None of the surgeons who have attempted spinal cocainization seem to be able to agree upon the smallest quantity that will ensure anesthæsia, and they are between the horns of the dilemma, that too strong a solution produces violent poisonous effects on the body, and one too weak gives out before the operation is ended, causing the predicament in which one surgeon found himself, when the anæsthetic effects wore off when he was half through, and, having opened the abdomen, he did not dare to permit the patient to sit up and lean over for a second injection.
In all cases, surgeons feel safer to have chloroform or ether at hand in chance of failure, and, when all is said, they do not see any very great advantage in performing the operation under cocaine over the old method. Moreover, many of them say that there is something rather uncanny in the feeling that the patient is conscious of and perhaps watching every stroke of the knife, for, strange to say sensations of heat and cold, touch and pressure, are still present, and only pain is absent. The older surgeons, before the days of any anaæthetic, mentioned this eerie feeling, and welcomed the patient's unconsciousness of what was being done to him as much as the patient did himself.
There is not enough yet known of the structure of that most wonderful detail of the human organism, the ganglionic nerve cell, to say what may be the effects of certain drugs upon it. Cocaine certainly has a sufficiently anæsthetic effect to make it valuable in those cases where an operation cannot be performed under ether or chloroform on account of a weak heart, or tendencies to asthma, kidney disease, or other complication. Where death would occur either with or without such an operation, it affords a comparatively safe loophole of escape; and at present it will perhaps be confined to such cases.
But, though cocaine anæsthesia cannot at present take the place of the other anæsthetics, it has given a hint of what may be developed; experiments will be continued, to render the lumbar puncture perfectly harmless, to determine the exact amount and strength of cocaine or any other drug that will produce a definite length of anæsthesia, to administer it in such a way as to lessen the unpleasant after-effects, and, if possible, to discover how the upper part of the body may also be rendered anæsthetic. The ideal, absolutely safe and universally applicable general anæsthetic is not yet discovered; but unquestionably a new way has been pointed out, and within a few years the results of scientific experiment will justify the hope that has sprung up at this method of cocainizing the spinal cord, the hope that anæsthesia is still in its infancy, and that when more is known about the effect of drugs on the nerve cells, it will be possible to banish pain, sensation and consciousness at will, and without danger to life.
