THE EFFECT OF ANÆSTHETICS ON THE LIVER.
1
769 should be that for a case of latent tuberculosis. The tendency to advance is hardly, if at all, influenced by withdrawal from further exposure to silica risk. Clearly both factors must be minimised, the dust hazard and tuberculous infection, in order to eliminate the disease. Much consideration is given to the factors leading to an observed increase in the production-rate of simple silicosis, 57 per cent. of which is accounted for solely by the altered average age of the personnel already mentioned ; while a great part of the remainder is due to greater refinement in the detection of cases. The evidence on the whole is encouraging to those who are applying practical preventive measures. The average duration of mining life of those who become silicotic has increased from 109 months in 1920-21 to 130 months in 1925-26 ; but the incidence of silicosis - still falls most heavily upon miners using machine drills. In 1917-18 among European miners 191 cases infected with tuberculosis were detected, compared with 37 in 1925-26. The native labourers are now recognised to be a potent source of infection, and steps have been taken to supervise their health more intimately. Apart from a strict initial examination on engagement any native losing 5 lb. or more in weight in three months, or 6 lb. or more in six months, is set Aside forstethoscopic examination; further, any native employed for five years or more is medically examined every three months and is radiographed annually. The native is as liable as the European to silicosis, but seldom remains a miner long enough to develop the disease ; he is far more liable to tuberculosis. Over 1000 cases of active tuberculosis, an incidence of 5 per 1000 native miners, were detected in 1925-26 ; in this way native " carriers " are being detected and eliminated. The results of these efforts to remove all sources of tuberculosis from among the mining community numbering nearly 200,000 males will be watched with interest. ____ THE EFFECT OF ANÆSTHETICS ON THE LIVER. Dr. S. M. Rosenthal and Dr. W. Bourne consider that the toxic effects of anaesthetics on a diseased liver play an important part in the causation of deaths during anaesthesia. To compare the action of various anaesthetics on hepatic function they have employed two tests. The first of these depends on I the disturbance of pigment metabolism, the amount -of urobilin in the blood and urine being an index of the damage sustained by the liver. The second is based on the power of the liver to remove brom- sulphalein from the blood and excrete it in the bile ; normally it is almost completely removed 15 minutes :after injection, but if the organ is injured the dye remains in the blood for a longer time. The experi- ments were done on dogs, and, with chloroform, it was found that brief periods of anaesthesia caused immediate toxic effects followed by functional impairment for eight days, whilst after two hours’ administration of chloroform recovery was not complete for six weeks. Disturbance of function could be shown by the bromsulphalein test long after the bilirubin in the blood and urine had returned to normal. Ether, on the other hand, had no effect on pigment metabolism and only a transient impair- ment was shown by the bromsulphalein test, recovery being usually complete in 24 hours. Nitrous oxide and ethylene, when given with oxygen, so that there was no cyanosis, caused no detectable changes with either test. When, however, these were given in such a way as to produce cyanosis, both immediate and delayed toxic effects could be demonstrated. It is suggested that cyanosis increases the vulnera- bility of the liver to anaesthetics. Large doses of morphine in dogs were found to act in the same way, and even without anaesthesia they caused considerable depression of function. Rosenthal and Bourne believe that in severe disease of the liver ethylene is the anaesthetic of choice. 1 Jour. Amer. Med. Assoc., Feb. 4th. Mr. Wilfred Trotter has been appointed Honorary Surgeon to the King, and Mr. Thomas Peel Dunhill has been appointed Surgeon to His Majesty’s Household. ____ WE regret to announce the death of Mr. Richard Lane Joynt, surgeon to the Meath Hospital, which occurred at Dublin on April 8th, at the age of 61. ’ Dr. George Chisholm Williams, who died on April 10th at his home in Finchley, had been disabled for many years as a result of radiological work carried out since 1895. Last year he was granted a pension on the Civil List in recognition of " Self-sacrificing services in the application of Rontgen rays to the treatment of disease." ____ THE Medical Registration Council of the Irish Free State has notified the Minister of Local Government and Public Health that the new Register will be established on May 26th, 1928. After that date no person whose name is not entered on the Register will enjoy the privileges of a qualified medical practitioner in the Irish Free State. In the first instance the Register will consist of those whose names are entered in the General Register with an address in the area of the Irish Free State and of those whose names are entered in the General Register with an address not within the area of the Irish Free State who notify to the Registrar within one month before May 26th their wish to be registered in the Irish Free State Register. While, therefore, every practitioner on the General Register is entitled to be registered on the Irish Register, only those resident in the Irish Free State will be automatically registered ; others must signify their wish to be so registered. After May 26th registration will only be effected on payment of a fee. As a result of visits to Central and Eastern Europe and the United States, the Malaria Commission of the Health Organisation of the League of Nations reported that the number of specialists in malaria was too small for the organisation of an effective campaign against the disease. To remedy this, the Health Organisation has arranged, since 1926, a series of special study courses in malaria for the benefit of doctors who have specialised, or who desire to specialise, in malariology. The courses are divided into two sections : (1) a theoretical course given in suitable institutes and laboratories ; (2) practical experience in infected areas where the campaign against malaria is actively carried out. In arranging the study courses, the Health Organisa- tion has secured the collaboration of Dr. Andrew Balfour, Director of the London School of Hygiene and Tropical Medicine ; Prof. E. Brumpt, of the University of Paris; Prof. Bernhard Nocht, Director of the Institute of Tropical Diseases at Hamburg ; and Prof. Vittorio Ascoli, Director of the School of Malaria in Rome. Instruction will be given in the language of the country where the course is being held. Courses in 1928, details of which are supplied by the Health Section of the League of Nations in Geneva, have been arranged in London, from April 25th to June 13th ; in Hamburg from May 7th to June 13th ; in Paris from June 1st to July 13th ; and in Rome from July 2nd to July 30th. SOCIETY OF MEDICAL OFFICERS OF HEALTH.- A meeting of this society will be held at the Guildhall, Bath, on Friday, April 20th, at 2.30 P.M., when there will be a discussion on Causes of the Decline in Tuberculosis Mortality. The opening speakers will be Sir Robert Philip, Dr. W. M. Willoughby, Prof. E. L. Collis, and Prof. Major Greenwood. Before the meeting the Mayor of Bath will entertain members of the society at luncheon. Those who intend to be present are asked to notify Dr. J. F. Blackett, M.O.H., Health Offices, Sawclose, Bath, not later than April 16th. ’
Transcript of THE EFFECT OF ANÆSTHETICS ON THE LIVER.
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should be that for a case of latent tuberculosis. Thetendency to advance is hardly, if at all, influenced bywithdrawal from further exposure to silica risk.Clearly both factors must be minimised, the dusthazard and tuberculous infection, in order to eliminatethe disease. Much consideration is given to the factorsleading to an observed increase in the production-rateof simple silicosis, 57 per cent. of which is accountedfor solely by the altered average age of the personnelalready mentioned ; while a great part of the remainderis due to greater refinement in the detection of cases.The evidence on the whole is encouraging to those whoare applying practical preventive measures. Theaverage duration of mining life of those who becomesilicotic has increased from 109 months in 1920-21 to130 months in 1925-26 ; but the incidence of silicosis- still falls most heavily upon miners using machinedrills. In 1917-18 among European miners 191 casesinfected with tuberculosis were detected, comparedwith 37 in 1925-26. The native labourers are nowrecognised to be a potent source of infection, and stepshave been taken to supervise their health moreintimately. Apart from a strict initial examination onengagement any native losing 5 lb. or more in weightin three months, or 6 lb. or more in six months, is setAside forstethoscopic examination; further, any nativeemployed for five years or more is medically examinedevery three months and is radiographed annually.The native is as liable as the European to silicosis, butseldom remains a miner long enough to develop thedisease ; he is far more liable to tuberculosis. Over1000 cases of active tuberculosis, an incidence of5 per 1000 native miners, were detected in 1925-26 ;in this way native " carriers " are being detected andeliminated. The results of these efforts to remove allsources of tuberculosis from among the miningcommunity numbering nearly 200,000 males will bewatched with interest.
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THE EFFECT OF ANÆSTHETICS ON THE
LIVER.
Dr. S. M. Rosenthal and Dr. W. Bourne considerthat the toxic effects of anaesthetics on a diseasedliver play an important part in the causation ofdeaths during anaesthesia. To compare the actionof various anaesthetics on hepatic function they haveemployed two tests. The first of these depends on Ithe disturbance of pigment metabolism, the amount-of urobilin in the blood and urine being an index ofthe damage sustained by the liver. The secondis based on the power of the liver to remove brom-sulphalein from the blood and excrete it in the bile ;normally it is almost completely removed 15 minutes:after injection, but if the organ is injured the dyeremains in the blood for a longer time. The experi-ments were done on dogs, and, with chloroform, itwas found that brief periods of anaesthesia causedimmediate toxic effects followed by functionalimpairment for eight days, whilst after two hours’administration of chloroform recovery was notcomplete for six weeks. Disturbance of functioncould be shown by the bromsulphalein test long afterthe bilirubin in the blood and urine had returned tonormal. Ether, on the other hand, had no effecton pigment metabolism and only a transient impair-ment was shown by the bromsulphalein test, recoverybeing usually complete in 24 hours. Nitrous oxideand ethylene, when given with oxygen, so that therewas no cyanosis, caused no detectable changes witheither test. When, however, these were given insuch a way as to produce cyanosis, both immediateand delayed toxic effects could be demonstrated.It is suggested that cyanosis increases the vulnera-bility of the liver to anaesthetics. Large doses ofmorphine in dogs were found to act in the same way,and even without anaesthesia they caused considerabledepression of function. Rosenthal and Bournebelieve that in severe disease of the liver ethylene isthe anaesthetic of choice.
1 Jour. Amer. Med. Assoc., Feb. 4th.
Mr. Wilfred Trotter has been appointed HonorarySurgeon to the King, and Mr. Thomas Peel Dunhillhas been appointed Surgeon to His Majesty’sHousehold.
____
WE regret to announce the death of Mr. RichardLane Joynt, surgeon to the Meath Hospital, whichoccurred at Dublin on April 8th, at the age of 61.
’
Dr. George Chisholm Williams, who died on
April 10th at his home in Finchley, had been disabledfor many years as a result of radiological work carriedout since 1895. Last year he was granted a pensionon the Civil List in recognition of " Self-sacrificingservices in the application of Rontgen rays to thetreatment of disease."
____
THE Medical Registration Council of the Irish FreeState has notified the Minister of Local Governmentand Public Health that the new Register will beestablished on May 26th, 1928. After that date noperson whose name is not entered on the Register willenjoy the privileges of a qualified medical practitionerin the Irish Free State. In the first instance theRegister will consist of those whose names are enteredin the General Register with an address in the area ofthe Irish Free State and of those whose names areentered in the General Register with an address notwithin the area of the Irish Free State who notifyto the Registrar within one month before May 26ththeir wish to be registered in the Irish Free StateRegister. While, therefore, every practitioner on theGeneral Register is entitled to be registered on theIrish Register, only those resident in the Irish FreeState will be automatically registered ; others mustsignify their wish to be so registered. After May 26thregistration will only be effected on payment of a fee.
As a result of visits to Central and Eastern Europeand the United States, the Malaria Commission ofthe Health Organisation of the League of Nationsreported that the number of specialists in malariawas too small for the organisation of an effectivecampaign against the disease. To remedy this, theHealth Organisation has arranged, since 1926, a
series of special study courses in malaria for thebenefit of doctors who have specialised, or who desireto specialise, in malariology. The courses are
divided into two sections : (1) a theoretical coursegiven in suitable institutes and laboratories ; (2)practical experience in infected areas where thecampaign against malaria is actively carried out.In arranging the study courses, the Health Organisa-tion has secured the collaboration of Dr. AndrewBalfour, Director of the London School of Hygieneand Tropical Medicine ; Prof. E. Brumpt, of theUniversity of Paris; Prof. Bernhard Nocht, Directorof the Institute of Tropical Diseases at Hamburg ; andProf. Vittorio Ascoli, Director of the School ofMalaria in Rome. Instruction will be given in thelanguage of the country where the course is beingheld. Courses in 1928, details of which are suppliedby the Health Section of the League of Nations inGeneva, have been arranged in London, from April25th to June 13th ; in Hamburg from May 7th toJune 13th ; in Paris from June 1st to July 13th ; andin Rome from July 2nd to July 30th.
SOCIETY OF MEDICAL OFFICERS OF HEALTH.-A meeting of this society will be held at the Guildhall,Bath, on Friday, April 20th, at 2.30 P.M., when there willbe a discussion on Causes of the Decline in TuberculosisMortality. The opening speakers will be Sir Robert Philip,Dr. W. M. Willoughby, Prof. E. L. Collis, and Prof. MajorGreenwood. Before the meeting the Mayor of Bath willentertain members of the society at luncheon. Those whointend to be present are asked to notify Dr. J. F. Blackett,M.O.H., Health Offices, Sawclose, Bath, not later thanApril 16th. ’
