Local Anæsthesia With the Pharyngeal Cocaine Syringe.

Abstract

Dangerous and disastrous results from the use of cocaine as a local anaesthetic was, from the start, the bugbear that stalked at the heels of this brilliant and most happy innovation, as it was upon the introduction of the general anaesthetics, chloroform and ether; and yet I should like to ask how many of the gentlemen present have found this objection a sufficiently grave one to have prompted them to desist from its use? Though we occasionally hear the note of warning, and here and there a fatal case has been reported, their proportion has not increased with the prevalence of the drug, while its use has become so universal, among the specialists particularly, that it is to be doubted if there are many of the latter who could now be induced to do without it. With the report of fatal cases we are almost invariably informed of the size of the dose administered, and I have yet to hear of a single one which was not much larger than necessary to produce satisfactory local anaesthesia.Aside from the repeated applications to the mucous membrane of the nose and throat, made almost daily over a period of about four years, I have, since May last, injected cocaine into the tissue at the vault of the pharynx of thirtyseven different patients. I have never failed to make a note of cases in which symptoms other than local anaesthesia were manifested, and of these there are nine all told. In five of the nine cases, toxic or constitutional symptoms, such as hilarity, pallor, somewhat labored respiration or tendency to synco¬ pe, occurred after the application of about 30 m. of a 20 per cent, solution with a brush. The remaining four cases occurred after hypodermic injection, and as follows: The first three happened among the first ten cases treated and following an injection of 20 m. of a 10 per cent, solution, or about 2 m. of cocaine, while the fourth was the only one which occurred among the last twenty-seven cases, after reducing the injections to 15 m. of the same solution, to which quantity they have since been confined. In only one of all the cases were the symptoms at all alarming. In this instance the patient was a robust boy 15 years of age, and the dose, which was injected with the syringe, was possibly a little more than 20 m. Within two minutes the patient became pale, and stated that he was growing numb and dizzy. He stamped about for a few minutes, slapping his hands and legs, which seemed to be rigid with cramp; his respiration became labored, the dizziness increased, and he insisted upon lying down to sleep. Some whisky, a current of fresh air from the open window, and friction, gradually rallied him from this condition, and within twenty to thirty minutes he was completely restored. A week later, an injection of exactly 15 m. into the same patient was followed by but slight pallor and somewhat accelerated respiration, which did not impede the operation.As the result of the above, as yet, rather limited observations, I infer that the amount injected should be about one-half that which may be applied to the muco...