Hello Everyone,
Last night I was reading a book on the medical services of World War II, covering everything from the frontline medics to the rear hospitals. One thing that struck me was the mention of only one pain killer used for the troops, that being morphine.
Today, there are so many pain killers available everything from Vicodin all the way to Demerol. I was just wondering how limited were doctors in World War I and II when it came to pain relief? Was morphine the only true course of action they had? I realize that asprin existed, but would be totally ineffective on serious wounds that caused massive pain. The biggest problem I see with something like morphine is that once given to a wounded soldier in the field he becomes pretty much useless for he is in a state of being drugged up. Did the medics in the field have any other options?
Vicodin is a combination of hydrocodone and acetaminophen. Both hydrocodone and Demerol are opioids. Neither of these helps to maintain a soldier’s ability to fight.
I think that the sentiment was that if you were still capable of fighting, then you were capable of fighting through the pain. An example that comes to mind is Lieutenant Colonel Benjamin Vandervoordt, who broke his ankle on a parachute drop into Normandy on the night before D-Day. After being seen by a medic, he decided to tighten the laces on his boot and carry on (not that he had much of a choice given the circumstances.)
I assume that the medic still had a fully supplied kit, and that morphine was the only pain relief in the kit.
If he is wounded seriously enough to warrant morphine, he is useless anyway. I am sure they did not give morphine for minor scrapes and bruises; our forebears just toughed out most pain.
Thinking about it, you may be asking two questions: were there other options for treating pain in the first half of the 20th Century, and were these options viable options for keeping soldiers deployed? I don’t know the pharmacology, but I suspect that most of the meds that they had at the time made people less alert and wouldn’t be an effective solution for soldiers.
Thanks for the reply. Actually I wasn’t thinking in terms of being an effective fighter. A serious wound would put about anyone out of the fight. I guess I meant more to the point that they wouldn’t be able to help themselves. Ie: walk to the rear or be aware of what is happening around them. Most injectible drugs have the effect of putting someone in another world.
Also, I suspect morphine was the only drug availble to the medics. That would stand to reason that someone with a less serious wound, but one that still caused a good amount of pain, would only have morphine to help him. As stated above, the morphine “cloud” he would be left him would not only bar him from the fight, but possibly make him unable to function enough to keep himself safe.
In 1900, drugs used for treatment of pain included morphine (an opioid), acetaminophen (commonly known as tylenol) and aspirin (a non-steroidal anti-inflammatory drug.)
Today, the most commonly used drugs for pain are opioids (including morphine), acetaminophen, and non-steroidal anti-inflammatory drugs like aspirin.
So what’s new in the last hundred years? Lots of tweaking of molecules in the opioid and NSAID classes to try to make them better (and a bit safer), and the general acceptance of acetaminophen in the US also occurred in the 1950’s, but IMHO there’s been no widespread fundamental change in drugs for pain in the past century.
Morphine is still one of the most effective opioid drugs out there for pain relief. Oxycodone has not been demonstrated to be superior, nor has fentanyl, nor as dilaudin or demerol. Just variations on a theme…
As a sidebar, one of the interesting things I learned about disaster nursing was about writing ON the patient pertinent medical information. Using a Sharpie, M meant this person has been looked at, T meant tourniquet, 4 mg meant patient had been given 4mg morphine followed by time and date, x was dead or dying (no hope, don’t waste time here) that’s all I remember right now, it was a chilling topic. Morphine was pretty much the only drug talked about, if one is genuinely allergic to morphine, one might be SOL in a disaster.
Interesting information about the coded symbols written on patients. I have always wondered about the above point your make. While I am on oral morphine for chronic pain and it works well, when I awoke from surgery they had me on IV administered morphine and it didn’t work. I might as well have been given a placebo. Thankfully the docs switched me to Demoral and that took care of the pain (if you ever want to know what ultimate pain feels like, try waking up after having your back sliced open and screws placed into your spine and having essentially no pain killers administered. Wow, that was a living hell). I always wondered what about those poor souls who have no reaction like myself to morphine or were allergic. I guess they were SOL.
You’re the doctor, but according to Wiki Paracetamol - Wikipedia acetomenaphen, under the name paracetamol, although first tried in 1887, was originally discarded (for possible side-effects) until restudied in 1947 and found superior to aspirin in certain applications (especially to children) and first appeared in the US market in 1953. Certainly I had never heard of tylenol when I was growing up so that accords with my memory too.
Apologies, but I’ve been wanting to see if anyone knows the answer to my question (below) and this seems a good place to ask it (it doesn’t merit it’s own thread). And, I really am hoping the amazingly-medically-eclectic Qad will know (and, since he’s following this thread, well. . .)
In the 1980’s, we used a commercial preparation that I seem to recall was a mixture of various opiates. For the life of me, I can’t recall its name (although I think the dose was 15 to 30 mg, although I could well be wrong about that).
FWIW, when I try to remember the name of this commercially prepared mixture, I see the letter ‘m’ in it, near the end I think. There may be a ‘u’ in front of it, or nearby. And, I don’t mean laudanum!