Anaesthesia
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The Reverend Doctor Robert Laws (1851-1934) followed in the footsteps of David Livingstone to Central Africa. At the beginning of a long and distinguished career as a medical missionary in Christian service to the country that has since become the Republic of Malawi, he was a prime mover in the setting up of a mission station at Cape Maclear, on the shores of Lake Malawi (formerly known as Lake Nyasa and closely associated with the discoveries of Doctor Livingstone). There, on 2 March 1876, Laws used chloroform to produce surgical anaesthesia when he operated on a young African male who had a cystic tumour above his left eye.
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Assessment of pain on injection of the emulsified formulation of di-isopropylphenol (propofol, 'Diprivan') was undertaken in 120 unpremedicated patients and comparison made with thiopentone. A high incidence of pain (37.5%) was found using dorsal hand veins, but use of forearm veins showed only a 2.5% incidence of pain. The use of intravenous lignocaine immediately before propofol injection only partially reduced the incidence of pain using dorsal hand veins (17.5%). A degree of cardiorespiratory depression accompanied induction but the incidence of other side effects was low.