Am.  Jour.  Pharm. 
Dec,  1884. 
JETydrochlorate  of  Cocaine. 
611 
relieving  pain  in  many  little  cases  almost  too  light  to  chloroform  or 
etherize  for.  With  inflamed  or  congested  eyes,  more  frequent  instil- 
lation and  longer  time  are  required  to  obtain  the  effect. 
Hypodermic  injection  under  the  conjunctiva  caused  its  anaesthetic 
action  deeper,  and  relieved  pain  in  tenotomy  in  strabismus  operations. 
The  4  per  cent,  solution  is  preferable  to  the  weaker  ones,  the  latter 
requiring  longer  time  in  proportion  to  their  strength. 
Dr.  Henry  S.  Schell,  of  Wills  Eye  Hospital,  gives  me  his  experi- 
ence, as  follows : 
"  1.  The  most  favorable  class  of  cases  for  the  use  of  the  drug  is 
that  where  a  foreign  body  is  embedded  in  the  cornea.  These  cases  are 
very  numerous,  are  accompanied  by  much  pain  and  are  often  difficult 
to  deal  with,  especially  in  children,  on  account  of  the  inability  of  the 
patient  to  control  the  movements  of  the  eye  when  it  is  approached 
with  a  spud  for  the  purpose  of  removing  the  offending  particle.  As 
a  general  rule,  however,  in  5  minutes  after  the  instillation  of  4  drops 
of  a  2  per  cent,  solution  of  cocaine  into  the  conjunctival  sac  pain  is 
gone,  and  the  cornea  is  insensitive,  so  that  the  foreign  body  can  be 
picked  out  with  deliberation  and  accuracy.  But  this  happy  result  is 
not  invariable.  In  many  cases  several  repetitions  of  the  instillation, 
at  intervals  of  3  minutes,  will  be  necessary  before  the  requisite  insen- 
sibility can  be  obtained,  and  in  some  instances  the  patients  have 
asserted  that  the  drug  had  no  effect  whatever. 
u  The  best  way  to  apply  the  solution  is  to  insert  the  drops  into  the 
outer  angle  of  the  eye,  the  patient  being  in  a  recumbent  position,  or 
with  the  head  thrown  well  back,  and  then  to  retract  the  eyelids  so  that 
the  fluid  can  find  free  access  to  all  parts  of  the  conjunctival  sac. 
"The  action  of  the  drug  is  accompanied  by  a  blanching  of  the  sur- 
face vessels,  as  well  as  dilatation  of  the  pupil  and  paresis  of  the 
accommodation.  The  progress  of  the  anaesthesia  may  be  measured  by 
occasionally  touching  or  scraping  the  conjunctiva  with  the  point  of  a 
needle. 
"  2.  In  strabismus  and  cataract  operations,  in  iridectomies,  etc.,  it 
will  be  found  necessary  to  use  the  cocaine  solution  more  freely  and  of 
greater  strength.  Two  drops  of  a  5  per  cent,  solution  may  be  instilled 
every  3  minutes.  After  from  four  to  eight  such  applications  the  opera- 
tion may  be  performed.  It  has  not  yet  been  my  good  fortune  to  see 
any  case  where  the  free  use  of  the  strabismus  hook,  or  the  cutting  of 
muscle,  was  unattended  with  pain.    I  have  been  told  of  a  case  where 
