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992 THELAKCKT,] DR. MAX VON PETTENKOFER ON CHOLERA. [DEC.6, 1884.stage of the operation ; she answered that she felt absolutely needle operations the anaesthesia of the cornea ie most satisfactory,and patients state that they feel no pain. For theno pain from the corneoscleral incision, the seizure andcutting off of the iris caused her but little pain. During the removal of foreign bodies from the cornea the cocainewhole operation there were no reflex movements. A like promises to be most serviceable. As a mydriatic, in someresult was obtained in the case of an idiotic woman upon patients it is very decidedly so, our present house -surgeon,whom the same operation was performed, and upon whom Dr. Mcintosh, who kindly allowed me to use it in his eye,Dr. von Reuss hesitated to operate because she was in other found that his pupil remained fully dilated for a week. Asrespects very sensitive.a controller of ciliary pain I have not yet found tbe cocaineThe following case appears to me to be worthy of notice of much value, nor have I been able to satisfy myself thaton account of its peculiar circumstances. Iridectomy was the conjunctiva or skin is much affected by it; but itsperformed upon the left eye of a man with a bilateral value in preveoting pain during an operation and keepingseclusio pupilloe. Cocaine was employed. The man did the eye soothed for some time after cannot fail to conduce tonot move in the slightest degree during the operation, and good results in ophthalmic surgery.asserted he did not feel the corneo scleral incision at all; Glasgow.that he felt the seizure and cutting off of the iris, butvi —rrit did not pain him. Eight days later tbe other eye wasoperated upon, but this time without the use of cocaine ; heCHOLERA,writhed and " bore down," so that the operation wasrendered decidedly more difficult. Although a large majorityBY MAX' YON PETTEMKOF.EE, M.D.,of people who have to undergo such operations are torpidOF mi-mcm,individuals and bear their pain with patience, nevertheless,(Continued from page WSK)the last case appears to me to prove that even in such casesan anaesthetic might be of excellent eervice.The translator of the above paper on the anesthetic use ofcocaine has been requested by the author to add the followingshort notice, the results of later experience in the useof the drug. Lack of time and space prevent detailsOperations for cataract are almost painless when performedwith cocaine. Hence in those cases of prominence of thebulbs, where there is great daDger of escape of the vitreoushumour during the operation, the elevator has been dispensedwith;. The importance of this will be appreciated by oculists.As predicted by Dr. Roller when he wrote his article, theoperations of puncture of the cornea, discissio cataractoe andcauterisation of corneal ulcers have since been frequentlyperformed under the cocaine anaesthesia, and absolutelypainlessly.That cocaine is of great value in relieving pain in iritis,the following case, given in brief, will show :—A woman, M. F——, forty-five years old, in Dr. vonReas's wards, suffered so much pain from iritis as to beunable to sleep. The insomnia was complete, and bad lastedseven days and nights. Atropine bad been employed continuously.Cocaine in 5 per cent, solution was instilled sixtimes in half an hour in the manner already detailed. Thepain disappeared completely but reappeared three hourslater. Cocaine was again instilled ; this time three times infifteen minutes. The pain vanished and the patient sleptcomfortably for the rest of the night. The next day on thereappearance of the pain a third lustillation was used, andthe pain disappeared and did not return.In the clinic of Dr. von Reuss nearly all the operationsare now performed under the cocaine anaesthesia accordiDgto the method already given in detail.NOTE ON THEVALUE OF HYDEOCHLORATE OF COCAINEIN OPHTHALMIC SURGERY.BY J. CRAWFORD RENTON, M.D. EDIN.,SURGEON TO THE EYE INFIRMARY, GLASGOW.FOLLOWING the recommendation of Dr. Roller of Vienna,which was brought under my notice by Mr. Marcus Gunnof Londojn, I have recently been using the hydrochlorate ofcocaine in all operations on the cornea. Two per cent, andfour per cent, solutions, some made with distilled wateralone, others with boracic acid and glycerine to preventputrefaction, have been used, as also the discs of the streng'h°f nh g r -i made by Savory and Moore on the suggestion ofMr. Nettleship, and I have no hesitation in saving that mybest corneal anaesthetic results have been obtained with thediscs, two beiog quite sufficient to produce complete anaesthesiain six minutes, and being maintained from fifteen totwenty minutes. The 2 per cent, solution in distilled wateracted well, but that made with Kl>cerine wa.s not satisfactory.One patient, who had both solutions used in a double iridectomyhe required for limellar catarac*, stated that he felt nopain whatever with the plain solution, but slight pain withthe glycerine preparation. In cataract extractions andTHE same considerations hold good is India* The famousplaces of pilgrimage, "whose sanctuaries are annually visitedby many millions of individuals* always have seme eases of' cholera amongst thsm, but it is only occasionally that anepidemic breaks out, and then it is only at those times whenthe fired imposition to cholera exists—-pe r sod? * be It noted , whichdo not for the most part coincide with the time when thenumber of pilgrims Is at its greatest, BOI when the principalfeasts are in progress, For instance, Bryden has .drawn uptables showing the number of admis-ioos into the hospitalat Purl is tbe neighbourhood of the sanetoaiv calledDaehagganath for the"years 1842 to 1866, and these statisticsshow the number o! receptions of cases of cholera for eaetimonth of the year. This jownml extending ever so- many>ears», most give a good idea of the frequency ol cholera ispilgrimage even though the numbers be hot small, Theprincipal feasts* when the chariot of the deity Is draws overthe breasts of the'faithful, occur m the middle of March, bat'the period at which cholera in at its height Is In Jane s : wheathere are 'many fewer pilgrims assembled. Altogether"therewere 313 eases ie March daiisg twenty-five' jears, whilst thenumber was 1155 tor June, or neaily four times as manyadaiisaions for daolera into tbe hospitals. Pur! lies oilthe south-west border of the territory where cholera isendemic, and hat the name rhvthm so far as cholerais cease rued as Madra*. Hsrcl^ar lies In the northwestof India, where the chief feast occurs In April, theprincipal day being the I2th # and often hundreds of thousands.vi pilgrim?, if sot millions, stream together heio ; yetcholera m\h; breaks out in an epidemic form when the regionsare predisposed to it. Ii wiif be interesting'to go furtherinto detail on this question. Hard war it situate about1000 feel above tbe level of the sen where the Ganges quitsthe Himalayas, and belongs to the holiest of places wnichtbe Hindoos worship, Cholera only oee«» oeessloa&llyto an epidemic form. In the last century (1783) a severeepidemic was known fo have occurred amongst the pilgrimsat Hard war. From 1S58 to 1867 the leasts passed on withoutthe occur!e'ace of any epidemic of cholera, and thisimmunity was believed to be doe to the sotmdoess of thearraoge meats which were enforced hy the Govern meat-, In1867 the whole prophylactic armour was throws aside, Butaheady is November, 1800, an epidemic of cholera wasapproaching the neighbourhood of Hard war from Agra. Thepilgrims twgaa fo arrive at Hard war nil April 1st OilAyrd 3rd the majority had assembled, although tbe streamof'pilgrims eoritiaaed to increase till the 12th. The who!©mmilmt of pilgrims reached about three niilhoxis* On April9t'h the fir*t case of cholera was detected by Dr. Kinds!! andfc*ke» into hospital, Oilier cases soon followed, 0a April12th, on holy dnj^ the pilgrims bathed from somise tosense! is the Ganges, to a'holy fort which la separatee!from the torrent of the fleer by a rail, so that thepeople could not he drowned, Through this fort there wasan incessant movement of men all clsy long. The waterbecame thick and amddy, partly from the ashes of the deadwhich the pilgrims had'brought with them to strew ia tbeafroaii^ aod partly from the* washing of the clothes andpersons .of the bathers, Every time a pilgrim entered lawiiolf fori he clipped himself three times imcbr, drinking the