459

In England Now’. A Running Commentary by Peripatetic Correspondents

ANÆSTHESIA is still drama outside the English-speakingcountries. I was told that the patient was going to havea small tumour of the lower jaw removed. Would Iadminister general anaesthesia, which had never pre-viously been used for such operations in that clinic ? It sounded too easy.A banquet of honour the previous evening had left

me in no mood to think of the patient until 7.30 nextmorning, when I opened my eyes and realised that theoperation was due to begin at 8 A.M. The professorand about half a dozen assistants were already robed incap, gown, mask, and gloves when I arrived. Thepatient was ready on the operating-table, I was told.On asking for the anaesthetic apparatus, a new andunused American apparatus that I had never seen before,and of rather terrifying appearance, was wheeled in.It had evidently been bought, when the hospital wasequipped, as part of the standard fittings every hospitalshould have. Two breathirrg tubes emerged from themachine, so a safe diagnosis was that it was a carbon-dioxide absorber, but there seemed no other way of usingit. Soda lime ? Never heard of it. Endotracheal tubes ?Blank looks. A few pieces of limp rubber tubing, ratherlike drainage tubing, were finally produced. My blood-pressure began to sink and a fine sweat broke out allover me. The one and only cylinder of nitrous oxidewas produced and that turned out to be empty whentested. By means of adhesive tape, odd bits of tubing,a glass- funnel, and some gauze, I managed to rig upsomething which might work and let me administer anendotracheal anaesthetic. A nod from me and I was ledinto the operating-theatre like a lamb to the slaughter.The theatre consisted of an enormous auditorium in

which some 200 students, all in white, in tiered rows,looked down into a sunken well in the centre in which wasthe table surrounded by a great number of surgeons andassistants. The patient proved to have a large tumourof his lower jaw. For some obscure reason his jawswere wired together so that he could barely open hismouth. He was so heavily morphinised as to be hardlybreathing. My -limp rubber tubes seemed ratherineffectual. Carbon dioxide, of which there was plentyin the theatre, soon made the patient breathe deeply,and a rubber tube thrust into his nose found its way intothe larynx, confirming my belief in the efficacy of simul-taneously keeping one’s fingers crossed and touchingwood. As soon as the tube entered the larynx an audiblemurmur-’arose from the’audience, who thereupon got upas one man and left the theatre, to my utter amazement.The rest of the operation was uneventful.The patient did nicely ; but it took several days

to refill my depleted suprarenals.* * *

Now that another cricket season is only just aroundthe corner, perhaps I ought to reveal what reallyhappened on that second day of the Oval Test-matchagainst India two years ago. Having no ticket, my onlyhope of admission was after the tea interval; so I dulyqueued up, clad in Army uniform and clutching somenewspapers, a mackintosh, and a large envelope con-taining a few dozen life-size photographs depicting, instark and vivid detail, the various local lesions that canresult from treponemata and allied organisms. Theturnstiles were finally passed and there was a happyrelease from the pressure of the queue amidst the millingthrong at the back of the pavilion. It was while I wasgroping from pocket to pocket to find the money for amatch-card that the precious envelope fell from undermy arm, spilling the pictures face upwards on theground. I hastily dropped the waterproof in an attemptto cover them up, but a gust of wind appeared fromnowhere and scattered them in all directions.The next few minutes are confused in my mind. I can

remember fumbling with the photographs at my feet anddropping as many as I picked up. I retain impressionsof many legs and of more than disinterested assistancefrom those who were close at hand ; of a small boyrunning down to the turnstiles and returning, crying,

" Here you are ’ llister ! " waving a large pictureabove his head. Some instinct told me that it would bethe one showing the secondary manifestations in thefemale : it was. Finally, with all recovered, the boypaid off, and the crowd dissolved, my composure beganto return. As I was trying to get into the stand thesole remaining spectator, a swarthy man with coatcollar turned up and hat pulled down over his face,sidled up tome and, giving a meaning look, softly asked:"Excuse me, sir. Those photographs : are they forsale ? "

* * *

The visitor to the United States soon observes threethings : the apparent plenty ; the high cost of thatplenty; and the readiness of America to share itsmaterial goods with Europe. In the Super-Markets-self-service food stores-all our rationed and pointsfoods, and many we never see, are piled on the opencounters for the American housewife to load into herbasket-on-wheels. Yet in fact her purchases are restrictedby the high prices-to give an extreme example, butterat this season is nearly a dollar a pound.The readiness to share with Europe is. evident at every

level down to the grass-roots. Congress has voted thefunds for Interim Aid to Europe ; the President callsfor the enactment of the European Recovery Program.The Friendship Trains and the Friend Ships havedelivered to France and to Italy their cargoes of foodvoluntarily given by communities and by citizens.Individual donors send to individual recipients giftparcels of food and other necessities through ’non-profit-making organisations such as CARE (Cooperative forAmerican Remittances to Europe), or through manycommercial firms, or make up their own parcels.Innumerable communities in the U.S.A. have adoptedtheir eponymous communities in Europe. Specialgroups of all kinds assist their sister groups. No doubtthere are some dissidents, and indeed I have read of,some in the newspapers, but I have not met any yet,or at least they have not revealed themselves to me.

* * *

What goes on in the schizophrenic mind ? This brilliantundergraduate and minor poet had been in catatonicstupor for nearly eight years, lying in bed with hisknees flexed and his head raised off the pillow, staringand speechless. For the last year he had been tube-fed. Then-his frontal lobes were cut and he began toeat. Another six months elapsed before he spoke ;quietly, slowly, condescendingly, but sensibly. WhenI met him he was reading, sitting in his wheelchair withankylosed knees. One is always struck by the solemnpreoccupation of these people, and I could not refrainfrom asking him eventually : " Have you got your senseof humour back ? " "I don’t think I ever lost it," washis smiling reply.

* * *

I had been in Malaya for only a few weeks when theytold me to keep next Tuesday free to examine the estatedressers in preventive medicine. There had been noexaminations all the time the Japs were here so therewere plenty of candidates. Being new to the countryI looked forward to Tuesday for I was sure I would learna lot. I did. Among the things I learned was that" typhus is spread by lies," that " herbs grow on thelips in malignant tertian malaria," and that " the serumis given by an indrawn muscular injection." It was aninteresting experience, but I fear that the enthusiasticcandidate who would cope with a smallpox epidemic by" vaccinating everyone, then wrapping the patients insheets soaked in formalin before burying them, andburning all contacts " would stop more than theepidemic !

* * *

Meeting one of my former chiefs-at the Royal Societyof Medicine he inquired how I was. " I’m a bit offcolour, sir," I told him. " Yes, you are ; you’rejaundiced," was the reply. So that was it-infectivehepatitis. Hence the nausea, anorexia, and lethargy,and, come to think of it, my urine was rather dark. Isthis the first case of a correct diagnosis at No. 1, WimpoleStreet ?