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Carl Koller, an ophthalmologist from Vienna, first described the use of
topical cocaine for analgesia of the eye in 1884.1 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 in order to produce anesthesia for
surgery.2 James Leonard Corning, a neurologist in New York
City, described the use of cocaine for spinal anesthesia in
1885.3 Since 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. Since Corning did not notice any effect after 8
min, 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.
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Dural puncture was described by Essex Wynter in 18915
followed shortly by Heinrich Quincke 6 months later.6
Augustus Karl Gustav Bier, a German surgeon, used cocaine intrathecally on
six patients for lower extremity surgery in 1898.7,8 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.9
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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 in order 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.10 Rudolph Matas, a
vascular surgeon in New Orleans, described the use of spinal cocaine on
patients and possibly was the first to use morphine in the subarachnoid
space.11,12 Matas also described the complication of death
after lumbar puncture. Theodore Tuffier, ...