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.