Dr. Clement had asked Apgar's advice about a puzzling case in which spinal anesthesia seemed to cause paralysis long after
the operation. In this letter, she encouraged him to publish an account of the case, which was the first of its kind in which
pontocaine was the drug used. She suggested the possibility that underlying neurological disease might have caused such a
response, as there were cases on record where this had happened with other spinal anesthetics. The exchange illustrates the
clinical problems encountered by anesthesiologists in the inter-war years, as well as their efforts to build up the knowledge
base in their new specialty.
Number of Image Pages:
1 (79,176 Bytes)
1938-04-25 (April 25, 1938)
Clement, F. W.
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
Reproduced with permission of Peter A. Apgar.
Medical Subject Headings (MeSH):
Establishing a New Specialty, 1938-1949
Letter from F. W. Clement to Virginia Apgar (March 28, 1938)
Thank you so much for your letter of March 28th. The case you describe is most interesting, and the first of its kind in
which pontocaine was the drug used. Similar cases have been reported with all other drugs used in spinal anesthesia, i.e.
procaine and its various combinations, nupercaine, stovaine etc. May I suggest that you publish this case soon, so that others
like it may come to light?
The mechanism of the paralysis is of course difficult to explain. Your technic [sic] seems infallible. Damage to the cord
or its meninges from the drug itself is possible, but it should happen oftener [sic]. I do not know of any experimental work
done with effect of pontocaine on the cord, as has been done with procaine and durocaine. It should be done. One possibility
we overlook too often, is the presence of central nervous system disease before anesthesia. A number of cases are on record
in which preexisting C.N.S. disease has been made much worse by spinal anesthesia, irrespective of the drug used. Autopsy
might have decided this point in your case.
The analysis of 1100 pontocaine spinal anesthesias at the Presbyterian Hospital is in preparation at present, as is also a
short paper on the "Late Effects of Oxygen Want in Spinal Anesthesia." I shall be glad to send you reprints, when
they are published.