Switching off the Brain.

Kaipara and Waitemata Echo, 17 July 1914, Page 2

Switching off the Brain.

PERFECT ANAESTHESTA BY A

NEW PROCESS

A remarkable development in surgery, by which the area operated on may be shut off entirely from the brain for a period of nearly a week if necessary, was announced by Sir Berkeley Moynihan, of Leeds, at the recent meeting of the British Medical Association at Brighton. Hitherto, it was explained, even when the patient was unconscious, each, incision of the knife was liable to cause shock to the brain, but under the new process barriers are placed on all the nerve centres, like gates across country roads,thus isolating completely the field of operation. Sir Berkeley M.olynihan pointed out that surgeons are apt to delude themselves that because a patient lies unconscious and apparently unresponsive to any hurt, no damage to--his nerve centres is possible. Here, however, a great mistake was made. Ether anaesthesia, declared Sir Berkeley, does not put all the brain to sleep. The larger part, and by far the more important part is awake, and ready to be acted on I and to be injured just as easily as if the patient were awake. " Happily," he said, "we are now able to make certain that any operative procedure in th.c abdomen can be carried out thoroughly without the infliction on the patient of any intolerable pain, and without his being caused to suffer any particular distress afterwards. We, owe this entirely to Crile (an American surgeon), to whom the' debt of surgery is already a heavy one, but I think that to the surgeon of tender heart his latest achievement must bring the most profound satisfaction." . - Sir Berkeley explained in greater detail the immense benefits of this new principle, which is termed "technical association." "Crile," he said, "has shown that in the condition recognised as 'shock ' definite and demonstrable changes occur in the cells of the brain, which have discharged all the energy they had stored. This exhausting discharge of nervous energy is due to the excitation which is caused by the infliction of numberless injuries, I each of them small, or to the infliction of one overwhelming impression. The fact that some .surgeons produce little constitutional disturbance or little shock, while others may cause very serious collapse, is not duo to differences in the patient, the anaes- I thetist, the method, or anything else but the surgeon himself. There are ' canine ' surgeons who operate on the ' canine ' principle of .savage attack, when the biting and tearing of tissues are terrible to witness. These are the surgeons who operate with one eye on the clock. They judge of the beauty of any procedure by the fewness' of the minutes which it has taken to complete. These have been described as ' carnivorous ' surgeons. But there are other surgeons who believe in the ' light hand,' who use the utmost gentleness, and who deal lovingly with every tissue they touch. The scalpel—an instrument of most precious use—is in some hands .a royal sceptre, in others it is but a rude mattock. The perfect surgeon must have the heart of a lion and the hand of a lady— never the claws of a lion and theheart of a sheep. "Now, I have said that under ether anaesthesia the brain is in great part wide awake, and during any surgical operation there is in reply to every incision, every pull of the retractors, indeed to every physical contact, a change in the-pulse, the respiration, and the blood pressure, and no general anaesthetic can shelter the brain from the assault committed on it by the injuries inflicted during an operation on another part of the body. It is now suggested, therefore, that by means of local anaesthetic—novocaine for the skin, quinine and urea for the parietal perrtoneum—a barrier can be erected round the area to be operated on, so that no nerve impulses can be conveyed from the territory so isolated. The field of operation, that is to say, may be temporarily disconnected from the brain not only at the time of operation, but for a period of from one to five days subsequently. "The effect of this," explained Sir Berkeley, "is that the operation can now be conducted in an area which for the time being does not belong to the patient, which he cannot reach by any impulse directed toward it,, and which can be dealt with las the surgeon wishes without the patient having any power of receiving impressions from it." Sir Berkeley said the most striking results of the surgeon's newpowers, which enabled him to investigate the conditions of disease in an entirely novel manner, were seen in the treatment of exophthalmic goitre. It was no uncommon thing in such cases to find the patient suffering profoundly from shock, and the heart often beat so rapidly that i it seemed to be galloping to death, but by the new method the patient's emotional activities were undisturbed, and within a few days his whole appearance and condition underwent a striking change for the better.

A cod weighing 7flb. lays nearly 7,000,000 eggs. ' 1899.