Tilting Tables: George Pitkin’s Gravity-defying Spinal Anesthetic

George Philo Pitkin, M.D. (1885 to 1943, lower left), New Jersey surgeon and proponent of spinal anesthesia, was born in the same year as the first neuraxial anesthetic. Pitkin later championed “controllable spinal anesthesia” using his signature formulation—weightless “Spinocain.” A low-density blend of procaine, alcohol, and saline, Spinocain contained a pinch of strychnine for myocardial stimulation and a dash of the starch protein gliadin for its thickening effect. Gelatinous gliadin limited the solution’s spread, while lightweight alcohol allowed it to “float in the [spinal] canal as an air bubble.” Relying on Spinocain’s viscosity and buoyancy, Pitkin could precisely position the patient to achieve his desired level of effect. The agent’s hypobaricity precluded the sitting posture, as a high spinal could ensue. On the flip side, steep Trendelenburg positioning (lower right) could “elevate” the featherweight anesthetic to the lower body regions. For exact measurement of the patient’s reclining angle, Pitkin encouraged placement of a “tiltometer” (upper middle)—another innovation of his—at the head of the table. (Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology.)