Analgesia

“ One would think that Physiology and Pathology had been silent on the facts of analgesia without anæsthesia, and of so much conscious sensation which is unaccompanied by pain.239 Who does not know that a patient will lose one kind of sensibility while retaining others—cease to feel pain, yet feel temperature, or be insensible to touch, yet exquisitely alive to pain?240 Inasmuch as Sensibility depends on the condition of the centres, an abnormal condition will obviously transform the reaction of the centres into one very unlike the normal reaction. ”

“ Others clinch their teeth and hands, and double their toes up in their shoes. Why do you suppose they do this? They do these, and many other natural and apparently inevitable things, because they are instinctive and scientific, and because Nature knows her business. We have done and shall continue to do them involuntarily and automatically, because they relieve pain and nerve tension, because they produce a form of analgesia, or pain-deadening, similar to that which follows the injection of water or some anesthetic solution into a sensory nerve. ”

“ Analgesia is the first stage of anesthesia—the "twilight zone" of approaching unconsciousness—in which the sense of pain is greatly dulled or entirely lost, while even that which is experienced is not remembered. It seems to the authors that "gas" is the ideal drug for producing this condition whenever it is necessary, as nitrous oxid is the most volatile of anaesthetics, acts most quickly, and its effects pass away most rapidly, while its administration is under the most perfect control—it may be administered with any desired proportion of oxygen—and may be discontinued on a moment's notice. ”

“ To those who have had experience with pressure analgesia in dentistry, and in the relief of rheumatism, lumbago, neuralgia, and other painful affections, mitigating—or even entirely relieving—the pains of childbirth seem quite within the bounds of possibility. ”

“ The thesis that pain is only a symptom, and altogether, in spite of the sovereign part it plays in human life, a superficial phenomenon in relation to the tendencies which lie at the basis of the affective life, finds support in the facts of analgesia, the disappearance of capacity to feel pain. ”

“ The anæsthesia relates to the different qualities of sensation, and is not only present in the patches, but progresses gradually from the periphery toward the centre, so that at last the whole extremity, and often also parts of the trunk, become anæsthetic; the face is always more or less anæsthetic. We have often found thermal anæsthesia present alone, or accompanied by anæsthesia or analgesia. The anæsthesia may become more and more extensive, or it may very gradually disappear, indicating that the neuritis of the affected nerve has disappeared. ”

“ On June 14, fifty days after the operation, the gradual shrinking in extent of the cutaneous analgesia on the arm was found to have continued (figs. 6, 7 and 8) , although the borders of the loss of sensation to cotton wool remained entirely unaltered. The loss of sensation to cold corresponded in extent with that of the loss to prick; but, wherever the part was feebly sensitive to 'the latter stimulus, sensibility to cold seemed to be absent. ”

“ One, a lady, about 55 years of age, had a growth on the side of her neck, diagnosed as cancer. By the bio-dynamic method, I confirmed this diagnosis. This growth was as large as an ordinary sized orange, and very hard and unyielding. The lady told us that, until she began being treated by means of zone therapy and zone analgesia, she had not slept for months without some opiate. For more than two years now she said she had taken no opiates, and had rested without any pain when zone pressure anesthesia was used. ”

“ Anæsthesia, not of a high degree nor at all coextensive with the paralysis of the muscles—sometimes, indeed, confined to very circumscribed areas—may be said to exist always in multiple neuritis—a fact of great diagnostic value. Hyperæsthesia of the skin is frequently seen. Hyperalgesia and analgesia are sometimes observed. Hyperæsthesia of the muscles is a very marked symptom in almost every case, and shows itself not only upon direct pressure being made, but also in the pain elicited by passive movements of the parts affected. ”

“ Mrs. McK., age 35; pregnant four and a half months; multipara. Placenta praevia (a grave condition, in which the afterbirth precedes the child in delivery) , aborted Dec. 5, 1915, curettement (scraping out of the uterus) , Dec. 7, 1915. Temperature 99, pulse 80. This case occurring during Dr. White’s lecture course in Denver, when Dr. Fitzgerald’s pressure method of analgesia was being discussed, I decided to try it out for the first time on this patient. She being a very nervous woman, I felt a little reluctant in the experiment. ”

“ Among the advantages, aside from the number of assistants required and the discomfort immediately following the administration of a general anesthesia, are the absence of remote ill effects of the invasion throughout the entire system of a noxious chemical substance and its direct deleterious effects on many large organs such as the lungs, heart, kidneys, and liver, and the assurance, when a proper drug, dosage, and technic are employed, that death cannot be ascribed to the anesthetic. ”

“ False pains are from various causes, such as fatigue of any kind, especially too long standing, sudden and violent motions of the body, costiveness or diarrhœa, general feverishness, agitation of the mind, or a spasmodic action of the abdominal muscles. It is necessary to adopt the means used for the relief of the pains to the apparent cause, and generally to give an opiate proportioned to the degree of pain, or to repeat in small quantities at proper intervals till the patient shall be composed. ”

“ A medicine may occasionally produce pain or sensation at a distant part, without reaching that part. We often find that a morbid action at one part of the body is capable of producing pain or uneasiness at another distant part by a reflex nervous action. We are familiar with instances of this among the symptoms of disease. The pain in the knee which occurs in disease of the hip-joint; in the left arm, in some cases of heart disease; and in the right shoulder, in disorders of the liver; are examples. Certain impressions on the surface of the stomach may cause such a reflex pain. ”

“ In minor or trivial affairs the elimination of pain is not to be considered lightly, for every patient, even the strongest, will appreciate [Pg 235] anything which will expedite a cure and at the same time will relieve him of suffering. Rather than lose time from their work or suffer the nausea and dangers of general anesthesia, these patients often bear for years conditions which could easily be cured by operations under local anesthesia. In this class one must first think of hemorrhoids; of cysts; of fatty tumors; of foreign bodies in the hands and feet; of verruca and of ingrown nails. ”

“ Though the patient may be convinced that he will suffer no pain, the mental attitude toward the local anesthesia, together with fear, may operate so strongly as to constitute a shock to the nervous system so great that a general anesthetic should be used and the local method abandoned, even were it apparently indicated.
Again, the injection of anesthetic drugs in cicatrical and inflamed tissues is quite difficult of accomplishment and because of the peculiarity of these tissues, diffusion throughout a given area is imperfect, hence insensibility is not complete. ”

“ My experiments and researches, during many months, have conducted me to this practical result, which is worthy of all attention. Whenever an acute pain exists in any part of the animal economy, whether the pain constitute the malady in itself or be only an integral and principal part of it, the physician can relieve the patient of it for a longer or shorter time, by one or various local anesthetic applications. ”

“ Pain Killers and Soothing Sirups.—All pain killers contain opium or morphine or other harmful drugs. They are therefore dangerous to use. Pain is useful in telling us that some organ is out of order and needs care. Killing the pain does not help the sick organ, and it may let the organ get so sick as to cause death.
One use of the nerves is to tell us when any part of the body is hurt or sick. Pain is nature's warning, and to numb the nerves which tell us about it is as foolish as to kill a person because he brings us bad news. ”

“ When such Fluxes appeared early attended with sharp Pain of the Bowels, and Signs of Inflammation; if the Patient [89] was strong, we began the Cure with opening a Vein, which the Patient bore easily, and it gave Relief; but when the Symptoms were mild, without any acute Pain, the Bleeding was omitted.—Commonly the Bowels were loaded with corrupted Humours, when this Symptom appeared; and, therefore, we found it of Advantage to give a Dose of the Salts with Manna and Oil, or some other gentle Purge, to carry them off; and in the Evening an Opiate to ease the Pain and procure the Patient Rest. ”

“ Mode of administering the anodyne vapour.—The great object to be attained is to so far influence the nerves of sensation as to prevent pain, and yet not carry the anæsthetic agent to the extent of producing unconsciousness. This can be effected in the following manner:—The woman, in the upright or recumbent position, as the case may be, holds the Inhaler in her right hand. She is directed to take a full inspiration, and then to apply the Inhaler to the mouth and nose. ”

“ The Injection of Alcohol into the Nerve.—The alcohol acts by destroying the nerve fibres, and must be brought into direct contact with them; if the nerve has been properly struck the injection is followed by complete anæsthesia in the distribution of the nerve. The relief may last for from six months to three years; if the pain returns, the injection may be repeated. The strength of the alcohol should be 85 per cent., and the amount injected about 2 c.c.; a general, or preferably a local, anæsthetic (novocain) should be employed (Schlösser) ”

“ If it is a flatulent spirit which causes the pain, after carminative injections and draughts, dry-cupping by means of large cupping-instruments, heated and fixed along the whole abdomen, often effects a cure. When the intestine is in a state of inflammation, we must bleed from the arm; but if dysuria prevails, we must likewise open the vein in the ankle, and use the remedies already mentioned, except those things which are acrid and powerfully cathartic; and we must rather use soothing injections, cataplasms, fomentations, placing the patient in a hip-bath of oil. ”

“ According as we settle in our minds whether a given case of pain is an exaggeration or a lessening of the ordinary physiological condition, our treatment will logically be either narcotic or stimulant. ”

“ The medicine man addresses his remedies first to the misery, with the desire to relax the nerves and overcome pain, and obtains this result through some class of opiates. After a short rest he addresses his attention to the motor action of the heart, with the view of giving arteries greater power to force arterial blood through all obstructions, and tries to stop all excretory wastings by the use of astringents combined with sedatives and soothing fluids. ”

“ For a slight operation, a very little of the drug will often suffice. In some hospitals abroad—and perhaps in America—it is the custom not to give anaesthetics to charity patients when the pain is not greater than the extraction of a tooth. Between a light anaesthesia and the deep insensibility required for some capital operation, THERE IS EVERY CONCEIVABLE DEGREE. We see the same thing in ordinary sleep. The deep unconsciousness of a thoroughly exhausted man is vastly different from the light slumber of an anxious mother, who is aroused by a word or touch. ”

“ For, bear in mind that it is not usually the cause which can be at once destroyed by drugs, but only the bodily capacity to react to it in the fashion we call pain. Ether, chloroform, cocaine, and many other drugs enable us to-day to feel sure that the mass of real pain in the world is vastly less than it was. It is, indeed, possible to prevent all pain, and pain has no real value which we need respect and desire to preserve; at least this is so from the physician's stand-point. ”

“ Treatment for acute kind.—The first thing to do is to rest in bed and control the pain and acute symptoms. Hot applications help to relieve the suffering. Patient must be kept comfortably and constantly warm and quiet. Hot applications of lead water and laudanum.
Medicines.—It may be necessary to use morphine to control the pain. Remedies such as antipyrine or aspirin are often used. A physician must be called. When the disease is caused by arsenic and lead and alcohol, of course you must remove the cause before you can hope for any improvement. ”

“ As simple as it may seem, there is a proper and consistent plan to enable you to reach full success. Before the patient commences to inhale he is informed of the fact that, while he will be unconscious of pain, he will know full, or partially well, every touch upon the person; that the inhalation must be vigorously kept up during the whole operation without for an instant stopping; that the more energetically and steadily he breathes, the more perfect the effect, and that if he cease breathing during the operation, pain will be felt. ”

“ The annulling of pain, and, in some cases, its complete annihilation, can be accomplished in many ways. Narcotics, anaesthetics--local and internal--direct action of cold, and mesmeric or physiological influence, have all their advocates, and each will surely do its work. ”

“ For we have already seen that the action of a Sedative medicine is of such a nature as to derange nervous force in some cases, and simply subdue it in others.
These actions are obviously nervous actions; for they are quick, sudden, and transient, and confined to parts supplied by a particular nerve. They are exerted upon nervous forces, and not upon the blood. If then they are nervous operations, they must either be directed towards the Vagus, or to the Sympathetic nerve, for these are the only nerves which supply the parts influenced by these medicines. ”