Anaesthesia anaesthetics et général et local . Fig. 47.-crêtes iliaques. brae est généralement sélectionnée. Chipault utilisé l'espace entre les couples lesvis vertèbre lombaire et le sacrum, qui est aussi byRodman préféré. Corning d'abord utilisé l'espace entre le eleventhand douzième vertèbres dorsales, mais plus tard préféré que thefourth entre et la cinquième vertèbre lombaire. Tait et Cagliari, de SanFrancisco, ont injecté aussi haut que le sixième de l'espace cervical, butmost injections condamner les autorités plus que le secondlumbar vertèbre. Emplacement et mode. La position latérale et la technique 162 LA RACHIANESTHÉSIE alre

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Anæsthesia and anæsthetics general and local . Fig. 47.—Iliac Crests. brae is usually selected. Chipault used the space between thefifth lumbar vertebra and the sacrum, which is also preferred byRodman. Corning first used the space between the eleventhand twelfth dorsal vertebrae, but later preferred that between thefourth and fifth lumbar vertebrae. Tait and Cagliari, of SanFrancisco, have injected as high as the sixth cervical space, butmost authorities condemn injections higher than the secondlumbar vertebra. Position and method. The lateral position and technique 162 SPINAL ANESTHESIA already described may be used. Matas recommends the methodemployed by Turner, and first used by Quincke. The patient is seated on a table with his back to the opera-tor (Fig. 46). His hands resting on his thighs support histrunk. The trunk is held nearly upright with the spine asstraight as possible. The highest points of the iliac crestsposteriorly are now identified (Fig. 47), and a horizontal line. Fig. 48.—Needle Entering Opposite Fourth Spine. connecting these points is drawn across the spine. The tipof the fourth lumbar spine touches this line. The canula isentered at a point just below and to the outer side of the junc-tion of this line with the fourth spine (Fig. 48). The skin atthis point and for a quarter of an inch to the right of the medianline may be infiltrated with a few drops of Schleichs cocainesolution No. 1 or No. 2. A Pravaz syringe, as used by Tuf- SPINAL ANAESTHESIA . 163 fier, may be employed (Fig. 49), with a platinum needle 8 cm.long, and a lumen of 6 mm. The various methods of insert-ing the. needle are shown in Fig. 50. Guinard claims to have succeeded in suppressing all aftereffects of medullar cocainization by using a solution of cocainein the rachidian liquid of the patient, 60 to 80 drops of thisliquid are collected in a sterilized bottle, and 6 or 7 drops of aconcentrated solution of cocaine (about 1 centigramme to 2drops of water) are added an

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