Some Aspects of the History of Local Anesthesia

Abstract

As befits its importance to the relief of suffering in man, the writings on the history of local anesthesia are extensive, as those also were in relation to its predecessor, inhalation anesthesia. Strangely, those accounts appear largely in the American literature although the first clinical application of the anesthetic properties of cocaine took place in Vienna, in 1884. Full credit, as we shall see, is now given to Koller, the perpetrator. Although his contribution was not beset with the kind of controversy that surrounded the advent of inhalation anesthesia, it might have been that local politics, Koller’s aggressiveness and his religious adherence caused the event to be underemphasized abroad. Although regional anesthesia (a term reputedly coined by the American surgeon Harvey Cushing) was immediately applied clinically in America, the scientific basis and its multifold techniques were established in Germany around the turn of the century. In England, where there already existed a considerable degree of anesthetic professionalism, inhalation anesthesia continued to dominate despite decades of debate over the merits of chloroform, its mode of administration as well as adverse pharmacologic effects and toxicity. In that country to this day, regional anesthesia constitutes only a small share of practice while in America resurgence of interest in the method has occurred. Moreover, intravenous agents for induction and maintenance of general anesthesia now preoccupy practitioners both in England and on the continent.