519

Harmful Pollution by Anæsthetic Gases?THE report last June by KNILL-JONES et al.l lent

substance to earlier accounts 2,3 of an abnormal

susceptibility to spontaneous abortion among womenpractising anaesthesia. While there are many possibleexplanations for this finding, there is widespreadbelief that it results from pollution of the operating-theatres by anaesthetic gases. In support of this viewis the knowledge that anaesthetic agents can be de-tected in operating-theatre air and in the expiredgas of theatre personnel.4 It is established that these

agents can cause abnormalities of cell mitosis in

vitro,5 while experiments in vivo have demonstratedan association between ansesthetic agents and fetalabnormalities in chick embryos 6 and rats.7

Is it possible that similar processes occur in man ?Although accepted practice is to avoid anxsthesia forpatients in the first trimester of pregnancy, there is noclear evidence that anaesthetic agents are teratogenicin man. Moreover, the concentrations of anaestheticgases in operating-theatres, and the likely concen-trations in body tissues of anaesthetists and othersexposed, are extremely small by comparison with theexperimental conditions. Nevertheless, there are

some important pointers. In addition to their data onabortion, the Glasgow group reported that womenanaesthetists had a high frequency of congenitalabnormality in liveborn children and an increaseddisposition to involuntary infertility. This suggestsa range of possible mishaps with abnormal celldivision as a common factor, rather than physical oremotional stress (which might explain abortion andinfertility, but not congenital abnormality). COHENet al. found that the abortion problem existed inoperating-room nurses to almost the same extent asin physician anaesthetists, but it is difficult to deter-mine whether these groups are essentially similaras regards factors other than pollution. An ad-ditional dimension to the problem is suggested byASKROG and HARVALD.2 In their survey, the wives ofmale anaesthetists had an increased frequency ofabortion and an increased proportion of female tomale children after their husbands commencedanaesthetic practice. Unfortunately this was not acontrolled study, and ageing of the individuals

1. Knill-Jones, R. P., Rodrigues, L. V., Moir, D. D., Spence, A. A.Lancet, 1972, i, 1326.

2. Askrog, V. F., Harvald, B. Nord. Med. 1970, 83, 498.3. Cohen, E. N., Bellville, J. W., Brown, B. W. Anesthesiology, 1971,

35, 343.4. Hallen, B., Ehrner-Samual, H., Thomason, M. Acta anæsth. scand.

1970, 14, 17.5. Nunn, J. F., Lovis, J. D., Kimball, K. L. Br. J. Anæsth. 1971, 43,

524.6. Smith, B. E., Gaub, M. L., Moya, F. Anesthesiology, 1965, 26, 260.7. Fink, B. R., Shepard, T. H., Blandau, R. J. Nature, 1967, 214, 146.

concerned may have influenced the results. If itwere shown that these trends are peculiar to anms-thetic practice, they would be difficult to explainexcept on the basis of a cellular effect.Three areas of this whole problem seem to merit

further investigation. First, it would be worth

knowing whether chronic exposure of animal speciesto low concentrations of anaesthetic agents such asoccur in operating-theatres produces abnormalitiesof cell division or, indeed, other morbidity. Second,in the general population chromosomal abnormalitiesare thought to be present in about a third of abor-tuses,8 and it would be important to compare thefrequency of such abnormalities in those exposed toanaesthetic agents-clearly the administrative prob-lems of this type of inquiry are formidable. Third,an abnormal conceptus tends to be shed early in thepregnancy 8,9 and an analysis of maturity mighthelp also to show the true incidence of chromosomalabnormalities.The University of Glasgow group are now extend-

ing their survey to include the wives of maleanaesthetists. If, as in the Danish investigation,2 2the findings are positive, this would be strong evi-dence of a cell toxicity effect. In the meantime, thereis bound to be anxiety among those who may beat risk. It is important for them to realise that pol-lution is not an established danger, and that thefactors responsible for the survey results may yet beshown to have no connection with working conditions.Nevertheless, in the present state of knowledge itwould be reasonable for a woman anaesthetist tryingto become pregnant, and having unexplained diffi-culty, to stop work. It is timely also to consider themost appropriate methods for reducing pollution intheatres. These range in complexity from greatercare on the part of individuals handling anaestheticsystems, or reducing the need for gaseous agents, tothe employment of scavenging systems and the re-designing of ventilating systems. Hospital authoritieshave their responsibilities, but there is much whichindividuals can do for themselves.

Wegener’s GranulomatosisTHE improvement in prognosis of Wegener’s

granulomatosis must rate as one of the therapeuticsuccess stories of the 1960s. From being a diseasewith an almost uniformly fatal outcome, it has becomean eminently treatable and, according to some reports,curable disease.

Wegener’s granulomatosis is an uncommon thoughby no means rare condition which affects all adult

age-groups of both sexes, and very occasionallychildren too. Of its pathogenesis little is known.

Many unsuccessful attempts have been made to

8. Carr, D. H. Obstet. Gynec., N.Y. 1965, 26, 308.9. Kerr, M. G., Rashad, M. N. Am. J. Obstet. Gynec. 1966, 94, 322.