Anaesthetist”

"Must Be Your Own

Work In Isolated Hospitals

DO medical men in well-equipped and well-staffed city hospitals ever think of the conditions under which their con freres work in some of those isolated Islands stations?

The speculation is induced by a para graph in the report of Dr. Clifford James, in charge of the Melanesian Mission’s hospital at Fauabu, North Mala, British Solomon Islands. This medical officer has a sense of humour. One chuckles with him as he describes his troubles in induc ing the local natives not to “pinch” the hospital’s modest crop of tapioca.

How would Dr. Macquarie Street like to work under these conditions:— “Anaesthetics are always an interesting subject to the medical officers of missions (says Dr. James) for the simple reason that we have to be our own anaesthetist, and our own surgeon at the same time.

Therefore any of these new-fangled things needing specialists and special apparatus for their administration are ruled out.

“Chloroform is too poisonous, and needs too much care in its administration to make it a fair deal to ask a nurse to give it.

“With these people, who talk a different language, and who do not react as white people do, such things as Evipan, Avertin, and the basal analgesics, I have found most difficult to judge the dose. To have to fall back on general anaesthesia to make up the shortage and to keep the pa tient under is no use where we are trying to avoid having an anaesthetist. We have therefore, to develop local anaesthetic methods coupled with morphine and atro pine.

“Spinal anaesthesis is excellent, and I have had no casualties with it, though now and then, with patients with poor ‘vital ity’ and low blood pressure, we have had to put them into a Trendellenburg, which is almost vertical, to counteract the fall in blood pressure. This occurred with Novocaine, but with Percaine made up with Glucose so as to make a heavy solu tion, the anaesthesia is much more under control. , The site of puncture, the speed of injection, and the amount given, and the way in which the patient is lying, are the important factors.

“I ‘do’ arm operations under local anaes thesia by injecting Novocaine into the brachial plexus above the clavicle. I have found it most satisfactory. This gives anaesthesia to the shoulder. The spinal anaesthetic will give anaesthesia to above the nipples, and much of the head and neck can be ‘done’ under local, but there is a residue which needs, as well as the local anaesthetic, some other general anaesthetic, such as avertin and/or chloroform.”

All of which conveys little to the layman, but will be read with interest by persons with medical knowledge.

Miss F. N. Inman, of the Australian Board of Missions teaching staff in Papua, returned to Samarai by the October Mon toro after spending furlough in Tasmania and Victoria.

Mr. Thomas Lockhead, who had been living in retirement at Tailevu, Fiji, died in the Colonial War Memorial Hospital, Suva, on October 8, at the age of 79. A retired N.Z. civil servant, he went to Fiji in 1921, and for a while was in the clerical branch of the Public Works Department at Levuka.