PHENATE OR CARBOLATE OF COCAINE 
AS A 
LOCAL ANESTHETIC. 
by 
D. B. KYLE, M.D., 
Assistant Demonstrator of Pathology in the Jefferson Medical College. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, JANUARY ib, r8Q3- 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER. 
1893. Phenate or Carbolate of Cocaine as a 
Local Anaesthetic. 
THE need of a good local ansesthetic from 
which there is no danger of oversys- 
temic action has long been felt by the medical 
profession. 
Probably no better drug than the muriate of 
cocaine has been produced, but it is open to 
the one serious objection that when applied to 
cut surfaces it produces dangerous systemic 
action, endangering the life of the patient, 
and in a limited number of cases causing death. 
Believing the combination of carbolic acid 
and cocaine to be an excellent one theoretically, 
from the fact of both possessing anaesthetic 
properties, and the former one of the best 
known antiseptics, the writer decided to test 
the practical use of the drug. 
The phenate of cocaine is one of the many 
preparations by Merck. It is described as a 
slightly-colored substance, of the consistence 
of thick honey, which readily melts when 
heated, and containing seventy-five per cent, 
of the cocaine alkaloid. 
It is soluble in alcohol of from thirty to fifty 
per cent., the solution having a faint odor of 
carbolic acid. 
The dose of the drug is from TV to l grain, 2 
repeated every four hours. Locally, it is applied 
in solutions varying from one to ten per 
cent. 
How much the antiseptic properties of the 
carbolic acid are affected by the chemical com- 
bination we leave open for discussion, suffice 
to say that the solution was applied to cut sur- 
faces in which no other antiseptic was used, 
and in all cases the results were equally as 
good as in those where such solutions as per- 
oxide of hydrogen or carbolized benzoninol 
were used. 
As to the antiseptic properties, some few 
tests have been completed and others are being 
carried on. 
These tests confirm the statement that the 
combination still possesses antiseptic properties, 
but not equal to the carbolic acid alone. 
It is the writer’s belief that it at least retards 
the growth of micro-organisms. 
As a local anaesthetic, the power of cocaine 
is very great over limited areas. This is espe- 
cially true when applied to mucous membranes. 
Applied to such structures as the Schneiderian 
membrane, the mucous covering of the glans 
penis, or by hypodermic injection, it causes 
limited blood-supply by contraction, and pro- 
duces temporary anaesthesia. 
If applied to the tongue, it temporarily per- 
verts both taste and tactile sensibility. Applied 
to the ocular conjunctiva, it not only produces 
profound anaesthesia of this membrane, but 
causes dilatation of the pupil, partial paralysis 
of accommodation, enlargement of the palpebral 
fissure, slight lachrymation, and often tempo- 
rary ptosis. 
The physiological action of the phenate of 3 
cocaine is practically the same, at least as far 
as the writer has been able to test. 
It might be best to state that the writer’s ex- 
perience with the drug has been limited exclu- 
sively to throat and nose work. 
In testing its anaesthetic properties, ten dif- 
ferent solutions were used, ranging in strength 
from one to ten per cent., the six- and eight- 
per-cent. solutions answering as well for all 
operations as the nine and ten. The applica- 
tions were limited to the nasal and pharyngeal 
mucous membrane. 
For thermo-cautery application in follicular 
or granular pharyngitis, where the burning is 
superficial, the two- to four-per-cent, solution 
gave equally as good results as the higher ones. 
The one- and two-per-cent, solutions were not 
satisfactory ; for prolonged operations and those 
involving deeper tissue the stronger solutions 
must be used. 
As a local anaesthetic, I have used the drug 
in twenty-four separate cases, as follows : Four 
cases when removing the hypertrophied inferior 
turbinated bone by means of saw and cautery 
snare; two cases of exostosis of septum re- 
moved by saw and knife; five cases of en- 
larged tonsils reduced by thermo-cautery; 
three cases of follicular pharyngitis treated by 
puncture with cautery needle ; two of adenoid 
vegetations at the vault of the pharynx treated 
by flat, curved cautery-blade; three cases of 
hypertrophic rhinitis; one case of hay fever, 
on which I operated for hypertrophied tur- 
binated bone; and four cases of nasal polypi. 
In each of these cases I kept a record of the 
number of times applied and length of time 
before anaesthesia was produced. Various theories are advanced as to how 
phenate of cocaine acts, whether by the para- 
lyzing of the terminal twigs of the sensory 
nerves, or by vaso-motor action, rendering the 
nerves bloodless, and thereby rendering them 
unable to transmit sensory impressions. 
However, this we will leave each to his own 
belief; we know it acts as a local anaesthetic. 
Combined with the aqueous extract of witch- 
hazel, it is an admirable astringent not only in 
hemorrhage but in acute catarrh. 
In one case of exostosis of the septum and two 
of hypertrophied turbinated bone, the anaesthe- 
sia was not satisfactory, as is usually the case 
when cutting of the bone or where deep tissue 
is involved ; the same can be said of the muriate 
of cocaine. 
The length of time to produce anaesthesia is 
somewhat longer than that required for the 
muriate; but, when once produced, it is more 
lasting. In the twenty-four cases reported, the 
average time was seven minutes, the total 
number of applications at different sittings 
being one hundred and fifty. 
The astringent properties of cocaine are well 
known. 
Having used the aqueous extract of witch- 
hazel with success in cases of nasal hemorrhage, 
I used this in making the test solutions. 
As the phenate of cocaine is insoluble in the 
witch-hazel, I first dissolved it in alcohol, then 
added this to the witch-hazel. 
An equally good combination is phenate of 
cocaine thirty grains, menthol fifteen grains, to 
one ounce of witch-hazel. This is, however, 
open to the objection of the bad after-effects 
of menthol, first causing contraction of the 
4 blood-vessels, which is afterwards followed by 
congestion, with decided irritation of the 
mucous membrane. 
In comparing the phenate with the muriate 
of cocaine, I believe it to be as good a local 
anaesthetic, and in none of the one hundred 
and fifty applications of which I kept record, 
and I feel safe in saying as many more of which 
I kept no record, did I have symptoms of 
cocaine-poisoning, nor did the patient com- 
plain of any bad after-effect. 
Yet in three cases there was cardiac disease 
and in one albuminuria. These conditions are 
known to be especial contraindications for the 
use of the muriate. 
As an antiseptic, I believe it equal to any car- 
bolized solution usually used in nasal operations. 
It can be safely used on cut surfaces, which, 
in using the muriate, is to be carefully avoided. 
It is superior to the muriate in the fact “ that 
it coagulates the albumin in the tissue, prevent- 
ing the absorption of the cocaine, thereby pro- 
longing the anaesthetic effect, and lessening the 
danger of systemic poisoning” (Hare). 
Dr. Isador Gluck has for several years added 
carbolic acid to solution of muriate of cocaine 
for the purpose of avoiding the after poisonous 
effects. 
Dr. Roberts Bartholow also states that phenol 
added to muriate of cocaine will lessen the 
danger of systemic poisoning. 
Dr. Von Oefele uses the drug exclusively in 
the place of the muriate, locally, internally, 
hypodermically, and in powder. 
For operations involving the deeper tissue, 
the drug must be used hypodermically, the 
eight-per-cent, solution usually producing suffi- 
5 cient anaesthesia. The alcoholic solutions give 
better results, but are more irritating. 
While we must not draw too positive conclu- 
sions from these few cases reported, yet the re- 
sults are such as to justify its use in minor 
surgery. 
6 JANUARY 16, 1893. 
WHOLE SERIES. VOL XVII. No. I. t THIRD 8ERIE3. VOL. IX. 
THE 
Therapeutic Gazette 
A MONTHLY JOURNAL 
— OF— 
General, Special, and Physiological Therapeutics. 
GENERAL THERAPEUTICS. 
H. A. HARE, M.D., 
Profeator of Tberapeullca la the Jeffenon Medical College. 
Ophthalmic and aural Therapeutics, Surgical ana Genito-uriNart Therapeutics, 
0. E. DE 8CHWEINIT2, M.D., EDWARD MARTIN. M.D.. 
Clinical Profettor of Ophthalmology In the ClinlcM Profettor of Genlto Urinary Diaeaic*, Uoireally of 
JelTertoo Medical College. Ptnntyl.anla. 
EDITORIAL OFFICE, 222 South Fifteenth St.. Philadelphia. U.S.A, 
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