CUTANEOUS ANAESTHETICS 177 



vomiting, and yet others fainting and collapse. Fatal 

 cases have often occurred even after moderate doses, 

 and it is never safe to give more than a quarter 

 of a grain of cocaine unless the patient has had it 

 before. 



Most surgeons will doubt if eucain is really as 

 powerful an anaesthetic as cocaine, but in its main 

 details the correctness of the above table has been 

 abundantly demonstrated by many independent 

 observers. 



Mr. Barker, and others following his example, have 

 claimed great advantage from combining adrenalin 

 with the cocaine or its derivative. The suggestion 

 is that the vasoconstriction induced keeps the 

 cocaine from being carried rapidly away by the 

 circulation. Thus we increase the local effect, which 

 is desired, and diminish the general or systemic 

 effect, which is not desired. There is no doubt that 

 the method is often most efficacious, but adrenalin 

 is a powerful agent, and occasionally it seems to be 

 responsible for alarming collapse. 



Whatever drug or combination of drugs is used 

 for hypodermic injection as an anaesthetic for opera- 

 tive purposes, it is of cardinal importance that it 

 should be correctly given, and an extraordinary 

 number of surgeons do not appear to know how to 

 secure a good result. Again and again one sees 

 cocaine injected, and one can foretell with certainty 

 that the patient will scream with pain when the 

 incision is made. In another case half the dose gives 

 a perfect anaesthesia. The whole point is that the 

 sensitive nerve-endings are not in the subcutaneous 



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