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The History of Surgery and Anaesthesia

The Military History of Anaesthesia.

Most of what has been written so far has its roots firmly in the military camp. Without the military involvement in surgery, surgery would not have progressed as far at it has done up to now.

The first real use of anaesthesia in war came during the Mexican War between 1846 - 1848. Ether was first administered in war to an accidently injured soldier during the battle of Vera Cruz. Barton was the surgeon and he successfully amputated a patients legs whilst under the influence of ether. At first there was opposition from some surgeons  to ether as they complained of side effects, namely that the patient bled more profusely.

It was also considered by some to be unnecessary, as I have commented in the pages about the Crimean War, the main surgeon there thought it better that the soldier felt the sharp end of the blade.

The problem with the use of ether in the early days, especially in the USA and its southern hot borders, the concentration given is unpredictable, and they were unaware of this at the time, so there was a tendency to overdo the vapour.Fig 305

It can be said with confidence that the first use of Anaesthetic during war was a great success.

The work of the Physicians like John Snow helped these anaesthetic agents into being accepted as an alternative to suffering pain. This especially after the Queen gave it royal approval an the birth of her son.

A lot has been made of the "Cock ups" of the Crimean war, there was the charge of the Light Brigade which was in fact a complete an utter disaster, although us British are great at turning a defeat into a victory.

Most think of the charge as a brave charge of British cavalry, that's British propaganda for you. and then you have the disaster at the hospitals, especially Scutari. What a mess, how many would have died if it was not for the Times Newspaper reporter.

But what was a great success was the introduction in was for the British and French armies of Chloroform, it saved many lives. Some would have you believe that they killed a lot of people with its overuse, I believe some died as a result of the wrong concentration, but more survived not dying in agony on the operating table as many used to.

Anaesthetic delivery systems are still being developed by the Military. Ivan Houghton a Military anaesthetist before, during and after my time has been uppermost in the development of the delivery systems. He developed one using a Laerdal Bag and the OMV vapourisers. He also invented other pieces of equipment for field Anaesthesia. He was affectionately known as the bionic hamster to those who worked with him.

The British Military have changed the way it responds to war casualties depending on the threat. During the time of the cold war, a definite chain of evacuation was formulated from the front line till the patient was evacuated from a dressing station to a forward hospital and eventually to the British Base Hospital, depending on the strategic position at that time.

The Field Surgical Team were independent operating teams that deployed to front line or  positions where it would be too dangerous for a forward hospital to locate. Today the scenario has changed, in the wars of recent years the enemy is all around, so the Medical Support Troop has been devised a a self contained surgical team with holding and evacuation assets. In instances such as Afghanistan, Hospitals such as Camp Bastion are set up in a relatively safe position surrounded by troops.

The trauma surgery that is carried out today is a modified version that Pare carried out during the 15th century. Today we have extremely good antibiotics and surgical equipment as well as anaesthetics that are far advanced from Morton's day. The wars of today, produce injuries that are horrendous, caused by modern explosive weaponry.

The difference is, today because of evacuation procedure that gets the patient to hospital quickly add to that the skill of the surgeons that operate on the patients who have studied the techniques that even Pare use to use, to the modifications of his techniques with the aid of ultra modern surgical equipment and ultra modern post opt care facilities, more soldiers are surviving wounds that they would have died of just ten years ago let alone 100 years.



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