SWITCHING OFF THE BRAIN

Stratford Evening Post, Volume XXXVII, Issue 18, 22 September 1913, Page 2

SWITCHING OFF THE BRAIN

THE PERFECT ANAESTHESIA

A remarkable development in surgery) by which the. area operated on may be shut.off entirely from the brailn tor'a period of nearly a week if necessary, was announced by Sir Berkeley Moynihan, of Leeds, at one of the meetings of the British Medical Association. 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 Moynihan pointed out that surgeons'are apt to delude themselves that because a patient lies unconscious and apparently unresponsive to anv hurt, no damage to his nerve centres is possible. Hero, 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 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 the abdomen can be carried oUt" thoroughly without the in fliction on the patient of any intoler able pain, and without his being cans ed to suffer any particular -distress afterwards. We owe this entirely to Crile (an American surgean), to whom the debt of surgery is already a heav.v one but I think that to the surgeon of tender heart his latest •achievement nmst, bring the most profound satis faction."

Sir Berkeley explained in greater detail the immense benefits of tin new principle, which is-termed "tech meal association." "Chile," he said, "has shown tha' in the condition recognised as 'shock' definite and demonstrable changes oc cur in the cells of the brain, whic: have discharged all the energy the; had stored. This exhausting dis charge of nervous energy- is due t the excitation which is caused by th infliction of numberless injuries, ea'c' if them small, or to the infliction o one overwhelming impression. ;' ■' "The fact that some surgeons pro luce lttle constitutional disturbances Ml& shock; ■ while -others -.majr.cftus! \iory serious collapse, is hot due tl ciiffdl'renees in the patient,' the anaerPietist, 'the m'et&od, or anything ehbut the stlVgeohhimsolf. There' ar, 'canine' 'surgeons wh6 operate on tli. ''canine' principle I >ot savage ' attack I. when the biting s andUearingi of tissue! arl terrible'to-witness. >-■ • < >•■'■<"■ "These are the 'surgeons who opon •ate with one eye on the clock. The judge of the beauty of any proceduv by'the fewness of the minutes whir it has taken to complete. These har< been described as 'carnivorous' sur geons. But there are other sur itif<the>Hight'hdud.v who use the. gentleness, an who deal, loving with, every tfeSiU" they'touch. The instrume:;' lof most precious use—is in some hand la royal sceptre, in others it is but : nide mattock., _,,, . ilfi ,., ■ * . , The perfect Wgeptt must have the heart of a lion and the hand of a lady —never the of a lion and th heart of a sheep.- - . .

I "Now, I have said that under etlie anaesthesia the brain is in great par [wide awake, : and during any surgica operation there'is in reply to ever: incision, every pull of the retractors indeed to every physical contact, t change in hte pulse, the respiration, and the blood pressure, and no gen era I anaesthetic can shelter the brain from the assault committed on it by the injuries inflicted during tin operatio on another part of the body. It i now suggested, therefore, that b means of local anaesthetics—novocaine for the skin, .quinine and urea for the parietal peritoneum —a barrier can b< erected round the area to be operated upon, so that no nerve impulsecan 1)0 conveyed from the territory so isolated. The field of operation, tha is to say, may be temporarily discon nectcd from tiie brain not only at tin time of operation, but for a period o from five to six days subsequently.

"The Bffect of thin," explained Si Berkeley, "is that the. operation c;i' lie conducted in. an area whirl) for th< time being does not belong to the pa tient, which he cannot reach by am impulse directed towards it, and whirl can be dealt with as the surgeon wishes without the patient having any powe. of receiving impressions from it."

Sir Berkeley said the most striking results of the surgeon's new powers which enabled him to investigate tin conditions of disease in an entirely novel manner, were seen in the treatment of exophthalmic goitre. It was no uncommon thing in such cases tr; find the patient suffering profoundly from shock, and the heart often beat so rapidly that it seemed to ho galloping to death, but by the new method the patient's emotional activities wvvc undisturbed, and within a few days his while appearance and condition underwent a striking change for the better.