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Ⅵ SPECIAL ARTICLE Anesthesiology 2003; 98:1503–8 © 2003 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. History of the Development and Evolution of Local Anesthesia Since the Coca Leaf Jesús Calatayud, M.D., D.D.S., Ph.D.,* Ángel González, M.D., D.D.S., Ph.D.† THE development of anesthesia in general and local up to 0.7–1.8% by weight.8,9 Many species of this genus anesthetics, in particular, required a cultural change. have been grown in Nicaragua, Venezuela, Bolivia, and The concept of pain (especially obstetric pain) was Peru since pre-Columbian times.7 linked to the concept of original sin, and the ability to The earliest cultivation and use of the coca leaf in the endure pain was regarded as a sign of character and, in Bolivian and Andean region date back to 700 B.C.,7 though men, was even associated with virility.1 recent discoveries in Ecuador indicate human use more The change that took place in Western Europe be- than 5,000 years ago.9 Alfred Bühler hypothesized that the tween 1750 and 1850, encompassing the industrializa- Arhuaco, a tribe from the Negro River region, were the first tion, progressive humanization, and democratization of to discover the properties of the drug and spread this society, created an atmosphere favorable to the discov- knowledge to other neighboring peoples.10 ery of anesthetics. Nothing comparable occurred in Asia, Further, according to Bühler, the first written record Russia, or the Islamic countries, where feudalism per- of the coca leaf is a mention by the Spanish Dominican sisted in a variety of forms. This general process altered friar Tomas Ortíz in 1499,11 a reference which is also the cultural, political, and religious climate, affecting a cited by other authors.12,13 This is, however, incorrect. significant number of individuals.1 A recent review of documents on Friar Tomas Ortíz Dentists, not doctors, were responsible for the discov- (1470–1538)14 show that he was ordained in the Convent ery of anesthesia, given their close day-to-day contact of San Esteban in Salamanca, Spain, in 1511, and it was only with pain and, hence, their motivation to seek the means later that he set out for America, where he eventually 1 to alleviate it. Doctors focused more on infections than became bishop of Santa Marta (Colombia).14–16 pain because people were dying of pneumonia, diphthe- For some writers, Florentine Amerigo Vespucci (1451– ria, gangrene, tuberculosis, tetanus, puerperal fever, and 1512) was the first European to document the human 1,2 so on. It was two dentists, then, who first introduced use of the coca leaf.9,14 Thus, in his account of his anesthesia: Horace Wells (1815–1848), with nitrous ox- voyage to America on the second Alonso de Ojeda and 3–5 ide in 1844, and William Thomas Green Morton Juan de la Cosa expedition in 1499–1500,17 he reported 6 (1819–1868), with ether in 1846. that the aborigines of the Island of Margarita chewed Local anesthesia, the basis of modern local anesthetics certain herbs containing a white powder. He included for dentistry and medicine, developed later. This article this observation in a letter written in Lisbon, Portugal, in reviews the discovery and evolution of local anesthesia 1504, sent to the Chief Magistrate (Gonfaloniero Per- from the Spanish discovery of the coca leaf in America, petuo) of the Florentine Republic, Piero Soderini, and outlining certain ill-known aspects of this early period. possibly published in Florence in 1505 or 1506.14,17 Nevertheless, Vespucci’s documents are partially or The Coca Leaf largely questionable and open to doubt and investiga- tion,14,18 and because his book contains no reference to Coca leaves are taken from a shrub of the genus Eryth- the printer, year, or place, all of these facts are little roxylum, a member of the Erythroxylaceae family, so better than educated guesses14,17 and are regarded as not named by Patricio Browne because of the reddish hue of wholly reliable by many historians. the wood of the main species.7 Of the various species in Among sixteenth century Spanish chroniclers, the ap- this genus, Erythroxylum coca contains the highest con- pearance of coca is associated with Francisco Pizarro’s centration of the alkaloid known as cocaine in its leaves, (1475–1541) conquest of the Inca or Tawantinsuyo em- pire in 1532. It is interesting to note that the early * Professor in Pediatric Dentistry, † Professor in Preventive Dentistry. chroniclers make no mention of the plant. Thus, the Received from the Departamento de Profilaxis, Odontopediatría y Ortodoncia, document known as the “anónimo,” dated in Seville Facultad de Odontología, Universidad Complutense de Madrid, Madrid, Spain. in 1534 (probably written by Cristóbal Mena, one of Submitted for publication January 24, 2002. Accepted for publication November 19 13, 2002. Supported by the Departamento de Profilaxis, Odontopediatría y Pizarro’s captains) or the chronicle of Francisco de Ortodoncia, Facultad de Odontología, Universidad Complutense de Madrid, Ma- Xerez (1497–1565),20 Francisco Pizarro’s secretary dur- drid, Spain. ing the conquest, contain no reference to coca. Neither Address reprint requests to Prof. Calatayud: Departamento de Profilaxis, Odon- topediatría y Ortodoncia, Facultad de Odontología, Universidad Complutense de of the two editions of the Historia General de las In- Madrid, 28040 Madrid, Spain. Address electronic mail to: [email protected]. 21 Individual article reprints may be purchased through the Journal Web site, dias, the one dated in 1535 in Seville or the Salamanca 22 www.anesthesiology.org. edition dated in 1547 by Gonzalo Fernández de Oviedo Anesthesiology, V 98, No 6, Jun 2003 1503 1504 J. CALATAYUD AND Á. GONZÁLEZ y Valdés (1478–1557), the official chronicler of the con- hunger and increase strength and stamina.30 Pedro Cieza quest, make any reference to coca leaves, either. None- traveled through America between 1530 and 1550 and theless, Fernández de Oviedo continued to rework his lived in Peru from 1548 to 1550.31 All of these chroniclers chronicles until the time of his death, and much later observed that coca consumption was widespread through- publications of his complete works do contain mentions out the population. of the coca leaf.23 The most prominent medical studies by contemporary Still, these early Spaniards must already have known of Spanish doctors are the surveys by Nicolas Bautista Mo- the plant and its use, because it is clearly described in the nardes Alfaro (1493–1588). Monardes, possibly the most later chronicles written by some of the men involved. famous Spanish physician of his time, practiced in For instance, an account dated 1571 and authored by Seville, where, in 1574, he published a collection of Pedro Pizarro (1515–1571), Francisco Pizarro’s cousin writings previously printed in 1565, 1569, and 1571, to who played a leading role in the capture of Atahualpa which he added a third part32 containing his first refer- (last king of the Incas), described coca consumption by ence to coca, with a description of its forms, uses, the nobles and high officials of the Inca empire.24 More- effects, and so on.33 The other great Spanish physician of over, in the closing lines of his 1571 chronicle, Diego the period was Francisco Hernández (1517–1587), Em- Trujillo, one of Pizarro’s soldiers, mentions coca reserves peror Philip II’s court physician. Hernández traveled stored in Cuzco, the capital city.25 through in Mexico in 1570–1577 to collect material on The reason for the belated mention of the coca leaf and flora and fauna. After returning to Spain, he continued to its consumption may lie, as the sixteenth century Span- receive material and devoted his time to the minute task ish chroniclers sustain, in the fact that its use was re- of ordering and cataloging his discoveries.34 Unfortu- stricted to the ruling class of the Inca empire and to nately, Hernández’ immense volume of work was not certain religious rites but did not extend to the popula- published in his lifetime, and only fragments appeared in tion as a whole. The notes that have reached our times, later years. Thus, the first text containing a reference to taken by Francisco de Toledo (1514–1584), Viceroy of the coca leaf was published in 1615, after it had been Peru in his report to the “Patronato de Indias” of the edited by Dominican Francisco Ximenez.35 Hernández’ Indies in 1571,26 Pedro Pizarro24 as mentioned above, complete works, published much later (mid-twentieth and Francisco Falcon, a lawyer established in Lima27 in century) depict the use and consumption of the coca leaf 1582, provide support for this assumption. Modern au- by Native Americans.36 thors have been able to verify that after the fall of the All of the sixteenth century Spanish chroniclers’ ac- Inca empire in 1532, coca consumption spread to the counts of the use of coca concur that it was mixed with population at large7,12 as the entire social system under- white powder from shell ash or chalk and rolled into went drastic change, particularly after 1540.7 small balls which were kept and later chewed to alleviate The first reliable account we have of coca leaf con- hunger and thirst and to bolster strength. They were also sumption (if we disregard Amerigo Vespucci’s version) aware of the drug’s euphoric effects. Currently, we is a manuscript letter from the bishop of Cuzco, Friar know that the white powder, calcium carbonate, en- Vicente de Valverde (15?–1542), to Emperor Charles V in hances the subjective effect of coca37 and absorption of 1539.28 This letter is important because Friar Vicente de the alkaloid.7 Moreover, although in current practice in Valverde accompanied Francisco Pizarro throughout the industrialized countries, cocaine is inhaled, Van Dyke conquest of Peru and was present at all of the relevant has shown that when taken orally, it passes into the events.

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