November 25, 1909] 



NA TURE 



99 



SPINAL ANjESTHESIA. 



T^HE visit of Prof. Tliomas Jonnesco, of the 

 -'■ University of Bucharest, to the Seamen's 

 Hospital, Greenwich, lias brought prominently before 

 the public the method of producing local anaesthesia 

 by the injection of anaesthetic solutions into the 

 spinal canal. 



Cocaine was introduced years ago as an anasthetic 

 fo" local application ; it was welcomed by the medical 

 piofession, and equally by patients, on account of its 

 invaluable services in operative procedures upon the 

 eye, the nose and the throat. By merely placing a 

 drop or two of a solution of cocaine (or one of its 

 salts) into the eye, or by painting a similar solution 

 upon the mucous membrane of the nose or throat, it 

 is possible to produce anaesthesia so complete as to 

 enable surgical operations to be performed upon these 

 patts without inflicting the least pain or discomfort 

 upon the patients. Certain objections to the use of 

 cocaine were not long, however, in showing them- 

 selves. Cocaine is a powerful alkaloid ; and if the 

 usual dose be exceeded, very grave results follow, a 

 number of patients having actually died as the result 

 of cocaine poisoning. Investigators were therefore 

 led to search for other substances, either like cocaine 

 occurring naturally, or prepared synthetically, which 

 would possess the properties of cocaine while being 

 less poisonous. 



In this way a number of anaesthetic drugs has been 

 introduced, including' alypin, holocaine, eucaine 

 (alpha and beta), scopolamine, novocaine, stovaine 

 and tropacocaine. Of these the three latter have been 

 chiefly employed in producing spinal anassthesia. The 

 method consists in injecting, by means of a syringe 

 and needle, a quantity (usually about i c.c.) of a 

 solution of one of these substances into the spinal 

 canal. The injection is made in the back, close to 

 the middle line, the needle being inserted between 

 two of the vertebras. With regard to the details of 

 the method, various procedures have been described, 

 and no agreement has yet been reached as to which 

 of these is to be considered the best. There is no 

 doubt that modifications are desirable to suit particular 

 requirements. Thus, many operators direct that the 

 drug be dissolved in cerebro-spinal fluid or else in a 

 saline solution having the same specific gravity and 

 the same osmotic tension as the blood-serum. Others 

 consider that the anaesthetic solution should be con- 

 siderably denser or more viscous than the cerebro- 

 spinal fluid, and for this purpose recommend the 

 addition of glucose or of gum-acacia to the solution. 

 These thicker solutions tend to remain at the spot at 

 which they are injected, while solutions in cerebro- 

 spinal fluid or in normal saline tend to spread up 

 and down the spinal canal, and thus have a more 

 widespread anaesthetic effect. It is usual to withdraw 

 a few c.cm. of cerebro-spinal fluid from the spinal 

 canal before injecting the anesthetic fluid. There 

 are two reasons for this — first, the surgeon is assured 

 that he has actually introduced his needle into the 

 spinal canal, and secondly he is certain to avoid 

 increasing unduly the cerebro-spinal pressure when he 

 introduces the anaesthetising fluid. 



On introducing the fluid into a particular part of 

 the spinal column, aneesthesia is produced of all parts 

 of the body deriving their nerve supply from this part 

 of the spinal cord, and all parts below. If the fluid 

 be allowed to ascend the spinal canal (e.g. by raising 

 the hips) the anaesthesia rises higher and higher as 

 the anaesthetic fluid reaches the trunks of the 

 nerves arising from the higher parts of the spinal cord. 

 Tf the patient be placed on one side while the injection 

 is being performed, the anssthetic fluid can be made 

 to enter one lateral half of the spinal canal, and in 

 NO. 2091, VOL. 82] 



this way it is possible to limit the anaesthesia to one 

 lateral half of the body. 



The anaesthetic fluid can be allowed to ascend 

 almost to the top of the thoracic spine without fear 

 of untoward consequences. When it reaches the base 

 of the neck, however, the phrenic nerve, concerned with 

 the movements of respiration, becomes involved, and 

 it was deemed impracticable to produce anaesthesia 

 of the head and neck by the spinal method. Prof. 

 Jonnesco, however, has shown that the addition of 

 strychnine to the ansesthetic solution produces so 

 powerful a stimulant effect upon the respiratory 

 centre in the brain that it is possible to introduce an 

 anaesthetic fluid into the upper part of the thoracic 

 spine, and to allow the fluid to ascend the spinal canal 

 in the neck so as to enable operations to be performed 

 upon the neck and throat. But it is as yet too early to 

 say whether this method may be considered a safe one. 



Of the three drugs which are now chiefly used for 

 the production of spinal anaesthesia, stovaine is found 

 to produce the most deleterious effect upon the 

 kidneys, acute nephritis having followed its injection 

 in quite a number of cases. Novocaine and tropa- 

 cocaine are less injurious in this way, while they are 

 equally efficacious as anaesthetics. It thus appears 

 likely that they will supplant stovaine in the near 

 future, and, in fact, tropacocaine in a one per cent. 

 solution is already being largely used for the purpose 

 in this country, the usual dose injected being about 

 ij grain. 



No doubt further experience will lead to modifica- 

 tions in the present method of performing spinal 

 anaesthesia which will result in its widespread use, as 

 there are a great many cases in which a local 

 anaesthetic is far more advantageous to both patient 

 and surgeon than a general anaesthetic. 



A. C. J. 



THE CAUSES OF THE GERMINATIVE 

 PROCESSES OF SEEDS. 



ONE of the most remarkable phenomena of vege- 

 table life is the occurrence in its cycle of a 

 resting period of varying duration, a period during 

 which the vital functions seem entirely suspended or 

 dormant, and the condition of the organism is hardly 

 distinguishable from death. This stage is most 

 common in connection with the reproductive pro- 

 cesses, and can be seen to belong to the constitution 

 of both spores and seeds. The more highly differen- 

 tiated the structure which shows it, the more pro- 

 longed, apparently, can be this resting period, but 

 sooner or later it gives place to the resumption of 

 growth and vital activities. 



The interpretation of the occurrence of this phase is 

 rather a matter of inference than proof ; probably it 

 was originally concerned in the protection of the 

 reproductive structure from adverse conditions of the 

 environment, for not only is the life rendered dormant, 

 but the resting organ is for the most part protected 

 by modification of its tegumentary covering. In this 

 condition it is able also to bear the severance of its 

 organic connection with its parent, and to subserve 

 the purposes of dispersal. It may, indeed, have arisen 

 with special reference to the latter process alone. 



The resumption of the growth and development of 

 the reproductive body after the period of rest may be 

 explained in a similar manner by the reversal of the 

 adverse conditions, these being for the most part 

 secured when its dispersal has been effected. 



These superficial considerations are found, however, 

 on reflection, to have others underlying them. Is 

 the resting period of any advantage to the living 

 substance of the reproductive structure, whether spore 



