STIMULANTS FOR SURGICAL SHOCK
Shock is a syndrome, usually brought on by blood or fluid loss, or perhaps an overwhelming infection. It leaves the patient pale, weak, and possibly unconscious, with a rapid, weak pulse and low blood pressure.
These symptoms also occur in people who have merely fainted. Historically it was believed that shock was a nervous complaint and could be resolved with stimulants.
With the advent of hypodermic injections, a variety of treatments emerged for surgical shock. Camphor and caffeine injections were among the many, and the highly poisonous strychnine was one of the more extraordinary.
In 1903, surgeon George Crile proved conclusively that adrenaline had a role to play in the treatment of surgical shock. His work brought a sophisticated scientific foundation to a previously poorly understood phenomenon.
Shock was not really understood until the introduction of routine blood pressure measurement in the early 20th Century. Blood pressure measurement enabled physicians and scientists to develop a greater understanding of shock and devise more appropriate measures for resuscitation.
STRYCHNINE TO TREAT SHOCK
Arabic physician Ali ibn Abbas al-Majusi first recorded using the nut of the Strychnox nux-vomica tree before 994CE. Poisoning is particularly unpleasant. The body contorts painfully resulting in respiratory arrest; consciousness remains until suffocation occurs. Strychnine continued to be advocated as a stimulant for many years. A 1932 Australian text booked recommended 1/30th of a grain.
Image: Practical Anaesthesia, by the Anaesthetic Staff at the Alfred Hospital, 1932
In 1890 Professor Horatio Wood recommended the use of strychnine for the treatment of shock. It was quickly taken up by others, and the medical literature was filled with reports of its use. Strychnine is highly poisonous and more famously used to kills rats and other large vermin.
Image: Portable doctors’ hypodermic kit including strychnine, c1888
In the past strychnine was available in a pill form and used to treat many human ailments. Strychnine removes inhibitory control at the neuromuscular junction leading to intense muscular contractions. In low doses it was regarded as energising; with high doses the muscles tire and the person can’t breathe. The difference between “therapeutic” amounts and overdose was minimal.
Image: Bottle of strychnine hydrochloride, c1932
In 1900, Japanese chemist, Jokichi Takamine, working with Parke, Davis & Co Laboratories, isolated a pure crystalline substance from the adrenal medulla and called it “adrenalin”. In 1903, surgeon George Crile realised its potential for treating surgical shock and discovered it could revive a patient from cardiac arrest. Adrenaline quickly became an indispensable drug.
Image: Box of adrenaline ampoules, c1930
Persian physicians Rhazes (860–932CE) and Avicenna (980–1037CE) mentioned coffee in specialised writings, describing its medicinal properties. Although caffeine took centuries to find its way to Europe, it was quickly found to have medicinal value. Coffee has been mentioned in medical journals since the beginning of the eighteenth century, emphasising its capacity for nervous and vasomotor stimulation.
Image: Caffeine ampoule, Date TBC (pre 1984)
Camphor has been used traditionally for many years, solely or in combination with other treatments for the relief of pain, inflammation and irritation in body and skin. Persian physicians Rhazes (860–932CE) and Avicenna (980–1037CE) used camphor extensively in the treatment of particular types of headache. Symptoms of camphor poisoning include “psychomotor agitation” and hallucinations.
Image: Camphor ampoules used in cardiac failure, c1923
TREATING SNAKE BITE
In 1867, George Halford promoted intravenous (into the vein) injections of ammonia to treat snake bite by stimulating the heart. It fell from favour in the 1890s, replaced by subcutaneous (under the skin) strychnine injections. Yet by far the most popular colonial remedy, both with practitioners and patients, was drinking copious quantities of alcohol, especially brandy.
Image: Snake bite kit containing chloride of lime, alcohol, hypodermic needle and syringe, c1895
INTRAVENOUS FLUID THERAPY
Cholera swept a deadly path through Europe in 1832. Irish physician, William O’Shaughnessy, proposed treating patients with saline infusions and Dr Thomas Latta of Leith, successfully applied the treatment. The intravenous route is the fastest way to deliver fluids and medications through the body. Today, fluid therapy is one of the most widespread interventions in acute medicine.
Image: 14 gauge intravenous cannula, c.1980 for rapid infusion through the neck
In a letter to The Lancet, dated 17 May 1913, John O’Connor reported the health benefits of an injection of dry champagne. Saline, strychnine and camphor have all been employed in the past but, “nothing seems to “lift up” the patient like champagne” during convalescence. According to O’Connor, the “pulse improve… skin becomes warm, the clammy sweating ceases, [and] the patient wakes up”.
ARTIFICIAL RESPIRATION FILM, c1940s
This film demonstrates the many mechanical methods available for artificial respiration available to patients with paralysis in the 1940s.
Courtesy of the Wellcome Library YouTube channel.
RESPIRATORY AND CARDIAC ARREST: No. 9, 1945
A technical film (part of a series) apparently aimed at the inexperienced anaesthetist.
Courtesy of the Wellcome Library YouTube Channel.