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Controversies in Anesthesia PDF

82 Pages·2010·11.63 MB·English
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The History of Anesthesiology Reprint Series: Part Eighteen Doctors Differ; Published in London, November 28th, 1785 by S. W. Fores at the Caracature Warehouse No. 3 Piccadily. Reproduced by cour tesy of the Boston Medical Library in the Countway Library of Medicine. CONTROVERSIES IN ANESTHESIA In any human endeavor whether it be in the realm of religion, meta physics or science, history shows that new ideas are rarely accepted without controversy. The reception of several innovations in anesthe sia surely falls into this pattern. Consequently, for the current reprint series on the History of Anesthesiology, the Trustees of the Wood Library-Museum have elected to address the subject of Controversies in Anesthesia. Leroy D. Vandam, M.D. HISTORY OF ANESTHESIOLOGY REPRINT SERIES Part Eighteen 1988 CONTROVERSIES IN ANESTHESIA TABLE OF CONTENTS I. Introduction. Vandam LD. Controversies in anesthesia. II. Controversy over Priority of Discovery. Horace Wells' little known tract is eloquent. Wells H. A history of the discovery of the application of nitrous oxide gas, ether and other vapors, to surgical operations. Hartford: J. G. Wells, 1847 III. Medical Resistance to the Use of Anesthesia in Obstetrics. Meigs CD. Letter to W. Channing, April 26, 1848. In, Channing W. A treatise on etherization in childbirth. Boston: William Ticknor & Com pany, 1848 IV. Was it Spinal or Epidural Anesthesia in 1885? Corning JL: Spinal anaesthesia and local medication of the cord. New York Med J 1885; 42: 483-485 V. The Ultimate Cause of Sudden Death during Chloroform Anesthesia. Levy AG, Lewis T. Heart irregularities, resulting from the inhalation of low percentages of chloroform vapour, and their relationship to ven tricular fibrillation. Heart 1911; 3: 99-108 VI. Neurological Sequelae of Spinal Anesthesia. Kennedy SF, Effron AS, Perry G. The grave spinal cord paralyses caused by spinal anesthesia. Surg Gyn Obst 1950; 91: 385-398 VII. Halothane Hepatotoxicity. Summary of the National Halothane Study. Possible association be tween halothane anesthesia and postoperative hepatic necrosis. JAMA 1966; 197: 775-788 Controversies in Anesthesia In any human endeavor whether it be in the realm of religion, metaphys ics or science, history shows that new ideas are rarely accepted without con troversy. The reception of several innovations in anesthesia surely falls into this pattern. Consequently, for the current reprint series on the History of Anesthesiology, the Trustees of the Wood Library-Museum have elected to address the subject of Controversies in Anesthesia. While we refrain from tilling the old ground over who should be given credit for the discovery, two items merit further comment. The first per tains to Horace Wells' 1847 tract on A History of the Discovery of Nitrous Oxide Gas, Ether and Other Vapors, to Surgical Operations. Wells, who is usually given little credit, eloquently displays some remarkable insight. "Reasoning from analogy, I was led to believe that surgical operations might be performed without pain, by the fact, that an individual, when much excited from ordinary causes, may receive wounds without manifest ing the least pain". This indeed is a thoroughly modern conception. Second, amidst the priority controversy, one should not disregard the medical opposition to the employment of anesthesia, particularly in obstet rics. This kind of reservation is revealed in Charles D. Meigs' turgid and obfuscatory letter of April 26, 1848, to Walter Channing, as reprinted in the Introduction to, "A Treatise on Etherization in Childbirth". The objec tion is quite modern in that anesthesia might adversely affect the forces of labor and harm the foetus as well. From time to time the statement is still made that Dr. J. Leonard Corn ing, neurologist, was the first to give a spinal anesthetic, in 1885. Little problem exists in discarding this claim in that Corning never once men tions the cerebrospinal fluid (CSF), that it was merely his intention to inject cocaine into the vicinity of the spinal cord, and further, that CSF was not recovered on lumbar insertion of the needle. For well over 50 years, controversy raged over the reason for the sudden patient collapse experienced during chloroform anesthesia, whether it re lated to respiration or circulation. Typically, as a result of advances in the collateral sciences, A. Goodman Levy, utilizing the electrocardiogram, showed in the cat that ventricular fibrillation was the cause. Furthermore, this occurred during the lighter planes of anesthesia and was readily in duced by the injection of recently discovered epinephrine. Thus was born the hydrocarbon-epinephrine experiment which concerns anesthesiolo gists to this day. Until the 1950s, spinal anesthesia was given with relatively little opposi tion under the most crude technical circumstances. Cumulative reports of neurological sequelae led S. Foster Kennedy to exclaim, "That paralysis below the waist is too large a price for a patient to pay in order that the sur geon should have a fine relaxed field of operation." The clamor was great but corrections were made and spinal anesthesia now enjoys a good reputa tion. Lastly, while overlooking the fact that chloroform anesthesia might cause delayed poisoning or acute yellow atrophy of the liver, halothane, a halogenated hydrocarbon, was introduced to practice in the 1950s. Al though preliminary testing in surgical patients allayed any fears that might have existed, a number of suspicious incidents occurred several years after widespread use of this new, nonflammable agent. Thus, an inquiry was begun by the National Research Council which resulted in a comprehen sive report of the National Halothane Study. Although it seemed fairly cer tain that acute hepatic necrosis might rarely develop after anesthesia, a long time elapsed before clinicians would accept the idea that halothane was re sponsible. Leroy D. Vandam, M.D. HISTORY OF THE DISCOVERY OF THE APPLICATION OF NITROUS OXIDE CIAS, ETHER, AND OTHER VAPORS, TO SURGICAL OPERATIONS. BY HORACE WELLS. HARTFORD: J. GAYLORD WELLS, CORNER MAIN AND ASYLUM STS. 1847. PREFACE. IN answer to a request, made by several scientific and medical societies of Europe, who have desired me to furnish them with the evidence of my priority of discovery of the application of gas, or vapor, for the performance of surgical operations, I have obtained testimonials and affidavits suffi ciently numerous and satisfactory, as I believe, to establish the fact beyond a doubt. I have forwarded the original papers to Dr. C. S. Brewster, of Paris, (No. 11 Rue de la Paix,) who will have charge of them until this question is settled. The following pages contain a correct copy of those papers, which prove, conclusively, that I made known this discovery in November, 1844, which date is nearly two years prior to that given by Drs. Jackson and Morton. HORACE WELLS. Hartford, March 30, 1847. HISTORY, &c. TO THE EUROPEAN AND AMERICAN PUBLIC: I propose, in the briefest manner possible, to give, in the following pages, a true and faithful history of the discovery which is at present causing an unparalleled excitement throughout the whole medical world. I refer to the administering of exhilarating gas, or vapor, to prevent pain in surgical operations. It is very unfortunate that there should be more than one claimant for the honor of the discovery; but so it is: and the only alternative now is, for the man who considers himself entitled to this honor to present his proofs, that a discriminating and impartial public may " give credit to whom credit is due." Reasoning from analogy, I was led to believe that sur gical operations might be performed without pain, by the fact, that an individual, when much excited from ordinary causes, may receive severe wounds without manifesting the least pain ; as, for instance, the man who is engaged in combat may have a limb severed from his body, after which he testifies, that it was attended with no pain at the time : and so the man who is intoxicated with spirituous liquor may be severely beaten without his manifesting pain, and his frame, in this state, seems to be more tena«* cious of life than under ordinary circumstances. By these facts I was led to enquire if the same result would not

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the Introduction to, "A Treatise on Etherization in Childbirth". The objec- .. books and dispensatories, as a diffusible stimulant, and that its fumes or
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