Report of the Anaesthetics Committee. (appointed 1891) July, 1900.

  • British Medical Association. Anaesthetics Committee.
Date:
1900?]
Catalogue details

Licence: In copyright

Credit: Report of the Anaesthetics Committee. (appointed 1891) July, 1900. Source: Wellcome Collection.

    72/148 (page 68)
    These several tables show certain facts. Under all anaesthetics, taken collectively, 93-6 per cent, of the tabulated operations took place between 6 a.m. and 6 p.m., less than 1 per cent, between midnight and 6 a.m., the remaining 54. per cent, after 6 p.m. The incidence of complications wholly or in part traceable to the anaesthetic is considered under the tables relating to each anaesthetic in turn. It must be remembered, however, that the cases of different parts of the day are not absolutely on a parallel. Thus, only cases of urgency are under operation before 6 a.m.; “ gas ” cases at the dental hospitals swell the records of the second and third quarters; the major operations at the large metropolitan hospitals usually occur in the third quarter. Many small operations performed by resident hospital officers are done after 6 p.m. These differences probably tend to vitiate deductions which might otherwise be drawn from these tables. Anaesthetic 1 (chloroform), was the agent used in 9,227 (52^37 per cent.), of the 17,626 cases, and was employed in no less than 94 of the 117 cases of danger recorded in the tables, and in 12 of the 18 tabulated cases of death. It was used in 77 of the 113 cases that occurred before 6 a.m., and in every one of the four cases of complication recorded in this quarter of the day. The percentage of cases of complication (5*19), in this small group of cases was much higher than the corresponding rate in either the second or third quarter, and more than treble the complication rate of the fourth quarter of the day (i‘54)- The danger rate before 6 a.m.—based, however, upon only 2 cases—was 2\ times higher than that in either of the next two quarters, and 4 times higher than the danger percentage of the last quarter of the day. The percentage of deaths was i-3 in the first quarter, 0^027 in the second, O'16 in the third, and C31 in the fourth. After the first quarter (of which the number of cases (77) is too few for fair comparison with cases of other quarters), the percentage of deaths rose quickly from the second to the fourth quarter. Another fact comes out in strong relief. In the 12 night hours (6 p.m. to 6 a.m.), of 6 cases classified under danger, 3 {i.e., 50 per cent.), died ; but of the 88 danger cases that occurred during the 12 hours of the day from 6 a.m. to 6 p.m., 9 (io-2 per cent.) died. Anaesthetic 2 (ether), was given in 3,073 cases ; of which 24 were before 6 a.m., and these were all without complication. The highest percentage of complicated cases (4^82) was between 6 a.m. and noon ; the corresponding rate in cases of the third quarter of the day was 2'qi ; and it sank to i-87 in the cases of the fourth quarter. The danger percentage only expressed itself in cases occurring between 6 a.m. and 6 p.m., being for those 12 hours o-28. This rate contrasts well with the “ danger ” percentage of chloroform cases occurring also between 6 a.m. and 6 p.m., which was ro3. But, whilst 79 of the 88 danger cases under chloroform {i.e., Sg'8 per cent.) in these two quarters of the day recovered, only 6 of the 8 danger cases {i.e., 75 per cent.) under ether did well. The 2 fatal cases recorded under ether both occurred in the third quarter of the day. Under anaesthetic 3 (gas and ether) 1,115 cases were tabulated. There were no cases before 6 a.m., nor complication after 6 p.m. The third quarter of the day, in which were 793 cases, furnished the chief number of complications, and the only 2 cases of danger. Under other anaesthetics the cases are too few for any useful comment. To summarise, the great majority of cases were recorded as occurring between 6 a.m. and 6 p.m. Under chloroform, in the few cases that took place before 6 a.m., there was a high rate of complications and dangers ; and of the cases occurring in the night which showed symptoms of danger half died. The death rate was much the lowest in the second quarter, and subsequently rose as the day advanced. Under ether, danger was only recorded in cases that occurred between 6 a.m. and 6 p.m. But it must be remembered that the differences in the complication and danger rates given in the tables may be explained by other influences than the time of day. SEX. The following table shows all the cases, irrespective of the anaesthetic used, in which the sex was recorded, and also the percentage frequency for each sex of cases attended by complications or dangers:—