Difference between revisions of "Paul Emil Flechsig"

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[[File:Paul_flechsig_perscheid_1906.jpg|thumb|Flechsig in 1906]]
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'''{{FULLPAGENAME}}''' ({{LifeData|birth=1847-06-29|birthplace=Zwickau|birthcountry=|death=1929-07-22|deathplace=Leipzig|deathcountry=Germany}}) was an eminent nineteenth-century German neuroanatomist, psychiatrist and neuropathologist.
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'''{{FULLPAGENAME}}''' ({{LifeData|birth=1847-06-29|birthplace=Zwickau|birthcountry=Kingdom of Saxony|death=1929-07-22|deathplace=Leipzig|deathcountry=Germany}}) was an eminent nineteenth-century German neuroanatomist and neuropathologist.
  
 
Professor Flechsig had an interest in  myelinogenesis — the development of the myelin sheaths for nerves.<ref name="myelogenesis2024">{{REFweb
 
Professor Flechsig had an interest in  myelinogenesis — the development of the myelin sheaths for nerves.<ref name="myelogenesis2024">{{REFweb
 
  |url=https://en.wikipedia.org/wiki/Myelinogenesis
 
  |url=https://en.wikipedia.org/wiki/Myelinogenesis
 
  |title=Myelinogenesis
 
  |title=Myelinogenesis
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|last=
 
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|first=
 
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|init=
 
 
  |publisher=Wikipedia
 
  |publisher=Wikipedia
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|date=
 
 
  |accessdate=2024-01-07
 
  |accessdate=2024-01-07
 
}}</ref> The myelin acts as an insulator to allow the electrical impulses to travel through the nerves.<ref name="myelogenesis2024" />
 
}}</ref> The myelin acts as an insulator to allow the electrical impulses to travel through the nerves.<ref name="myelogenesis2024" />
  
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Flechsig observed that the myelin sheath is not yet formed in newborn babies,<ref>{{REFjournal
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Flechsig (1872) observed that the myelin sheath is not yet formed in newborn babies,<ref>{{REFjournal
 
  |last=Flechsig
 
  |last=Flechsig
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  |init=P
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  |init=PE
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  |author-link=
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  |author-link=Paul Emil Flechsig
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|last2=
 
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|init2=
 
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|author2-link=
 
 
  |url=https://zenodo.org/records/1428540
 
  |url=https://zenodo.org/records/1428540
 
  |title=Developmental (Myelogenetic) Localisation of the Cerebral Cortex in the Human Subject  
 
  |title=Developmental (Myelogenetic) Localisation of the Cerebral Cortex in the Human Subject  
 
  |journal=Lancet
 
  |journal=Lancet
 
  |date=1901-10-19
 
  |date=1901-10-19
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|volume=
 
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|issue=
 
 
  |pages=1027-9
 
  |pages=1027-9
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  |accessdate=2204-01-07
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  |accessdate=2204-01-07}}</ref> which he reported in 1876.<ref>{{REFbook
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}}</ref> so he came to the unfounded conclusion that the newborn cannot feel [[pain]].<ref>{{REFjournal
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|last=Flechsig
 +
|first=Paul Emil
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|init=PE
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|author-link=Paul Emil Flechsig
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|year=1876
 +
|title=Die Leitungsbahnen im Gehirn und Rückenmark des Menschen auf Grund entwicklungsgeschichtlicher Untersuchungen
 +
|trans-title=The pathways in the human brain and spinal cord based on developmental studies
 +
|language=German
 +
|url=https://ia903406.us.archive.org/9/items/bub_gb_0UxvjrYgAJQC/bub_gb_0UxvjrYgAJQC.pdf
 +
|location=Leipzig
 +
|accessdate=2024-01-12
 +
|format=PDF
 +
}}</ref> Unfortunately, he came to the unfounded conclusion that the newborn cannot feel [[pain]].<ref>{{REFjournal
 
  |last=Cope
 
  |last=Cope
 
  |init=DK
 
  |init=DK
 
  |author-link=
 
  |author-link=
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|last2=
 
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|init2=
 
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|author2-link=
 
 
  |url=
 
  |url=
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  |title=Neonatal pain: The evolution of an idea.  
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  |title=Neonatal pain: The evolution of an idea.
 
  |journal=The American Association of Anesthesiologists Newsletter
 
  |journal=The American Association of Anesthesiologists Newsletter
 
  |date=1998-09
 
  |date=1998-09
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|volume=
 
−
|issue=
 
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|pages=
 
 
  |accessdate=2024-01-06
 
  |accessdate=2024-01-06
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}}</ref> So great was his reputation and influence that his views were accepted without question, even though empirical studies had not been carried out. As a result, surgical operations have been carried out on infants without pain medication for more than 100 years.
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 +
{{PUB}}
 +
* {{REFbook
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|last=Flechsig
 +
|first=Paul Emil
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|init=PE
 +
|author-link=Paul Emil Flechsig
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|year=1927
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|title=Meine Myelogenetische Hirnlehre: Mit Biographischer Einleitung
 +
|trans-title=My myelogenetic brain theory: With a biographical introduction
 +
|language=German
 +
|url=https://books.google.com/books?hl=en&lr=&id=FiyEBwAAQBAJ&oi=fnd&pg=PA1&dq=Paul+Emil+Flechsig&ots=vHHjZ2xluC&sig=TDbWc5mxl1zJdy-jTstO48oznrQ#v=onepage&q=Paul%20Emil%20Flechsig&f=false
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|scope=
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|ISBN=978-3-662-32788-3
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|accessdate=2024-01-08
 +
}}
 +
 +
Professor Flechsig published numerous books, articles, and other publications in German on a wide variety of subjects. In accordance with IntactiWiki policy they will not be listed here.
 +
 +
==Flechsig's views are disproved==
 +
 +
It was not until a century later that medical science started to question his views. Talbert et al. (1976) measured the rise in cortisol and cortisone in [[circumcised]] infants and found an increase in "stress".<ref>{{REFjournal
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|last=Talbert
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|first=
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|init=LM
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|author-link=
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|last2=Kraybill
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|first2=
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|init2=EN
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|author2-link=
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|last3=Potter
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|first3=
 +
|init3=HN
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|author3-link=
 +
|etal=no
 +
|title=Adrenal Cortical Response to Circumcision in the Neonate
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|journal=Obstet Gynecol
 +
|date=1976
 +
|volume=46
 +
|issue=2
 +
|pages=208-10
 +
|url=https://www.cirp.org/library/pain/talbert/
 +
|archived=
 +
|quote=
 +
|pubmedID=940653
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|pubmedCID=
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|accessdate=2024-01-07
 +
}}</ref> Gunnar et al. (1981) also examined serum cortisol and behavior after neonatal [[circumcision]]. They reported "striking increases in serum cortisol concentrations" after unanesthetized non-therapeutic [[circumcision]].<ref name="gunnar1981">{{REFjournal
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|last=Gunnar
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|first=
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|init=MR
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|author-link=
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|last2=Fisch
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|first2=
 +
|init2=RO
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|author2-link=
 +
|last3=Korsvik
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|first3=
 +
|init3=S
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|author3-link=
 +
|last4=Donhowe
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|first4=
 +
|init4=M
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|author4-link=
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|etal=no
 +
|title=The effects of circumcision on serum cortisol and behavior
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|journal=Psychoneuroendocrinology
 +
|location=
 +
|date=1981
 +
|volume=6
 +
|issue=3
 +
|pages=279-75
 +
|url=https://www.cirp.org/library/pain/gunnar/
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|archived=
 +
|quote=
 +
|pubmedID=7291435
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|DOI=10.1016/0306-4530(81)90037-8
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|accessdate=2024-01-07
 +
}}</ref>
 +
 +
[[Kanwaljeet J. Singh Anand| Anand]] & Hickey (1987) published a magisterial article in the ''New England Journal of Medicine'' that conclusively settled the issue. The authors stated:
 +
 +
<blockquote>
 +
Numerous lines of evidence suggest that even in the human fetus, pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns.<ref>{{REFjournal
 +
|last=Anand
 +
|init=KJS
 +
|author-link=Kanwaljeet J. Singh Anand
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|last2=Hickey
 +
|init2=PR
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|author2-link=
 +
|etal=no
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|title=Pain and its effects in the human neonate and fetus
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|journal=N Engl J Med
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|location=
 +
|date=1987-11-19
 +
|volume=317
 +
|issue=21
 +
|pages=1321-9
 +
|url=http://www.cirp.org/library/pain/anand/
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|archived=
 +
|quote=
 +
|pubmedID=3317037
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|pubmedCID=
 +
|DOI=10.1056/NEJM198711193172105
 +
|accessdate=2024-01-07
 
}}</ref>
 
}}</ref>
 +
</blockquote>
 +
 +
==Conclusion==
 +
Flechsig's error condemned millions of infant girls and boys undergoing surgery to acute [[pain]], [[trauma]], and [[shock]] for over a century and that practice is still ongoing today. For example, open heart surgery on infants was done without anesthesia until 1987.<ref>{{REFweb
 +
|url=https://www.newsweek.com/when-doctors-start-using-anesthesia-babies-medics-thought-they-couldnt-feel-pain-1625350
 +
|title=When Did Doctors Start Using Anesthesia on Babies? Medics Thought They Couldn't Feel Pain
 +
|last=Lea
 +
|first=Robert
 +
|init=R
 +
|publisher=Newsweek
 +
|date=2021-09-02
 +
|accessdate=2023-01-07
 +
}}</ref> The [[AAP]] belatedly acknowledged the need for anesthesia in 1987.<ref>{{REFjournal
 +
|last=Committee on Fetus and Newborn
 +
|last2=Committee on Drugs
 +
|last3=Section on Anesthesiology
 +
|last4=Section on Surgery
 +
|etal=no
 +
|title=Neonatal anesthesia
 +
|journal=Pediatrics
 +
|date=1987
 +
|volume=80
 +
|issue=3
 +
|page=446
 +
|url=https://www.cirp.org/library/pain/aap/
 +
|quote=There is also increasing evidence that neonatal cortical function is far greater than previously thought and some suggestion that short-term behavior may be affected by prior painful stimuli.
 +
|pubmedID=3627897
 +
|accessdate=2024-01-07
 +
}}</ref> Boys may have suffered more than girls because of the practice of non-therapeutic neonatal [[circumcision]], including the after effects of [[PTSD]] and behavior changes.<ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>
  
 
{{LINKS}}
 
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  |url=https://www.uniklinikum-leipzig.de/einrichtungen/pfi
 
  |url=https://www.uniklinikum-leipzig.de/einrichtungen/pfi
 
  |title=Paul-Flechsig-Institut – Zentrum für Neuropathologie und Hirnforschung
 
  |title=Paul-Flechsig-Institut – Zentrum für Neuropathologie und Hirnforschung
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  |url=http://www.whonamedit.com/doctor.cfm/3146.html
 
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{{REF}}
 
{{REF}}
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{{DEFAULTSORT:Flechsig, Paul Emil}}
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[[Category:Person]]
 
[[Category:Person]]
 
[[Category:Male]]
 
[[Category:Male]]
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[[Category:Deceased]]
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[[Category:Physician]]
 
[[Category:Physician]]
 
[[Category:Psychiatrist]]
 
[[Category:Psychiatrist]]
 
[[Category:Author]]
 
[[Category:Author]]
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[[Category:Pain]]
 
[[Category:Pain]]
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[[Category:Trauma]]
  
 
[[Category:Germany]]
 
[[Category:Germany]]

Latest revision as of 17:25, 17 January 2024

Flechsig in 1906

Paul Emil Flechsig (29 June 1847 in Zwickau, Kingdom of Saxony – 22 July 1929 in Leipzig, Germany) was an eminent nineteenth-century German neuroanatomist and neuropathologist.

Professor Flechsig had an interest in myelinogenesis — the development of the myelin sheaths for nerves.[1] The myelin acts as an insulator to allow the electrical impulses to travel through the nerves.[1]

Flechsig (1872) observed that the myelin sheath is not yet formed in newborn babies,[2] which he reported in 1876.[3] Unfortunately, he came to the unfounded conclusion that the newborn cannot feel pain.[4] So great was his reputation and influence that his views were accepted without question, even though empirical studies had not been carried out. As a result, surgical operations have been carried out on infants without pain medication for more than 100 years.

Publications

Professor Flechsig published numerous books, articles, and other publications in German on a wide variety of subjects. In accordance with IntactiWiki policy they will not be listed here.

Flechsig's views are disproved

It was not until a century later that medical science started to question his views. Talbert et al. (1976) measured the rise in cortisol and cortisone in circumcised infants and found an increase in "stress".[5] Gunnar et al. (1981) also examined serum cortisol and behavior after neonatal circumcision. They reported "striking increases in serum cortisol concentrations" after unanesthetized non-therapeutic circumcision.[6]

Anand & Hickey (1987) published a magisterial article in the New England Journal of Medicine that conclusively settled the issue. The authors stated:

Numerous lines of evidence suggest that even in the human fetus, pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns.[7]

Conclusion

Flechsig's error condemned millions of infant girls and boys undergoing surgery to acute pain, trauma, and shock for over a century and that practice is still ongoing today. For example, open heart surgery on infants was done without anesthesia until 1987.[8] The AAP belatedly acknowledged the need for anesthesia in 1987.[9] Boys may have suffered more than girls because of the practice of non-therapeutic neonatal circumcision, including the after effects of PTSD and behavior changes.[10]

External links

References

  1. ↑ a b REFweb Myelinogenesis, Wikipedia. Retrieved 7 January 2024.
  2. ↑ REFjournal Flechsig PE. Developmental (Myelogenetic) Localisation of the Cerebral Cortex in the Human Subject. Lancet. 19 October 1901; : 1027-9. Retrieved 7 January 2204.
  3. ↑ REFbook Flechsig PE (1876): Die Leitungsbahnen im Gehirn und Rückenmark des Menschen auf Grund entwicklungsgeschichtlicher Untersuchungen. [The pathways in the human brain and spinal cord based on developmental studies] (German). Leipzig Retrieved 12 January 2024.
  4. ↑ REFjournal Cope DK. Neonatal pain: The evolution of an idea.. The American Association of Anesthesiologists Newsletter. September 1998; Retrieved 6 January 2024.
  5. ↑ REFjournal Talbert LM, Kraybill EN, Potter HN. Adrenal Cortical Response to Circumcision in the Neonate. Obstet Gynecol. 1976; 46(2): 208-10. PMID. Retrieved 7 January 2024.
  6. ↑ REFjournal Gunnar MR, Fisch RO, Korsvik S, Donhowe M. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology. 1981; 6(3): 279-75. PMID. DOI. Retrieved 7 January 2024.
  7. ↑ REFjournal Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med. 19 November 1987; 317(21): 1321-9. PMID. DOI. Retrieved 7 January 2024.
  8. ↑ REFweb Lea R (2 September 2021). When Did Doctors Start Using Anesthesia on Babies? Medics Thought They Couldn't Feel Pain, Newsweek. Retrieved 7 January 2023.
  9. ↑ REFjournal Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery. Neonatal anesthesia. Pediatrics. 1987; 80(3): 446. PMID. Retrieved 7 January 2024.
    Quote: There is also increasing evidence that neonatal cortical function is far greater than previously thought and some suggestion that short-term behavior may be affected by prior painful stimuli.
  10. ↑ REFjournal Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1 March 1997; 349: 599-603. PMC. DOI. Retrieved 15 November 2022.
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