J. Leonard Corning

James Leonard Corning (1855 - 1923)

James Leonard Corning (1855 – 1923) was an American neurologist.

Published over forty articles and five books on topics in the fields of anaesthetics, neurology and psychiatry including one of the first books on local anaesthesia (1886), and the first textbook on pain (1894).

Corning was known for his early experiments on neuraxial blockade. In 1885, 3 years before August Bier, Corning injected cocaine between the lumbar spinous processes and into the epidural space, first in a dog and then in a healthy male. Later review determined that Corning had performed the first epidural block in 1885 and Bier the first spinal block in 1898.

In 1885, Corning described a new method of regional anaesthesia using subcutaneous injections of cocaine hydrochloride ‘incarcerated’ by a proximally placed Corning tourniquet and clamp; an early precursor to intravenous anaesthesia or Bier block


Biography
  • Born in 1855 in Stamford, Connecticut
  • 1861 – Moved to Stuttgart, Germany at the outbreak of the American Civil War
  • 1878 – Medical degree, University of Würzburg
  • Died 1923

Next to averting death, the most royal prerogative of the modern physician is the annihilation of pain.

Corning 1886


Medical Eponyms
Regional anaesthesia (1885)

On December 28, 1885 Corning read his paper – On the prolongation of the anaesthetic effects of the hydrochlorate of cocaine when subcutaneously injected – before the Medical Society of the County of New York.

When we shut off the blood from a portion of the body previously injected with a comparatively weak solution of the hydrochlorate of cocaine, we maintain the latter for a protracted period of time in contact with the filaments of the sensory nerves; we incarcerate the solution in the field of operation, and are consequently enabled to perpetuate those chemical changes in the sensory filaments which are necessary to a suspension of conduction – to the maintenance of a prolonged condition of anaesthesia.

Regional anaesthesia procedure for upper and lower limb blocks.

  • Exsanguination: Esmarch elastic bandage (a) is wrapped around the limb from distal to proximal, with the limb elevated and the bandage held in continuous stretch (b)
  • Application of anaesthetic: Multiple subcutaneous injections of 0.5-1.0% cocaine hydrochlorate injected with syringe (e)
  • Incarceration of anaesthetic in the field of operation: Corning originally used the tourniquet of Esmarch, but converted to a tourniquet of his own design – the Corning tourniquet (c) and Corning clamp (d):
Corning regional anaesthesia 1886
Prolonged local anaesthetization by incarceration of the anaesthetic fluid in the field of operation Corning 1886

…an India-rubber band two inches broad and three feet long, the edges of which are nicely rounded. The tourniquet is applied around the limb above the anaesthetic zone in two or more folds, and secured in place by means of a powerful clamp of my own designing – It consists, in the first place, of two wings or blades, provided with round, ridge-like elevations on their inner surfaces. The two wings are joined at one end by means of a stout hinge, and at the other there is a powerful screw, which, being actuated by a milled wheel grasped by the hand of the operator, causes the jaws of the blades to close upon the folds of the India-rubber strap and hold the tourniquet securely in place (f)

Corning predicted the future of regional anaesthesia thus:

I feel certain that, we shall never be scientifically justified in dispensing with the precaution of incarceration by suspending the local circulation. My reason for this conviction is based upon the probability, almost amounting to a certainty, that any substance which possesses strong chemical affinity for the nerves must have like attraction for the complicated organic bodies which compose the central nervous system.

Corning 1885

Key Medical Contributions
Epidural block (1885)

1885 – Corning’s early research was conducted using hydrochlorate of cocaine as the only available local anaesthetic choice. He observed that subcutaneous injection of cocaine was associated with both vasoconstriction and local anaesthesia.

I decided to inject the anaesthetic between the spinous processes of the lower dorsal vertebras. I was led to resort to this expedient from a knowledge of the fact that in the human subject numerous small veins (venae spinosas) run down between the spinous processes of the vertebra, and, entering the spinal canal, join the more considerable vessels of the plexus spinalis interna…

I hoped to produce artificially a temporary condition of things analogous in its physiological consequences to the effects observed in transverse myelitis or after total section of the cord…I was bent upon abolishing reflex action and annulling sensory conduction in the cord

Experiment I: Corning injected 1.5mL of 2% cocaine solution between the spinous processes of the inferior dorsal vertebrae of a young dog. After 5 minutes he noted incoordination, followed by weakness and anaesthesia of the animal’s hind quarters. The effect resolved completely within 4 hours

Experiment II: In a male subject suffering ‘spinal weakness and seminal incontinence’ Corning injected 2 ml of 3% cocaine into the T11/12 interspinous space. Initially there was no effect and the dose was repeated. Ten minutes later the subject remarked that his legs felt ‘sleepy’ and Corning was able to demonstrate ‘Currents which caused lively sensations of pain and reflex contractions in the upper extremities were disregarded and barely perceived in the lower limbs‘. No motor weakness or gait disturbance was noted.

The man made a full recovery but interestingly, Corning recorded that he complained of headache and vertigo the next morning. Possibly this early experiment had resulted in inadvertent dural puncture and intrathecal injection with post-dural puncture headache (PDPH)

A thorough examination the next day showed no ill effect…

On making an examination with the electric brush, sensibility was found to be normal in the lower limbs, scrotum, and glans penis. The passage of the sound was, as formerly, accompanied by some pain, and the urethral electrode provoked unpleasant sensations, even when mild currents were employed.

Corning continued to experiment with interspinous injection, later proceeding to intentional intrathecal injections in the treatment of various neurological conditions [A further contribution on local medication of the spinal cord, with cases]

Whether the method will ever find an application as a substitute for etherization in genito-urinary or other branches of surgery, further experience alone can show. Be the destiny of the observation what it may, it has seemed to me, on the whole, worth recording.

Corning 1885

Major Publications

References

Biography

Eponymous terms


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UK Doctor currently working in the emergency medicine department at SCGH in Perth. Graduated from Leeds University with MBCHb and BSc in microbiology in relation to medicine. Special interests in emergency medicine, critical care and anaesthetics

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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