Analgesia lasts from 30 minutes to 4 hours. 9. Depression after the puncture is inconsiderable. The use of ethyl chloride (Bengue) largely prevents pain when tbe needle is introduced. 10. The preparation of the patient, the use of nitroglycerin by hypodermic injection, or the employment of coal-tar products with caffeine, COD trol the headache, which is in many instances an after effect of spinal puncture. 11. In a few cases there may he motor paraplegia or vertigo. Both are temporary. 12. Spinal puncture has not affected normal or diseased kidneys. 13. Usually the tactile power. muscular sense, and the ability to deteet heat and cold are re tained. The cautery at a dull-red heat causes no pain, while hot water pro duces marked discomfort. 14 Usually the patient sleeps the first night. 13. Tbere is often ft temperature of a few degrees within eight Or ten honrs of the operation. Whether this is the direct result of the puncture or the effect of psychical disturbances is not deter mined. The circulation and respiration are not seriously embarrassed. W. S. Bainbridge (Med. .News, May 4, 1901).
Series of 406 cases operated on under this method of antesthesia without a death. A solution of from 1 to 2 centi grammes (LA, to Va grain) of cocaine, made up with eerebro-spinal fluid which had previously been withdrawn by punct ure, was used in all the eases. Although there have been no fatal eases, the author has observed nearly all the un pleasant sequelfe, such as headache, etc. The method has proved satisfactory, but should not be used in the presence of contra-indications. Sequen in his last series of cases reports 2 deaths. In 1 there Wit S an incarcerated hernia with the phenomena of septieternia, while in the other arteriosclerosis was present.
In the discussion which followed Jon nesco stated that he used the method in only 8 Ca SeS, and in 1 of these with a fatal result; no arteriosclerosis nor organic lesions were present, and death was attributed directly to the cocaine. The author has abandoned this method, for the reason that its mortality is higher than ether or chloroform, and the after-effects, as a rule, are severe. thicoviceano-Pitesci (Bull. et Mem. de la Soc. de Chir. de 13ucarest, Dec., 1901).
The injection of sterilized water into the arachnoid sac accomplishes the same ana.sthesia, but is apt to cause the same accident as the subarachnoid injection of cocaine in the treatment of sciatica. For subarachnoid use, aqueous solutions of cocaine should not be diluted with water; after the injection, patients must be kept in bed for from two to three days. M. Cuinard (Jour. des
Pratieiens, March 22, 1902).
Corning emphasizes the following pre cautions: The puncture must not be made in the operating-room. The needle must be very thin, the solution one of 2-per-cent. of cocaine hydrochlo rate. The patient should sit up, and the puncture should then be made on the level of the crests of the ilium. The in jection should be made very slowly, tak ing a minute for injecting 15 minims of the liquid. The most common disad vantages of this method are vomiting during operation and headache after ward. Six cases, out of 2000 operations, died after lumbar puncture, 3 of them with tuberculous meningitis.
In 314 times, alarming symptoms oc curred in but 1 case. The ages of the patients varied from 8 to SG years, and many of them suffered from well ad vanced organic disease. Remote compli cations from the use of the drug were not observed. -N. AV. Morton (,..k.mer. Med., Aug. 3, 1901).
Cocainization of the spinal cord has been carried out on 62 occasions in the clinic of von --Alikuliez. In 40 cases the analgesia was complete, in 9 it was in complete, and in 12 there was none at all. The injections were frequently fol lowed immediately by such symptoms as sickness, vomiting, profuse sweating,. a feeling of general oppression, and tremors all over the body. Twice there was genuine collapse. Among the un toward after-effects were continuous vomiting. pains in the loins and back.
and severe headache. On several occa sions there was retention of urine. The nnreliability of the method and the oc currence of these unpleasant symptoms have led to the abandonment of the in jection of cocaine into the spinal canal at von 3likulicz's clinic. (Beitritge z. klin. Chin, Bd. xxxv, Ff. 2, 1903.) Topical Administration.—Cocaine is applied locally to the mucous membranes and the skin for the relief of pain, to in duce local anmsthesia for operative pur poses, to control hazmorrhage, and for diagnostic purposes. When applied lo cally to a mucous membrane, cocaine causes a temporary blanching and shrink age, with an anmsthetic condition of the part. The former are due to a construc tion of the blood-vessels, the latter to a paralysis of the peripheral filaments of tbe sensory nerves. The anmmia pro duced is only temporary, and is followed by a marked congestion. For therapeutic study we will observe the application of the remedy on the various organs, noting at the same time the strength of the solu tions generally used in each case.