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Regional Anesthesiology
Introduction
* A relatively unheralded field, in which dentistry and the commercial
manufacturers of local anesthetics have made a noteworthy contribution,
is that of regional anesthesiology.
The advancement of local anesthetics has developed as a result of ex-
-tensive research in many fields, including anatomy, biochemistry, phar-
macology, bacteriology, and physiology. Starting with the article which
appears below, written by Dr. Milton Asbell, a noted dental historian, the
Newsmonthly will present to its readers various papers on'the 'field of
regional anesthesiology.
This series of articles is meant to serve as a tribute to American den-
tistry for its role in developing the field of local anesthesia to the.advanced
stage at which it stands today. Credit must be given, also, to the phar-
maceutical industry and its research scientists for their outstanding con-
tributions to this field. LIONEL GOLD, D.D.S., Camden, New Jersey
An Historical Sketch on Local Anesthesia
Milton B. Asbell, D.D.S., M.Sc.*
* If local anesthesia denotes an Egyptians [moistening it with wine
insensibility to pain in a particular or vinegar caused the escape of a
portion of the body, it should be "gas" (carbolic acid?) to numb the
noted that the procedure, in one part with which it came in con-
form or another, has been prac- tact]1.
ticed for thousands of years. The Perhaps the first successful meth-
ancient surgeons of the Near East od of alleviating pain was the pres-
used the anesthetic properties of sure upon nerve trunks attributed
hemp; the compression of the ca- to the Arabs centuries ago. This
rotid artery, causing partial brain tradition was carried on through
anesthesia, was known to the Assy- succeeding centuries to Ambrose
rians; the Greeks utilized ointments, Pare (1510-1590) and to John
lotions and other plant concoctions Hunter (1728-1793).2 The use of
for their sedative and analgesic a refrigerant dates from Marcus
properties; the famous "stone of Aurelius Servinus (16th Century)
Memphis" was employed by the who used snow to induce local
anesthesia.3 The natives of ancient
* Head Dept. of Dental History and
Literature,. Seton Hall University, Col-
Peru knew about the anesthetic
lege of Medicine and Dentistry. qualities of the coca plant.
[12]
In modern times, the earlier ef- mankind. In 1885, J. Leonard Corn-
forts in local anesthesia were made ing of New York first suggested and
by Europeans. For example, Francis demonstrated the method of block-
Tynd of Dublin tried to administer ing nerve trunks through the use
drugs hypodermically as early as of an anesthetic solution. In 1903,
1845, as did Charles P. Pravaz of when he introduced his method of
Paris in 1851. In 1853 Alexander spinal anesthesia as a substitute for
Wood introduced the hypodermic general, it may be said that this
syringe.4 In the 1860's ether, used was the beginning of nerve block
as a spray for its local anesthetic anesthesia. In 1885, William S.
properties, was introduced by Ben- Halstead of New York and Balti-
jamin W. Richardson of England.5 more, following the findings of
It is of greatest interest to note Corning, blocked the inferior den-.
that in 1859 Walter F. Brindley tal nerve. He emphasized the im-
published the first work on the portance of employing a very
"freezing" technic in dentistry, dilute solution. Together with Hall,
Painless Dental Surgery. A Popular at this time, he also first introduced
Treatise on Congelation: Its Ef- the infiltration method of produc-
ficiency and Safety in Producing ing local anesthesia in a localized
Insensibility to Pain in Cases of part. This was the beginning of
Tooth Extraction and other Dental dental local anesthesia.6 Halstead
Operations. It was in 1884 that was honored by the National Den-
Carl K611er of Germany demon- tal Association in 1921 with a gold
strated the anesthetic action of medal given "in grateful recognition
cocaine. of his original researches and dis-
America Birthplace of Local coveries upon which the technic of
local and neuro-regional anesthesia
and General Anesthesia in oral and dental procedures" is
It should be a matter of great founded.7
pride to the physicians and dentists Various technics were soon pro-
in the United States that it was mulgated. To be mentioned are:
through the efforts of American regional or circular by Hacken-
men that this country can be called bruch, extraoral infiltration by
the birthplace of both general and Schleich, submucous and subperi-
local anesthesia. For it was through osteal infiltrations, the peridental,
their efforts that anesthesia became the pressure method developed by
internationally recognized as one Morton and Briggs and the high
of the greatest contributions to pressure method attributed to
[13]
Meyers, Ingalls, Jackman and developed by von Heyden, and
Sapp.8 apothesin by Woodbridge. In 1922,
Many members of the dental pro- Schuleman developed tutocaine
fession experimented with various and, in 1924, isocaine; Miescher
forms of cocaine in the production also developed nupercaine.1l' 12 Leo
of anesthetic solutions, such as J. Winter, in 1933, introduced a new
M. Lewis, N. S. Hoff, A. C. Hewitt, ischemic agent, cobefrin (corbasil)
and W. T. Martin. The following after the work of Gruettenfien, Tif-
prescription was introduced by J. feneau and Schaumann. In 1936,
W. Hope: Mendel Nevin introduced mono-
1i. Cocaine hydrochloratis 5 parts caine, following the investigations
Acidi carbolici 6 parts of Goldberg and Whitmore.
Camphorae 6 parts
Alcoholis (95%) The Beginning of Present-Day
q.s. to make 120 parts M Local Anesthesia
Sig: Inject, with a hypodermic syr-
inge, 1 to 3 minims deeply into the When, in 1905, novocaine was
inner and outer surface of gum. synthesized by Alfred Einhorn and
Apply over the gums absorbent cot-
ton saturated with the solution. Wait used clinically by Heinrich F. W.
4 or 5 minutes.9 Braun, the beginning of present-
However, it was the researches day local anesthesia began. Novo-
of men like Lieberman, Wellstaeter, caine was introduced in America in
and particularly Alfred Einhorn on 1907 by Schley.13 It was accepted
the chemical structure of cocaine, by the leading dentists of the United
which led to the development of States, through whose efforts it was
new drugs for local anesthesia, in popularized. Hermann Prinz de-
order to circumvent the objec- scribed its use in dentistry as early
tionable features of cocaine.10 As as 1910. Theodor Blum was greatly
early as 1881, Wiltgerodt intro- instrumental in disseminating its
duced chloretone; then came ane- use by establishing one of the first
sethin and subcutin (Ritsert, 1890), courses of instruction during the
tropacocain (Giesel, 1891), eucain period 1912-1914.14 In 1913, Guido
(Merling, 1896), beta-eucain (Vinci Fischer (Germany), during a visit
and Haycock, 1897), holocain to the United States, gave further
(Tauber, 1897), orthoform (Ein- impetus to local anesthesia, stress-
horn and Heinz, 1897), nirvanin ing the value of novocaine.'5 His
(Einhorn and Heinz, 1898), stovain Local Anesthesia in Dentistry was
(Fourneau, 1904), alypin (Hoff- published in English by Richard H.
man and Impens, 1905) and acoin Riethmuller in 1912. In 1914, Kurt
[14]
Thoma published Oral Anesthe- REFERENCES
sia: Local Anesthesia in the Oral 1. Smith, Arthur E., Block Anesthesta
Cavity. These books were the and AUllied Subjects, C. V. Mosby
Co.. St. Louis, 1920, p. 22.
pioneer publications in the field. 2. Buxton, Dudley W., Anaesthetics,
T7heir Uses and Administration, P.
It is interesting to note that the Blakiston's Son & Co., Phila., 1915,
anesthetic cartridge was invented p. 6.
3. Lane, Levi C., Sensation and Pain -
by Harvey S. Cook, a Valparaiso, Past Efforts to Control Them, Den-
Indiana physician who, during tal Items of Interest, 6:9. 1884.
4. Mlead, Sterling V., Anesthesia in
World War I, needing a local anes- Dental Surgery, C. V. Mosby Co.,
thetic as quickly as possible, being St. Louis, 1935, p. 48.
5. Tainter, M. L., A Century of Pro-
inspired by the cartridges used by gress in Local Anesthesia in Den-
the Army riflemen, made brass tistry, Proceedings Dental Centenary
Celebration, Baltimore, 1940, p. 655.
syringes which locked a double- 6. Smith, Arthur E.. op. cit., p. 26. -
pointed needle in place. He cut 7. Lufkin, Arthur W'., A IHistory of
Dentistry, Lea and Febiger, Phila.,
glass tubes himself and rubber 2nd ed., 1948, p. 336.
pencil erasers were used for rubber 8. Smith, Arthur E., op. cit., p. 644.
9. Gorgas, Ferdinand J. S., Dental
stoppers." Medicine, A Manual of Dental Ma-
One of the prime objects of the teria Medica and Therapeutics, P.
Blakiston and Son, Phila., 6th ed.,
dental profession is to relieve 1898, p. 336.
human suffering. An understanding 10. Winter, Leo, A Textbook of Exo-
dontia - Exodontia, Oral Surgery
of the principles of anesthesia is, and Anesthesia, C. V. Mosby Co.,
therefore, one of the most import- St. Louis, 1937, p. 28.
11. Fischer, Guido and Riethmuller,
ant parts of the dentist's scientific Richard H., Local Anesthesia in
knowledge. Although the work in Dentistry with Special Reference to
the Mucous and Conductive Methods,
local anesthesia has not been as Lea and Febiger, Phila., 1912, p. 23.
12. Mead Sterling V., op. cit.
glamorous as that in general anes- 13. Schley, W. S., Novocain in Local
thesia, research workers have striven Anesthesia, New York State Journal
of Medicine, 7:494, 1907.
diligently to develop local anesthe- 14. Blum, Theodor, Contemporary His-
tics for use in oral surgery and tory and Use of Local Anesthesia in
Dentistry, Horace Wells-Dentist-
operative dentistry that meet the Father of Surgical Anesthesia
highest standards. "The birthplace Memorial Volume, 1948, p. 51.
15. Posner, John J., Local Anesthesia
of both general and local anesthe- Simplified, C. V. Mosby Co., St.
Louis, 1925, p. 18. -
sia was in America, and their de- 16. Lufkin, Arthur W., op. cit., pp. 346-
velopment . . . to a large extent, 347.
17. Smith, Arthur E,. op. cit., p. 30.
(was) due to the constant research
25 Hadden Avenue
and work of Americans." Camden, New Jersey