LOCAL ANÆSTHESIA BY THE HYDROCHLORATE OF COCAINE.
By R. J. Levis, M.D., Surgeon to the Pennsylvania Hospital and to the Jefferson Medical College Hospital.
The notes of a few cases of the use of the hydrochlorate of cocaine will illustrate its perfect efficiency in some and its apparent inertness in others, and may help toward its proper application and general appreciation.
In a double extraction of hard cataract there was no pain produced by the graspings of the conjunctiva in the fixation of the eyes, in the corneal incisions, and in the iridectomies.
A 4 per centum solution was freely brushed over the entire conjunctival surface three times, at intervals of ten minutes, and the operations were commenced in forty minutes after the first application. No irritation was produced, and the only sensation described was that of "numbness and hardness." The entire conjunctival surface seemed insensible to repeated pinching with the fixation forceps.
In a single extraction of hard cataract a 4 per centum solution was brushed over the ocular and palpebral conjunctiva, with the eyelids freely everted. Three applications were made at intervals of ten minutes, and the operation was performed at the lapse of twenty-five minutes. The patient asserted decidedly that she felt no pain whatever.
Preparatory to the operation for uterine procidentia and rectocele, the vaginal and labial mucous surface was wiped dry, and a 4 per centum solution of the hydrochlorate of cocaine was thoroughly brushed over it. The sensitiveness was tested at three intervals of ten minutes each, and the application was repeated three times. There appeared to be at no time any decided loss of painful sensibility, and the operation was finally performed under the anæsthesia of sulphuric ether.
For the removal of a rather large tarsal tumor, the ocular and palpebral conjunctiva and the exterior of the eyelids were brushed with the solution as previously used, at intervals of ten minutes, and the excision was performed at the lapse of forty minutes. The operation seemed to be as painful to the patient as if performed without an attempt at anæsthesia.
For the operation for lachrymal obstruction the application was made in the same manner and at the same intervals. The slitting of the punctum and caniculus gave no pain, but the passage of the dilating probe down the lachrymal canal seemed to produce some uneasiness.
Prior to applying nitric acid as a caustic to a syphilitic ulcer on the tongue, the same manner and number of applications were repeated, the tongue having been wiped dry and held protruding between the teeth. No pain was produced on the thoroughly benumbed tongue.—Med. News.