FIFTH ANNUAL REPORT OF DIVISION OF ANESTHESIA 1942 The year 1942 was marked by quite an inerease of ac~ tivity, both in the amount of clinical work accosplished, and also in the amount of teaching. Of the 11,678 aneethesias administered throughout the Medical Center, 5,855 were given by the medical anesthesia staff. This amounts to an increase of 1,719 cases over the year 1941. Much of the increase is due to the addition of the obetetrical anesthesias, which were begun at the request of Dr, Watson, be- cause of the shortage of staff in Sloane Hospital. Only the day~ time cases are covered by the anesthesia residents, About 450. cases were anesthetised by the nine surgical residents who were assigned to anesthesia for a period of two to six weeks, beginning February let. HEW AGENTS AND TECHNICS Now new technics were added in 1942. The popularity of continuous spinal anesthesia continued unabated, as it should within reason. The ee of intravenous anesthesia is being exten- ded gradually in the field of laparotomies, and seems to be satis~ factory in gynecological intraperitoneal operations of a simple nature, A few upper abdominal operations have been performed with this anesthesia, but it is much lese satisfactory in this field. An anesthesia procedure for poor risk Caesarian section patients has been worked out with the Sloane staff--local infil- tration to the peritoneal layer, then pentothal intravenously for the peritoneal-dadenjebine jactsions. Respirations of the baby have been excellent provided not more than two minutes elapses before its extraction. Several new drugs have been used with varying success. Monocaine formate has been used in over 100 cases for spinal snes- thesia. 1ts action seems to be similar to procaine hydrochloride, of which it is an optical dsomer. Primocaine, another brand of procaine, tas been used satisfactorily. Two new inhalation agents were used in anima]: anesthesia and in humans, tetrachlorathylene and trichlorethylene, Both were supplied by the duPont Chemical Company, and were of great intsrest . . an because of their non-exploaivenessg Although both are potent anes- ee thetic agents, nejther is satisfactory because of a very high vapor Anesaeed density, which does not eliow rapid vaporization. Both also are drritating to the respiratory tract, and tetrachlorethylene caused several minor ekins burne. Their use hes been discontinued. | A new chemical, ammonium chloride, 0.75%, bas ‘been used by regional, nerve block methods, for treatment of intractable pain. The cases are too few in number to draw any conclusions. Its use ta designed to replace absolute alcohol ttn nerve blocks. A new carbon dioxide absorbing chemical, Baralyme, has been proved more efficient and more satisfactory than Sode-lime. It is being used throughout the hospital, as well 4s in Dr. Barach's department. About $103 RESIDENTS Two residents completed their training in the departaent. Dr. Samuel Rochberg, after three months at Welfare Hospital, for training in cyclopropane, became Birector of Anesthesia at Sinai Hospital, in Baltimore, Maryland. He has since resigned that position (January 1, 1943) and has entered private practice, Dr. Kingsley Bishop, after two and one half months at ' Bellevue Hospital, for training in cyclopropane, became Director of Anesthesia at Philadelphia General Hospital on January 15, 1943. Eight new residents joined the staff during 1942. Three of these left for other positions during the year. Dr. Belmont Musicant: January 1, 1942 Dr. Herman Levins January 15th to October 25th. After ten months, Dr. Levin was called to active duty in the Army, and after a period of training at Walter Keed Hospital, he has been assigned the position as Chief of Anesthesiology at the Brun Gen~ eral Hospital, Santa Fe, New Mexico, | Dr. Dita Sternova: February let to July let. Dr. Sternova had one yearts,.fraining under Dr. Henry Beecher, and, after five months, went to Welfare Hospital, for training in oyclopropans. Dr. Grace Franks: June let to ,Getaber lst. Dr. Frank had two years training in Canada, and after tRowe and one half months with us, took the position as Director of Anesthesia at the Methodist Episcopal Hospital in Brooklyn on October 25, 1942. Dr. Mildred Thompson: August 1, 1942 Drs. Slisabeth Conover: September 15, 1942 Dr. Helene Mayer: October 1, 1942. Dr. Mayer had two year's experience with Dr. Huberta Livingstone, in Chicago. Two other physicians spent short periods of tine with us for inatruction end to serve as additional staff members during the WuwuirA monthes Dr. Jamse Caldwell: two weeks Dr. Vendela Olson: two months. an * Staff meatings weekly at 4100 P.M. on Thursdays served as the principal means of resident teaching .Akternste Thursday evenings, a resident presented a topic of anesthetic interest before &@ group of present and past residents, who entered into active dis~ cussion of the subject. In addition, through the kindness of Dr. Morton of the Anatomy Department, a cadaver was obtained for gross dissections, Yor the first time, surgical residents were assigned to anesthesia for a period of two to six weeks, a step which bes been contemplated for four years. Their work was uniformly good, but since their time on the service was limited only to afternoons, it is fortunate that ena, ounrell Cope 17D, as it is. The morning schedules provide a wider selection of cases, and a larger number for teaching purposes. The surgical residents who received such training were Dra. beakes, HKandall, Buchsnany. Thompson, O'Malley, Harrison, Porter, Wiedel and Auchincloss. STUDENT TZACHING There was no change in the plan of student teaching. Dr. Blien Foot, met all the Third Year students .on their wards, © throughout the year, for discussion of preoperative and postopera- tive problems as well as choice of agents and technics. : The Fourth year students worked in the operating rooms pee mornings. Each administered about five anesthesias a piece, “and observed gany others. It is unfortunate that Bables Hospital tonsillectomies are now performed only during the summer months, as they are the sost plentiful source of open drop efor cases. Several students who were assigned to Roosevelt, Bellevue or Welfare Hospi- tals for their surgical quarter, worked during vacation periods, FINANCES A brief financial statement rotons (C-4 An aide, Viola Grollimund, was added to the department on October 27th, whose work in maintaining the anesthesia equipment has added much to the service of the department. Her technical assistance has enabled the secretary, Mrs. Schoen, to spend more time in assististing in. the preparation of papers and maintaining an excellent anesthesia bibliography. NURSING STAFF There were two leaves of absence granted for Army Service, and one resignation. One additional nurse was added on The nursing staff, under ifiss Penland's direction, has rendered valu- able assistance. One discussion group wae held with them, at Miss Penland's request. Although it ig recognised that certain problems exist, which might be improved by 4 change in organization of the department, it ie recommended that such changes be made at a later date, because of certain inevitable resignations which would take place when such a change is made. With the severe shortage of both medical and nurse anesthetists in the country as a whole, our own shortage would be overwhelming, unless a group of Navy or army Officers were added. | No new changes in technic were made. 4 conductive rubber floor installed in two operaliag and anzsthesia rooms has maintained good conductivity. All the conductive rubber bought for the anes- thesia machines has become non-conductive. LECTURES January 2nd-w-Becture to Hesidents on Asphyxia and Re~ suscitation, February 4the-Third Year Lecture February llth-Third Year Lecture March 25th——-Lectre to Johns Hopkins University Medical Students . April 23rd-—--Yearly Report 0 Surgical Staff Meeting May 2lete-----Dental Journal Club : Augnet 8th-—-~—Combined Clinie—Medicines Strychnine Poisoning October LOth--Lecture to Army Plastic Group Octéber 28th--Lecture to 2nd Army Plastic Group October 3let--Combined Clinic-Medicine: Intractable | ’ Pain November llth-Third Year Lecture November 1&th-Third Year Lecture November 19th-Lecture to army Neurological Group (October 5th—Dr. Rovenstine gave lecture to Fourth Year Students in Applied Pharmacology) December let-Lecture Fourth Year Dental Students doture Fourth Year Dental Students December 15th-Lecture Fourth Year Dental Students MEDIGAL MEETINGS aTTENDED February i2th~--——-A.8.A. Meeting-Presented Paper on "Continuous Spinal" April 4th-7th-——--Agualumni Meetings Madison, Wisconsin Presented two brief paperas i. "Convulsions during Anesthesia" 2. "& New Uxygen Nask(Barach~Eckman)* April RTE wwe mmnvomoni SA a Meeting: Coluabus, Ohio Attended by Dr. Ellen Foot May 1llth—~--~-~ New England Society of Anesthesia Boston, Mass, June 6th & 7the-Atlantic City-—American Board of Anesthesiology Examinations~+«£xaminer June 10th----—-~ Atlantic City--Ameriocan Medical Association Exhibit. Dre. Bishop, Musicant & Sternova attended. Discussed paper on "Spinal Anesthssia® October Sth---—-A,5.A. Meeting, 4.¥.C. December lith—-~A.S.A. Meeting, N.Y.C. PAPERS PUBLISHED / ge oF i. "Continuous Spinal Anesthesia" 3/ 9% a- Fe? | - . ae "The matacolee Effectg of the Anesthetic Agents® BE so ee - ye we" ~+ 9 “236-34 5" Cnn Aety « $9 ter 3. *The trentaent of Untoward Effects from Nitrogen" = oy GL AGS AT: Hyg Of 1 E Zone 4 "Tetrachlorethylene ag an Anesthetic Agent® (In Press) Duties af treasurer and meaber of Board of Directors of the American Society of Anesthesiology continued. Reelection to office as treasurer for threa years. There were several trips to friboro Hospital for chest surgery, and instruction of the resident on the steff there, as well as several trips to Welfare Hospital for the same purposes. The problem of paramount importance during the coming year is one of providing gocd anesthesia service with a diminishing staff, and increasing number of surgical cases. Because of the lack of satisfactory wedical applicants, it seems wise to consider the addi+ tion of a few oral surgical graduates to the ataff. Sigod, their first two years of dental school is identical with the nedical school work, it seems likely that they are better fitted to enter the field of anesthesia, than nurse technicians sith a minimal background of basic sciences, There are ample teaching cases to conuider the addition of three to five Army or Navy Service Men to the staff. Thie arrangement would be more satisfactory than a group of twenty Officers at once, The possibility of research work ie even more remote than last year, because of the increased clinical demands, but prob- dems are being formulated until such suitable tine presents itself for their approach. The thanks of the department are extended once again to the Surgical Department and its Director and to the Hospital Admin- 4atration for their earnest cooperation. Hespactfully subaitted, 2/15/43 Virginia Apgar, H.D. Report of M.D. AnesthesiaDepartment—-Income over Salary Expense 1942 MONTH NET INCOME SALARY EXPEVSE ZNCOME over SALARIES January $ 1,980.22 $ 1,050.00 $ 930.22 February 1,306.71 1,125.00 161.72 March 2,650.46 1,130.00 1,520.46 April 2,221.50 1,130.00 1,091.50 May 1,980.00 1,210.00 770.00 June 1,669.25 _ 1,215.00 454025 July 3,022.75 1,305.00 1,707.75 August 2,356,585 1,380.00 976.85 Septeaber 21,992.63 1,362450 630.13 October 1,926.00 1,470.00 446.00 Novenber 2,304.00 1,375.00 929.00 December 1,862.63 1,375.00 487.63 $25,253.00 $15,127.50 $10,125.50