Ventricular Fibrillation Causing Sudden Death of a Patient With Disease of the Left Coronary Artery

Abstract

RESULTSIn acute attacks the effect of the treatment is amazing. Patients who have been disabled by acute sprains or acute muscular spasm often regain the full use of the affected parts immediately. The pain frequently does not recur in cases of minor involvement and rarely recurs in full intensity in those of more serious involvement. Two to four treatments usually suffice to bring about, even in more serious cases, a minimum degree of discomfort. Thus, in all cases the period of disability is reduced drastically. Atrophy of the muscles involved does not develop to the same degree as when immobilization is employed. Swelling is more readily absorbed. Patients treated by this method are less apt to sustain the same injury again than those treated by immobilization. The same holds true for chronic and "rheumatic" conditions, although a longer period of treatment is usually required in those cases.As a means of aiding in diagnosis and in the evaluation of roentgenograms, this treatment is of great value. Further analysis and experience will be needed to establish general rules. As compared with the injection of procaine hydrochloride into the muscles and ligaments (Leriche4), this method shows the following advantages :1. Application is simpler.2. Repeated application is possible, with less difficulty and risk.3. Large areas can be controlled which otherwise would call for the use of vast quantities of procaine hydrochloride.4. It does not work when fractures or tears are present ; thus it is less dangerous and more selective.5. It is more advantageous in its use as a diagnostic means, being more selective.6. There is less risk of a local after-effect and no general after-effect such as is sometimes seen after the administration of procaine hydrochloride.7. There is no danger of infection. THEORYPayr 5 described the "chain effect of painful muscle spasm." He described how pain, originating in one portion of the sensory motor chain, leads to reflex muscular spasm and locking of joints. This chain consists of the following elements : sensory nerve, nerve center, motoric nerve, muscle and sensory nerve. Pain originating in the course of this chain leads to muscular spasm. The spasm is in itself painful and leads to more spasm. Elimination of pain at any point of the chain results in the breaking of the chain and therefore in relaxation of the muscular spasm. This may be achieved directly by the injection of an anesthetic into the muscle, joint, ligament, sensory nerve or spinal cord.If the pain-free interval is used to restore the muscle to normal function, the spasm does not recur or recurs with much less intensity. Empirically, on the basis of this chain, cutaneous anesthesia similarly relieves the deep-seated pain in muscular spasm.I have no explanation to offer as to how this deep effect of surface anesthesia works. It seems to be a fact, but the underlying physiologic explanation presents an interesting field for exploration. It must be definitely understood that in no case will the ethyl chloride alone, without a...