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Deo. G, 1884.] LEADING ARTICLES.641THENEW YORK MEDICAL JOURNAL,A Weekly Review of Medicine.Published byEdited byD. APPLKTON & Co. PRANK P. FOSTER, M. D.NEW YORK, SATURDAY, DECEMBER 6, 1884.THE NEW LOCAL ANAESTHETIC.FOR several weeks past the medical press, including thisjournal, has teemed with testimony to the wonderful anaestheticeffects of the hydrochlorate of cocaine.Under ordinary circumstances,we should have waited for as many months toelapse before formally granting the truth of such allegations asare commonly put forth in behalf of any new remedy.But,although the available supply of the salt has thus far continuedto be exceedingly limited, but a very small quantity has beenneeded to establish its marvelous power, and that little hasbeen used to good purpose.We have no longer any hesitation,therefore, in proclaiming the announcement of the anasstheticpower of cocaine to be the most important that has been madein therapeutics since Morton astonished the world with hisdemonstration of the power of ether—the first and still the bestof general anaesthetics.Uatil within the past few weeks, coca had been known andused chiefly—almost exclusively—as a stimulant, and it is thereforenot a little remarkable that its alkaloid-should suddenlyhave made a brilliant reputation as a nullifier, for the time being,of the function of sentient nerves.On the other hand, asDr. Squibb pointedly remarks, in his admirable article on thesubject, in the November number of the "Ephemeris," it isalmost as unaccountable that the full anaesthetic power of thedrug was not brought to light before, seeing that its dilatingeffect on the pupil was well known, and that it was even in useto some extent by the laryngologists to benumb the throat sothat it would admit of readier manipulation.But this latterconsideration should not detract in the least from the credit tobe given the medical student, Koller, for his discovery.Even if it had turned out to be the case, as was at first supposed,that the anaesthetic effect was limited to the tissues thathad actually imbibed the solution—and therefore to such smallareas that the anaesthesia would scarcely have been availableoutside of ophthalmic practice—the great advantage of theagent would have remained unquestioned.That the range ofits application would have been thus hampered is not disproved,practically speaking, by even so startling a fact as that laparotomyhas been performed with no other anaesthesia than thatproduced by it, for we take it that the performance of abdominalsection under local anaesthesia is at best but a curiosity, andnot at all likely to become a settled practice.What is possibleis not always the most desirable, and it seems to us extremelydoubtful if surgeons will be willing to dispense with generalanesthesia as a rule in major operations.Leaving these out ofaccount, however, there is a wide range of operative proceduresin which it is necessary to have a considerable area anaesthetized,but in which there is no need of abolishing the patient'sconsciousness.These cases could not well have been met by alocal anaesthetic acting merely by imbibition, and it. is for thatreason that the newly discovered fact that the parts supplied bya sensory nerve may be made insensitive by an injection ofcocaine in the immediate neighborhood of the trunk of thatnerve is of an importance that can not be overestimated.Thatdiscovery seems to have been well established by the experimentsperformed by Dr. Halsted and Dr. Hall, recounted in thelatter gentleman's letter, which we publish in another column;and we must not omit to credit Dr. Burke, of South NorwalkrConn., with having practically hit upon the same idea, as maybe gathered from his letter which we published last week.No doubt much yet remains to be done in the way of experimentand observation before the precise sphere of the newana?sthetic can be defined, and it would be prudent for thosewho may undertake to furnish us with these data not to counttoo much upon the innocuousness of the drug, for it should benoted that Dr. Hall experienced marked constitutional symptomsfrom an injection of thirty-two minims of a four-per-cent.solution of the hydrochlorate.While caution is to be observed,,therefore, the teachings of even our present limited experiencewith cocaine ought to go far toward silencing the senseless babbleso often indulged in about the uselessness of experimentingwith the comparatively unknown substances of the vegetablemateria mcdica.Here was an alkaloid supposed to be wellnighworthless, but it has suddenly been raised to the first rank.Who can doubt that our knowledge of its power would havebeen considerably delayed but for the work of the pharmacists?Had the Darmstadt laboratory remained, even up to the presenttime, the sole available source of its supply, much of what hasalready been accomplished with cocaine would unquestionablyhave been blocked by the sheer impossibility of obtaining thedrug.We have all along been loath to believe that Americanchemists were unable to produce it, and we are gratified to beable to note that the potent product with which Dr. Halstedand Dr. Hall conducted their experiments was made by Messrs.Parke, Davis & Co.This aspect of the matter is not withoutits economic bearings, for we learn from Dr. Squibb's articlethat one of the cHief obstacles to the production of the drug ona large scale in this country is the enormous tax which the Governmentsees fit to levy on alcohol and ether, those substancesbeing the chief solvents used in the separation of the alkaloid.•.•••'-.• MINORPARAGRAPHS.KOCH'S REPLY TO HIS OPPONENTS.THE "Deutsche Medizinal-Zeitung" publishes a long letterby Koch, in which he replies to the objections urged againstthe specific character of the comma bacillus, and discusseschiefly the counter-experiments by Lewis and Holder and Prior*We have not space to quote the letter at length, but would referthe reader to the original. The main point urged is, that all thegentlemen who have-questioned the writer's results have notshows sufficient ear© in the conduct of their own experiments.He sees no reason m yet to lose faith in the importance of hisdiscovery. Ooe statement which he makes is of great weight