Paul Emil Flechsig
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Paul Emil Flechsig (29 June 1847 in Zwickau – 22 July 1929 in Leipzig, Germany) was an eminent nineteenth-century German neuroanatomist, psychiatrist 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] so he came to the unfounded conclusion that the newborn cannot feel pain.[3] So great was his reputation and influence that his views were accepted without question, even though empirical studies had not been carried out. Surgical operations were carried out on infants without pain medication.
Flechsig's views are disproved
It was not until a century 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".[4] Gunnar et al. (1981) also examined serum cortisol and behavior after neonatal circumcision. They reported "striking increases in serum cortisol concentrations" after unanesthetized circumcision.[5]
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.[6]
Conclusion
Flechsig's error condemned millions of infant girls and boys to acute pain, trauma and shock for more than a century and still persists today. Open heart surgery on infants was done without anesthesia until 1987.[7] The AAP belatedly acknowledged the need for anesthesia in 1987.[8] Boys may have suffered more than girls because of the practice of non-therapeutic neonatal circumcision, including the after effects of behavior changes[9] and PTSD.
External links
Paul Flechsig
, Wikipedia. Retrieved 7 January 2024.-
Paul-Flechsig-Institut – Zentrum für Neuropathologie und Hirnforschung
, University of Leipzig. Retrieved 7 January 2024. -
Paul Flechsig
, Who Named It. Retrieved 7 January 2024.
References
- ↑ a b
Myelinogenesis
, Wikipedia. Retrieved 7 January 2024. - ↑
Flechsig P. Developmental (Myelogenetic) Localisation of the Cerebral Cortex in the Human Subject. Lancet. 19 October 1901; : 1027-9. Retrieved 7 January 2204.
- ↑ Cope DK. Neonatal pain: The evolution of an idea.. The American Association of Anesthesiologists Newsletter. September 1998; Retrieved 6 January 2024.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ (2 September 2021).
When Did Doctors Start Using Anesthesia on Babies? Medics Thought They Couldn't Feel Pain
, Newsweek. Retrieved 7 January 2023. - ↑ Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery. Neonatal anesthesia. Pediatrics. 1987; 80(3): 446. Retrieved 7 January 2024.
- ↑ 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.
