nerves are very large, and as they course down the arm or leg, are as big as
a pencil before they branch out into tiny tendrils to where they terminate
in muscles or the skin. Within each nerve there are imperceptible nerve
fibers that are alternately carrying signals down from the brain or upward
toward the brain. Motor nerve fibers carry the electrical signal down the
spinal cord, along the peripheral nerve, and connect to the muscles they
command. Conversely, sensory nerve fibers within the peripheral nerve
carry the electrical signals from the skin, bones, and soft tissues,
communicating messages of pain, touch, sensation, vibration back to the
“central processing unit,” the brain.
Halsted was sailing in completely uncharted waters. The only way to
test his hypothesis of regional anesthesia was to start injecting subjects,
and what would be impossible now, he approached the best guinea pigs he
could find: his medical students at the quiz sessions. By comparison, Koch
seems positively cosmopolitan by experimenting on his daughter’s pet
rabbit.
Within two weeks of Noyes’s publication, Halsted had secured a 4
percent cocaine solution from Parke-Davis and Company, and began
injecting students in his Madison Square home office. The injecting
parties that ensued must have been sensational. Halsted, elaborate metal-
and-glass syringe in hand (no modern sensibilities of “single-use”
needles), parading around the parlor and plunging the needle into arms and
legs. Occasionally thrusting deeply into a nerve, with an electrical blast of
pain down a limb, Halsted would have been as frightened as his vassal.
However, when the medicine was deposited adjacent to the nerve,
numbness ensued down the limb in an anatomic distribution. Within days,
it was obvious that regional anesthesia was not just a conceptual dream, it
was a reality.
Many of the students experienced a rush of energy, with occasional
nausea, flushing, palpitations, and dizziness. By altering the concentration
of cocaine, symptoms were mitigated. Soon, operations were being
performed on real patients on a regular basis at Roosevelt, and dental
procedures were also accomplished by Halsted’s dentist friends.
Today, names like lidocaine, Novocain, and xylocaine are familiar to the
reader, but few appreciate their close kinship with cocaine. While the
former group of medicines are safely, and innocently, used in clinical
settings around the world, cocaine is a different beast altogether. As Noyes
marcin
(Marcin)
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