Remarks ON EIGHTEEN CASES OF SPINAL ANALGESIA BY THE STOVAINE-STRYCHNINE METHOD OF JONNESCO: INCLUDING SIX CASES OF HIGH DORSAL PUNCTURE
BMJ (Clinical Research Edition)
IT-will be within the recoUection of the members of the medical profession that in the autumn of last year Professor Thomas Jonnesco of Bucharest demonstrated before the Surgical Section of the Royal Siaety of Medicoln, and also in the operating theatre of the Seamen's Hospital, a method of spinal analgesia introduced by him with the obieot of rendering possible operations on the head, neck, aud pper extremity. As was mainly respons.ble fow tee demo itraticts, and have since then submitted
... then submitted o=awo's aetod lto -the test of praotioal application in my -wards, I have ventured in this comtion to placthe -reults obtained before my pro-fesso8nl conft-aea,as much to satisfy many iquirers,as toisosuea warnuig those who may wiah, like ;myself, to see the practice of -spinal analgesia exteaded to -the utpper regions of -the body. Jonnesos ,method is based on -the snppos*tiQu that *lie additionof neutral strychnine sulphate ts the 1stovaine .employed is capable of overcoming tbe danger of respiratory paralysis when the injection is made between the spines of the first and second dorsal vertebrae, or when, the solution having been injected at a lower level, it has been purposely allowed to gravitate to the upper r¢ions of the cord,Athe patient being in the Trendelenburg poition. With regard to the results obtained by Professors Joxnesco, Janio, and Nasta,1 it must be admitted that, as rqported, they would suggest a very high measure of success and safety, and, compared kwih my cases here wooipted, Ahao;a marked ooontrast, since it is 'laimed that in no case was any ill effect noted. Whether this is due to exceptional experience, or to some peculiarity in the 41ls of patint submitted to operation in our respective countries, unable tosay; it is, however, reasonable to suppose thAt the method, when-frst-attempted by Professor Jonnesco, qwas as new to him as it was to me when I tcllowed his example. Whatever the results obtained in Bucharett xmay have been, It will be remembered by those wihp weewpresent in the opexating theatre of the Seamen's Hospital, that of the three caes injeoted by Professor Jonnesoo by his own method and using his own drugs and instruments, only one-a case of tuberculous cervical glands-was completel,y sueossful. In the second-a laparotomythe injeetion was made in, the dorMi-lumbar interspace, and the patient, although analgesic, so far as his-skin and muscles were concerned, to a point.considerably above the level of his fifth cervical vertebra, complaed of dragging sensations when his intestines were Aniplated, and had to be submitted -to a genral anaesthetic. The third case, that of a boy of 12, was gven 2 cg. of stovaine and -4 mg. of strychnine, with a view to exploration of his mstoid antrum; -cmplag of pain -on the application of tbe gouge, he was given a second dose of the same amount; he still complained of pan, and was then given chloroform. Et is, however, .oAly .4s ton saythat this boy assured me on the following -ay th, being afraid, h6e had lied, and that he had -experienced no pain whatever, and that it was the grating of the metal on the bone which frightened him. Further, the fact remains that all three of these patients were Waalgesic to above their phreuic origins, two of them actually to the vertex, and yet there wa -neither respiratory paralysis-nor any ill effect afterwards.