A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

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    and rectum, and to parts of the body where the circulation can be under the control of the operator, as in the extremities. Wende (^Jour. de Med., Paris, January 15, 1888) recommends lanolin, contaniing four per cent, cocaine, as an application for Burns. He state's that it forms a protectant, anodyne dressing that is easily managed. Cocaine being insoluble in fatty substances, it is advisable, where it is to be used in ointments, to first dissolve it in oleic acid and afterward to add to it the other substances in small quantities at a time. Treated in this way, cocaine may be mingled with greasy substances and a homo- geneous preparation obtained. All things remaining the same, the impression of cocaine is of use in proportion as the pain is of an irritable and exciting character. It is of special value on mucous surfaces in the regions near skin surfaces, e.g., the vagina, urethra, and rectum, etc. A few indications will be given for its use in the female genito-urinary tract. In estimating the value of cocaine in gynecology, it must be remembered that its field is limited, as there are many women who are too sensitive and too apprehensive to be kept quiet during a pro- tracted operation by anything short of general ana3sthesia. According to Polk, cocaine may be of service in operations on the uterine cervix. In this connection may be mentioned incisions, forcible dilatation of the canal, the application of caustics, or the use of the curette. Even in commencing Cancer the free application of the actual cautery can be made if the sensibility of the part has been previously blunted with cocaine injections, three to five minims of a four per cent, solution, into the region that is to be operated upon. In the vagina more care must be exercised, owing to the greater sensitiveness of the tissues. Satisfactory results are obtained in the treatment of small Vesico-Vaginal Fistula. Four minims of a four per cent, solution are injected on either side of the fistula half an inch away. The mucous membrane of the vagina and bladder is then freely painted with the solution, after which the tissues can be excised without pain. In the removal of super-sensitive Urethral Caruncles a four per cent, solution of cocaine may be successfully injected at their lines of attach- ment. In like manner Chancroids and Chancres may be painlessly cauterized after painting the surfaces several times with a four per cent, solution. In Vaginismus it is of special service applied in the form of an ointment (five grains to the ounce) to the vagina and vulva a short time before coitus or the introduction of a speculum. Nagura has used cocaine with satisfactory results in obstetric practice. According to this writer, the drug not only shortens labor, but also annuls pain. Doleris (Therapeutic Gazette, 1889, p. 733) is reported by Fischel (in the Wiener Medicin. Presse, April 26, 1886) to have applied it to the vaginal mucosa and the external genitals in aqueous solution or in the