The birth of modern local anaesthesia

Updated - November 10, 2021 12:32 pm IST

Published - September 13, 2015 05:20 pm IST

Story of how Austrian ophthalmologist Karl Koller discovered the modern local anaesthetic

Story of how Austrian ophthalmologist Karl Koller discovered the modern local anaesthetic

A little over a decade before Dr. John Snow had laid the foundations of modern epidemiology, medical field was seeing another substantial transformation. Ether was administered as a general anaesthetics and the advantages it brought along were innumerable.

Anaesthesia corresponds to the insensitivity towards pain, especially that induced artificially by the administration of gases or injection of drugs before surgical procedures. Despite the success, general anaesthesia had its share of drawbacks.

Need for local anaesthesia For one, patient's involuntary responses were still beyond the surgeon's expectations. Also, the surgeon required the patient's cooperation in certain procedures. Secondly, general anaesthetics sometimes had undesirable side effects, including vomiting.

The need to cater for some specific treatment, rather than in general, was on the rise. Procedures pertaining to dental care and eyes were especially hard, as the involuntary movements were a nuisance to both parties involved. In short, both surgeons and patients were ready for local anaesthesia.

Freud has a role to play Sigmund Freud, as a young researcher and long before he became an expert in psychoanalysis, was interested in cocaine, after he noticed its pain-killing properties. Karl Koller, a 27 year-old physician who was practising medicine at the same Royal General Hospital in Vienna, Austria as Freud, had already tried out solutions of chloral hydrate, bromide and morphine as a local anaesthetics without any success.

Freud, who was attempting to cure a friend of morphine addiction, asked Koller to investigate cocaine as a possible remedy. Koller's research led him to the fact that in addition to its pain-killing properties, cocaine also had tissue-numbing properties, which gave it the potential to be a local anaesthetic.

Along with an assistant, Koller conducted tests to realise this potential. Drops of a solution of cocaine were added to one eye of a frog, while the other eye was left alone. Within a minute, the frog allowed the cornea of the eye treated with cocaine to be touched, while reacting with the usual agitations on attempts to touch the other eye.

Instant success

Identical tests were done on a rabbit and a dog and the results were found to be satisfactory. They next tested it on themselves by placing a drop of the solution under the eyelids of each other. Standing in front of mirrors, they went on to touch their corneas and realised that they couldn't feel it.

A mere four days after his preliminary observations were made, they were presented at the Ophthalmology Congress of the German Society held in Heidelberg, on September 15, 1884. As Koller couldn't afford the trip himself, he had hastily scribbled down his observations on both sides of a single sheet of paper, which were presented by the Triestin ophthalmologist Josef Brettauer, after he had stopped in Vienna on his way to the Congress.

The experiments were an instant success, not just in Germany but with doctors from around the world. Surgeons started experimenting with cocaine not just in eye surgeries, but in any case where a local anaesthetic was needed, and was found to be useful.

Cocaine, however, is no longer used as an anaesthetic, as it not only damages the cornea, but also has addictive potential. A number of other agents, be it natural or synthetic, that have significantly lesser or negligible abuse potential have replaced it as local anaesthetics.

As for Koller, he immigrated to the United States in 1888 and continued his practice as an ophthalmologist. He went on to be honoured by the American Ophthalmological Society in 1922 with the very first Lucien Howe Medal, recognising his outstanding achievements in ophthalmology.

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