64 SPINAL ANAESTHESIA. 



by twitches or other appliances. In another case, having cast but 

 not chloroformed or twitched the horse, he divided the median nerve 

 without causing any struggle. In this instance the nerve sheath 

 was injected. At the point of operation the nerve was insensitive, 

 but pressure with the needle at any spot beyond the cedematous zone 

 produced lively reaction. Employing infiltration Moller successfully 

 performed an extensive operation for hernia on a horse without 

 casting. This method is particularly useful in dogs, which seem 

 specially susceptible to the action of chloroform, and not infrequently 

 die as a consequence of prolonged administration. 



SPINAL ANESTHESIA. 



The event of the surgical year 1900 in Paris was undoubtedly 

 the impetus given by Tuffier to the method of inducing anaesthesia 

 by medullary injections of cocaine, a suggestion previously made 

 and acted upon by Bier, of Kiel, Seldowitsch, of Russia, and Corning, 

 of Chicago. Tuffier was first led to use it as a means of relief in the 

 case of a young man suffering from an inoperable osteosarcoma of 

 the ilium for which morphia had been employed without benefit. 

 The result of the injection of cocaine was striking. The patient, 

 who was crouching down in the position of greatest ease, felt 

 the pain disappear in a few minutes, and was even able to rise. 

 There was at the same time absolute anaesthesia reaching to 

 the umbilicus. Unfortunately the relief lasted only a few hours, 

 and the injection was repeated two days later with similar effect, 

 pressure over the tumour for some hours causing no pain what- 

 ever. A few days later a similar injection was tried for a 

 patient with a recurrent sarcoma of the thigh, and to Turner's 

 surprise he was able to remove the tumour completely with abso- 

 lutely m pain to the patient, the anaesthesia lasting over an hour. 

 At first, therefore, used only in the surgery of the lower limbs, Tuffier 

 rapidly extended its use to operations upon the perinaeum, the rectum, 

 the anus, the bladder, the ureter, the kidney, and such laparotomies 

 as hysterectomy, removal of the appendix, and even gastro- 

 enterostomy. Finally, removal of the breast has been effected with 

 complete anaesthesia. Convinced of the absolute harmlessness of the 

 injections, Tuffier then used them in general gynaecology, and per- 

 formed such operations as hysteropexy, drainage of salpingitis, 

 ovariotomy, vaginal hysterectomies, etc., with equal success. 



Intra-spinal anaesthesia is now widely employed in human surgery. 

 Cocaine has been replaced by stovaine, tropacocaine, or novocaine, 

 and the injection is made up with sterilised water containing sodium 



