| dc.description.abstract | In my final year at Edinburgh, 1904, I had the pleasure
of hearing Mr. Caird's introductory lecture on Surgery, in
which he briefly outlined the recent advances made in the
field of Local Analgesia, which had paved the way for the
introduction of a still more wonderful development, viz:
Spinal Analgesia.
So, impi-essed was I by the remarkable accounts of the
operations which Mr. Caird had recently seen performed under'
Spinal Analgesia, by Bier in Germany, that I determined, should
the occasion arise to give the method a tx'ial. It was not
however until more than a year later towards the end of 1905,
that while Resident at the Hull Royal Infirmary, I had, with
the kind permission of the Senior Surgeon, the opportunity
afforded me of inducing my first Spinal Analgesia.
Since that date up to the present time I have employed
the method in a fair number of cases with varying success, and
the results of my experience of the method in Modern Surgical
Practice, have afforded me the scope of this Ihesis.
A.lthough not yet -out of the experimental stage, it has
fully established itself as an alternative to. General Anaesthesia,
and in cei’tain cases, I can unhesitatingly say, its superiority;
and lives which would undoubtedly have been lost undex* a
General Anaesthetic, have been saved by its means.
But as in the introduction of all important Surgical
procedures, the evolution has been slow.
One authority gives a glowing account of the virtues
Spinal Analgesia whereas another points -out only the dai‘k side
of the picture, inducing the medical man whose experience .of
the method is limited to the Literature only, to look upon it with
fear and trepidation.
Thus it happens that although as far back as August 1893,
Spinal Analgesia was employed by Eier in the performance of
surgical operations; the method was not adopted in this
country until several years later,in the first instance, when
Gocaine was employed, the disagreeable sequelae that followed
the injection in many cases rendered the general adoption of
Spinal Analgesia undesirable. But since the discovery by
Pourneau. of Stovaine the method has been extensively adopted
and few surgical developments -of recent years have provided
us with such a powerful weapon to combat the perils of
general anaesthesia in certain grave cases.
Where the surgeon is likely to have doubts as to the
safety of his patient under general' anaesthesia, during the
operation, or to his welfare after it, the field is open for
Spinal Analgesia; and in the near* future there is no doubt but
that the method will be more extensively practised. Even now,
where the choice lies between a general anaesthetic at the
hands of ah inexperienced man, and Spinal Analgesia in the
hands of an expei't, it would undoubtedly be wise to choose in
favour' ,of the latter.
But, when it is a question of choice between the two
methods at the hands of ah expert, in most cases, the advantage
would probably lie with the -older method. Poi* although
the general results of Spinal Analgesia are exceedingly good, it
has still not reached that stage of perfection as to be absolutely
reliable in every case, and as long as this fear of
uncertainty exists, it will be a serious obstacle to its advancement.
Bven men experienced in the method have to recount
a number of failures, which if occurring in anything like the
same proportion in the administration of chloroform -or etnei* by
an Anaesthetist, would stamp him as incompetent. Whether,
however, with further insight into thè method the failures will
be eradicated, it is rather premature to say, but if they can
.only be finally overcome, Spinal Anaesthesia will .obtain a sound
footing. At present the opinion as to its general adoption
is still "sub judice" and further investigation of its merits
and demerits is necessary.
But it must not, however, be too severely condemned on
account of cex-tain of its earlier misfortunes, for had the first
mischances of chloroform led to its being discarded, -of what
a blessing would humanity have been deprived! While admitting
that several mishaps have occurred with this new method, to its
credit are due many lives, lives that would, under, a general
anaesthetic, have undoubtedly been lost. It is -especially in
cases where great shock is anticipated that Spinal Analgesia has
proved -of inestimable value whilst in combating the paralytic
condition ,-of the intestine in some cases .of peritonitis, its
effect has been marvellous.
The more I see of the method., the more I like it, and. I
feel convinced that ere many years have elapsed, Spinal Analgesia
will have obtained a strong foothold 'in the practice of modern
surgery.
In the present thesis I have given a short historical outline
.of Spinal Analgesia, the methods in vogue at the present
day, the various drugs employed &c. and finally I have added a
list of cases in which I have either personally produced Spinal
Analgesia or assisted in doing so. | en |
