Chapter 23: Spinal Anesthesia

THE HISTORY OF SPINAL ANESTHESIA

Carl Koller, an ophthalmologist from Vienna, in 1884 first described the use of topical cocaine for analgesia of the eye.¹ William Halsted and Richard Hall, surgeons at Roosevelt Hospital in New York City, took the idea of local anesthesia a step further by injecting cocaine into human tissues and nerves to produce anesthesia for surgery.² James Leonard Corning, a neurologist in New York City, in 1885 described the use of cocaine for spinal anesthesia.³ Because Corning was a frequent observer at Roosevelt Hospital, the idea of using cocaine in the subarachnoid space may have come from observing Halsted and Hall performing cocaine injections. Corning first injected cocaine intrathecally into a dog and within a few minutes the dog had marked weakness in the hindquarters.⁴ Next, Corning injected cocaine into a man at the T11–T12 interspace into what he thought was the subarachnoid space. Because Corning did not notice any effect after 8 minutes, he repeated the injection. Ten minutes after the second injection, the patient complained of sleepiness in his legs but was able to stand and walk. Because Corning made no mention of cerebrospinal fluid (CSF) efflux, most likely he inadvertently gave an epidural rather than a spinal injection to the patient.

The presence of a neuraxial fluid was first noted by Galen in ad 200, and CSF was later studied in the 1500s by Antonio Valsalva.⁵ Dural puncture was described in 1891 by Essex Wynter⁶ followed shortly by Heinrich Quincke 6 months later.⁷ Augustus Karl Gustav Bier, a German surgeon, used cocaine intrathecally in 1898 on six patients for lower extremity surgery.^8,9 In true scientific fashion, Bier decided to experiment on himself and developed a postdural puncture headache (PDPH) for his efforts. His assistant, Dr. Otto Hildebrandt, volunteered to have the procedure performed after Bier was unable to continue due to the PDPH. After injection of spinal cocaine into Hildebrandt, Bier conducted experiments on the lower half of Hildebrandt’s body. Bier described needle pricks and cigar burns to the legs, incisions on the thighs, avulsion of pubic hairs, strong blows with an iron hammer to the shins, and torsion of the testicles. Hildebrandt reported minimal to no pain during the experiments; however, afterward he suffered nausea, vomiting, PDPH, and bruising and pain in his legs. Bier attributed the PDPH to loss of CSF and felt the use of small-gauge needles would help prevent the headache.¹⁰

Dudley Tait and Guido Caglieri performed the first spinal anesthetic in the United States in San Francisco in 1899. Their studies included cadavers, animals, and live patients to determine the benefits of lumbar puncture, especially in the treatment of syphilis. Tait and Caglieri injected mercuric salts and iodides into the CSF, but worsened the condition of one patient with tertiary syphilis.¹¹ Rudolph Matas, a vascular surgeon in New Orleans, described the use ...