CORRESPONDENCE.
NEW YORK LETTER.
THE USES OF COCAINE IN SURGERY.
It is not the object of this communication to speak of the discovery of this drug and the experiments which were necessary to bring it before the profession as a reliable and trustworthy agent. That cocaine is a valuable addition to the armamentarium of the surgeon, I think no one will doubt, but how beneficial, I think but few fully realize.
Cocaine is constantly growing in favor with the surgeons here in New York. New fields of usefulness are opening, and in nearly all of the minor and many of the major operations it is taking the place of ether and chloroform. These older anæsthetics, although so useful, were accompanied by danger, and many deaths are attributed to their use, while so far, I know of no well authenticated case where death or serious symptoms have resulted from the use of this new anæsthetic. Its first use was restricted almost exclusively to the eye and mucous membrane, but the hypodermic syringe has made it as useful to the general surgeon as to the oculist.
There is not a day passes but that we see operations of more or less magnitude performed under its influence at some of the clinics or hospitals of New York. Circumcision, hemmorrhoids, fistula in ano, felon, ingrowing toe-nails, hydrocele, cutting for foreign bodies, removal of small tumors, etc., are some of the operations for which we very seldom see an anæsthetic given.
At St. Luke's hospital an operation for ventral hernia was performed by the use of cocaine alone, where it was necessary to open the abdominal cavity for three inches and reach into the abdomen with the fingers to draw up the peritoneum, and all done with perfect success. Amputations of the fingers and toes are not uncommon, and amputation of the leg and fore-arm have been successfully performed by its use.
External and internal urethrotomy and cleft palate are usually performed by its aid. I have seen large stones removed from the urethra in this way without any expression of pain from the patient, he talking with the surgeon about the case while it was in progress.
Dr. Corning, of New York, has devised a method by which the local effect of the drug may be indefinitely prolonged. His theory was that the drug was washed from the tissues of the blood and its effects thus lost. To prevent this he applies elastic ligatures around the part, between the injection and the heart, about two or three minutes after the injection is made. When the injection is on the body or face where the ligature can not be used, he uses large rings to surround the part, so arranged that firm pressure can be made upon them, and thus cut off the active circulation. He claims for this that a weaker solution can be used and the effects continued for a much longer time.
The mode of proceeding is usually to inject from ten to fifty drops of a 4 per cent. solution around the part to be operated upon, using an ordinary hypodermic syringe. From three to five drops of this solution are injected at short intervals in a zone surrounding the part to be operated; or a larger quantity is injected near the body of the nerve supplying the part. If this is reached the anæsthesis is complete. In two or three minutes the knife can be freely used, and the patient feels no pain, although they look at the knife as it divides the tissues. In the throat clinic a solution of cocaine is used with an atomizer to allay the irritability of sensitive parts, that a more thorough examination may be made. At the eye clinic cocaine is used as a mydriatic, atropia being seldom used for the purpose of examinations.