(470-400 B.C.) spoke of "water on the brain," i.e. hydrocephalus.
In 1692 Valsalva noted a watery fluid around the spinal cord of a dog, when cutting through the cord. At that time it was common practice to decapitate cadavers when dissecting them, resulting in CSF leaking out before the brain and cord were examined.
1764 Domenico Cotugno explained, in his landmark description of cerebrospinal
fluid, "De ischiade nervosa
Standard practice in the 1800s was to inject anesthetic (cocaine or morphine) as close as possible to the site that needed to be anesthetized. Experimenting on a dog, Corning injected 20 minims of 2% cocaine "into the space situated between the spinous processes of two of the inferior dorsal vertebrae." This resulted in loss of sensation and incoordination of the hind legs of the dog. Although he did not recognize it, Corning had injected cocaine into the subarachnoid space. No mention was made of withdrawing CSF ( Lee).
In December 1890, Quincke performed three lumbar punctures on a comatose 21-month-old boy suspected of having tuberculous meningitis. Quincke punctured the subarachnoid space in the lumbar area with a needle and passed a cannula between the third and fourth lumbar spinal arches to drain CSF. The child recovered. In April 1891, Quincke relieved the headache of a 25-year-old man with hydrocephalus by means of lumbar puncture. Previously in 1888, Quincke had removed CSF from the cerebral ventricles of a 12-year-old boy through holes trephined in the skull ( Sakula).
In February 1889, an Englishman, Walter Essex Wynter, had done a lumbar puncture on a 3-year-old boy suffering from meningitis following an ear infection. Wynter made an incision at the midline at the second lumbar vertebra and cut down to the dura where he passed a Southey’s tube (see definition) In an attempt to relieve increased intracranial pressure, Wynter subsequently did lumbar punctures on three other children with tuberculous meningitis All four patients died. Because Wynter did not report these cases until the May 2, 1891 issue of Lancet, Quincke is usually credited with performing the first lumbar puncture (Sakula).
A Southey’s tube was a hollow metal tube into which a trochar could be inserted. It could be advanced subcutaneously or into the peritoneum to drain massive pedal edema or ascites, respectively.
"Bier and Hildebrandt gave each other spinal anesthesia through injections of cocaine solution into the lower (lumbar) areas of their backs; the aim was to block the nerves in the lower part of the body. They took careful notes of the experience. The initial thrust of the needle caused no pain beyond the usual jab and a short, mild stabbing sensation in one leg. Bier felt a mild tugging sensation when Hildebrandt began the injection. But Hildebrandt was nervous, and much of the solution trickled down Bier’s back. They waited ten minutes before Hildebrandt pricked Bier’s thigh with a pin. It hurt: not enough cocaine had penetrated the spine.
the more experienced Bier injected the solution into Hildebrandt’s back
just a few drops escaped. Within seven minutes Hildebrandt could feel
pinpricks only as pressure; tickling of the sole of the foot hardly
minutes after the spinal injection, Bier put the lighted end of his
cigar on Hildebrandt’s legs. The burn caused no pain. Hard hammer blows
against his shins were painless. On and on, Bier battered Hildebrandt.
It took forty-five minutes for the effect of the drug to wear off and normal sensitivity to return.
The two doctors dined together that evening, drinking wine and smoking several cigars. They went to bed about eleven o’clock. Bier, whose body had absorbed almost no cocaine, slept soundly and awoke refreshed. When he finished his customary morning stroll, he found he had a slight headache.
At the clinic he found Hildebrandt looking wan; he had not slept and was able to stand only with great effort. Later that morning Hildebrandt had a severe headache, which may have been due to a hangover or to the spinal injection, followed by an attack of vomiting. By mid-afternoon he was forced to go to bed. Although still suffering from a headache, he returned to work the next day." (Altman)
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