EUCAIN IN OPHTHALMIC SURGERY.

By Surgn'.-Captain F. P. Maynard

Offii7. Civil Surgeon. Ranchi.

Eucain hydrochloride is a white, bitter neutral crystalline powder, soluble in ten parts of water on boiling. The salt is not aflectecl by the

boiling. Its chemical formula is Clg H27 No4 HC1. It was introduced by Sobering as a new an {esthetic.

It has been tried by various surgeons,? Vinci,1 Vollert,2 Berger,3 DeMets,4 and Hirsch-

berg,5 for eye operations, and by Gorl0 in a

case of tumour of the bladder, but with contra- dictory results. These authors do not even

agree regarding its solubility ; the manufacturer and some surgeons saying it is soluble in water in the proportion of 1 in 10, while Berger states that it is but little soluble in water, and its hydrochlorate (?) only to the extent of six

per cent. This has been my experience. Boiling, however, at once causes the hydrochloride to dissolve, and on cooling a 10 per cent, solution gives only a slight re-crystallisation, and a 2

per cent, none at all. These conflicting ex-

periences point to a possible variation in the salt as manufactured.

The authors already quoted all agree that annesthesia results when eucain is instilled into the e3Te, that it lasts from eight to thirty minutes and is complete, that smarting pain and lachrymation are more pronounced than with cocain. They also agree that whereas with cocain there is conjunctival anremia, widening of the palpebral chink and projection forward of the eyeball, with eucain there is marked

injection of the conjunctiva, but the eye appears otherwise normal. As regards other

effects, however, they differ. Vollert states that the corneal epithelium is destroyed in much

larger masses by eucain than by cocain, and that numerous experiments on animals have proved this. Berger, on the other hand, states that it does not tend to produce the same desquamation of epithelium as cocain. The latter author

again and Vinci say that eucain affects neither

pupil nor accommodation, whereas Vollert affirms that mydriasis and decrease in accommodation are both to be observed,

" especially when, as during operations, the instillation is plentiful." Manometric observations with eucain have given Vollert, after a temporary increase of 1 to 1*5

mm., a decrease of tension amounting to 3 to 5 mm. as with cocain. No one has yet found eucain toxic like cocain.

My own experience with eucain is limited to 20 trials in the following cases and operations:?

Six cataract extractions, 1 pterygium, 2 iridectomies, 2 iridotomies, 3 needlings, 4 massag-

1 Vinci, and "

Vollert, Munch. Med. Wocheuschr., 1896, No. 22 (quoted in (1) );

3 Bercfer, Revue de Therap , June loth, 1S96 (quoted in " B M J.." Epitome No. 51, 1890) ;

4 DeMets. Bely. Med., October 22nd, 1896 (quoted in "B. M. J.," Epitome No. 467, 1896) ;

5 Ilirschberg, Centralbiatt F. p?, Augenheilkunde, No. 8 1896, p. 238;

6 Gorl, Therap. Monatshefte, July 1896 (quoted in " B. M.

J.," Epitome No. 230, 1896).

Feb. 1897.] MAYNARD ON EUCAIN IN" OPHTHALMIC SURGERY. 45

ings of the cornea, and twice in my own eye.

The instillations consisted of three drops of a ten

per cent, boiled solution. It will be best to

describe the results under the following heads :? Pain usually lasted | to 2 minutes and

ceased as suddenly as it began. Burning in 4,

severely so in 1, slight in 13, very slight in 1, and none at all in 1.

Lachrymation lasted | to 3 minutes; severe

in 1, moderate in 7, slight in 8, very slight in 2, and none at all in 2.

Injection of blood vessels came on with

the lachrymation and lasted several minutes

longer. Involved the deep ciliary zone as well as the conjunctival vessels, the latter losing their injection first; severe in 1, moderate in

13, slight in 2, very slight in 2, none at all in 2. It was noticed that these three effects?

pain, lachrymation and injection?were more marked in fair skinned persons, and less marked, the blacker their skins.

Anaesthesia came on in 1 to 3J minutes; usually within 1 minute, and becoming complete within 3 minutes. Its duration could not be noted in most of the operation cases, as the eye was bandaged as soon as the operation was

finished, and few of these operations lasted as long as live minutes. In no case had the

? r*

anaesthesia passed off before the operation was completed. In all cases both cornea and con-

junctiva were rendered anaesthetic, the cornea first and most completely. No patient whose iris was cut, shrank or gave any sign of pain, as they not infrequently do with cocaine anaes- tliesia. In two cases (not included here) eucain failed to produce anaesthesia of the conjunctiva, though the cornea became anaesthetic. In them the conjunctiva was much inflamed and some- what ciiemosed. Cocain was nexte tried and

failed equally, as it generally does in such cases. Tension.?In several of the cases the nature of

the operation performed prevented any observa- tion of the tension being made, bnt in the others it was invariably and quickly lowered to ?l,and in some instances even more. The diminution lasted some time. In one case of chronic glau- coma the tension was lowered slightly before the operation for iridectomy was begun.

Iris was not affected in any except one case in which the pupil became very slightly dilated half an hour after instillation, and reacted slug- gishly to light both directly and consensually. The reaction of the pupil to accommodation remained perfect in all cases where the iris was intact.

Effect upon corneal epithelium was nil, al- though the tests were severe, and in several cases the cornea was rubbed and subjected to treat- ment which, with cocain, would have probably resulted in considerable loss of epithelium.

Conclusions.?My experience of the drug has been favourable, and at present I use it in nearly all eye cases requiring an anaesthetic.

Its drawbacks are :?(1) pain first and foremost, but varying in degree (apparently with the race of the individual); (2) lachrymation; and (3) injection; (2) and (3) also varying in degree. The injection it produces may prohibit its use

in cases where haemorrhage is to be feared. Its

advantages are:?(1) the anaesthesia is quick, complete and sufficiently lasting for ordinary- operations even after one instillation (and of course more can be used); (2) the tension is diminished. Whether this is of any lasting effect in glaucoma requires more than my brief

experience of it to say; (3) there is no effect on either pupil or accommodation; (4) no damage to corneal epithelium follows its use; (5) its solution can be sterilised by boiling as often as necessary; (6) it is not toxic like cocain ; (7) last, but not perhaps least, is the cheapness of eucain compared with cocain; their present prices in

Calcutta are Rs. 2 and Rs. 3-8 a drachm.

Since writing the above I have employed a 2 per cent, aqueous solution, but find that in my own eye it produces as much smarting pain as the 10 percent, solution, while the anaesthesia is less complete and less lasting. In other cases

I find several instillations of a 2 per cent, solu- tion act as well as one of a 10 per cent., but of course it takes longer to produce complete anaesthesia. DeMets found a mixture of 3 parts eucain to

1 part cocain, of whatever strength, very useful. I have not yet tried this.