489

Hospital. 31, 3 At a theoretical level fascinating challengesare posed by huge regional variations in waiting-lists.Stand on the Pennines and look east and you willfind waiting-lists per 100,000 population (and per

consultant) half of those at your back. Are abdominalwalls really more secure and veins and hips really inbetter condition in the West Riding than amongMancunians ? Substantial improvement in waiting-times can only come from cooperative inquiries be-tween doctors and administrators, and economistsmust be invited to add expert help.

ANAESTHETIC BANGS

BETWEEN 1947 and 1954, thirty-six explosionsduring anaesthesia were reported to the Ministry ofHealth.33 Only three of these were fatal. 3 In roughlythe same period only a single death due to explosionwas recorded among the thousand deaths investigatedby the Association of Anaesthetists 35; but even so,a working-party was established to discover means ofpreventing such accidents. The obvious remedy-abandonment of all inflammable anaesthetic agents-was not then practicable, for only chloroform waspotent enough for all purposes and it was too toxicfor use in every patient. But halothane, which cameon the anaesthetic scene in 1956, was nearly as potentand useful, and seemed to have none of chloroform’sbugbears (risks of primary cardiac failure and laterhepatic damage). Indeed, it is interesting to speculatewhether, had halothane been as widely used in 1954as it was in 1964, there would have been the sameneed for the working-party. In 1961 only a singleexplosion was reported to the Ministry and in 1962there were none at all. 3 In view of the wide use of

halothane, it is an open question whether this reduc-tion in the numbers of explosions was the result ofthe working-party’s activities.

In some ways the 1956 report led to over-protection,for there followed a mania for eliminating sources ofignition in operating-theatres. It was believed thatthe zone of risk extended for only a few feet round thepatient’s head (in fact the width of this zone is probablyonly about 1 foot); none the less, switches on thewalls of operating-theatres which could be up to

15 feet away from the patient, and furthermore were4t feet above the floor and well out of the way ofdrifting clouds of ansesthetic vapour, were flame-proofed. Some believed that even central-heatingthermostats 7 or 8 feet up on the theatre wall shouldbe spark-free. This insistence on safe switches wasapplied to the diathermy foot-pedal, long after every-one knew it was unsafe to use inflammable anaestheticagents simultaneously with electrocoagulation.

It may seem complete nonsense to spend consider-able sums of money eliminating sources of ignition

31. Chant, A. D. B., Jones, H. O., Weddell, J. M. ibid. 1972, ii, 1188.32. Piachaud, D., Weddell, J. M. ibid. p. 1191.33. Anæsthetic Explosions: Report of a Working Party. H.M. Stationery

Office, 1956.34. Vickers, M. D. Anœsthesia, 1970, 25, 482.35. Edwards, G., Morton, H. J. V., Park, E. A., Wylie, W. D. ibid. 1956,

11, 194.36. Burns, T. H. S. in A Practice of Anaesthesia (edited by W. D.

Wylie and H. C. Churchill-Davidson); p. 440. London, 1972.

from operating-theatres, except perhaps from thesmall zone of risk around the patient’s head. But theissue is not straightforward. Diathermy is widelyused. At the moment there is in halothane a relativelysatisfactory non-inflammable anaesthetic agent, thoughit may have ill effects when given repeatedly to thesame patient. If a successful suit for damages werebrought against an anaesthetist who used halothanefor two successive anaesthetics, or if an otherwiseextremely useful inflammable anaesthetic agent (orperhaps some other therapeutic agent similarly liableto catch fire and explode) were discovered, it mightonce again become necessary to provide full protectivemeasures. Although it is expensive to eliminate

ignition risk in the design of a new operating-theatreit is a lot more expensive to do it in a theatre which isalready working. This question is debatable. The

position with regard to static electricity is ratherdifferent.3’ Here there can be no defined zone of risk.Sparks may occur anywhere where a charged bodydischarges itself to earth. There is therefore somesense in persevering with the usual antistatic precau-tions, which are relatively inexpensive. Not only arestatic sparks liable to ignite anaesthetic vapours; theymay also ignite vapours arising from fluid used to cleanthe skin before operation.

ANOTHER WATCHDOG FOR SCIENCE

THE Council for Science and Society, the latestentrant to the modern specialty of doomwatching,sounds a rather grand body. Conceived by a lawyerin Nature a year ago, it was born, with an E80.000silver spoon from the Leverhulme Trust in its mouth,in the hallowed precincts of the Royal Society inJuly. Its thirty-three self-selected members includeDr J. H. Humphrey, Dr Henry Miller, Dr AlexComfort, Sir Denis Hill, Prof. Patricia Lindop,and Dr Anthony Storr. The Council’s objects includeattempts to " try to identify areas of research inscience and technology which could have importantsocial consequences for good or ill, but which arenot yet fully explored; to study these objectively;to attempt to foresee what their consequences mightbe; whether they could be controlled, and how;and to publish reports designed to stimulate widepublic debate about some of the issues of the future,based on the best information available ". The Councilfor Science and Society is not simply the Establish-ment’s answer to the more activist British Societyfor Social Responsibility in Science; none the less,the Council’s members will number many who alreadyadvise Government in some capacity or other. Itwill be interesting to see if there is any conflict hereand if the Council sticks to the declared principleof publishing its working-parties’ findings 38 whetherit agrees with them or not, and whether it can find

something more novel to look at than antibiotics inanimal feeding stuffs (a subject thoroughly tackled bythe Council’s own chairman Sir Michael Swann) andcomputer privacy, another topic upon which littlenew can be said.

37. Vickers, M. D. Ann. R. Coll. Surg. Engl. 1973, 52, 354.38. Science, 1973, 181, 420.