NODAL FEVER: (ERYTHEMA NODOSUM, ERYTHEMA MULTIFORME.)
Authors: A. A. Lendon
Journal: BMJ (1925)

A 4 MI tJfNDAL FEYEA Tn.II 65 81 *tAP 1r, 4.. T'"-j f MEDIciL JouENAZ manoeutivres which have been shown, bevonid reasoniable doi-at,' to) be of real value.Discredit cai only be brouglt oa1 a. i-atioialai method (f ana,esthesia by its too ardenit applicatioi .to a regiDn to which it is very qulestionablv suitel.A modification of Labat's method was.used in 32 cases,.wvith good resu4ts in 11.Of these, 4 were partial gastree- tames, 3! gastro-enterostoirnies, and 1 a choledo)schotoinix.It is impossible to be suxe f however, just how miuchl of the -sut o-was dine to the anaesthesia of the abdonaln.alsnMi?atheti-c nerves, which LabVt's mvethod, induces.The most imnportant result of regiolf anaeasltesia is demonstrated rather by experience thia figuies.It is that in almost all eases the patient is the better for his regioial an-aesthetic, and even if inhalation aniasthesia is also needed,.the patient is held, with a minimiiiumui of iiitrotis oxide or ethylkene often.sufficient oil1y to abolish cons5cioIiSIWSs.RE.AeCT5BNS ' TO EGIONAL ANAEMSTFESIA.These ar'e easily indlced unless strict watch is kept on the patient and the variolus signs noted.:It va.tlhe rutlle in all the cases of the present series for a Wr*se to sit at the patient's-heaid.an,d record the pitihe.In1head, spi-nal eord, and abdnm-iieal cases shfe also took the blood pressuire..All' these wer iecordedi on, a sheet of'4wpaper whiclh the adiiinis- trn4sr could seeLanA so' mvoix alarming the patient by verbal inquiries.The iu-rse &14ao engaged; the patient in conversa- tion and withdrew his attentions from the meanip*ilations.A reaetiow-may' be, due either to' the adrenainie in-jected or to thle movcain, or both.An adrenaline, reawtion is early-, a novocain reeti'on la-te.Th-e elellents of an adrenaline reaction i:rr the order of their app-earance are:(1)-increased respiration, (2).rapid puise, (35) palpitatiDri, (4y apprehensive excitement, (5) tremor ,. (6) sweating, (7) d'vspnoea, anid (8) precordial paiii.The last two, unlike the others, are late in onset.Aniy three of tlhe fir'st six constitute a marked reaPtiun;' the last two are lhappiv as rnare as tlhey are seriois.The elenments of a niovocaii reaction are, those of spinal anaesthesia: slow pul,se, fall; in tfiood pressu-re, pallur, cyranosis, nausea, and-Vomiting.'The treatmenrt for' either type of reaction is that o-f pre- reirtion.SafetT is ensured, by slow injection aid' cessation as.soon as the reaction appears.The effect wears off in a few minutes.It is not ciirmulative and injection m-ay pro- ceed after an interval.In the event of a severe adrenialine reaction, oxygen conitaining 5 per cent. of carbons dioxide is given.This relieves the air hiunger and, alnginalI pain. (Mote -than 30 minim-s of adrenialine shoul'd niever be given to onie patient.There was onlyv one severe adrenialinie reaction in the present series.That was in the case of a patient who, was afterwards found to iave a family history of capillaiy atonicitv.Both blood pressure anid pulse rate were abuiot miialIy lbowX and, his type would nowl be consider ed uinsuitable for1 regional anaeshesia.An ampoule containing 3 grains of caffeinie, 7 grains of sodium beizoate, and (F.025 grain of strychniine should be in.readiness in tlhe event of a severe novocaii reaction.For severe cases of pallor, nausea, and slow pulse, fromi 5 to 10 minims of adrenaline are inijected.A celtain measure of success may be attained by practice of the technical methods herein detailed'.To impro've on that ald to recduce failure to a miimlum carlefil' study of tlle anatomy of' the region is essential.It is neceskary tof visualize the, field in perspectitve, and to be prepared fQi' those variations from.normal topogr;aphv anid relationis wlhicli are lnot to be dealt with by rule of th.umb.BIBLTOCRAPHY.