English: Identifier: textbookofoperat01koch

Title: Text-book of operative surgery Year: 1911 (1910s) Authors: Kocher, Theodor, 1841-1917 Subjects: Surgical Procedures, Operative Surgery, Operative Publisher: New York : Macmillan Company Contributing Library: Francis A. Countway Library of Medicine Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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Text Appearing Before Image: nal canal. The puncture is not easilyaccomplished, and we have per- formed it with the patient in the lateral position. A needle, 1\ inches long, isinserted below the last sacral spine between the two prominent posterior sacral tubercles.It is then pushed forwards in the triangulär space between these tubercles tili it hassufficiently penetrated the thick membrane which closes the space. The needle isthen directed upwards towards the sacral canal for a deptli of 1 to 2 inches, exactlyin the middle line, when the injection is given. Cathelin explains that the injection acts by the entrance of the aneesthetic intothe rieh venous plexus between the dura and the wall of the spinal canal. It hasalso, however, a local action, as he has found the injection produce very satisfactoryresults in neuralgia of the lower extremities, lumbago, in the radiating pain of tabesand also in cases of enuresis. Cathelin injects 1 drachm (4 g.) of a ^ per cent^ Bull, de la Soc. de Chir., 1901, et Soc. Biol.

Text Appearing After Image: F:g. 22. FiGS. 21 and 22.—To illustrate Cathelins method of injectinginto sacral canal. Note the alteration in the directionof the needle. 46 OPERATIVE SURGERY Solution of Cocain. In clogs he was able to produce complete anaästhesia of thewliole body. Tlie two conditions in which Cathelins method are chiefly indicated areincontinence of urine and pain in the lower half of the body. (o) Furthep Details on General Ansesthesia Rose has stated that no one can avoid an occasional fatality under ancesthesia, asa patient may die suddenly from the nature of his disease, quite apart from the useof the antesthetic. The truth of this cannot be denied. Death may occur verysuddenly from the Status thymicus and status lymphaticus, and also from certaincirculatory disturbances, e.g. atheroma of the coronary arteries. Patients who havea high blood-pressure are liable to apoplexy, and in this connection death has takenplace suddenly from an increased blood-pressure in the vessels of the bräin. Ind

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