Spinal Anaesthesia

Abstract

TREATMEINT o01 ASTHMA BY t3LThA-IOLET LG{ i reason of the greater wealth of ultraviolet rays in the solar spectrum at those heights. Unfortunately, even this mechainism fails to explain all the clinical phenomena. For example, Case I, during his asthmatic attack, was apparently suffering from acute suprarenal dysfunction which means either that there was an inadequacy of dopasubstance, or else that the suprarenals were failing to convert it to adrenaline. The fact that he did not pigment in an Addisonian manner does not necessarily indicate the latter; it may have been too slight to be noticeable. He was given suprarenal extract (empirically) by mouth, and this was followed by improvement. But we do not know the real effect of suprarenal extract given by mouth. It may be the adrenaline content that is absorbed, or a ferment-in which the suprarenals are temporarily deficient-for converting dopa-substance into adrenaline. Whichever it may be, the whole scheme breaks down when the patient-on regaining his suprarenal function and normal blood pressure-develops an attack of asthma. One would have expected him to do this earlier, when his adrenaline production was at a low ebb. The only possible (and to my mind rather weak) plea is that he may not have had the allergic provocation during that time. Then the coma by which Case II distinguished himself cannot be explained by this mechanism. Summary 1. The beneficial effects of actinotherapy in cases of asthma cannot be attributed alone to the suggestibility of the patient. 2. At present no theory can be propounded which covers all the clinical observations. 3. The most striking clinical observation-that is, the relation between immunity and pigmentation-leads me to propound a theory involving the relation of adrenaline and melanin. 4. It is perhaps noteworthy that in none of these twelve asthmatic patients or in any of the fifty to sixty patients treated by ultraviolet rays for other conditions has pulmonary tuberculosis manifested itself either during treatment or subsequently.

Leo Doyle, Master Surgeon

“…His experiences with spinal anaesthesia formed the basis of an article that was published in the British Medical Journal in 1936. 18 Doyle showed that with proper safeguards spinal anaesthesia was both safe and effective.…”