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The Introduction of Local AnesthesiaFOREWORDThis set of reprints commemorates the advent of surgical local anesthesia in fin-desiecleVienna, one hundred years ago. It presents Roller and his epochal report on cocaineanesthesia of the eye in the context of precursors who foreshadowed but missed thediscovery and innovative followers who soon extended it to nerve block, dental anesthesia,medication of the spinal cord, subarachnoid, sacral epidural, and intravenousroutes to regional anesthesia, and, not least, the pioneering search for the active anesthesiophoricgroup which culminated in the synthesis of a much less toxic drug(novocaine) by Einhorn. Lastly, we reprint, by permission of The Psychoanalytic Quarterly,the fascinating account of the discovery and its aftermath, retold with exemplaryfilial scholarship by Hortense Roller Becker.Rarely in the field of pain relief has so much been owed by so many to so few. Thelatter-day repercussions include the emergence of anesthesiology as an autonomousspecialty of medical practice and, more recently, the burgeoning international assault onpain mechanisms and chronic pain. Fittingly, the Wood Library-Museum of Anesthesiologyand the American Society of Anesthesiologists, who are responsible for itsproduction, have made this commemorative set available for distribution to registrantsof the IVth World Congress of the International Association for the Study of Pain,meeting in Seattle in 1984.For perspective on the significance of -the centennial, suppose for a moment that acongressional Big Brother took it into his head to ban all classes of drugs, save one to beselected by popular vote. Which would survive? Local anesthetics? Or go back to 1884and allow the world just one medicinal plant. Erythroxylum coca?The discovery of surgical local anesthesia with cocaine intersected two major currentsof biological thought of the second half of the nineteenth century, vitalism and reductionism.Vitalists held that anaerobic release of energy within the cell is a vital action, achemical process inseparable from the life and .organization of the cell. Cocaine, theactive principle of Erythroxylum coca leaf, had an occult power to release energy nototherwise available to the organism. That was why the Indians of the Andean altiplanochewed the leaf. How else would they be able to endure the cold, the fatigue and thehunger of their thin existence? Freud had a notion that the Indians' traditional coca chewcould be turned into an effective and manageable medicinal psyche booster if taken neatin the form of cocaine. Freud's efforts to verify his exciting conjecture did not work out,but they had the inestimable importance of bringing the drug to the mouth of hiscolleague and close friend, Carl Roller, who had a narrower, reductionist goal. Reductionistphysiologists thought that the organism's release of energy was from a whollyphysical or chemical machine, exemplified in the electrical action of nerves demonstratedby DuBois-Reymond. If mechanical it must be controllable, and this, wittingly ornot, underlay the conviction of Freud's junior colleague and friend, Carl Roller, that localanesthesia of the eye was within the realm of the possible. This idea had been implantedin Roller by Arlt, his professor of ophthalmology — ophthalmology, the first of thespecialties — arousing in Roller the soaring ambition to become an assistant in thefamous Viennese clinic, for which post he would qualify by making a notable discovery.Or so he hoped. He did make the discovery, for Roller's mind was well prepared and thetime was ripe. But the appointment was denied him, as inexorably as in a Greek tragedy.B. Raymond Fink