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In 1909 when work on the Panama Canal was being vigorously pushed, Hospital Santo Tomas, the government hospital of the Republic of Panama, found its admissions increasing rapidly without a corresponding increase in equipment and assistance. For this reason more than others, the surgical staff began the use of spinal anesthesia. Since that time it has been used as a routine procedure, except when contraindicated, for all surgical operations below the umbilicus. It has been used frequently for operations on the upper abdomen and rarely for higher regions of the body. The administration of the anesthetic has not been restricted to any one or to any set of operators, but has been used by new interns. In all, twenty-seven different physicians have contributed to this series of cases. This, of course, is not conducive to the best results, but the opportunity to review results under these conditions is interesting and
BOYD AS, YOUNT CC. ROUTINE SPINAL ANALGESIA: WITH REPORT OF 6,229 CASES. JAMA. 1917;LXVIII(8):601–604. doi:10.1001/jama.1917.04270020265005
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