Monday, February 23, 2015

This Month in Anesthesia History: February


1723 February 25: Christopher Wren died in London. Around 1660 the English architect and astronomer began to experiment with the transfusion of blood between animals and intravenous injections into animals. An account of his work was published in the Philosophical Transactions of the Royal Society of London in 1665. [see Bergman NA. Early intravenous anesthesia: an eyewitness account. Anesthesiology 72:185-186, 1990] Recent biographies of Wren include Lisa Jardine's On a Grander Scale: The Outstanding Life of Christopher Wren and Adrian Tinniswood's His Invention So Fertile: A Life of Christopher Wren.
1804 February 6: Joseph Priestley died in Northumberland, Pennsylvania. Among many other achievements, this English Unitarian minister and scientist isolated nitrous oxide. In 1774 Priestley wrote about his research on gases, "I cannot help flattering myself that, in time, very great medicinal use will be made of the application of these different kinds of airs..." [Priestley J. Experiments and Observations on Different Kinds of Airs. 6 vols. 1:228, 1774] Priestley was born on March 24, 1733, near Leeds, England. For many years he was a member of the Lunar Society, a loose organization made up of scientists and industrialists such as James Watt and Josiah Wedgewood. Many of these men later supported the research by Dr. Thomas Beddoes and Humphry Davy on nitrous oxide and other gases. Priestley was a supporter of the American Revolution and considered by many a heretic; on July 14, 1791, his home in Birmingham was burned by a pro-Royalist mob. His laboratory, large library and unpublished manuscripts were destroyed. In April, 1794, Priestley and his wife sailed to America. You can learn more about him at http://www.historyguide.org/intellect/priestley.html
1807 February 27: American poet Henry Wadsworth Longfellow was born in Portland, Maine. On April 7, 1847, physician/dentist Nathan Cooley Keep administered the first obstetric anesthetic in theUnited States in Cambridge, Massachusetts. Dr. Keep was a prominent physician of the Boston area and the first Dean of Dentistry at Harvard. The patient was Frances Appleton Longfellow, second wife of Henry Wadsworth Longfellow. In his journal entry for April 1, the famed poet and scholar had noted, "Went to town the first time for several weeks and had a conversation with Dr. Keep about the sulphuric ether and its use." Under ether anesthesia, Fanny did not lose consciousness but felt no pain during the birth of her child. She later wrote about her experience, "I am very sorry you all thought me so rash and naughty in trying the ether. Henry's faith gave me courage...I feel proud to be the pioneer to lessen suffering for poor, weak womankind. This is certainly the greatest blessing of this age and I am glad to have lived at the time of its coming and in the country which gives it to the world..." [See Clark RB. Fanny Longfellow and Nathan Keep. ASA Newsletter 61(9), September 1997]
Henry Wadsworth Longfellow, his wife Frances Appleton Longfellow, with sons Charles and Ernest. Circa 1849. From the collection at the Longfellow National Historic Site, Cambridge, MA. <br><i>Copyright Easter National Park and Monument Association</i>
Henry Wadsworth Longfellow, his wife Frances Appleton Longfellow, with sons Charles and Ernest. Circa 1849. From the collection at the Longfellow National Historic Site, Cambridge, MA.
Copyright Easter National Park and Monument Association 

1814 February 7: Gardner Quincy Colton was born in Georgia, Vermont. Colton introduced nitrous oxide to Horace Wells, among other achievements.
1824 February 21: Englishman Henry Hill Hickman wrote a letter to T.A. Knight describing his experiments with painless surgery on animals using carbon dioxide as an anesthetic.
1829 February 15: Silas Weir Mitchell was born. This American surgeon, neurologist, novelist and poet explored the relationship between pain and the weather and eye strain to headaches. Mitchell died on January 4, 1914.
1836 February 25: A patent was granted to Samuel Colt for his revolving pistol. In the 1830s Colt, calling himself "Professor Coult" or "Doctor Coult" of "Calcutta, London and New York", toured the eastern United States giving demonstrations of nitrous oxide inhalation to raise money to put his revolver prototype into production. In 1836 he patented a revolving-breech pistol and founded the Patent Arms Company in Paterson, New Jersey. The company failed in 1842, but an order for 1,000 revolvers by the U.S. government five years later during the Mexican War allowed Colt to restart his business. Colt was born in Hartford, Connecticut, on July 10, 1814 and died on January 10, 1862. The text of an advertisement for Colt's nitrous oxide demonstration in Portland, Maine, on October 13, 1832, can be found in Smith, Under the Influence: A History of Nitrous Oxide and Oxygen Anaesthesia [pp 37-38].
1848 February 1: The Mexican-American War ended with the signing of the Treaty of Guadalupe Hidalgo. The first major battle of the U.S. war with Mexico was fought at Palo Alto, Texas, on May 8, 1846. Ether anesthesia was first used in a military conflict in this war, sometime in the spring of 1847 under the direction of American surgeons Edward H. Barton and John B. Porter. [See Aldrete JA, Marron GM, Wright AJ. The first administration of anesthesia in military surgery: on occasion of the Mexican-American War. Anesthesiology 61:585-588, 1984] The Library of Congress offers an excellent list of resources on this conflict at http://www.loc.gov/rr/program/bib/mexicanwar/
1873 February 1: First documented death from nitrous oxide inhalation in Great Britain was reported in this issue of Lancet.
1874 February 16: Pierre-Cyprien Ore [1828-1891] reported to the French Academy of Sciences a case in which he administered the first intravenous general anesthesia in humans. “Ore was very enthusiastic about intravenous anesthesia with chloral hydrate, and believed it to be superior to inhalation anesthesia with ether or chloroform.” [Keys, The History of Surgical Anesthesia, p. 57] Two years earlier he had published a preliminary report on the technique. In 1875 he published the first monograph on the technique, Etudes Cliniques sur L’Anesthesie Chirurgicale par La Methode des Injections de Chloral dans Les Veines. Acceptance of the method was delayed by slow recovery and high mortality.
1878 February 10: Claude Bernard, French physiologist, died. Bernard's classic work, Lectures on Anesthetics and on Asphyxia [1875], is available from the Wood Library-Museum of Anesthesiology in a fine translation by B. Raymond Fink, MD, published in 1989.
1884 February 26: Scottish physician Alexander Wood died. Wood introduced the hypodermic syringe for drug administration.
1908 February 22: A.D. Waller described his chloroform balance at a meeting of the Physiological Society in London. This apparatus was the first to give a continuous and almost instantaneous reading of the concentration of vapor received by the patient.
1909 February 20: Congress passed the first U.S. law prohibiting the manufacture and sale of opium. Opium had been used for centuries to relieve pain, but by 1900 an estimated 200,000 people in the U.S. were addicted to opium and its derivatives such as laudanum, paregoric and morphine.
1936 February 13: American Society of Anesthetists was founded. In a letter from Paul Wood to John Lundy, dated February 14, Wood noted, "I was reminded at the meeting last night which approved the change in title from New York to American Society of Anesthetists..." This letter is in the Collected Papers of John Lundy, Mayo Foundation Archive in Rochester, Minnesota. In a few years another name change would create the current name. The ASA can trace it’s history back to the Long Island Society of Anesthetists founded in the very early 20th century. A history of the ASA isBacon DR, McGoldrick KE, Lema MJ, eds. The American Society of Anesthesiologists: A Century of Challenges and Progress [Wood Library-Museum, 2005].
1938 February: The American Board of Anesthesiology became affiliated with the American Board of Surgery.
1941 February 16: The American Board of Anesthesiology achieved independent status.
1943 February 13: Sir Robert Macintosh published as article in Lancet about the laryngoscope blade that now bears his name.[Mactintosh RR. A new laryngoscope. Lancet 1:205, February 13, 1943]
1969 February 2: British actor Boris Karloff died at age 81. Although perhaps best known for two roles, as "The Monster" in Frankenstein (1932) and the title character in The Mummy (1932), Karloff acted in dozens of films between his start in 1916 in silent films and his death. In one of the films made toward the end of his career, Corridors of Blood (1958), he plays Dr. Thomas Bolton, a physician in the early Victorian era who is determined to find a drug that will obliterate pain during surgery. As he tells the other hospital physicians who mock his efforts, "Operations without pain are possible, and I'll not rest until I prove it to you." Like some of the historical figures in early anesthesia history, Bolton experiments on himself as he searches for the right dosage and becomes addicted.

Sunday, February 22, 2015

Don't go to the mall

Islamic Retribution for the Crusades

Obama warned us that being Christian we are deserving of terrorism from the unnamed terrorists. Don't blame the muslims because not all of them are bad, but you can blame all modern day Christians and non Christian Americans for the acts of Christians over 900 years ago. Never mind that Islam aggressively used the sword 900 years ago to convert and gain territory.

If you look at Muslim countries throughout our world, they are 99.9% muslim. This isn't obtained through peaceful adherence and peaceful belief in a religion. This is obtained through coercion that is both church and state based. Saudi Arabia, the Mecca of the muslim world, is also 99.9% muslim and is theocratic in its laws and government. To evangelize is an illegal act punishable by death. There are only a few recognized religions, the other religions, including atheism is not recognized and is punishable by death.
Saudi Arabia has long been criticized for its human rights record. Human rights issues that have attracted strong criticism include the extremely disadvantaged position of women, capital punishment for homosexuality, religious discrimination, the lack of religious freedom and the activities of the religious police.
In 2010, the U.S. State Department stated that in Saudi Arabia "freedom of religion is neither recognized nor protected under the law and is severely restricted in practice" and that "government policies continued to place severe restrictions on religious freedom". No faith other than Islam is permitted to be practiced, although there are nearly a million Christians—nearly all foreign workers—in Saudi Arabia. There are no churches or other non-Muslim houses of worship permitted in the country. Even private prayer services are forbidden in practice and the Saudi religious police reportedly regularly search the homes of Christians. Foreign workers have to observe Ramadan but are not allowed to celebrate Christmas or Easter. In 2007, Human Rights Watch requested that King Abdullah stop a campaign to round up and deport foreign followers of the Ahmadiyya faith.

Conversion by Muslims to another religion (apostasy) carries the death penalty, although there have been no confirmed reports of executions for apostasy in recent years. Proselytizing by non-Muslims is illegal, and the last Christian priest was expelled from Saudi Arabia in 1985. There are some Hindus and Buddhists in Saudi Arabia. Compensation in court cases discriminates against non-Muslims: once fault is determined, a Muslim receives all of the amount of compensation determined, a Jew or Christian half, and all others a sixteenth. Saudi Arabia has officially identified atheists as terrorists. The regulations place secular citizens who commit thought crimes in the same category as violent terrorist groups Proselytizing by non-Muslims, including the distribution of non-Muslim religious materials such as Bibles, is illegal. The country has just recently passed a law recommending the death penalty for anyone caught carrying or smuggling a bible into the country. Killing someone for handing out a bible isn't hostile? Demanding non muslims to celebrate Ramadan and not allowing them to celebrate Christmas, isn't hostile? Giving plaintiffs that are non muslim 1/16th of a recourse isn't hostile? Death penalty for atheists and homosexuals isn't hostile?

Saturday, February 21, 2015

President Barack Obama is a fool


Krauthammer 'Stunned' By Obama's 'Banal & Offensive' Prayer Breakfast Remarks




Discussion regarding false moral equivalency of the presidents statements



How does the president reconcile the fact that he is making a straw man argument? In order for his argument to work, you first need to be a Christian, if you are a Jew, Hindu, Atheist, etc, his argument means nothing. Your ancestors weren't Christians that were involved in the Crusades, so how does that fact exonerate the fact that muslims are killing innocent people? It doesn't, his argument is flawed.
Weak part of argument number two. The Crusades happened nearly a millennia ago. There has been a number of occurrences in Western Civilization that have managed to alleviate the power that the Christian church has over society. In order for President Obamas argument to hold any sway, you would have to wipe out the Enlightenment, the introduction of movable type, the mass literacy of the populace, and the internet. Once people were able to read the bible themselves and the failings of the bible were brought to the open, the bible was no longer allowed to have the same fundamental innerancy that it once had. These events have not had the same hold on Islam as it has on most other parts of the world. Illiteracy in muslim countries is widespread. The introduction of freedom of religion and freedom from religion is not the norm in muslim countries.
Issue number three. The objective of the crusades was to prevent the islamization of the entire western world and to try to regain some territory that had been lost from the west to the muslims. This point was entirely missed in the presidents speech. Besides it wouldn't have been the fault of the muslims, as they gained all territory peacefully in his mind, I am sure.
The main issue that I have with President Obama is he understands the lack of knowledge of his core constituency. He owns the Walmart shopper. He doesn't own the Saks or Wall street type. The troubling part of the matter is that he also owns most academicians, simply because the Republicans are the home of the religious right. With the press and university in his corner, Obama is able to speak such dribble without any backlash. He is able to spread the blame for terrorism. He can make the argument that it isn't the fault of the terrorist, but the real fault is in each of us, each American.

Here are some of Obamas famous quotes, if you agree with these quotes, I would enjoy knowing why.

"If you've got a business- you didn't build that, someone else made that happen."

"I've got two daughters. 9 years old and 6 years old. I'm going to teach them first of all about values and morals. But if they make a mistake, I don't want them punished with a baby."

This quote is especially cringe worthy. Is this a utilitarian philosophy he is trying to espouse? That the best decision is what garners the greatest happiness? Is he espousing hedonism here? But is this truly the most happy of decisions? In his mind it must be. The baby is labeled as such..a baby, he doesn't say fetus or pregnancy, he says baby. To him, a baby is equal to a mistake. 

If you are at all interested in a what an intellectual has to say about the future and the truth of our current world crisis, then listen to an intellectual. Obama is clearly a populist president. He makes zero qualms about this. He enjoys debasing himself (or being himself) in order to relate to what he supposes is the mindset of his constituents. He paints a bleak portrait of the common man and woman. He thinks them so stupid as to believe or to view a baby as a mistake and to think that terrorists actions are exonerated due to the actions of a group from a thousand years ago.



Christopher Hitchens debating Islam

Sunday, February 8, 2015

Hypnosis and its use in Anesthesia


Approaches to Hypnosis


This is an interesting adjunct to my anesthetic regimen.

A link to societies for hypnosis

American Society of Clinical Hypnosis

The American Board of Medical Hypnosis


I try to ensure I am giving positive suggestion and am always aware of my own ability to affect the patients experience through my words and actions. I try to make the experience one that is positive for the patient. I have always wanted to broaden my ability to make the patient more relaxed and in a suggestible state to have a better overall experience.

Use of hypnosis as a substitute premedication and adjunct to anesthesia

What is Guided Imagery?

Guided Imagery & Heart Surgery

The effect of preoperative suggestions on perioperative dreams and dream recalls after administration of different general anesthetic combinations: a randomized trial in maxillofacial surgery

Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures

Selected topics in perioperative multimodal pediatric pain management


Above are a few guided imagery studies and sites. I will look into hypnosis and non pharmacological means to assist a patient recover and get through positively the preoperative experience.

This video is a demonstration of hypnoanesthesia.


Hypnosis in the OR, ICU, and ER

Interesting Book on Medical Hypnosis: Clinical Hypnosis and Pain Therapy-Palliative

Thursday, February 5, 2015

2014 in retrospective, Medical school and Affirmative Action

This has been a crazy year, to say the least.
Highlights of the year
1) Simon learning he loves ice skating, Jena skating, and Oliver playing basketball
2) play lots of basketball
3) join the Mount Holyoke gym with Oliver
4) post a ton of pics to pinterest
5) visit D.C.
6) visit the Cape
7) visit Bahamas

Might as well promote my pinterest page

https://www.pinterest.com/tnobabbott/

I am going in a new direction on my blog. I had in the past posted quite a few things on Facebook. I think in the future posting on my blog would be more beneficial. Fighting with people on Facebook is about as useful as a punch to the face.

One of the issues that I have argued about in the past consistently is affirmative action. I am vehemently against affirmative action, and this is why. I argue that affirmative action is racism. Racism is the belief that one race is superior to another race. Affirmative action was put into place originally as a system to break the barriers that were inherent in many corporations, universities, and societies. What was once used to allow people of differing races to enter into a job, profession or obtain an education, is now a system of white guilt appeasement. Affirmative action was used to allow people of differing colors with the skill sets necessary or the aptitude necessary to compete with whites of similar aptitude and skill set. That is no longer the case. The case now has been to put people of color with lesser skill or lesser aptitude in positions that they could not compete for without a system in place that gives them credit for being black. It is a racist system that judges a person competent based solely on the color of their skin and not on their skill set. This is racism.

In order to matriculate in a medical school an applicant needs to have the necessary credentials to do so. An applicant must have an overall GPA >3.8 and a science GPA>3.7, a MCAT score >32, and be a well rounded individual. What constitutes a well rounded individual? Community service, having a skill in a science or non science related field (being a concert pianist, having engineering experience, etc), would constitute what medical schools would be looking for to round out a well rounded individual that would separate them from the other stellar applicants. Does being black entitle one to the criteria of being well rounded? Does diversity mean you are well rounded?

The argument for diversity usually revolves around the future patient. Many believe that patients would like to be treated by someone of their own cultural and racial makeup. However when I posted some time ago on a medical forum that there were too many Asians and that I think that impairs my ability to be seen by a white physician, I was rightfully argued against that I was being racist and that this type of thinking is unacceptable in this day and age. If it is unacceptable for me to desire to be seen by someone of my cultural and racial makeup, then why is it acceptable and sought after to go after black applicants that have lesser aptitudes than other applicants? Would it be acceptable to fill an NBA team with white players in order to meet a quota? To accept players with lesser skill, simply due to race?

Here are the facts that clearly show a discrimination towards accepting blacks with lesser qualifications than whites and asians:

MCAT Scores and GPAs for Applicants and Matriculants to U.S. Medical Schools by Race/Ethnicity, 2014

There is a large statistical gap separating the MCAT and GPAs of white/asians from blacks. This is clear racism against white/asian applicants in order to benefit black applicants. Should we be judging based on the content of a persons skill set or on the basis of the applicants skin color? If the tilt was to the opposite direction, say whites with lower GPAs and MCAT scores in comparison to blacks with higher MCAT scores and GPAs the outcry I am sure would be widespread and immediate.

Mindy Kaling's brother exposes affirmative action