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Show Pictorial Diagram Illustrating the Position in fMMf-tK f : jf JrX- v 'V X Which a Child Is Placed for the Intra-Spin-al kikii f ,f , P . Injection. The Body Is Bent Into a Bow So '"aajp .Vj-V 1 ' ' " A That the Spaces Between the Vertebrae Are ts$-&Z&Sr ' f V v, '''. 1 ,0 Opened to the Utmost. This Permits of the ST'W f , , , J C V '"j-"' S $ Instertion of the Needle Between the Third and Fourth Lumbar Vertebrae. By a - ' V1 Puncture of the Spinal Canal at This Point a small Quantity of the Spinal Fluifl , " 4 '-f v.vT'n4' Can Be Drawn Off for Chemical Analysis and Later, If Desired, an Injection of . 4.. V -vf.-f, t- - J Serums or Drugs Can Be Made Into the Spinal Canal Where They Will Act Directly 4, ( " ff ' ? : on the Spinal Fluid. A ' U V i Tie Battle Against Infantile Paralysis and if - wH. NSs---'- P Other Diseases by Injection Directly 1 hp v Into the Spinal Fluid ;:rr . ; : jj t - A-' r r 11 A1 1 n T know, however, that if tlie sninal fluid 3 ;t- V ; , v ,v- A-'1 '- s. T) By Uonald lvlcUaskey, lvl. u. from a chiId sufrering from infantIe : . fcW'4. " . , , .. , , .., v,. u.. paralysis is injected into the brain of a . ; f.'-j sir. xiF a a " A ANB of the most interesting and im- mmed.ately on top o both h p bone o nkey, or rubbed into the mucous mem- i ' g&-'J f ) portant methods of treatment m mbnicuB and 'li ihe ?car It croa- branes of the nose of a monkey this in- -J -B Science's never-ending struggle to lne lunlbar rLgion 0f the spina, which is sidious disease will be produced in the , v - , - - 1 St A) cure disease and save human life, is that ordinarily known as the small of the animal. f-- f . , ...1 Sjt ? of puncturing the spinal canal with a back. The exact point where this liae Spinal puncture experimental work in , , J? P"u" s iHoPiloH to this crosses the si ine in the rear :s taken as the study of infantile paralysis has been, t AJ hypodermic needle. Attached to this entranM ,nt of llncture or the during the last few years, widely carried t - , A needle on the outside is a syringe through syringe needle. on In the research laboratories of the 3 , ' V which a quantity of the fluid which fills The small of the back consists of the Rockefeller Institute. fi '' 1 Y the spinal column can be extracted for flve iumbar vertebrae out of the thirty- Since the present epidemic of Infantile t - . : analysis and studv. By a similar method, two vertebrae which comprise the entire paralysis, Dr. S. J. Meltzer, at a meeting f J, .t( . -s if desired, serums and other curative spinal column. The line drawn as de- of the New York Academy of Medicine, - J $ V 3 O W V-isr--' V Z: agents may be injected into the spine scribed usually crosses the spine between advocated the injection into the spinal - lt j Sta&Z&i?' where they can act directly on the spinal the third and the fourth lumbar vertebrae. canal of sufferers from infantile paraly- ' f&-M --. fluid. The child is placed upon its left side. sis of the drug known as adrenalin xsi "Y.i , . Sfe: v This treatment is one of the most dar- The surgeon has the youngster pull its chloride. This is a glandular secretion C!1 s I' ' "vTl ing attempted by medical science for few knees up close to the chin. The head is produced by two glands known as the The qjj Method of Drawing Off Portions ' I Jf'S j parts of the human body are more deli- made to bend as far forward as possible. adrenal glands immediately above the of the gpjnai Fluid. Now It Is Considered i txN--'v 5' cate, sensitive and complicated than the This brings about a very marked curva- kidneys. While as yet an insufficient gafer t0 Have the Little Patient Lie on the SSS' I )W,;'v' spine. As every body knows xa very ture of the spine. It makes itconvex, and number of cases have been treated by j,eft Side with Knees and Chin Drawn -1- N I - slight injury to the spinal column Is lia- separates as widely as possible the va- this method to draw any positive and Close Together So That the Spine Presents B XgSgpSiS" ble to cause death or at least to cripple rious vertebrae one from another. This conclusive results, it is believed this a convex Surface for the Surgeons Needle. rs one for life. 1 separation of the vertebrae gives the form of treatment for infantile paralysis Yet when administered by a skilful surgeon the best possible opportunity to may iiave great virtue. Tn lnf,mntnr ntaxI, ,t has hee fourj(1 I1 physician it involves less risk than one puncture the , mal calwth his needle In tne very early stages of infantile t i' ordinarily appTed , would imagine. A bad headache is usu- eryaS eptic precaution is taken The .paralysis it has teen found by post- through the blood current does not reach CV W w ' ' ally the only serious effect felt from Bkin over the child s spine is thoroughly mortem study that the blood vessels of the of the spir0chetae which are in 0W WfeC V a successful puncture of the canal and a scrubbed with soap and water and then the spinal cord are exceedingly dilated. the nervoug strucPtUre of the spinal cord. WT5 ! withdrawal of a small quantity of the vigorously rubbed with 95 per cent alco- , Wherever this excessive dilation has oc- ,n order 0lat ,hey can be reached it ba3 VVi ' j.. X fluid To prevent this and to help the hoL curred. paralysis develops rapidly been found that only a direct method is g? ' 1 1 changed auanUty of the spinal fluid to With the needle in his right hand the The whole idea back of the adrenalin effective. The Intraspinal treatment has fZ0fT? G Jtlt it? po iUbrum some phvsicians surgeon with the left hand determines Intraspinal injection treatment is based aftorded tnia dlrect route, and it often U7 k f ,) J regain its equilibrum s0"e p,a the space between the third and fourth upon the power of this drug to constrict Efve, a marked relief from the distress- 11 - recommend making the patient . He no vertebrae and deliberately thrusts the this blood vessel congestion and thus re- svmptoms of locomotor ataxia. vJ" t I for a few hours after the operation itn needle forward between the two verte- lieve the localized pressure and possibly There are a number of very interesting l Wl the head considerably lower man tne brae, gently and firmly, untilhe feels the the localized toxemia m the delicate and unusual features connected with the JflV jf J hips. resistance of the vertebra on the far side spinal cell structure. . modern intraspinal treatment of disease. fir f 1 W Of course, the Injection of drugs or Qf fhe ,nal cana, Whether or not we persist in the The spinal flidi fop exampiei is a m0re or ((if J JJ uJ4. serums into the spinal canal is a more In or(Jer fQr thg SDinal flll,d tQ flQW Qut adrenalin spinal injection treatment, its less costant quantity. In disease, How l; serious matter and neither this or a mere thr0ugh the neediest is necessary that curative powers can be determined only ever, ot the spjnal canal the quantity ia . ot ormi spi-ri 1 1 puncture of the spinal canal should be withdraw the needle verr atter a sl,ftlclent lnPfe ot 1 me' dur, n? greatly increased, with an increase of sho-inB (a) Cu.bioni i.) sen.orr ,.-.... ,.. .?... 7Z "L o V,,t ti,. mnRt. skilful ?,e,.!,Ure. .W'V??r.aW 6 i.T6,rT which accural estatisticscan.be compiled ' , imnn the delicate sninnl struc ) Motor Osll.i S,W '"". ntnjLrramnintlc View of the Spinal Column. Thm White Line Indlcntpn the Spfnnl C'ord. The Arrow Indlraten the Point Between the Third nnd Fourth Vcrtphrae Where 3Iedirn1 Science HfiN Found It SafeNt to Puncture the Spinal Cord. J'mTERL JaracIinojdKX m m .pimalScoro ninRrammatlc View of n Section of the Snlntil Column Showing Its Ucllcnte and Complicated Compli-cated Structure. Pictorial Diagram Illustrating the Position In S'4itfhvrfM$'-&-- Which a Child Is Placed for the Intra-Spiival tAlhrflWii4ja4, Viii; Injection. The Body Is Bent Into a Bow So --aajjy - That the Spaces Between the Vertebrae Are Opened to the Utmost. This Permits of the Instertion of the Needle Between the Third and Fourth Lumbar Vertebrae. By a Puncture of the Spinal Canal at This Point a small Quantity of the Spinal TluiJ Can Be Drawn Off for Chemical Analysis and Later, If Desired, an Injection of Serums or Drugs Can Be Made Into the Spinal Canal Where They Will Act Directly on- the Spinal Fluid. The Battle Against Infantile Paralysis and Other Diseases by Injection Directly Into the Spinal Fluid By Donald McCaskey, M. D. ONE of the most Interesting and important im-portant methods of treatment in Science's never-ending struggle to cure disease and save human life, is that of puncturing the spinal canal with a hypodermic needle. Attached to this needle on the outside is a syringe through which a quantity of the fluid which fills the spinal column can be extracted for analysis and study. By a similar method, if desired, serums and other curative agents may be injected into the spine where they can act directly on the spinal fluid. This treatment is one of the most daring dar-ing attempted by medical science for few parts of the human body are more deli- cate, sensitive and complicated than the spine. As every body knows xa very slight injury to the spinal column is liable lia-ble to cause death or at least to cripple one for life. i Yet when administered by a skilful physician it involves less risk than one would imagine. A bad headache is usually usu-ally the only serious effect felt from a successful puncture of the canal and a withdrawal of a small quantity of the fluid. To prevent this and to help the changed quantity of the spinal fluid to regain its equilibrum some physicians recommend making the patient lio down for a few hours after the operation with the head considerably lower than the hips. Ot course, the Injection of drugs or serums into the spinal canal is a more serious matter and neither this or a mere puncture of the spinal canal should be '. intrusted to any but the most skilful and experienced physician. What is Tcnown as the intraspinal treatment was introduced less than fifteen fif-teen years aeo. and it has been developing with "wonderful strides. The latest disease dis-ease to be combated by this method is infantile paralysis, or, as it is known to science, poliomyelitis. This is the disease dis-ease which has been epidemlo in New York City, claiming hundreds of victims. It was not. until this epidemic that any great scientific thought was given to the value of the intraspinal treatment In infantile in-fantile paralysis. We know to-day that the germ which causes Infantile paralysis Is present In a virus, which gains access to the human body, particularly of children from two to fourteen years of age, through the mucous membranes of the nose and the throat. Prom here it proceeds along the delicate lymphatic channels at the base of the brain, travels backward and downward until it reaches the spinal cord. In the tissues of the delicate spinal cord there are certain food chemicals that the germ selects as Its particular and peculiar habitat. Once lodged in these delicate spinal structures an inflammation inflamma-tion is set up, and the child who goes to bed at night In a perfectly healthy condition condi-tion suddenly wakes in the morning with one arm and one leg, or both arms and both legs totally paralyzed. As a result of this inflammation certain chemical changes occur In the fluid of the spinal canal. This canal surrounds the cord, and acts as a protecting layer between It and the bony structure of the spinal vertebrae. By the use of the syringe needle, the chemical composition of the spinal fluid can be accurately ascertained, as-certained, and here Is the way that the . doctor proceeds. A horizontal line is drawn around the patient's waist both in front and in back immediately on top of both hip bones of the pelvis, lu front this line asses near the umbilicus, and in the rear it crosses the lumbar rLgion of the spine, which is ordinarily known as the small of the back. The exact point where this liae crosses the si ine In the rear is taken as the entrance point of puncture for the syringe needle. The small of the back consists of the five lumbar vertebrae out of the thirty-two thirty-two vertebrae which comprise the entire spinal column. The line drawn as described de-scribed usually crosses the spine between the third and the fourth lumbar vertebrae. The child is placed upon its left side. The surgeon has the youngster pull its knees up close to the chin. The head is made to bend as far forward as possible. This brings about a very marked curvature curva-ture of the spine. It makes it convex, and separates as widely as possible the various va-rious vertebrae one from another. This separation of the vertebrae gives the surgeon the best possible opportunity to puncture the spinal canal with his needle. Every aseptic precaution is taken. The skin over the child's spine is thoroughly scrubbed with soap and water and then vigorously rubbed with 95 per cent alcohol. alco-hol. With the needle in his right hand the surgeon with the left hand determines the space between the third and fourth vertebrae and deliberately thrusts the needle forward between the two vertebrae, verte-brae, gently and firmly, until he feels the resistance of the vertebra on the far side of the spinal canal. In order for the spinal fluid to flow out through the needle it is necessary that the surgeon withdraw the needle very slightly so that its open end will not be in direct contact with the bony portion of the spine. Inside of each spinal puncture needle there is a plug known as an obturator. When the needle gets inside of the spine this plug or obturator is withdrawn, and if the needle is in proper position within the spinal canal, the fluid within the canal will begin to flow out through the needle. If it flows drop by drop it Indicates a normal pressure of the spinal fluid. When, however, the fluid spurts or flows In a stream, it indicates an excessive or diseased dis-eased pressure within the spinal canal. This is the first valuable scientific indication indi-cation to be obtained from the spinal puncture. If the pressure within the spine Is normal, as tho fluid makes its way through the puncture needle, the pressure is sufficient to force a thin column col-umn of water up through a glass tube to the height of 60 millimeters or a trifle over two inches. The spinal fluid Is collected In a sterilized steril-ized test tube, and is studied under the microscope, and by chemical means. In these ways its normal or diseased condition condi-tion is determined. The weight of the spinal fluid containing contain-ing all of its soluble substances in a normal nor-mal condition, Is very nearly the same as water but slightly heavier. Compared bulk for hulk the ratio of the spinal fluid to water is as 1005 Is to 1000. Every spinal fluid contains a Bmall percentage per-centage of mineral salt of albumin nnd glucose, or sugar. Where tubercular spinal meningitis has developed, the spinal fluid contains a delicate clot In which is found the tubercular tuber-cular bacilli, but it remains as yet for the laboratory to discover any germ in the spinal fluid of infantile paralysis. We do Copyright, 1016, by the Star Company. know, however, that if the spinal fluid from a child suffering from infantile paralysis is injected into the brain of a monkey, or rubbed into the mucous membranes mem-branes of the nose of a monkey, this insidious in-sidious disease will be produced in the animal. Spinal puncture experimental work In the study of infantile paralysis has been, during the last few years, widely carried on In the research laboratories of the Rockefeller Institute. Since the present epidemic of Infantile paralysis, Dr. S. J. Meltzer, at a meeting of the New York Academy of Medicine, advocated the injection into the spinal canal of sufferers from infantile paralysis paraly-sis of the drug known as adrenalin chloride. This is a glandular secretion produced by two glands known as the adrenal glands immediately above the kidneys. While as yet an insufficient number of cases have been treated by this method to draw any positive and conclusive results, it is believed this form of treatment for infantile paralysis may have great virtue. In the very early stages of infantile paralysis it has been found by postmortem post-mortem study that the blood vessels of the spinal cord are exceedingly dilated. Wherever this exces-sive dilation has occurred, oc-curred, paralysis develops rapidly. The whole idea back of the adrenalin Intraspinal injection treatment is based upon the power of this drug to constrict this blood vessel congestion and thus relieve re-lieve the localized pressure and possibly the localized toxemia in the delicate spinal cell structure. Whether or not we persist in the adrenalin spinal injection treatment, its curative powers can be determined only after a sufficient lapse of time, during which accurate statistics can be compiled and thoroughly analyzed. Certainly at this time medical science has welcomed with open arms the idea advanced by Dr. Meltzer, of the Rockefeller Institute, that perhaps in adrenalin we have Cne means of lessening the ravages of this virulent epidemic. But while as yet the intraspinal Injection Injec-tion treatment of infantile paralysis is on trial there are many diseases where its efficiency and its helpfulness to mankind have already been placed beyond the circle cir-cle of doubt. In spinal meningitis, for example, where the Infective organisms attack the membranes mem-branes of the brain as well as the spinal cord, Dr. Simon Flexner, the director of the Rockefeller Institute, when helping to combat a recent severe epidemic of spinal meningitis in Texas developed a serum. This serum he found, when injected in-jected into the spinal canal of the victim, rapidly lessened the virulent ravages of the disease. Working on the same experimental lines, physicians have begun to apply this method in tho treatment of hydrophobia, of tetanus or lockjaw and of locomotor afnxla and of general paralysis. In the treatment of hydrophobia sulphate of quinine is injected into the spinal canal. In the intraspinal treatment, of tetanus or lockjaw the tetanus antitoxin is in-v in-v jected into the spinal canal. In the treatment of locomotor ataxia, of which the germ known as the spirocheta pallida is the cause, there has recently been devised a serum known as the Swift-Ellis Swift-Ellis serum. This serum Is made by the patient himself. The patient is injected with a well-known drug. When his system sys-tem has become saturated with it about a pint of his blood is withdrawn. Tho blood is allowed to stand and settle, set-tle, and the blood serum is then extracted. It is this which is then Injected into the spinal cannl. Great Britain Rights Reserved. The Old Method of Drawing Off Portions of the Spinal Fluid. Now It Is Considered Safer to Have the Little Patient Lie on the Left Side with Knees and Chin Drawn Close Together So That the Spine Presents a convex Surface for the Surgeons Needle. In locomotor ataxia It has been found that treatment as ordinarily applied . through the blood current does not reach the foci of the spirochetae which are in the nervous structure of the spinal cord. In order that they can be reached it ha3 been found that only a direct method is effective. The Intraspinal treatment has afforded this direct route, and it often gives a marked relief from the distressing distress-ing symptoms of locomotor ataxia. There are a number of very interesting and unusual features connected with the modern intraspinal treatment of disease. The spinal fluid, for example, is a more or less constant quantity. In disease, how ever, of the spinal canal, the quantity is greatly increased, with an increase of pressure upon the delicate spinal structure.' struc-ture.' Some extraordinary effects have, been noticed when the quantity of spinal fluid has been lessened by an abnormal amount. Herein lies one of the strongest virtues In the intraspinal method of treatment. When the excessive pressure in the spinal canal can be reduced to normal, and likewise like-wise tho spinal fluid can be brought down to normal quantity, the symptoms of disease dis-ease which are the direct result of the excessive pressure and the excessive amount of spinal fluid oftentimes disappear, disap-pear, or at least are great relieved. This affords a better opportunity for a normal blood supply and a healthy state of nutrK xion, so that the inflamed tissue cells can recover their healthy vigor In acute infectious diseases of the spinal canal, the study of the spinal fluid by means of the intraspinal method ha3 proven to be a much more sensitive index than the study of the 'blood. We have in the suggestion of Dr. Meltzer Melt-zer in the use of adrenalin chloride a remedy which may very possibly be of great value because of its constrictive power over the blood vessels of the diseased dis-eased area of the spinal cord. To what extent, however, this drug will develop any permanent curative value is still a matter of speculation, and this method of treatment is still on trial. The best remedy that we have thus far discovered for infantile paralysis is the remedy of isolation, good nursing, scrupulously scrupu-lously hygienic conditions of cleanliness as regards bathing, feeding, pure water and pure food and the generous applica-t'on applica-t'on of fresh air and sunlight. Whether or not the invading organisms of infantile paralysis can be checked "by the intraspinal intra-spinal injection of adrenalin chloride; whether in this treatment science possesses pos-sesses a remedy as valuable in combating combat-ing this virulent epidemic as has beeu definitely proven In checking the syniD- 1 Cross-Section of Normul SPI"' f Showlns (a) Cmhloni s"" (e) Motor tells, (d) Spinal ""-p,,,,, 2 TleEinnlnp of InfeetUm ( el ( t ,,, Flittering Throuch Cushion () ' ' - Cord) If) lllooili Id) Spln'. " foil""' S The Infection Complete em HnviuR Filtered Throuirh Cuhlonil Filled the Anterior Portion at , Cord (R) with Blood, and Olsow" Broken the Sen.orr and Motor '""' M, Nerves (d) Have Shrunk anaAreJ Hov, an Obstruction in a" '"rt, ,r,,J the Blood Supply ""''"", the "P1"' OrlK.na,lnB in That MJ toms of locomotor ' ment of tetanus or of hjdro a question winch onl ' nf, tion can determine Du e . looks so promising : that s e to couraged to believe that i .pon cure, or at least ' most of these diseases. |
