In my previous post I wrote about my discovery that people who had had infant surgery to remedy infant pyloric stenosis (“PS”) during much of the 20th century could recognize the symptoms of post-traumatic stress disorder (“PTSD”) in later life. And that there could be marked and significant similarity in what those affected reported.
So much so that they could link their PTSD symptoms with what we have learnt only in recent years about the way that surgery was done at the time. Until the late 1980s it was widely believed, certainly in the U.S.A., that “babies do not feel and certainly cannot remember pain”, and much surgery was done on that assumption.
In researching how PS surgery has been done in the century since its development, I have read many medical journal articles and written a lengthy series of posts giving an overview of this material. The series is entitled “Past Pylorix Pages” and was posted weekly for 4 months starting 27 October 2011: it may be easily referenced using the Archives box on the right of this page.
The research for these posts made clear why some of us who had had PS surgery before 1990 have been affected by PTSD.
1 The German Dr Conrad Ramstedt was one of several surgeons who in the years up to 1912 published a promising surgical technique to remedy infant PS. Interestingly, Ramstedt’s public and published presentations seem to have won him greater recognition than his colleagues have received!
From the start, surgeons differed in their attitude to and use of analgesia (pain control) when working on babies and infants. Specialist pediatric surgeons and anesthetists were virtually unheard of before 1950, anesthesia was always more hazardous than today, there was no anesthetic equipment designed for babies and children as there is today, and anesthesia was especially dangerous for infants in their first two years. Nevertheless, Ramstedt advocated the use of a light ether anesthetic for “his” pyloromyotomy surgery.
2 Those who preferred to use a (light) general anesthetic gave several reasons. Working on a crying and tied down but flexing baby was difficult, hazardous and upsetting; the straining also affected the closure of the wound. Skilful use of the available anesthetics could keep the morbidity (complications) and mortality rates down to acceptable levels – considering the alternatives. Moreover, local anesthetics affected the tissue around the wound in unhelpful ways.
3 The use of local anesthetics also had advantages. It avoided the hazards of rendering a baby unconscious with the use of powerful agents difficult to control as accurately as was necessary in infant surgery. It removed the pressure of time, allowing the surgeon to work at a more comfortable rate. The use of light anesthesia while safer could be less than effective in controlling pain, whilst the use of more gas required the intubation of the baby to maintain lung function, a traumatic and difficult procedure even for adult patients.
Several reports mention that some surgeons had the policy of giving the baby a sugar cube to suck on, perhaps laced with a little brandy – to help calm it while the surgery was done using local anesthetic. A safe thing to mention!
4 If the numbers of medical journal articles are any guide, those favouring each of these techniques were about equal.
5 While I have not found any articles mentioning or advocating it, there was a third option, very much based on the belief that “babies do not feel or remember pain”.
There was it seems a veil of silence over this third technique, no doubt because it was an uncomfortable matter to discuss in print, and to avoid alarming parents and the general public.
If a tiny patient did not suffer or remember pain, it would be much easier to ignore the question of anesthesia or analgesia altogether. It was only Drs K J S Anand and P R Hickey (1987) who spelt out what that really meant.
These babies were intubated (had a breathing tube pushed into their windpipe) while awake, and were then given a paralysing drug, curare, so that they could not scream or writhe. When the surgery was complete they were given an antidote to the curare and ventilation could cease.
This approach to infant surgery avoided the hazards and disadvantages of the first two techniques. It could also be carried out more easily by doctors not experienced in infant surgery and in local and less well-resourced and equipped hospitals.
It is difficult to measure how commonly this third option was used.
It is not difficult to imagine and understand the effect it had on the subconscious or body (“somatic”) memory of a baby, and that it could have major repercussions in the patient’s later life.
While we can be very thankful for the work and advocacy of Dr Anand and others, there needs to be a far greater understanding of how infant surgery, as done in the past, may have affected many people.
This site and others are committed to lifting the veil, raising public awareness, and reassuring and networking those affected, often without their understanding the cause of their particular PTSD symptoms and “black dog”.