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._