Injection Anesthesia and its Critics.

G. H. CANDLER, M. D., CHICAGO, ILLINOIS

The success of the new anesthetic—hyoscine, morphine, cactin compound—seems to have no limit. The more it is tried the greater the demand and the more enthusiastic the reports from those who utilize the formula in their surgical and obstetrical work. Dr. Abbott informs me that he has now placed in the hands of the profession at large over two millions and a half tablets. This would probably mean about one million anesthesias.

Up to the present, despite the facts that the anesthetic is an entirely new thing, used under all sorts of conditions by all sorts and conditions of men, one death only has been charged to H-M-C. Enquiry proves that in this solitary fatality, death followed, not the anesthesia but the swallowing of his tongue by the patient, who was carelessly left by the nurse. This accident occurs during anesthesia quite often, regardless of the anesthetic used, and the unparalled safety of hyoscine, morphine, cactin would seem to the observant physician established beyond question.

Certainly we must discount seriously the statement made by the younger Wood that this agent would cause the death of one patient in each 221 anesthesias. There is a striking difference between one death in 221 and one in one million anesthesias. Neither ether nor chloroform, even today, when their use is so thoroughly understood, can show such a record, and it would be invidious to compare the fatalities which followed their use in the early days with this showing. There seems to be absolutely no disapproval of the new anesthetic save the almost venomous opposition offered to Dr. Abbott and his product alike by the group of men connected with the Journal of the A. M. A. and the Council of Pharmacy. The attacks made by these gentlemen upon H-M-C reveal an animus which entirely prevents a fair presentation of the subject.

The main attack of late has been made on cactin—earlier hyoscine hydro-bromide received some violent but mistaken criticism. It is unfortunate that most of the testimony in regard to the therapeutic efficacy of cactus comes from eclectic sources, and these the council finds it convenient to ignore. I fancy the Council will find it rather difficult to convince the eclectics that cactus is "inert" and useless, simply because they failed to find an alkaloid or other active principle in it. It seems difficult sometimes for more than one idea to find lodgment in a man's brain. The Council made a number of laborious experiments, and determined that cactus could not replace digitalin and strychnine in therapeutics.

If they had turned to the eclectic literature upon the subject, or even to the few reports that have been made on cactus by the old school physicians, they would have found that this was exactly what the advocates of cactus have always held. If one of these critical theorists would relinquish his preconceived ideas and try cactin clinically he would within a week discover that its action upon the heart is promptly and positively apparent.

The principal object of this article is to call attention to the "impartiality" and scientific acumen of this Council of Pharmacy and Chemistry. It is well to recollect, however, that this body is composed exclusively of chemists, that there is not a single practising or practical physician in it, excepting Dr. Simmons, and so far as is known Dr. Simmons himself has never had any experience in medicine save along homeopathic lines.

There is, therefore, not a man on the Council who is really qualified to pronounce upon any question of therapeutic efficacy or clinical observation. Their weakness in this direction, however, does not seem to have penetrated the consciousness of the members of the Council, who have given their judgment in this matter from the standpoint of the pharmacist purely.

In very striking contrast to their presentations are the reports emanating from regular, homeopathic and eclectic practicians alike. In these not a trace of sectarianism or partisan spirit is shown, (why should there be ?) but full credit is given the formula and its originator, with a frankness and enthusiasm which must grate harshly upon the sensibilities of the Council whose ipse dixit runs so entirely to the other extreme on H-M-C anesthesia.

Reading the reports from perfectly competent men it seems inexplicable that any physician would allow prejudice or the "say so" of some self-constituted authority to deprive him of the enormous advantages offered by H-M-C. The output of the preparation and the steady stream of "repeat" orders prove conclusively that in this as in other matters the mass of the profession prefers to think for itself.

One cannot but hope that the triumph of this preparation will cause a thorough study of the vegetable materia medica by the physicians of the regular school. Eclectic physicians have for many, many years called attention to the inestimable richness of this field, the superior efficacy of the remedies obtainable therefrom. Alkalometry, with its insistence upon the exhibition of the "smallest-known-to-be-effective" dose of the always-evenly-effective remedy has given us over fifty well understood active principles, and the laboratory is continually giving us new alkaloids, glucosids or resinoids which, exhibited in definite quantity, give definite therapeutic results.

Medicine promises to become a positive science, and those who would obstruct us in our search for truth and positive therapeutic agents need better arguments and. more efficient champions than have made their appearance so far. Powdered cinchona bark served the Jesuit fathers, but we prefer quinine; ether and chloroform have an unquestioned value, but H-M-C bids fair to surpass them both in general utility and safety.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.