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The claim was made on parenting.se that "not so long ago, babies were operated on without anaesthetic because they weren't considered 'conscious' enough to feel pain".*

A Google search revealed several other references to this claim.

I've heard of circumcisions being done without anesthesia, but was it common practice (say, > 25% of the time) to perform other types of surgical procedures on babies without using an anesthesia, and was the rationale really that children that age weren't "conscious enough" to understand pain? For a target time period, let's say anytime since anesthesia became widely available (for argument's sake, about 10 years after the introduction of medical anesthetic, or 1860 on).

Andrew Grimm
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Beofett
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    Can you define "not so long ago"? Anesthesia as is commonly understood, has been used for really only about 160 years, with the majority of them being developed in the 20th century. – horatio Dec 07 '11 at 15:53
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    I take it the OP is interested in whether anesthesia was withheld because of the given rationale, not because it was simply unavailable. – MetaEd Dec 07 '11 at 16:03
  • @horatio good point. I've edited to specify any time since 1860, as a (somewhat arbitrary) starting point. – Beofett Dec 07 '11 at 16:14
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    An additional comment related to @horatio's point: early anesthesia was *dangerous* and hard to meter. It's pretty easy to kill a patient with ether, for instance, and I presume that infants were harder still to dose. – dmckee --- ex-moderator kitten Dec 07 '11 at 18:34
  • I actually looked for some references esp. 19th century medical journals via Google books, but I didn't feel like linking and extensively quoting. Yes, there was an issue with dosages, especially due to the inhalation method of providing it (ether and chloroform) from what I saw, but there was little concern that it could not be mitigated. – horatio Dec 07 '11 at 19:26
  • and even today, the side effects of some anesthetics may well be considered too dangerous for small children. e.g. some can induce paralysis lasting after recovery (in my mother, it lasted for months, same drug in a baby might have killed it). – jwenting Dec 08 '11 at 06:57
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    This sounds like something a doctor might say to a mother when they did not anesthetize their baby before surgery because it was more dangerous than without. – Chad Dec 08 '11 at 19:56
  • Does circumcision count as surgery? – Jay Bazuzi Dec 13 '11 at 18:27
  • @JayBazuzi As I mention in the question, I've heard of circumcisions being done without anesthesia. I'm only skeptical about other types of surgeries and the rational being that children aren't "conscious enough" to understand pain. – Beofett Dec 13 '11 at 18:37

1 Answers1

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Interesting. I came to this question predicting I would find a long history of anaesthetic use in infants, lagging a little behind the adults (until the anaesthetics had been demonstrated to be safe and effective.) I expected that any doctors subscribing to the view that infants don't need anaesthetic would be maverick outliers. I found a lot of indirect evidence to convince me otherwise. Unfortunately, the ultimate evidence is behind paywalls or not online.

The use of anaesthesia in infants and children does go back many years.

This review article discusses some of the early research, including:

Spinal anesthesia was used in children in Toronto by anesthetists in 1933 (12,13) and in Montreal in 1949 (14). Junkin commented on the lack of articles describing its use in children and, of those, he found them indefinite and unenlightening in their brevity. Junkin used morphine and Nembutal for premedication and inserted the needle at L4–5 because the spinal cord reaches lower in infants than adults – an important observation. It was used from 2 weeks of age upwards for a wide variety of cases including four thoracic operations

...

By 1950, Harry Curwen in Durban, South Africa, was using caudals in neonates.

The review discusses much earlier studies in "children", but I selected these examples to demonstrate they were anaesthetising babies (as opposed to 10 year olds. I am sure no-one denies they feel pain.)

So, this shows some doctors considered babies needed anaesthesia.

The claims that some doctors considered babies to not require anaesthesia comes from a number of sources, many of which cite references that I have been unable to confirm.

A Time Magazine article cites Dr. Robert Wilder, an expert on paediatric anaethesiology (I guess it is "pediatric anethesiology" as he is from the USA.)

"There was a whole series of papers showing that [giving anesthesia] was a bad thing to do," says Dr. Robert Wilder, a co-author of the Mayo Clinic study. "One thing that is very clear is that kids who have surgery without the appropriate anesthetic have higher degrees of morbidity and, in some cases, even mortality associated with surgery compared to kids who have gotten the appropriate anesthetic."

In the preface to the book 1000 Doctors Against Vivisection, Hans Ruesch cites the Lancet and Parade Magazine:

So the Lancet, Britain's most authoritative medical journal, could report with its usual professional aloofness in its January 31, 1987 issue that at Oxford's John Radcliffe Teaching Hospital eight premature babies had been subjected to open-heart surgery without any anesthesia. The controversy that flared briefly in a few press organs concerned mainly the question as to whether the babies had or had not received painkillers during the operation.

...

Reported Parade magazine, USA, April 12,1987:

"Doctors have struggled with the problem for years. At a conference of anesthesiologists held in Palm Springs, California, in 1970, a doctor stated that premature infants did not need anesthesia, just some adhesive tape to hold them down."

Given the strong partisan nature of the book, it would be better to see the original stories, which I haven't found online. (The Parade Magazine article has been cited elsewhere as "Ubell E.. Should infants have surgery without anesthesia?. Parade Magazine April 12, 1987: 18-19.")

At the Second International Symposium on Circumcision, San Francisco, California, May 2, 1991, Dr David Chamberlain presented "Babies Don't Feel Pain: A Century of Denial in Medicine"

Hospitalized newborns, from preemies to babies up to 18 months of age, have been routinely operated upon without benefit of pain-killing anesthesia. This has been the practice for decades but was unknown to the general public until 1985 when some parents discovered that their seriously ill premature babies had suffered major surgery without benefit of anesthesia.

Chamberlain provides a long list of references to support his claims, including:

  • Several letters to journals with case studies from a couple of individuals.
  • A survey of neonatal intensive care units
  • Discussion in the literature about the ethics
  • Studies looking at the benefits of anaesthetics in pediatric and neonatal intensive care units.

Conclusion

Due to the dates, it is difficult to read the original sources, and come up with strong evidence that it was common practice not to anaesthetise babies, without getting up from my desk and actually visiting a decent medical library.

However, there are many sources (both reputable and not) available online that make consistent claims, with references to precise journal articles to support their position.

It seems safe to conclude that the original claim was right: that babies were commonly operated on without anesthesia prior to the mid-1980s, by western doctors who believed that this was the most appropriate treatment.

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Oddthinking
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    Wow. I am speechless. – Sklivvz Oct 26 '12 at 18:53
  • People have also claimed until recently that [animals cannot feel pain](http://en.wikipedia.org/wiki/Pain_in_animals#History). – ChrisW Jun 26 '14 at 00:59
  • This is one of those things that you really wish wasn't true... – Benjol Jun 27 '14 at 12:07
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    One thing that is missing from this - the reason being "they don't feel pain." My vague recollection, and I can't cite from where, was the feeling that the risk, + the idea that their brains were too immature ***to form long-term memories*** was the reason, not lack of ability to feel pain. But, as I mentioned, I don't remember the details, and can't say that was the reasoning, but the reason why I noticed what I did about this answer is it didn't put that vague impression I had to rest. – PoloHoleSet Oct 02 '17 at 18:44