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History - Surgery - Pain

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on 7 December 2013

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Transcript of History - Surgery - Pain

Early Attempts
to Control Pain
First Developments of Anesthetics
Was Simpson Important?
meant that many surgeons didn’t use chloroform straight away.
Simpson discovered chloroform by chance - it could have been anybody.

It was Snow who made Chloroform safe.

The use of chloroform led to the
‘Black period of Surgery’.
The death rate actually went up. Without their patients writhing in agony, surgeons could now take their time over operations and could do ‘invasive’ (inside the body) surgery. The potential for infection without the later understanding if the Germ theory was massive!

Other anesthetics were deemed to be more effective later. Cocaine was used as a local anesthetic from 1884 and Novocaine as a general anesthetic from 1905

Dealing with Pain
The importance of Simpson's work
James Simpson
, a young surgeon from Edinburgh, experimented with chemicals after inviting other doctors to his house. After inhaling Chloroform, they fell unconscious. Chloroform seemed to put them to sleep without the negative side effects of ether.

Simpson soon begun to use chloroform to ease the pain of childbirth and wrote articles about it so that other surgeons could copy his ideas.
The Transformation of Surgery 1845-1918
Pain & Anaesthetics

Problems of Pre-1845 Surgery:

Before 1845, there was
no (reliable) anaesthetic
, despite earlier discovery of nitrous oxide (laughing gas) in 1799.
Patients held down during operations despite use of alcohol etc.
was of the essence which led to
And death from
was fairly common. Only
surgery was possible, no internal surgery was performed, only amputations.

Why was Simpson able to make an impact?
- Snow’s inhaler.
Individual genius
- Simpson was dedicated and convinced that his discovery would work, despite the opposition.
‘Govt.’ – Acceptance
of chloroform after Queen Victoria used chloroform during the birth of her 8th child in 1853.
- Experimentation with chemicals
Chance –
- Unconscious by chance
–- Simpson wrote articles about his discovery.

- Laughing Gas
a British man called
Humphrey Davy
discovered that laughing gas made you less aware of pain.

Then in
, it was first used as dental anesthetic by
Horace Wells.

Positives and Negatives?
+ It eased the pain a lot and made you feel happy.

- It did not knock you out properly and could not be used for serious operations.

- Ether
Ether was used for the first time as a dental anesthetic by
William Morton
in a hospital in America. He showed how teeth could be extracted painlessly with it, and then used it to operate on a neck tumor.

The first amputation to use Ether was by
Robert Liston
, also in 1846.

+ It does knock you out properly –and you feel nothing. It can be used for serious operations.
- It is flammable. It also damaged the lungs and could cause coughing & vomiting during the operation. The effects could also last for days.

- Chloroform
a doctor called
James Simpson
used chloroform for the first time. He tried it out on himself and two other doctors and all went totally unconscious. He used it first to help
women in labour
but soon it was used for operations.

+ It was the most long lasting and reliable anesthetic – it could knock people out for long operations. It gave surgeons the chance to do longer and more complicated operations

- but this often just made the chances of infection afterwards even greater.
to Chloroform and Simpson's Work
1. Chloroform was a new and untested gas. Long-term side effects?
2. Hannah Greener died in 1848 after having been given chloroform in an operation to remove a toenail.
3. Many religious people felt that pain (particularly in childbirth) had been sent by God and should therefore not be tampered with.
4. It was difficult to get the dose of chloroform right. This was until
John Snow
developed an inhaler in 1848 to regulate the dosage.
5. Chloroform could affect the heart. A number of young, physically fit patients died after being given too large a dose.

Was Simpson Important?

In the long term, after the introduction of antiseptic and aseptic surgery, many more complex and ‘invasive’ operations could be carried out. Many operations today clearly need an effective anesthetic!

Very few now died from shock

Surgeons could take their time over operations. Fewer mistakes were made.
Operations were easier for the surgeon to carry out as the patient wasn’t moving!

Simpson’s contribution was recognised. He was the first man to be knighted for services to medicine and 30,000 attended his funeral.

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