610 
Hydrochlorote  of  Cocaine. 
/Am.  Jour.  Phaim. 
1      Dec,  1884. 
of  operation  upon  fistula  in  ano.  Plans  have  been  in  vogue  for 
smearing  bougies,  catheters,  etc.,  with  narcotic  ointments  while  dilat- 
ing, cauterizing  or  incising  urethral  strictures. 
B.  W.  Richardson  (1866)  used  the  atomizer  for  rendering  parts 
insensible,  the  most  volatile  liquids  producing  the  best  results. 
H.  J.  Bigelow  recommended  the  use  of  rhigolene  spray.  By  these 
means  the  part  (o  which  the  application  was  made  was  temporarily 
frozen,  and  thus  the  sensibility  was  almost  entirely  destroyed.  Freez- 
ing mixtures  of  salt  and  ice  Avere  long  formerly  used  for  this  purpose. 
Von  Anrep,  the  first  one  to  apply  cocaine  to  the  eye,  in  1880,  used 
a  solution  containing  J  milligram  to  the  conjuctiva.  He  noticed  it 
caused  temporary  dilatation  of  the  pupil,  but  took  no  note  of  the  tem- 
porary insensibility  produced. 
Dr.  Isaac  Ott  experimented,  in  1876,  internally,  and  noticed  result- 
ing pupillary  dilatation. 
In  order  to  obtain  reliable  information  concerning  this  new  agent, 
the  writer  has  interviewed  some  of  the  leading  oculists  of  this  city, 
and  obtained  from  them  their  experience  and  opinions  in  regard  to  it. 
Peter  D.  Keyser,  M.  D.,  Professor  of  Ophthalmology  in  the  Med- 
ico-Chirurgical  College,  and  one  of  the  Surgeons  to  Wills  Eye  Hos- 
pital, stated  that  his  experience  had  been  with  varied  operations,  and 
that  he  finds  it  to  be,  as  a  local  anaesthetic,  "  one  of  the  grandest  things 
discovered,  but  it  does  not  seem  to  pass  deeply  into  the  tissues."  In 
cases  of  strabismus  there  was  not  the  least  pain  in  grasping  and  cut- 
ting the  conjunctiva,  nor  until  the  hook  was  passed  under  the  muscle 
and  its  tendonous  attachment  cut. 
This  part  of  the  operation  was  very  painful.  In  cases  of  discision 
for  soft  cataract,  and  in  removing  a  cretaceous  capsule,  it  acted  charm- 
ingly, but  when  the  iris  was  grasped  and  cut  there  was  the  usual  pain. 
In  the  removal  of  foreign  bodies  upon  the  cornea,  it  comes  splendidly 
into  place.  The  proper  way  of  instilling  it,  is  to  run  a  drop  over  the 
cornea,  every  minute,  of  the  4  per  cent,  solution,  for  3  or  4  minutes, 
and  then  go  ahead  with  the  operation,  for  by  that  time  the  complete 
anaesthetic  influence  is  attained.  If  the  operation  is  a  little  long,  the 
instillation  is  continued  every  few  minutes  during  the  whole  time. 
Its  influence  passes  off  in  about  10  to  15  minutes.  As  a  whole,  it  is 
one  of  the  most  advantageous  substances  that  has  yet  come  into  use 
for  the  purpose  intended,  as  it  will  save  the  trouble  of  etherizing  in 
many  cases,  and  be  the  cause  of  saving  time  in  operations  as  well  as 
