Sunday, December 25, 2005

Anesthesia Antics

It's a little known fact that I actually talked my wife into going into anesthesia. That's not to say that I am more interested in it than she is... far from it. She loves her job. It's just that I am also very interested in it. These people stop and start hearts regularly... on purpose... and while in the pantheon of modern medicine that is relatively mundane.. for me... it's never really lost its cool factor.

The history of anesthesia is also something that we really enjoy. Honestly these are strange birds... and their ways never cease to amuse... Plus there is glorius contraversy. For example... The matter of the first anesthesia ever performed isn't even agreed on. Some textbooks claim a yankee was the first because he was the first to document his practice... while of course... the doing is far more important than the documenting... so other textbooks point to a God Fearing Southron who used ether decades earlier.

In this vein I offer you a taste of medical history... The account of the first experiments with spinal anesthesia... using cocaine... in 1890.

"Bier and Hildebrandt gave each other spinal anesthesia through injections of cocaine solution into the lower (lumbar) areas of their backs; the aim was to block the nerves in the lower part of the body. They took careful notes of the experience. The initial thrust of the needle caused no pain beyond the usual jab and a short, mild stabbing sensation in one leg. Bier felt a mild tugging sensation when Hildebrandt began the injection. But Hildebrandt was nervous, and much of the solution trickled down Bier’s back. They waited ten minutes before Hildebrandt pricked Bier’s thigh with a pin. It hurt: not enough cocaine had penetrated the spine.

When the more experienced Bier injected the solution into Hildebrandt’s back just a few drops escaped. Within seven minutes Hildebrandt could feel pinpricks only as pressure; tickling of the sole of the foot hardly bothered him. A minute later Bier drew a large curved needle through the skin of Hildebrandt’s thigh. Again his assistant sensed no pain. Two minutes later Bier thrust a needle into Hildebrandt’s thigh bone; he felt nothing. Bier squeezed Hildebrandt’s skin between the teeth of a hooked forceps. Hildebrandt perceived the pinching only as pressure.

Thirteen minutes after the spinal injection, Bier put the lighted end of his cigar on Hildebrandt’s legs. The burn caused no pain. Hard hammer blows against his shins were painless. On and on, Bier battered Hildebrandt. Pulling out pubic hair felt like lifting a skin fold, whereas plucking hairs from the chest was painful. Strong pressure and tugging on Hildebrandt’s testicles produced no sensation.

It took forty-five minutes for the effect of the drug to wear off and normal sensitivity to return.
The two doctors dined together that evening, drinking wine and smoking several cigars. They went to bed about eleven o’clock. Bier, whose body had absorbed almost no cocaine, slept soundly and awoke refreshed. When he finished his customary morning stroll, he found he had a slight headache.

At the clinic he found Hildebrandt looking wan; he had not slept and was able to stand only with great effort. Later that morning Hildebrandt had a severe headache, which may have been due to a hangover or to the spinal injection, followed by an attack of vomiting. By mid-afternoon he was forced to go to bed. Although still suffering from a headache, he returned to work the next day." (Altman)

Obviously I added the emphasis.

Tugging. On. The. Testicles.

Oh my.

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