Infiltration anaesthesia of the lower arm and hand.

I N the treatment of surgical diseases of the upper extremity, partly local and partly general anaesthesia are used. The opinion of Kochert, that local anaesthesia is advisable only when contra-indication of narcosis exists, is no longer accepted. We cannot lay down any general rule as to the best types of anaesthesia to be applied, for example, the age of the patient or his psychic disposition has often induced us to complete under narcosis an operation which is normally carried out by employing only local anaesthesia. On the other hand, it may happen that the patient's fear of narcosis is so great that in order to avoid it he is ready to bear even considerable pain. However, whatever the method the surgeon employs, his aim is always to carry out the operation with the minimum of pain. This can only be achieved through the choice of drugs of the appropriate kind and quantity and through the use of correct methods correctly applied. The oldest, as well as the best known methods of analgesia, employed in surgical treatments of the upper extremity, are the two evolved by Oberst and KullenkampfT. The first of these, though simple, is not in all cases without danger, as we shall see later. The second, besides requiring specialized technical skill, also leads in a certain number of cases, not only to unpleasant symptoms such as paralysis of the cervical sympathetic system, blocking of the phrenic nerve and pain in the chest, but also to serious collapse, pneumothorax and even death. On account of these dangers, these methods can certainly not be employed for ambulant cases. In the last century, Korning and Goldscheiner investigated the problem of infiltrative anaesthesia. In animal experiments,