| COCAINE ANALGESIA OF THE SPINAL CORD. |
By SMITH ELY JELLIFFE, M.D., Ph.D.
THERE are surgeons living to-day who remember the fascination and horrors of necessary operations, when speed was as great a requisite as skill to shorten the mortal agony, and when a famous surgeon would remove a limb in eleven minutes. There are many who remember how slowly the boon of chloroform worked its way against prejudice. To give it to ease the pain of childbirth was not only unsafe, according to the family doctor, but sacrilegious, according to the preacher, for did not the Holy Writ say, 'In sorrow shalt thou bring forth children,' and who of Adam's daughters should presume to escape the curse? Had it not been for the wit of Dr. Simpson, who insisted that the Lord performed the first surgical operation under anæsthesia when He caused Adam to fall into a deep sleep and took a rib from his side, and the courage of Queen Victoria, who set the example to the women of her empire by trusting her physician to give her chloroform at the birth of one of her children, it is quite possible that the ease from pain of all kinds might have been longer delayed.
Soon after chloroform came ether, the safer anæsthetic, and the one more frequently used, to produce unconsciousness in pain; and then cocaine, that peculiar drug that, injected into the tissues, benumbs the nerves and abolishes sensation of pain, and that gives the last word of the century on anæsthesia.
When the anæsthetic properties of this alkaloid of coca were discovered, and it had been demonstrated that abscesses could be opened and slight, but otherwise very painful, operations could be performed without pain, under its influence, it was considered the one thing necessary to complete the series of anæsthetics. The nerves, however, quickly recovered from the effects of the drug, and hence operations had to be accomplished in a comparatively short time. Until recently, only minor operations of the external parts of the body could be performed, and cocaine has been classed merely as a local anæsthetic; but its future has suddenly opened along new and startling lines in the discovery that when it is injected into the spinal cord it causes a total loss of sensation to pain below the point of puncture, so that most elaborate and difficult operations may be carried on while the patient chats pleasantly with the surgeon and attendants.
This discovery, like so many in medical science, did not flash into existence like a new star in the firmament, but was the result of
