Chapter 1

The history of local anesthesia suffers, if it suffers from anything, from the lack of a distinct Eureka moment. It is arguable that we do not have in our history a pivotal day that signified the wholesale change from an era before local anesthesia to the dawn of a new and wonderful age that included parts of the body being rendered insensate for therapeutic reasons. We do not have the equivalent of 16 October 1846 and the trembling hands of William Thomas Green Morton. What we have is a remarkably slow concatenation of the three elements necessary for the administration of the vast majority of local anesthetics: a syringe, a needle, and a local anesthetic drug. Many, however, would argue that to these three need be added several other factors: a detailed knowledge of anatomy and an appreciation of the body's pain mechanisms and more objective methods to localize peripheral nerves and monitor administration of local anesthetics. The authors make no excuse for concentrating in this chapter on the early history of local anesthesia in order to dissect the development of these three vital components.

The origins of the first attempts at some form of local analgesia or anesthesia are lost in the mists of time. Direct nerve compression and the direct application of ice to peripheries before surgery have distant origins but were certainly in regular use from the latter half of the eighteenth century. The first detailed appreciation of the benefits of local anesthesia was written by James Young Simpson and published in 1848, decades before local anesthesia became a practical possibility (Figure 1–1). In this paper, he also described his own unsuccessful experiments with the topical application of a variety of liquids and vapors in an attempt to produce local anesthesia. The paper was published less than 2 years after Oliver Wendell Holmes had coined the term anesthesia, and it therefore almost certainly represents the first use of the term local anesthesia, although Simpson would have used the (arguably more correct) English spelling anaesthesia. However, Simpson was well aware that his were far from being the first attempts to produce peripheral insensibility, for he refers to some ancient methods, which he considered `apocryphal,' and also to Moore's method of nerve compression (Figure 1–2).1

Fig. 1-1

James Young Simpson.

Fig. 1-2

Nerve compression technique.

Another distinguished British physician and president of the Medical Society of London in 1868 was Sir Benjamin Ward Richardson. He spent many years in the attempt to alleviate pain by modifying substances capable of producing general or local anesthesia. He brought into use no fewer than 14 anesthetics and invented the first double-valved mouthpiece for the administration of chloroform. He initially experimented with electricity before turning ...

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