NOTES ON COCAINE OPERATIONS. By Surgeon GL CAPEL HALL, i.m.s., Acting Civil Surgeon, Cuddalore. Withtn the last month two cases of cancer of the penis came under my care. Having seen Mr. Jordan Lloyd, of Birmingham, perform the operation of circular amputation of the penis with cocaine injection as the sole auajsthetic, I followed his method thus:? The pubes and penis being shaved and cleansed and patient blindfolded, the skin on dorsum of penis is pinched up into a fold by thumb and forefinger of left hand, and the needle of the hypodermic syringe, loaded with freshly prepared solution of cocaine hydrochlorate, strength 10%, is inserted in the median line at position of incision, and passed as far as possible down one side of the penis, in line of incision, in the connective tissue between skin and body of penis and 2 minims of solution there injected, another 2 minims during its withdrawal, and another 2 at point of entrance of needle. Here the needle is not entirely taken out, but the point is turned under the skin and is pushed down the opposite side of the penis as far as possible and injection similarly performed. On withdrawing from this latter side, the needle again is not taken out, but the point pushed vertically downwards as far as possible in the direction of the under surface of the penis, keeping within the future line of incision, iii15



jection there

made final withdrawal. In these

(5 m.)





I always avoid fresh skin far as possible, in view of the extra pain caused thereby. For a small penis as in No. I case this is sufficient for an absolutely painless operation (with a small exception noted below) which is commenced 12 minutes after the injection is


injections as


large thick penis as in No. II case it obviously impossible, from the small area of anajsthesia that cocaine produces, to obtain the For



desired result in the same way ; so in this case with the penis well held up I also injected in a similar manner from the median line of its under surface?perfect auoesthesia resulted. Case No. I.?C. M., aged 55, penis small, 15m. of 10% solution l^ grains, sufficed. Case No. II.?P., aged GO, penis large and thick, 40m. of 20 % solution =8 grains injected. A really good hypodermic syringe and sharp strong needles are essential. In dividing and stitching the urethra, I pass needle and silk through skin at A, then through urethra at B, and skin again at C, needle is then taken away and silk left in situ, thus? =


of puncture

Point ofpuncture

The silk at B is then drawn

out with forceps the loop divided and the ends passed on one side. The floor of the urethra is now slit up with a bistoury and the silk can then be tied 011 one side to obviate all chance of stricture. It was at this point in both cases that slight pain was felt from the cocaine being unable to travel along the urethra. In a case where I attempted to remove the upper arm under cocaine for gangrene, 60 in. of 20% solution 12gr. were injected, but the patient's fright, a lad of 20, was so great and increasing at even the sight of the needle that I desisted and operated under chloroform, when the small quantity necessary was noticed, viz., 3 drams. In other small operations for piles, removal of small tumours, including a cancerous growth as large as a walnut from a woman's mouth, I have used cocaine and so far without any bad results. The ancesthesia passes off within half an hour, and the wounds apparently bleed as freely and heal as readily as others.

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Notes on Cocaine Operations.

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