PROCAINE 323 



In addition the following undesirable results have been occasionally 

 seen: sepsis and meningitis, 4 to 14 per cent, of failures to secure 

 good anesthesia, collapse, retention of urine, chills, fever, vomiting, 

 sweating, persistent paraplegia, pain in back and legs for months, nausea, 

 cramps in the limbs, incontinence of urine, etc. 



Cocaine or its substitutes must be sterile for spinal anesthesia. As 

 cocaine can not be boiled it may be dissolved in ether and when the 

 ether has evaporated sterile water is added. A 2 per cent, solution of 

 cocaine is commonly employed. Of this the dose is as follows: H., 

 n\,xx to xlv; Dog and Cat, ni.v to xv. The puncture may be made 

 with the syringe attached to the needle for a handle. Then detach the 

 syringe. After the spinal fluid drips from the needle which has entered 

 the dura the syringe, already filled with the cocaine solution should be 

 again attached to the needle and the proper amount injected. On re- 

 moving the needle the puncture should be closed by collodion and cotton. 



Rudolf Klapp (Deutsche Zeitschr. f. Chir. 1904, Vol. Ixxi, p. 187) 

 has experimented upon animals with spinal injections for the production 

 of anesthesia, and finds by combining gelatin, adrenalin and cocaine, the 

 toxic effect of the latter is wholly averted and that this combination is a 

 safe and perfect anesthetic for dogs. Five mils of a sterilized 10 per 

 cent, aqueous gelatin solution, containing ITtx of adrenalin (1-1000 solu- 

 tion) and 0.02 to 0.04 Gm. of cocaine, are then injected through the 

 trocar and the puncture sealed with iodoform collodion. 



The following operations have been performed painlessly under 

 spinal anesthesia in the lower animals: neurotomy, tenotomy, cauteriza- 

 tion, oophorectomy, castration, operations on the uterus and rectum, 

 urethrotomy, herniotomy, etc. Wherever local anesthesia is available 

 spinal anesthesia should not be used on account of its much greater dan- 

 gers but its field of usefulness is wider than in human surgery. 



Use Internal.— Cocaine may be administered in aqueous solutions 

 for the relief of persistent vomiting in dogs. The alkaloid is occasionally 

 used as a stimulating and supporting agent in asthenic fevers and ady- 

 namic conditions of the human patient. The subcutaneous injection of 

 cocaine (gr.iii) is of great value in heat prostration of horses. According 

 to Quitman, no other agent equals cocaine for instilling courage and con- 

 fidence in a horse that is down on the street and refuses, or is appar- 

 ently unable, to rise. For this purpose it should be given in full medicinal 

 but not toxic doses (gr.ss for each 100 pounds of live weight). 



Procaine. (Novocaine.) 



Novocaine is the German name but now that the drug is made in America 

 it is called procaine. 



Procaine, NH^ CoHj COC2 H4N (CaHj)!, occurs in colorless crystals very 

 soluble in water. It is the latest and apparently the best substitute for cocaine 

 as it is equal to cocaine as a local anesthetic and is one-seventh as toxic and much 

 less irritating to the tissues — less, indeed, than either eucaine or stovaine. 



One-half to two per cent, solutions are suitable for subcutaneous use. 

 Dropped into the eye in 6 to 10 per cent, solutions it will anesthetize the eye so 

 that operations may be done on the eyeball or lid. It does not constrict vessels 

 and therefore should be combined with adrenalin — ^25 minims to 100 mils of pro- 

 caine solution, using normal saline as a solvent. This combination is the best 



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