A textbook on surgery, general, operative, and mechanical / by John A. Wyeth.

  • Wyeth, John A. (John Allan), 1845-1922.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A textbook on surgery, general, operative, and mechanical / by John A. Wyeth. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    41/910 (page 23)
    For the eye, drop two or three minims of a 4-per-ceiit solution into this organ every minute or two, until fi'om five to ten minutes have elapsed For light work, such as the removal of a foreign body, or touching the lids with blue-stone, the smaller quantity-v\-i]l suifice ; for corneal section, iridectomy, etc., the anaesthesia should be more profound. In the mouth, it wUl sufEce to paint the part to be antesthetized with the 4-per-cent so- lution bj' means of a camel's-hair brush, every two or three minutes, for a half-hoiu' before, and at intervals during the operation. In this way ulcers may be cauterized, or limited incisions made with perfect insensi- bility, and by the employment of this agent any irritable condition of the mouth and throat may be relieved. I have ojierated for cleft of the soft palate in an adult ^vith perfect antesthesia by this method. In minor surgical operations upon the extremities, a prolonged and perfect anfesthesia may be secured by the method of Corning, which con- sists in injecting the fluid into the tissues of the part to be antesthetized, waiting from two to five minutes for absorption of the solution by the vessels, and then keeping the cocaine in the tissues, by arresting the cir- culation, with a rubber tourniquet applied between the injection and the heart. The efiiciency of this method has been amply demonstrated. The twenty or thirty minims of 4-per-cent solution should be distributed equal- ly in the line of the incision. A single puncture with the hypodermic needle will sufiice to allow the fluid to be thrown over an area an inch in length, and the effect is so rajAd that the second puncture can be made through the anaesthetized skin. The needle, after passing thi'ough the integument, travels along just beneath it to its full length. One or two minims are then forced out, the needle withdrawn a quarter or half inch, and a like quantity discharged. If a deep incision is required, the needle should go into the deej^er tissues. One advantage of this method is that a smaller quantity of cocaine 'nill produce a greater degree of anaesthesia, and with less constitutional effect. When as much as thirty minims are used, the excess may be squeezed or pressed out of the part, or washed out with the irrigator. As to the length of time for which a tourniquet may safely remain holding the part beyond fuU of stagnant blood, I would say that a half-hour would be within the limit of safety. I have con- stricted the iDenis continuously for an hour in circumcision, the great toes on several occasions for more than half an hour in removing ingrowing nails, and the arm for half an hour in a number of cases. It is, however, not always necessary to entirely arrest the circulation of a part, for, if the elastic be applied close behind the part to be incised, the superficial com- pression mil retard the flow at this point, while the deeper vessels and remote capillaries are not materially interfered with. In minor operations upon the trunk, face, head, and neck, greater pre- caution must be taken, for here the solution is carried directly to the center. This is especially necessary in the head and face, for reasons above given. If the i^recaution is taken to throw in a small quantity—say five or ten minims—in the line of the proposed dissection, and immediately incise and dissect as far as the zone of anaesthesia extends, so much of the injected cocaine escapes with the oozing that comparatively a small proportion