F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
523
lower limbs is the puncture performed between the nth and I2th dorsal vertebrae.
2-3 cc of cerebro-spinal fluid is withdrawn, followed by slow injection of absolute ethyl
alcohol (i cc per minute). The total amount of the injected alcohol depends on the time
of the disappearance of reflexes—the first being the sole and ankle jerks—and the develop
ment of total flaccidity. This can be achieved in the majority of cases following injection
of 6 cc. It is essential that an assistant records, following testing, the details of trans
formation of the spastic lesion into a lower motor neuron lesion. Following injection,
the patient is left for about 3 min in the same position and then, maintaining the tail-up
position, is very slowly turned to the opposite side so that the alcohol can circulate and
block the opposite spinal roots. After 5 min, the patient is turned slowly on to his back,
where he remains for several hours. The tail-up position can be discontinued, as a rule,
after 2-3 hours.
The absorption of ethyl alcohol from the subarachnoid space
Earlier work on the absorption of substances from the subarachnoid space in man was
mainly concerned with the absorption of 2 ml of 10 per cent sodium iodide solution in
the urine in cases of cerebral syphilis and schizophrenia (Guttmann, 1929). It was found
that onset and duration of the excretion could be greatly delayed.
Katzenelbogen (1935) came to the conclusion from animal experiments that there are
two pathways of absorption, one directly into the venous blood and the other indirectly
into venous blood by the way of the lymphatics. Aird & Seifert (1952) assumed that the
absorption of alcohol from the subarachnoid space takes place very rapidly, but these
workers did not offer any experimental evidence to substantiate their assumption.
Eggleton (1942) showed that ethyl alcohol administered orally is rapidly absorbed and
can be found in the blood, cerebral spinal fluid and urine within a few minutes of its
administration. It seemed, therefore, worth while to investigate this problem following
intrathecal alcohol injection in complete lesions of the spinal cord, which the writer in
co-operation with Robinson, the biochemist of Stoke Mandeville Centre, carried out
(Guttmann & Robinson, 1956).
Method and procedure
The Cavett method was used to determine the absorption in blood and urine (Kent-
Jones & Taylor, 1954). No fluid intake was allowed for 2 hr before and for at least 2 hr
after the intrathecal injection. Urine specimens were collected by means of an indwelling
catheter and blood specimens by finger prick. The urine specimens were tested by
Rothera's method, and in all experiments blank determinations were carried out on
blood and urine specimens collected immediately before the alcohol injection. It was
usually found that there was blank value equivalent to about 10 mg of alcohol in urine
and about half that value in blood.
Results
(Fig. 2i8a, b, c)
In all cases, alcohol could be detected in the blood within 15 min and in urine within 40
min of injection. Sometimes, the alcohol was found in the blood within 5 min and in the
urine within 20 min. Alcohol was not found in the urine later than 5 hr after the
