_Subcutaneous injection._ This is a modification of Schleich’s method,
and was first introduced by Neumann of Vienna. It consists in injecting
a very weak solution of cocaine and adrenalin chloride subcutaneously
beneath the periosteum lining the auditory canal. By this method even
the complete mastoid operation has been performed, and in certain
clinics it is used continually in the minor operations of paracentesis
of the tympanic membrane, division of intratympanic adhesions,
extraction of polypi, and ossiculectomy. A solution of beta-eucaine or
novocaine may be used in preference to cocaine, as being less dangerous.
According to Neumann, three solutions are necessary: (_a_) a 1 in 2,000
solution of adrenalin chloride containing a 1% solution of beta-eucaine;
(_b_) a 1 in 3,000 solution of adrenalin chloride containing a 1%
solution of cocaine; (_c_) a 20% solution of cocaine.
The syringe for injecting the solution has a capacity of I cubic
centimetre, and for convenience its needle is fixed at an obtuse angle
to the body of the syringe (Fig. 177). The technique of the injection
depends on whether the operation is to be limited to the auditory canal
and tympanic cavity, or is to involve the mastoid process.
[Illustration: FIG. 177. NEUMANN’S SYRINGE FOR SUBCUTANEOUS INJECTION.]
If the complete mastoid operation is going to be performed, the needle
of the syringe, now filled with the eucaine solution, is thrust through
the skin about the middle point of the mastoid process, and a few drops
of the solution are injected. The needle is then forced upwards towards
the temporal ridge, at the same time being thrust in deeply until it
touches the bone, so that a syringeful of the solution is injected
beneath the periosteum. The needle is then withdrawn and reinserted at
the same point, but in a backward direction, the solution being injected
along the posterior portion of the mastoid process; in a similar manner
the solution is injected downwards towards the tip of the mastoid. The
ear being now pulled well forward, the needle is made to pierce the fold
between the auricle and the mastoid process, just above the posterior
ligament, and is pushed inwards between the anterior border of the
mastoid process and the cartilage of the meatus, and a further
syringeful of the solution is injected. A large speculum is now inserted
into the ear, so that by pressing it against the wall of the meatus the
skin, at the termination of the cartilaginous portion, is made to
project in folds. The needle of the syringe, filled with cocaine
solution, is pushed into this fold, and a few drops of the solution
injected. By degrees the needle is still further pushed inwards, keeping
it in close contact with the bony wall so that the fluid is injected
beneath the periosteum. If the injection has been successful, a white
bulging of the superior wall of the auditory canal will be noticed. To
render anæsthesia complete, further injections may be made into the
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