Volume 9b - History of Anaesthesia Society

Dr R W Patterson (Los hgeles)
Reprts in American medical journ.31~ of 1300 enthusiasticslly acclaimed
the latest Euro,oean advancement, surgical anal~esia accomplished by
subrachnold injection of cocaine. Fifteen years previously the reprt
by an knerican neurologist, Dr Jms Leonard Coming, describing the
extent of neural blockade resulting Erom the identical technique and
suggesting tinat such medication would be useful for surgical procedures,
was totally ignored. l
Irmrediately following the intrduction of topical cocaine in 1884, the
demonstration of conduction block of peripheral nervss by injection
(Halsted) signalled to the dental prof eusion a therapeutic choice free
from t5e problem of general anaesthesia. Surgeons, though openly
expressi~g dissatisfaction with anaesthetic complications, neglected to
investigate in suitable cases, the solution proffersd by Corning. That
this might have been thr-: act of a s;?lf-conscious cha~ministic sixcialty
isolatinr~ itself Erom anything the group itselE did not initiate, is
sllggested by the life-long I-Ialsted antisthy and hatred t~nmrcls Coming.
However, the relative reticence and ah.ence of proselytising by Coming
concerning his subs~quent clinical studies, and by other American
investigators concerning their clinical studi9s involving llonbar
pllacture during thew yedrs prior to 1900, points to a more encompassing
hmda~nental determinant of m3dicll practice: confonnity dictated to
avoid society's scrutiny ,et1161 stricture.
a3zmingts early Life
The American Civil war unsettled the faith and bonds of religious
traditionalism of Coming's father, a Unitarian preacher and spradic
fundaner~talist, and in 1369 this sixth generation Yan!cee trans~rted his
entire family to Europe. Thus, unlike m y of his Arwrican rneclic~l
colleagues who in the latr? ninetzenth century felt obliged t,o add a
continental cachet ,.iith a year of touc.hg Europan medical clinics and
surgical theatre;, Coming, from the age of fourteen had been schmled
in Genmny. He received his m3ica1 degree from Wurzbg in 1878. His
disszrtation was directed bv the anatomist Rindfleisch in the Demrtment
of Pathola~. In this milieu, expsuce to lcnuwledge of the spGal cord
and cdrehrospinal fluid was unavoidable. Throuqhout the 1870's Retzius
and Axe1 ~e; extensively .investigated and dz?kribed, in German, the
rnerrlbranes and cavities oE the brain and spinal cord. In 1972 Guincke
pub~ished his first study on the %;>a echnoid space wherein he adverts
to the prfomutce of lumbar puncture.'
In 1079 Corning returned to the United States, to New York City, to
psue his spcial interasts in diseases of the nervous system. The
first step in introducing himself into the clos:?d-rank medical
establishment was to obtain one of tile few, je;ilorlsly quarded, highly
carrpetitive appintments as Wsistant Physician at an institution where
there would be clinical material for investigative studies. He began
the period of required experience in the service of the renowned surgeon
(and Vice Przsident of the New York Neurolcgic31 Society) Dr J Varion