The Clinician Looks at Neuromuscular Blocking Drugs

Abstract

Use of neuromuscular blocking drugs by physicians is alleged to have begun more than 160 years ago when William Soule and Sir Benjamin Collins Brodie recommended “curare” for the treatment of tetanus and hydrophobia in 1812. Scattered reports of its administration for chorea, epilepsy, tetanus and strychnine poisoning appeared in the French medical literature of the 1850’s. In the twentieth century, West in 1932, and Burman six years later wrote of management of spastic states with “curare”. The introduction of pentamethylenetetrazol (Metrazol) and electric shock for the therapy of mental depression was accompanied by the disturbing occurrence of fractures and dislocations resulting from the massive contraction of skeletal muscles. It was natural to attempt to minimize this undesirable muscular reaction through the use of a neuromuscular blocking drug. Such a goal apparently led A. E. Bennett to seek supplies of crude South American curare from Richard Gill in the late 1930’s and to urge the manufacturing chemists, E.R. Squibb and Sons, to purify the crude material (see Bennett, 1968). This, despite the fact that in England, Harold King had isolated D-tubocurarine from so-called tube curare in 1935.