Medicine: Standardized Anesthesia

Dr. Paluel Joseph Flagg, No. 1 U.S. anesthetist, recently warned his colleagues that in the Army & Navy the delicate work of administering anesthesia is often mishandled. Under present Army conditions the customary teamwork between surgeon and anesthetist does not exist. And without teamwork there may be trouble.

The root of the trouble is a difference of medical opinion. There are many anesthetics, each with its pros & cons, from which a surgeon may choose. For abdominal operations, for example, some surgeons prefer a spinal anesthetic. Other surgeons avoid spinals because they entail a somewhat greater risk of complications (e.g., occasional paralyses, persistent headaches and other late effects) than anesthetic gases. Many patients prefer the new rectal anesthetics because they leave none of the aftereffects which ether usually produces. Some doctors contend that nearly all the unpleasant effects of ether (vomiting, nausea, etc.) can be avoided if the anesthetist is properly skilled.

Because of these differences of opinion among doctors and anesthetists many surgeons in civilian life either take the anesthetist’s advice or find an anesthetist who agrees with them. An Army surgeon, however, is seldom free to choose his anesthetist. But he still remains boss in the operating room, specifying the kind of anesthesia to be used. Even though the anesthetist’s experience and training lead him to prefer a different technique, he must follow orders.

The results may be unhappy. An Army surgeon may, for example, prefer spinal anesthesia. His anesthetist may be skilled in ether and other gases, but not wholly familiar with the often complicated nerve-blockings he is called upon to perform with the spinal and regional anesthesia. Such disagreement increases the patient’s risks (deaths from anesthesia are by no means unknown). Meanwhile, the quality of anesthesia suffers, and the professional anesthetist is reduced to a mere technician.

Best remedy for the situation, said Dr. Flagg, is for the Surgeons General to specify what anesthetic should be used under every circumstance. Disputes can then be settled by a rule book, and the integrity of the anesthetist will survive.

Systematized Army anesthesia is not the first cause that Dr. Flagg has vehemently embraced. The growing stature and autonomy of U.S. anesthetists is to a large extent a result of his years of untiring research and example. In 1936, mainly at his instigation, the A.M.A. at last formed a committee on asphyxia.

White-bearded Dr. Flagg, 56 and the father of twelve, is the man who brought Lindbergh and Dr. Alexis Carrel (now working for Vichyfrance) together to develop their mechanical heart. He also suggested to aviation engineers the principles (first embodied in T.W.A.’s Stratoliner) on which planes could safely take passengers into high altitudes without asphyxiating them. Asphyxiation is Dr. Flagg’s special horror, and he thinks the subject should be combined with anesthesia into the science of pneumatology (Dr. Carrel’s word).

“The man best fitted to resuscitate people, to bring them out of unconsciousness,” insists Dr. Flagg, “is the man who already knows how to put them in.” He takes as a personal challenge the fact that over 50,000 people die every year in the U.S. of asphyxiation. For years his Society for the Prevention of Asphyxial Death has been working, despite a lack of funds, for a wider knowledge of resuscitation techniques by laymen and especially doctors.

About 60% of the 50,000 asphyxial deaths represent newborn babies who never breathe at all or who gasp feebly and then turn blue. Dr. Flagg is famed for his skill in urging the breath of life into the newborn, and he believes that probably 20% of these 30,000 breathless babies could be saved—if 1) anesthetists more often took charge of them, 2) ordinary doctors learned more about the art of resuscitation and anesthesia.