, persuading and insinuating "argument" is at hand for use on both the newspapers of the State and the lawmakers themselves. G OULD, with his well-known keenness of insight, in an editorial in a recent number of the Philadelphia Medical Journal, calls attention to an ethical rule which all the profession of the world should recognize. All physicians agree that true medical ethics, as well as our Code, require that a patient shall not be treated either at his house or at the physician's office, until it is certain that he is under the care of no other physician. Indeed, were this rule not in the main observed, medicine would become a sort |