Eucaine as a local anaesthetic in the surgery of the throat, nose, and ear : preliminary communication / by W. Jobson Horne and Macleod Yearsley.

  • Horne, Walter Jobson.
Date:
1897
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Licence: Public Domain Mark

Credit: Eucaine as a local anaesthetic in the surgery of the throat, nose, and ear : preliminary communication / by W. Jobson Horne and Macleod Yearsley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    a. Ansesthesia is more extensive than with cocaine, both as rc^rards time and locality. In my experience the ansesthesia has in individual cases extended to the muscular tissues. ^ , 3. Solutions prepared with sterilised water and maintained at the room tcnipcr&turo rom&in always clear even without the addition of carbolic or salicylic acid, and never become llocculent like those of cocaine. One more advantage—considered by Berger to be one of its most valuable properties—is that eucaine can be sterilised by boiling without undergoing decomposition. In investigating the uses of eucaine in the surgery of the throat, nose, and ear^ we feel that the points to which we should endeavour to direct special attention are: 1. The strength of solution required. 2. The rapidity, intensity, and extent of the anaesthesia. 3. The general and local action upon the circulatory system. 4. The after-effects. Although upon all these points the opinions we have been enabled to form are favourable, we wish it to be clearly under- stood that they are but tentative, and our final verdict is withheld until we have given the drug a more extended trial. Tlie number of occasions on which we have employed eucaine is thirty-two, and they may be classified as follows: A. Examinations: 1. Ear 2. Laryngoscopy and posterior rhinoscopy B. Operations: I. Ear: 1. Myringotomy 2. Furuncle ... II. Nose: 1. Galvano-cautery 2. Spurs 3. Polypi 4. Other growths III. Throat: Tonsillotomy 2 4 4 I II 4 I I 4 Of these, 19 were males varying in age from 4 to 42, and 13 were females from 6 to 70 years. Moreover, 6 of the patients (3 males and 3 females) had experienced the local anmstlicsia of cocaine, a fact to which wo shall revert later. I. Strength of Solution required,—The solutions used were in three strengths, 2, 5, and 8 per cent. Of these, we found that the 2 per cent, is quite suflicient for anaesthetising the uvula, etc., for laryngoscopy or posterior rhinoscopy, and for aural examinations. In one case (Case 11, male, aged 21) seven drops of a warm 2 per cent, solution dropped into the left ear and retained (with the head inclined to the right) for 5 minutes caused complete ansesthesia of the membrana tym- pani lasting nearly 20 minutes. Another man (Case xxvn, aged 42) who was most intolerant of laryngoscopy, permitted a complete examination. In the latter case, the 8 per cent, solution was first used, but on the next occasion the 2 per cent, was found suflicient, as also for Case xxxii and for Case XXIX (posterior rhinoscopy). The 5 or 8 per cent, solu- tions have been used for operative procedures on nose, throat, and ear; and, although in Case iv an aural furuncle was in- cised without pain under the 5 per cent., and in Cases iii, vi, VII, and X the same solution sufficiently anaesthetised the membrana tympani to permit of myringotomy, it was gene- rally found that for all operative measures on throat, nose, or ear the 8 per cent, solution was the more reliable. Furthermore (as will be noted below), eucaine being in our