Pain / by Thomas Lewis.

  • Lewis, Thomas, Sir, 1881-1945.
Date:
1942
Catalogue details

Licence: In copyright

Credit: Pain / by Thomas Lewis. Source: Wellcome Collection.

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    (107). It is also agreed that traction upon the hollow viscera, especially upon those of the upper part of the abdominal cavity, is painful. While Lennander originally attributed this to drag on the parietes, there seems clear evidence that at least the basal parts of the mesenteries are supplied by sensory nerves and that traction can affect these. There is also evidence that pain nerves are contained within the lesser omentum and that they occur in relation to the pancreas, to the renal pelvis and ureter, and to the base of the bladder. These observations upon man have been repeated extensively in animals. Kast and Meltzer (99, 100), using dogs chiefly, opened the abdomen under anaesthetic, closed it with stitches, and, after recovery, allowed a loop of gut to protrude. As the result of many carefully conducted experiments, they stated em¬ phatically that, if the bowel is tested early and is kept warm and moist within or without the abdominal cavity, signs of pain can be elicited by pricking or pinching the bowel itself or by fara- dising it. The signs consisted of whining or cries, or of struggling. Using dogs under morphia, Ritter (196, 197) confirmed these findings for gut and included appendix, stomach, liver, and spleen, though it is clear from his protocols that the responses lacked uniformity. Ritter also reported that he had found the human bowel itself sensitive to pinches in some instances and Kinsella (107) speaks of the inflamed appendix in the same way. In unanaesthetised dogs, Kappis (96) failed to provoke signs of pain except from the vessels of the mesentery. Kast and Meltzer believed that their observations upon dogs proved the bowel wall to be painful, and that failure to provoke similar pain in man has been due to the absorption of local anaes¬ thetic and its action upon the central nervous system or to loss of function of the pain nerves to the bowel through exposure. When a simple solution of cocaine was the local anaesthetic used, the idea that its absorption and central action masked pain had more force. Doses of cocaine equivalent to those used by Kast and Meltzer in their experiments showing this central effect would now be regarded as unsafe by surgeons; and, in fact, such doses abolished pain responses from the parietes as well as from the viscera. In the later observations upon man, much less toxic substances, such as eucaine and novocaine, have been employed;