Operative surgery . drop of carbolic acid applied at theseat of puncture renders penetration painless. A solution of cocain raisedquite to the boiling point two orthree times does not materiallyaJSect its anaesthetic properties. Spinal Ansesthesia.—To Corn-ing belongs the credit of first usingthe spinal injection of cocain to causeanfesthesia. Spinal ansesthesia maybe employed when local ansesthesiais impracticable and general anfes-thesia is contra-indicated in opera-tions of magnitude. A Pravazsyringe with long needles of relia-ble strength or apparatus especiallydevised for the purpose may
Operative surgery . drop of carbolic acid applied at theseat of puncture renders penetration painless. A solution of cocain raisedquite to the boiling point two orthree times does not materiallyaJSect its anaesthetic properties. Spinal Ansesthesia.—To Corn-ing belongs the credit of first usingthe spinal injection of cocain to causeanfesthesia. Spinal ansesthesia maybe employed when local ansesthesiais impracticable and general anfes-thesia is contra-indicated in opera-tions of magnitude. A Pravazsyringe with long needles of relia-ble strength or apparatus especiallydevised for the purpose may beemployed (Figs. 29, 30). Thecocain solution should certainlybe sterile.* Sterilization may beattained by means of the ordinarysteam sterilizer (fractional method),or after the manner of Matas, whodissolves in a hundred minims ofhot sterilized water five tablets,each containing one-fifth of a grainof cocain hydroehlorat, one-fortieth . «of a grain of morphin hydroehlorat, i. SLand one-fifth of a grain of sodium. Fig. 30.—Tuffiers spinal syringe for spinalanesthesia. chlorid. Twenty minims of this solution equals the strength of a single tablet. After resterilization by the fractional method twenty-two minims are injected, thus allowing two minims for waste and twenty * W. C. Reilly, N. Y. Med. Record, vol. Ix, 1901, page 213. 42 OPERATIVE SURGERY. minims for medication. The fluid should be at about the temperature of100° F. when introduced. The Operation of Injection (Tuffier).—Seat the patient on a table withthe back toward the operator, the hands resting on the thighs to supportthe trunk; prepare the lumbar region with antiseptic care, make the spineas straight as possible by holding the trunk nearly upright; identify thehighest point of the iliac crests posteriorly, and connect them with a hori-zontal line (Figs. 31, 32) ; identify the tip of the fourth lumbar spine at thepoint it is crossed by this line; introduce the needle at point just below theouter side of the
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