64 OPERATIVE TECHNIQUE. 



resistance is at once felt, and almost at once the clear, yellowish 

 cerebro-spinal liquid escapes drop by drop. The syringe has been 

 already prepared, containing from one to two cubic centimetres of the 

 2 per cent, solution, i. c. from one to two centigrammes of cocaine 

 (from twenty to thirty minims, containing about a quarter of a grain of 

 cocaine), and is now fitted to the needle, and the solution is very 

 slowly injected. The quantity of cocaine injected, it will thus be seen, 

 is very small, and yet the anaesthesia resulting will last about one and 

 a half hours. The little puncture is then sealed with collodion, the 

 patient lies down, and an assistant at once begins to cleanse and to 

 prepare the field of operation. The analgesia passes gradually from 

 the feet upwards, and for a laparotomy it may be necessary to wait 

 from ten minutes to a quarter of an hour before commencing. 



Tufher, whose experience is probably greatest of living surgeons, 

 has not yet observed an accident which he could attribute to the in- 

 jection or to the cocaine. He has by this method performed over 200 

 operations, of which more than half have been intra-peritoneal. 

 Legueu prefers eucaine to cocaine, owing to its lesser toxicity and its 

 greater stability during sterilisation by heat. Hydrochloride of eucaine 

 may be sterilised either in an autoclave or by heating the solution for 

 half an hour on three successive days to 100° C. Hydrochloride of 

 cocaine, on the other hand, will decompose at this temperature. 

 Legueu's conclusion, after some weeks' experience and over fifty opera- 

 tions, is that as a method of anaesthesia it is destined to take an im- 

 portant place in a great number of operations, and specifies all below 

 the level of the umbilicus, all operations on the perinaeum, the lower 

 urinary passages, the lower limbs, always supposing that muscular 

 contractions do not too greatly embarrass the surgeon. Some draw- 

 backs, such as incompleteness of the anaesthesia produced and signs 

 of poisoning, have been noted by one or two observers. 



Messrs. Cuille and Sendrail, of the Toulouse Veterinary School, 

 have tested this method in the horse, ox, and dog. They report that 

 their first experiments have given complete satisfaction. 



Horse. — They employ a trocar about 4 inches long by y^ of an inch 

 in diameter. The place where the puncture is made is found midway 

 along a line joining the internal angles of the two ilia. Implanted 

 vertically at this point the trocar enters the neural canal, traversing 

 the lumbo-sacral space. It is the only accessible spot ; further forward 

 the vertebral laminae are too close together and imbricated. During 

 the operation the animal scarcely moves. The application of a twitch 

 and the lifting of a fore-foot are the only precautions required. Dis- 

 infection of the cutaneous surface, sterilisation of the needle, syringe, 

 and solution, are absolutely necessary. 



First experiment. Aged mare. Injection of i fluid drachm of 2 

 per cent, solution of cocaine. Five minutes later the subject rocked 

 slightly; when made to move she showed weakness behind, and went 

 over on her side. The students practised neurectomy on all four legs. 

 Cutting through the nerves of the hind limbs caused no pain, but 

 section of the nerves in the fore-limbs produced pain, manifested by 

 struggling of all the limbs. 



