Tro

Case XI.-P. T.; Troop L, Fifth Cavalry; age, 23. External hemorrhoids. Operation, February 1, 1905. pococaine spinal injection, grain three-fourths, third and fourth lumbar interspace II a. m. Operation, II:20. Forcible rectal dilatation, removal hemorrhoids, clamp and cautery with entire absence of pain. Patient conversed and laughed during performance. Analgesia complete umbilicus to toes, lasting two hours. Complained of slight headache for a few hours after. Duty, February 22.

Case XII.-A. W. K.; corporal Company I, Twentyninth Infantry; age, 28. External hemorrhoids. Operation, February 8, 1905. Tropococaine, grain three-fourths, spinal injection, third and fourth interspace, 11:37 a. m., losing about 10 minims cerebro spinal fluid from slip of syringe. Operation, 11:40. Forcible rectal dilatation, clamp and cautery, entirely painless, patient talking and laughing during performance. Analgesia lasted two hours and fifteen. minutes. No after effects. Duty, February 15.

Case XIII.-A. H.; musician Company I, Twenty-ninth Infantry; age, 22. Operation, February 17, 1905. Extensive growth of venereal warts on glands penis and foreskin. Tropococaine, grain three-fourths, spinal injection third and fourth lumbar interspace IIII a. m. Complained of slight nausea immediately following, but passed off at once. Operation perfectly painless. Analgesia lasted two hours and twenty minutes.

Case XIV.-C. K. B.; private Troop L, Fifth Cavalry; age, 25. February 21, 1905, sustained a compound fracture both bones right leg middle third by fall from a horse at Cossack drill. Tropococaine, grain three-fourths, spinal injection third and fourth lumbar interspace 11:30 a. m. Analgesia complete 11:50. Fracture reduced, dressed and placed in plaster cast with entire absence of pain. Analgelsia lasted three hours. No after effects. Returned to quarters for kitchen and police duty May 15, 1905. Excellent union.

Case XV.-M. M.; private Troop L, Fifth Cavalry. Extisis two by two and one-half to three inches above knee. femur anterior portion. Operation, April 16, 1905. Tropocicaine, grain three-fourths, spinal injection third and fourth lumbar interspace. Analgesia appeared promptly and operation began without pain. Analgesia lasted only ten minutes, and operation completed under chloroform. It subsequently developed that the tronococaine used was an old tube that had previously been subjected to excessive

heat, 232 degrees C., for half an hour, and this is believed to have been the cause of the short analgetic effect. headache or after effect.

No

Case XVI.-J. W. L.; private Troop L. Fifth Cavalry. Rectal fissure and ulceration anus and rectum. Operation May 24, 1905, in the presence of Lieutenant-Colonel Edward B. Moseley, chief surgeon of the dpeartment. Tropococaine, three-fourths grain, spinal injection third and fourth lumbar interspace at 10:02. Operation at 10:10. Forcible dilatation of rectum and cauterization of fissures and ulcers, entirely painless. Analgesia in this instance extended over the entire body. Needle inserted through cheek or scalp without pain or complaint, and an operation could have been performed on any part of the body. gesia lasted for three hours. No after effect.

Anal

Case XVII.-H. H.; white; male; age, 22. Diagnosis, psoas abscess, tubercular, pointing just below apex scarpa's triangle right thigh. Patient suffering from advanced tubercular pulmonary involvement. General anaesthesia contra-indicated. Tropococaine, three-fourths grain, spinal injection third and fourth lumbar interspace. Operation twenty minutes after injection. Patient nervous and excitable, and during operation complained of some pain, but the following day acknowledged it was painless, and his complaint was due to fright. No after effects.

Case XVIII.-W. W.; white; male; age, 47; laborer. Infected gland of neck, indurated and partially suppurative. Tropococaine, grain one and one-fourth, spinal injection second and third lumbar interspace. Operation May 31, 1905. Analgesia complete from umbilicus to toes. Partial in field of operation. No other anaesthetic required.

Case XIX.-P. B.; Mexican; laborer; age, 72. Marked debility, mal nutritio and emaciation. Diagnosis, left indirect complete inguinal hernia. Administration of a general anaesthetic unjustifiable. Tropococaine, grain threefourths, spinal injection third and fourth lumbar interspace. Analgesia over seat of operation immediate. Operation for the radical cure of hernia, a Bassini, lasting one-half hour. Absolutely painless operation. No after effects. Operation performed June 2, 1905.

Case XX.-T. G.; white; male; miner; age, 54. Diagnosis, prostatic hypertrophy. Operation perineal prostatectomy June 2, 1905. Tropococaine, three-fourths, spinal

injection, third and fourth lumbar interspace. Analgesia over seat of operation immediate. No pain from incision or decapsulation gland, but complained of trifling discomfort from traction and pressure of hand in perineal and during exterpation. Patient talked and laughed during operation.

Case XXI.-M. G.; white; male; occupation, miner; age, 43. Displaced astralagus right foot of several years standing, rendering foot practically useless. Operation June 2, 1905. Tropococaine, grain, three-fourths, spinal injection third and fourth lumbar interspace. Analgesia complete and immediate. Excision of astragalus and lower portion of tibia accomplished with entire absence of pain. of operation, fifteen minutes. No after effects.

Length

Case XXII.-S. M. E.; general military prisoner; age 23. Diagnosis, external hemorrhoids. Operation June 3, 1905. Tropococaine, three-fourths grain, spinal injection third and fourth lumbar interspace. Analgesia immediate. Forcible rectal dilatation, clamp and cautery entirely painless. Analgesia lasted one hour and twenty minutes. No after effects.

Case XXIII.-C. Y.; white; female; wife of physician; age, 31. External and internal hemorrhoids. Operation June 12, 1905. Tropococaine spinal injection, grain threefourths, third and fourth lumbar interspace. Analgesia immediate from ribs to toes. Forcible rectal dilatation, clamp and cautery entirely painless. Analgesia lasted one hour and twenty minutes. No after effects.

Case XXIV.-D. G.; white; male; retired miner; age, 62. Diagnosis, empyrema right cavity. Patient very low condition. Disease had existed seven years. Dyspnoea marked; paracentis had been performed one week previous with but very slight and temporary benefit. Some cyanosis present. Heart's action weak, labored and rapid. Emaciation had cachexia marked. Haemoglobin 45 per cent. Employment of a general anaesthetic positively contra-indicated. Operation June 15, 1905. Tropococaine, grain one, spinal injection second and third lumbar interspace. In this instance unusual difficulty was experienced in entering canal, due to the spinal curvature incident to the empyema. Analgesia present over thorax in fifteen minutes. Operation resection two inches right seventh rib. No pain experienced from incision nor separation of thoracic muscles or detachment of periosteum, but when rib itself was excised, patient complained of pain. Large quantities

of pus evacuated with immense relief. No unpleasant after effects.

Case XXV.-J. S.; white; male; occupation, miner; age, 50. Diagnosis, vesical calculus. Operation June 26, 1905. Tropococaine, grain one, spinal injection third and fourth lumbar interspace. Analgesia immediate. Median perineal operation with entire absence if pain. Patient talked and laughed, and when told incision was being made remarked "You are joking.” Large stone removed in fragments. Length of operation, twenty minutes. Analgesia lasted one hour. No after effects.

Case XXVI.-M. C.; white; male; occupation, miner; age, 45. Diagnosis, necrosis os calcis and tibin right ankle. Operation June 28, 1905. Tropococaine, grain one, spinal injection third and fourth lumbar interspace. Analgesia immediate. Removal os calcis entire and resection lower portion of tibia, with through and through drainage of foot with entire absence of pain. Length of operation, fifteen minutes. Analgesia, one hour. No after effects.

Case XXVII.-W. N.; male; white; occupation, druggist; age, 65. Diagnosis, prostatic hypertrophy and complete urethral stricture. General condition of patient alarming and urgent from prolonged uraemia. Pulse and respiration rapid and weak. General anaesthesia out of the question. Operation, perineal prostatectomy, June 29, 1905. Tropococaine, spinal injection, three-fourths grain, third and fourth lumbar interspace. Analgesia immediate. Painless operation lasting forty minutes. Analgesia, two hours. No after effects.

Case XXVIII.-C. P.; white; male; occupation, carpenter; age, 43. Compound comminuted fracture both bones left leg received by being forcibly blown off stand eight feet in height by premature explosion of fire-works, and thrown fifty feet, July 4, 1905. Fracture tibia two inches below knee, right side. Compound fracture same three inches above ankle. Fracture fibula at middle. Tropococaine, three-fourths grain, spinal injection third and fourth lumbar interspace. Analgesia immediate. Fractures reduced, dressed and plaster cast applied with entire absence of pain or suffering. Analgesia lasted two hours and a half. No after effects.

Case XXIX.-M.; white; female; age, 32; occupation, housewife. Diagnosis, retained secundines following incomplete abortion of a few days previous. Pain and ten

derness severe left iliac region, causing patient continuous suffering. Temperature, 104; pulse, 110. July 21, 1905, tropococaine, grain, three-fourths, spinal injection third and fourth lumbar interspace. Relief of pain immediate; complete analgesia prompt; relaxation of genitalia most satisfactory. Operation instrumental and digital curettage, with entire absence of pain. No abscess discovered. No after effects. Recovery prompt.

45.

Case XXX.-P.; male; white; occupation, carpenter; age Diagnosis osteomyolitis following typhoid fever, right tibia August 5, 1905, tropococaine, three-fourths grain, spinal injection third and fourth lumbar interspace. gesia complete lower extremities. Operation lasted fifteen Analgesia one hour. No after effects.

minutes.

Anal

APENDECTOMY WITH SPINAL ANALGESIA.

Case XXXI.-G. V.; white; female; occupation, housewife; age, 28. Pregnant multipara (4). August 20, 1905, at full term premature rupture of waters; pains severe; patient hysterical; pains continued violent and progress of labor slow; patient begged and pleaded for relief; chloroform short of complete anaesthesia ineffectual. At 2:25 a. m., August 21, 1905, tropococaine, grain one-half, spinal injection third and fourth lumbar interspace. Pains entirely absent five minutes later, but uterine contractions contin