Out of Our Comfort Zone: History

The earliest recorded use of anaesthesia in war is during the Mexican/American War in March or April 1847. A senior American surgeon was critical of it and believed that it caused infection, impaired wound healing and caused coughing blood in patients with gunshot wounds. However, it was used successfully during the Russian campaign in the Caucasus between July and September 1847.

Baron Dominique Jean Larrey
Baron Dominique Jean Larrey

Baron Dominique Jean Larrey (1766-1842) stressed the need to treat and evacuate the wounded quickly. Unlike domestic disasters and acts of terrorism, wounded soldiers sometimes have to travel long distances when they are evacuated. Larrey treated wounded soldiers regardless of rank or which army they were fighting for.

During the First World War, the Royal Army Medical Corps was expanded and specialist anaesthetists worked at casualty clearing stations. Though the role developed as a specialism throughout the war, anaesthetics were also administered by other doctors, nurses and sometimes priests- often whoever was close by.

In 1940, civilian air raid casualties were rarely given morphine. However, soldiers wounded in Italy were given morphine during their long evacuation. An initial report of 1948 suggested that morphine and anaesthesia could be given to wounded soldiers but in 1950 this advice became much more cautious: no spinal anaesthetics should be given and skilled administration of anaesthesia was needed. The sudden attack on Pearl Harbor and the lack of facilities and trained anaesthetists to treat casualties, led to the comment that more servicemen died as a result of receiving thiopentone than were killed by the Japanese. This idea has since been refuted.

IWM E_(AUS)_714
An Australian medical officer treats a wounded soldier at an Advanced Dressing Station in the Third Battle of Ypres, 1917, (C) IWM E (AUS) 714

Pain relief was not always given because of fears that it could lead to morphine addiction.

Before 1960, seriously injured people received little or no life-supporting treatment before arriving at hospital. Modern resuscitation methods had not yet been developed, and there was less training for emergency workers. Even as late as the 1980s, pain relief was discouraged because of problems in delivering it. Anaesthetists argued that it was essential on both scientific and compassionate grounds.

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