COCAINE ANALGESIA. 283 



None of the surgeons who have attempted spinal cocainization 

 seem to be able to agree upon the smallest quantity that will ensure 

 anesthesia, and they are between the horns of the dilemma, that too 

 strong a solution produces violent poisonous effects on the body, and 

 one too weak gives out before the operation is ended, causing the pre- 

 dicament in which one surgeon found himself, when the anassthetic 

 effects wore off when he was half through, and, having opened the 

 abdomen, he did not dare to permit the patient to sit up and lean over 

 for a second injection. 



In all cases, surgeons feel safer to have chloroform or ether at 

 hand in chance of failure, and, when all is said, they do not see any 

 very great advantage in performing the operation under cocaine over 

 the old method. Moreover, many of them say that there is some- 

 thing rather uncanny in the feeling that the patient is conscious of 

 and perhaps watching every stroke of the knife, for, strange to say^ 

 sensations of heat and cold, touch and pressure, are still present, and 

 only pain is absent. The older surgeons, before the days of any 

 anaesthetic, mentioned this eerie feeling, and welcomed the patient's 

 unconsciousness of what was being done to him as much as the patient 

 did himself. ■ ,v: 1 



There is not enough yet known of the structure of that most 

 wonderful detail of the human organism, the ganglionic nerve cell, to 

 say what may be the effects of certain drugs upon it. Cocaine cer- 

 tainly has a sufficiently anaesthetic effect to make it valuable in those 

 cases where an operation cannot be performed under ether or chloro- 

 form on account of a weak heart, or tendencies to asthma, kidney dis- 

 ease, or other complication. Where death would occur either with or 

 without such an operation, it affords a comparatively safe loophole of 

 escape; and at present it will perhaps be confined to such cases. 



But, though cocaine anaesthesia cannot at present take the place 

 of the other anaesthetics, it has given a hint of what may be developed ; 

 experiments will be continued, to render the lumbar puncture perfectly 

 harmless, to determine the exact amount and strength of cocaine or 

 any other drug that will produce a definite length of anaesthesia, to 

 administer it in such a way as to lessen the unpleasant after-effects, 

 and, if possible, to discover how the upper part of the body may also 

 be rendered anaesthetic. The ideal, absolutely safe and universally 

 applicable general anaesthetic is not yet discovered; but unquestionably 

 a new way has been pointed out, and within a few years the results 

 of scientific experiment will justify the hope that has sprung up 

 at this method of cocainizing the spinal cord, the hope that anaes- 

 thesia is still in its infancy, and that when more is known about the 

 effect of drugs on the nerve cells, it will be possible to banish pain, 

 sensation and consciousness at will, and without danger to life. 



