Pathfinders in oncology from the end of the 19th century to the first description of Ewing sarcoma.

During the period 1884 to 1922, the only option in cases of operable cancers was radical surgery, and only a minority of patients were cured. Sporadic attempts were made to treat inoperable cancer patients with bacterial toxins; however, with the discovery of x-ray and radium, the era of radiation treatment as an alternative to surgery began. The discovery of transmissible cancers and experimental growth of cancer cells offered new information and not only led to a better understanding of the cellular composition of cancers but also yielded important information that ultimately paved the way to chemotherapy. These efforts also advanced the understanding of the pathogenesis of tumors and induced new clinical and pathologic classifications and subspecializations. It is important to emphasize that many of the initiatives and discoveries made in Europe in the second half of the 19th century were first put into clinical practice in the United States during the first 2 decades of the 20th century, including the use of x-ray and radium for irradiation and as diagnostic tools. All things considered, the progress made between 1884 and 1922 came about through the hard work of many eminent individuals; however, there were 7 foresighted pathfinders (3 surgeons, 2 pathologists, 1 internist, and 1 physicist) who-despite their widely diverse backgrounds, personalities, and expertise-made remarkable contributions to oncology to an extent that is still felt today.

Henryk Hilarowicz: The Forgotten Polish Inventor and Pioneer of the Interscalene Brachial Plexus Block.

Professor Henryk Hilarowicz was a Polish surgeon who first described the technique of brachial plexus block performed in the interscalene groove between the anterior and middle scalene muscles. The article devoted to the technique appeared in the German-language journal Zentralblatt für Chirurgie in 1925, 45 years before Alon Winnie, who is widely regarded as the originator of this method, published his paper in Anesthesia & Analgesia in 1970.

Procaine and Local Anesthetic Toxicity: A Collaboration Between the Clinical and Basic Sciences.

In 1924, the Therapeutic Research Committee of the American Medical Association appointed a special committee to investigate deaths following the administration of local anesthetics. The Committee for the Study of Toxic Effects of Local Anesthetics found procaine, although a safer clinical alternative to cocaine, was capable of causing death when large doses were injected into tissues and advised that it should be used with caution. This article describes a collaboration beginning in 1928 between Dr John Lundy of the Mayo Clinic and Dr Robert Isenberger of the University of Kansas, which arose from a controversy surrounding systemic adverse reactions to procaine. Isenberger then traveled to the Mayo Clinic to conduct research on various procaine local and spinal anesthesia doses and sodium amytal's protective effect against procaine-induced toxicity. Lundy and Isenberger's work would add to the ongoing discovery of systemic reactions to local anesthetics.

Intrarectal Anesthesia in Neurosurgery.

In the early days of modern neurologic surgery, the inconveniences and potential dangers of general anesthesia by chloroform and ether using the so-called "open-drop technique" led to the quest for alternative methods of anesthesia. This became all the more necessary, since patient positioning and the surgical arrangements often hindered the use of a drop bottle. One approach to solve this problem was intrarectal ether application. The present article aims to shed light on this original, less well-known anesthesia technique in the neurosurgical field.

[Beginning of continuous wound infusion with local anesthetics : With special emphasis on the contributions from Walter Capelle and Ewald Fulde]. / Anfänge der kontinuierlichen Wundinfusion mit Lokalanästhetika : Unter besonderer Berücksichtigung der Beiträge von Walter Capelle und Ewald Fulde.

Wound infusion with local anesthetics is a proven and safe analgesic procedure for modern perioperative patient care. Even the pioneers of local anesthesia practiced wound analgesia and emphasized the shortcomings of "single-shot" wound infusions. At the same time, they drew attention to the importance of long-lasting pain relief to prevent sequelae, especially after upper abdominal surgery with pneumonia, embolic events or postoperative ileus. In the early 1930s there were first sustained efforts to improve the efficiency and quality of pain therapy, especially after upper abdominal surgery by continuous wound infiltration with local anesthetics via intraoperatively introduced special cannulas. This measure was carried out to enable reduction in pain and allow early postoperative mobilization. The conceptual development of this pioneering analgesia method is closely connected with the names of the Berlin surgeons Walter Capelle and Ewald Fulde; however, their inaugurated and propagated therapy concept did not find the attention and dissemination that it deserved. This is a reason for us to remember their pioneering ideas on pain management in the context of current developments.

The place of James Arnott (1797-1883) in the development of local anaesthesia in dentistry.

Dental disease in the form of caries and abscesses has been known since antiquity. Before the advent of anaesthesia, operations upon the mouth were painful. The introduction of general anaesthesia in the form of ether and chloroform seemed to provide a solution, but there was an unacceptable level of mortality. James Arnott introduced local anaesthesia by means of freezing with ice, which he considered safer. He waged a long campaign and his method received recognition and was used in France and the USA. His method stimulated the development of pharmacological anaesthesia.

[The Origins of the Words : Zenshin Masui and Kyokusho Masui.]

In 1850, Seikei Sugita coined the word "Masui" to describe a physical condition induced by ether inhala- tion. Therefore, the word"Masui"initially meant general anesthesia. After physical methods to produce local numbness were introduced to Japan, it was necessary to make a new phrase to express the methods and the physical condition produced by them, and "Kyokusho Masui" was made, in which "kyokusho" means local. Then,"Zenshin Masui", indicating general anesthesia, was made to form a set of "Kyokusho Masui" and "Zenshin Masui". It was 1876 when Tadanori Ishiguro published "Geka Tsujutsu", in which he described a clear definition of "Kyokusho Masui" and "Zenshin Masui". This is one of the earliest uses of "Kyokusho Masui" together with "Zenshin Masui" in Japan.

[On Anaesthetica by Johann N. von Nussbaum who Introduced the Concept of Local Anesthesia to Japan].

Because the Japanese word of Masui (Anesthesia) was originally coined to mean general anesthesia in 1850, there was no Japanese phrase corresponding to general anesthesia in the period between 1850 and 1877. In 1878, Tadanori Ishiguro, a military surgeon who was impressed by Johann N. von Nussbaum's Andsthetica, published Shitu narabini Masuiho (Analge- sia and Anesthesia). In this book, he coined new Japa- nese phrases Kyokusho Masui and Zenshin Masui which corresponded to German phrases Lokale Anaes- thesie and Allgemneine Anaesthesie, and he described the definition of those terms. Since then, the terms, local anesthesia and general anesthesia, have prevailed in Japan.

[From the legacy of Carl Koller. Notations on his experiments with cocaine]. / Aus dem Nachlass von Carl Koller: Aufzeichnungen zu seinen Experimenten mit Kokain.

The history of local anesthesia began with the discovery of the anesthetic properties of cocaine by the physician Carl Koller from Vienna 130 years ago. After he had realized the options for painless surgery using this substance, he analyzed cocaine in detail from this point of view and evaluated the drug's significance in animal experiments, in self-experiments and in colleagues. The findings of his experiments were accurately recorded by Koller and after his death remained in the possession of the family for a long time until his daughter Hortense Becker-Koller handed these documents over to the Library of Congress in Washington. These recordings were recently studied and will now be presented to the public for the first time ever.

Local anaesthesia through the action of cocaine, the oral mucosa and the Vienna group.

Local anaesthesia through the action of cocaine was introduced in Europe by the Vienna group, which includeed Freud, Koller and Königstein. Before using the alkaloid in animal or human experimentation all these scientists tested it on their oral mucosa - so-called self-experimentation. Some of them with different pathologies (that is, in the case of Freud), eventually became addicted to the alkaloid. Here we attempt to describe the people forming the so-called 'Vienna group', their social milieu, their experiences and internal disputes within the setting of a revolutionary discovery of the times.

History of anaesthesia: early forms of local anaesthesia.

The direct application of volatile anaesthetic and the application of intense cold to traumatic injuries and surgical sites were important steps in 18th and 19th century anaesthesia. Local tissue temperature could be brought down by the application of ice and salt by the surgeon. Techniques used topical applications of chloroform, Dutch Oil, amyl hydrate, the vaporisation of nebulised ether, methylene and ethylene chloride applied by spray or fumigation and vaginal douche with carbonic acid gas. Mastering the projection of cold was extremely difficult. Keeping the aperture of the device used for the spraying of anaesthetic liquids clear of obstruction became a major challenge for instrument makers. To improve the precision of the jet, a different system of nozzles had to be invented. Nineteenth century medical practitioners were able to call on general anaesthesia, but some individuals and specific indications such as minor surgery called for an alternative approach. The introduction of cocaine in 1884 completely changed common practice.

Some (mostly Scottish) local anaesthetic heroes.

In 1884 a young Viennese doctor, Carl Koller, was the first to recognise the significance of the topical effects of the alkaloid cocaine and thus introduced drug-induced local anaesthesia to clinical practice. Most subsequent development took place in Europe and the United States, with British interest not becoming apparent for over twenty years. This is surprising because a number of doctors working in Scotland, or with Scottish connections, had made important contributions to the earlier evolution of local anaesthetic techniques. This paper reviews the relevant work of James Young Simpson, Alexander Wood, James Arnott, Benjamin Ward Richardson and Alexander Hughes Bennett and the role of John William Struthers in the later promotion of the techniques.

Carl Koller, cocaine, and local anesthesia: some less known and forgotten facts.

Modern-day local anesthesia began in 1884 with a discovery by a young unknown ophthalmologist from Vienna named Carl Koller, who placed a cocaine solution on the cornea, thus producing insensibility. The news of his discovery spread throughout the world in less than a month. "Not surprisingly," a controversial priority discussion emerged. There is little information about this "dark side" of Koller's discovery and only sparse data about the personalities involved in this controversy. In addition, Carl Koller's decision to leave Vienna is also surrounded in secrecy. The story surrounding the revelation of the local anesthetic effect of cocaine and the personalities involved is fascinating and relatively unknown.

(Almost) painless surgery: a historical review of the evolution of intraurethral anesthesia in urology.

OBJECTIVE: The discovery of local anesthesia revolutionized urologic surgery. We investigate the evolution of intraurethral anesthesia in urologic surgery beginning in 1884. METHODS: A review of the literature was performed, reviewing the history of local anesthesia for urologic surgery, with a specific emphasis on intraurethral anesthesia. Using the University of Rochester libraries catalog "Voyager," a search was performed reviewing the primary literature published on intraurethral anesthesia beginning from 1884 through 2009. We also reviewed published literature in Ovid Med and PubMed for articles relevant to the topic of intraurethral anesthesia. The search terms were intraurethral, cocaine, lidocaine, and anesthesia. RESULTS: In the 1840s, it was demonstrated that ether, nitrous oxide, and chloroform could prevent the pain of surgery, resulting in a dramatic increase in surgery. At Massachusetts General Hospital between 1845 and 1847, surgeries increased 2.5-fold. Four decades later, it was demonstrated that cocaine allowed for adequate analgesia without the side effects of general anesthesia, resulting in a dramatic increase in urologic surgery. Cocaine was gradually replaced as an intraurethral anesthetic as safer local anesthetics, such as lidocaine, became introduced. Modern studies show conflicting results over the efficacy and ideal administration of intraurethral anesthetics. CONCLUSIONS: Local anesthesia was rapidly accepted by urologists around the world and used in a wide variety of urologic surgeries, contributing to the acceptance of anesthesia and a revolution of the practice of surgery. To this day, intraurethral anesthesia continues to be a widely used and effective technique in urology, although the ideal method of use is largely left up to individual preference.