James Leonard Corning (1855 – 1923) was an American

neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...

, mainly known for his early experiments on

neuraxial blockade Neuraxial anesthesia is local anaesthesia placed around the nerves of the central nervous system, such as spinal anaesthesia, caudal anaesthesia, epidural anaesthesia, and combined spinal and epidural anaesthesia. The technique is used in surgery, o ...

New York City New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...

Education

Corning was born in

Stamford, Connecticut Stamford () is a city in the U.S. state of Connecticut, outside of Manhattan. It is Connecticut's second-most populous city, behind Bridgeport. With a population of 135,470, Stamford passed Hartford and New Haven in population as of the 2020 ...

. When the

American Civil War The American Civil War (April 12, 1861 – May 26, 1865; also known by other names) was a civil war in the United States. It was fought between the Union ("the North") and the Confederacy ("the South"), the latter formed by states th ...

began in 1861, Corning's family moved to

Stuttgart Stuttgart (; Swabian: ; ) is the capital and largest city of the German state of Baden-Württemberg. It is located on the Neckar river in a fertile valley known as the ''Stuttgarter Kessel'' (Stuttgart Cauldron) and lies an hour from the ...

Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...

. Corning studied

chemistry Chemistry is the science, scientific study of the properties and behavior of matter. It is a natural science that covers the Chemical element, elements that make up matter to the chemical compound, compounds made of atoms, molecules and ions ...

at the Stuttgart Polytechnic Institute under

Hermann von Fehling Hermann von Fehling (9 June 1812 – 1 July 1885) was a German chemist, famous as the developer of Fehling's solution used for estimation of sugar. Biography Hermann von Fehling was born in Lübeck. With the intention of taking up pharmacy he e ...

. He later studied

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

Heidelberg University } Heidelberg University, officially the Ruprecht Karl University of Heidelberg, (german: Ruprecht-Karls-Universität Heidelberg; la, Universitas Ruperto Carola Heidelbergensis) is a public research university in Heidelberg, Baden-Württemberg, ...

under

Wilhelm Kühne Wilhelm Friedrich Kühne (28 March 183710 June 1900) was a German physiologist. Born in Hamburg, he is best known today for coining the word enzyme in 1878. Biography Kühne was born at Hamburg on 28 March 1837. After attending the gymnasium ...

, and

pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...

at the

University of Würzburg The Julius Maximilian University of Würzburg (also referred to as the University of Würzburg, in German ''Julius-Maximilians-Universität Würzburg'') is a public research university in Würzburg, Germany. The University of Würzburg is one of ...

. After receiving his

medical degree A medical degree is a professional degree admitted to those who have passed coursework in the fields of medicine and/or surgery from an accredited medical school. Obtaining a degree in medicine allows for the recipient to continue on into special ...

in 1878, he left Germany and visited

Vienna en, Viennese , iso_code = AT-9 , registration_plate = W , postal_code_type = Postal code , postal_code = , timezone = CET , utc_offset = +1 , timezone_DST ...

Paris Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...

, and

London London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a majo ...

before finally returning to the United States.

Neuraxial blockade

In 1884, Karl Koller became the first to describe the

anesthetic An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two ...

properties of

cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...

. The following year, Corning injected cocaine between the

spinous process The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...

es of the lower

lumbar vertebrae The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse p ...

, first in a dog and then in a healthy man. His experiments are the first published descriptions of the principle of

Controversy

On August 16, 1898, German surgeon August Bier (18611949) performed surgery under

spinal anesthesia Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarac ...

Kiel Kiel () is the capital and most populous city in the northern Germany, German state of Schleswig-Holstein, with a population of 246,243 (2021). Kiel lies approximately north of Hamburg. Due to its geographic location in the southeast of the J ...

. Following the publication of Bier's experiments in 1899, a controversy developed about whether Bier or Corning performed the first successful spinal anesthetic. There is no doubt that Corning's experiments preceded those of Bier. The controversy centers around whether Corning's injection was a spinal or an

epidural Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians an ...

block. The dose of cocaine used by Corning was eight times higher than that used by Bier and Tuffier. Despite this much higher dose, the onset of

analgesia Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...

in Corning's human subject was slower and the dermatomal level of ablation of sensation was lower. Also, Corning did not describe seeing the flow of

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the bra ...

in his reports, whereas both Bier and Tuffier did make these observations. Based on Corning's own description of his experiments, it is apparent that his injections were made into the

epidural space In anatomy, the epidural space is the potential space between the dura mater and vertebrae ( spine). The anatomy term "epidural space" has its origin in the Ancient Greek language; , "on, upon" + dura mater also known as "epidural cavity", "ext ...

, and not the

subarachnoid space In anatomy, the meninges (, ''singular:'' meninx ( or ), ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in th ...

. Finally, Corning was incorrect in his theory on the

mechanism of action In pharmacology, the term mechanism of action (MOA) refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect. A mechanism of action usually includes mention of the specific molecular targe ...

of cocaine on the

spinal nerve A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into th ...

s and

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...

. He proposed – mistakenly – that the cocaine was absorbed into the venous circulation and subsequently transported to the spinal cord. Although Bier properly deserves credit for the introduction of spinal anesthesia into the clinical practice of medicine, it was Corning who created the experimental conditions that ultimately led to the development of both spinal and epidural anesthesia. He published one of the first books on local anesthesia and the first textbook on pain.

Other work

During his career, Corning published at least forty articles and five books on topics relating to neurology and psychiatry. He studied the theory that

epileptic seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with los ...

s were the result of increased blood flow to the brain. He proposed that reducing the cerebral blood flow would reduce the frequency and duration of seizure activity. To this end, he developed several instruments for the compression of the

jugular vein The jugular veins are veins that take deoxygenated blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid ...

. One of these devices was a fork-like compression tool for immediate treatment of seizures, and another was an adjustable belt-like instrument, widely used for preventing seizures. He later developed this approach in combination with other methods for reduction of cerebral blood flow, such as transcutaneous electrical stimulation of the

vagus nerve The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and right ...

. This treatment method was abandoned due to its significant

side effect In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...

s, which included

slow heart rate Bradycardia (also sinus bradycardia) is a slow resting heart rate, commonly under 60 beats per minute (BPM) as determined by an electrocardiogram. It is considered to be a normal heart rate during sleep, in young and healthy or elderly adults, a ...

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical c ...

and syncope.

Vagus nerve stimulation Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Medical use VN ...

has since regained its status as an adjunctive treatment for certain types of epilepsy, especially

partial seizure Focal seizures (also called partial seizures and localized seizures) are seizures which affect initially only one hemisphere of the brain. The brain is divided into two hemispheres, each consisting of four lobes – the frontal, temporal, parie ...

s, and also as an adjunctive treatment for treatment-resistant

major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...

in adults.FDA Summary of VNS Data
/ref>

Education

Neuraxial blockade

Controversy

Other work

See also

References

Further reading