Remarks ON EIGHTEEN CASES OF SPINAL ANALGESIA BY THE STOVAINE-STRYCHNINE METHOD OF JONNESCO: INCLUDING SIX CASES OF HIGH DORSAL PUNCTURE
Authors: L. McGavin
Journal: BMJ (1910)

It will be within the recollection of the members of the medical profession that in the autumn of last year Professor .Thomas Jonnesoo of Bucharest demonstrated before the Surgical Section of the K,oyal Society of Medi cine, and also in the operating theatre of the Seamen's Hospital, a method of spinal analgesia introduced by him with tibe objeot of rendering possible operations on the head, neck, anj? upper extremity. As I was mainly re sponsible lor these demonstrations, and have since then submitted Jonneaco s method to the test of practical application ?in my wards, I have ventured in this com munication to place the results obtained before my pro fessional confreresis1 it must be admitted that, as reported, they would suggest a very high measure of success ?and safety, and, compared with my cases here reported, show,a marked contrast, since it is claimed that in no case was any ill effect noted. Whether this is due to exceptional experience, or to some peculiarity in the -class of patient submitted to operation in our respective countries, I Am unable to say ; it is, however, reasonable to suppose that the method, when first attempted by Professor Jonnesoo, was as uew to him as it was to me when I followed his example. Whatever the results obtained in Bucharest may have been, it will be remembered by those who were presentan the operating theatre of the Seamen's Hospital, that of the three cases injected by Professor Jonnesoo by his own method and using his own drugs and instruments, only one?a case of tuberculous cervical glands?was completely successful. In the second?a laparotomy?the injection was made in the dorei-lumbar interspace, and the patient, although analgesic, so far as his skin and muscles were concerned, to a point consider ably above the level of his fifth cervical vertebra, com plained of dragging sensations when his intestines were manipulated, and had to be submitted to a general anaesthetic. The third case, that of a boy of 12, was given 2 eg. of stovaine and i mg. of strychnine, with a view to exploration of his mastoid antrum ; complaining -of pain on the application of the gouge, he was given a second dose of the same amount; he still complained of pain, and was then given chloroform. It is, however, only fair tosay that this boy assured me on thefollowing day that, being afraid, he had lied, and that he had experienced no pain whatever, and that it was the grating of the metal ou the bone which frightened him. Further, the fact remains that all three of these patients were analgesic to above their phrenic origins, two of them actually to the vertex, and yet there was neither respiratory paralysis nor any ill effect afterwards. The reason of the early publication of so few cases from my own wards is, I regret to say, that I have not been convinced of the safety of Jonnesco's method ; nor, from what I have seen of it, do I feel justified in employing it further for the present. I have set forth the report of my oases without any attempt either to magnify the im portance of those which were successful, or to mitigate tbe adverse facts in those in which the method failed. The statements with regard to each are strictly accurate in every detail. Professor Jonnesco claims as his method both high and low punctures whenever strychnine is combined with stovaine. I have therefore included all such cases in my report, although some of the latter might possibly have been done equally well without strychnine, for I have frequently obtained analgesia to the clavicles by stovaine alone without any sign of respiratory paralysis. The chief interest, however, lies in the six cases of high dorsal puncture (Nos. 7, 8,10,12,14,15), and in the two cases (Nos, 1 and 2) in which, the puncture being made at the level of the eighth dorsal spine, the analgesia rose above the phrenic origins, and in that of No. 6, in whiqh artificial respiration was successfully employed for a period of sixty-five minutes. It is a matter of great regret to me personally? as I am sure it will be to Professor Jonnesco, whose great courtesy I wish to acknowledge most cordially here, that these cases hav not in my hands borne out his contentton that the addition of strychnine is capable of preventing respira tory paralysis. The fact is, however, obvious, that although in some ses respiratory paralysis does occur, there are ot ers in which there is no sign of it. In the state of our knowledge of the subject, and with the drugs at present at our command? the method appears to me to be fraught with con iderable danger, apart from which the condition of a patient suffering from respiratory paralysis and yet per fectly conscious, even if artificial respiration can be success fully applied, is one of great mental anguish and bodily discomfort, and extremely harassing to witness.