How does one's knowledge of pain affect the physical "being" of pain? Following German idealist philosophy, unconsciousness to such knowledge would seemingly abdicate the very nature of pain. "Nothing exists but thoughts!--the universe is composed of impressions, ideas, pleasures, and pains!" Humphry Davy exclaimed upon leaping out of the laughing gas chamber where he had breathed some 100 quarts of nitrous oxide. The discovery of nitrous oxide gas as an agent of transubstantiation led to the discovery of the medical science of anesthesia by a genius, but backcountry physician, Dr. Crawford Long in 1841. This paper presupposes that the Romantically introspective effects of diethyl ether inhalation led Dr. Long to yearn melancholically for his lover and underestimate his momentous discovery, as the physical abdication of pain could not quench the doctor's subliminal anguish. Within is an account of the arcane nature of one of medicine and history's most significant discoveries, one wrought out of intelligence and the wondrous curiosity of the Romantic period.
A. H. “Buddy” Giesecke Jr, MD, is an important figure in the history of the Department of Anesthesiology and Pain Management at the University Southwestern Medical Center and at Parkland Memorial Hospital in Dallas (Figure 1). He studied anesthesiology and later practiced there, where he worked closely with other renowned anesthesiologists, including M.T. “Pepper” Jenkins. Dr. Giesecke’s articles on endotracheal intubation in obstetrics and the interaction between succinylcholine and magnesium produced change in the practice of anesthesia. In his later years, he became interested in the history of anesthesia and was very active in the Anesthesia History Association. His passion for the specialty was evident in the way he spoke about anesthesia. Hear his words, and perhaps even his voice, in the interview below. school, I did my internship at William Beaumont Army Hospital in El Paso. I went into the army because the pay was better, and we were extremely poor. I went through medical school on $200 a month.
INTRODUCTION:Anesthesia historians believe they have difficulty in getting their work published in peer reviewed journals devoted to anesthesiology. To test the hypothesis of whether such publication bias exists, we conducted a review of all articles published in six journals.METHODS:We examined all articles published between January 2001 and December 2010. In order to enable comparison among journals, articles were categorized as major or minor. We also examined whether there were trends in publication over this period.RESULTS:During this 10-year period, 30,600 articles were published in these journals (range, 2573 to 8563 articles). Of all articles published, only 382 (1.25%, range, 0.41% to 2.87%) were related to the history of anesthesia. The proportion of all articles related to history showed a significant difference with time (P<.001), primarily from differences in minor articles (P<.001). Analysis of the number of history-related articles published shows no obvious difference over the 10-year period (P=.25), but a significant difference among journals (P=.005). For major articles, there was a significant effect with time (P=.046) and journal (P<.001). Minor articles revealed no significant effect with time (P=.15), but significant differences among journals (P=.02).CONCLUSIONS:Our analysis of 30,600 articles published in six mainstream journals devoted to anesthesiology found that considerable differences exist in the proportion and number of articles that were related to history of anesthesia.
Editor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a primer on the history of medicine and anesthesia history. The goals of this primer are to educate and to help individuals target future study. Below is the second article in a continuing series.
Because daguerreotype photographs are usually reversed laterally from actuality, images of W.T.G. Morton falsely suggest that he sometimes changed the side of the part in his hair. Because of daguerreotype image reversal, a statue of Apollo in the Ether Dome at the Massachusetts General Hospital appears to have been moved for the 50th anniversary of Ether Day.
In this issue of the Bulletin, Mulita and colleagues1 present a 10-year analysis of publication trends for articles about anesthesia history. They conclude that the publication of history articles is “low” at 1.25% of all articles. Even this frequency is inflated. Subtracting the “Cover Notes” of Anaesthesia and Intensive Care and the “Reflections” in Anesthesiology leaves a more indicative estimate of about 0.7%. To be sure, there are legitimate concerns about this article: the absence of factoring in the number of submissions; the lack of comparison to other specialties; and the role of authors’ perceptions of the ability to get published. But these concerns do not outweigh the need to discuss the conclusions. How legitimate is the value judgment that mainstream journals publish too few history articles? That depends on the mission. While missions of journals vary, the British Medical Journal provides a good summary: “Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. We aim to help doctors to make better decisions.”2 All the while, among other matters, editors must keep an eye on the influential impact factor, which reflects the number of citations of the journal’s articles. The American football coach Bill Parcells quipped, “You are what your record says you are,” in response to teams claiming that they were better than their won-lost records indicated. According to Parcells, the number of history articles published is the correct number of articles for those journals. I agree. The characteristics of published history articles reflect in large part the cachectic academic discipline of anesthesia history in the United States. Reversing this state requires a robust academic home. Without a home, young academics struggle to develop careers, senior academics do not receive proper credit within the anesthesiology community, and the anesthesia history community withers. Successful academic homes have meaningful journals. A respected Bulletin of Anesthesia History will provide a home for aspiring authors to hone their skills and gain academic credibility. It will spur interest in history, which will increase publications in mainstream journals. The right Bulletin will undergird a credible, self-sustaining academic discipline. The progenitor of the Bulletin, the Anesthesia History Association Newsletter, was started in 1982 by the first editor, Selma H. Calmes, MD. Dr. Calmes was followed by C. Ron Stephen, MD, and who later passed the pen to my immediate predecessor, Doris K. Cope, MD. These editors (with unflagging support from many others, including Roderick K. Calverley, MD, and A. J. Wright, MLS) brought the Bulletin from a “cut-and-paste” kitchen-table newsletter to being recognized within the history community as the United States journal for anesthesia history. The next step is to move that recognition into the mainstream academic community. To do so requires investments that are neither simple nor risk-free. So I am asking readers to weigh in. What should the Bulletin be? Whom should it serve? Most importantly, do we want to take that next step? I invite your thoughts.
William Thomas Green Morton, the man most commonly associated with the introduction of anesthesia in 1846, fathered William James Morton. William James Morton's contributions to society were substantial. He conducted pioneering work in radiology, radiation oncology, and therapeutic electricity. He authored numerous textbooks and articles, and he was an editor of a journal on human behavior. His expertise on diamond mining led to an error in judgment that resulted in a felony conviction. We examine his career and contributions to society, and consider his career in light of his father, William Thomas Green Morton.
Success with the medical management of pain grew tremendously after William Thomas Green Morton's successful demonstration of surgical anesthesia in 1846: Henry K. Beecher's clinical and experimental contributions to anesthesia during and after World War II had a profound impact on how clinicians and experimentalists study human populations in medicine. Beecher found that pain research required human subjects because pain was different for each individual. Nearly 100 years before Beecher, Claude Bernard similarly considered the complexity and uniqueness of human research subjects. Bernard and Beecher both preferred animal subjects in research when appropriate, but suggested that studies involving some mental, bodily, and cognitive processes required human subjects. Although Beecher and Bernard's lives did not overlap, these two men similarly confronted the issues of complexity in human and animal research, particularly in those phenomena involving higher cognitive functions.
Lucien E. Morris, inventor of the Copper Kettle, the first precision anesthetic vaporizer, died peacefully at his home in Seattle, Washington, on November 15, 2011, two weeks before his 97th birthday. He was one of four remaining Aqualumni, the doctors who trained with Dr. Ralph Waters at the University of Wisconsin. His life epitomized Waters’ admonition “to teach doctors to go out and teach other doctors” the medical specialty of anesthesiology. Lucien was born November 30, 1914, at his maternal grandparents’ home in Mattoon, Illinois.1 Lucien’s father was a Harvard-trained biochemist teaching at his first post-graduate appointment in the medical school at Washington University in St. Louis. In 1918, he was appointed Head of Biochemistry at the Western Reserve University School of Medicine. Lucien’s sister, Marcia, was born when he was six years old and added to his memories of a happy early childhood. Family vacations were to northern Canada, planned to ease Lucien’s seasonal hay fever. This established a pattern that Lucien would follow in his young adult years. Tragedy struck when Lucien’s father was diagnosed with pulmonary tuberculosis, the most common cause of mortality at the time. This necessitated a sanitarium stay at Saranac Lake, New York, that separated him from the family in 1925. He died a year later following a pulmonary lobectomy, never having returned home. Lucien, at age 11, became the last male in the Morris line. The family remained in their Cleveland Heights home with help from Lucien’s paternal grandmother who provided a modest monthly stipend that sustained them through the Great Depression. Lucien was a good student with an interest in the sciences, and he found ways to keep himself in spending money through his hobbies, notably stamp collecting and photography. In high school he discovered fencing, a sport that would come to figure prominently in providing his future education. The family was able to continue to vacation in Canada, where Lucien’s interest in camping and canoeing was nurtured. After graduating from high school in 1932, Lucien matriculated at Oberlin College, a small undergraduate institution near Cleveland with a reputation for academic excellence (Figure 1). Lucien pursued a degree in chemistry. He worked in food service, a “board job,” first washing dishes and then as a waiter in a women’s dorm dining hall. He joined the fencing club and in addition to honing his skill as a competitive fencer, he became the spokesman and manager of the team and convinced Oberlin’s athletic department to make fencing an intercollegiate sport. With a degree in chemistry, Lucien chose to follow in his father’s footsteps with graduate studies in biochemistry. He secured a position at Western Reserve University that included a teaching fellowship. As a laboratory instructor for medical and dental students, he received free tuition and a stipend of $65 a month. Wishing to stay physically active, Lucien investigated practicing with the neighboring Case Institute of Technology fencing team and discovered they were in need of coach. He served as the volunteer head coach for the next seven years. The team developed sufficiently to win five of eleven competitions against Big Ten schools between 1941 and 1943. Part of Lucien’s own curriculum included medical school courses. He wanted to understand what his students, as future practitioners, needed to know about biochemistry to make his teaching more relevant. Lucien decided to take the full medical course of study. He was able to maintain his teaching fellowship in biochemistry, but soon recognized that obtaining a medical degree would enhance his future opportunities. In 1939, Lucien met a young Canadian woman studying Public Health Nutrition, Jean Pinder, who was taking biochemistry with the dental students. Their friendship blossomed. They were engaged in the spring of 1941 and married in June of 1942 (Figure Fig. 1. Lucien Morris, probably at the time of his graduation from Oberlin College in 1936. Photo courtesy of Don Morris from the Oberlin College Archives. 2). Jean had completed her master’s degree, and Lucien was beginning his senior year of medical school. Due to the war and the need for doctors, the medical curriculum was accelerated and vacations and holidays were cancelled. Lucien’s medical program became full time with no time for his teaching fellowship. That in turn meant that his stipend and tuition-free education ended. Jean’s job as an assistant nutritionist for the City of Cleveland provided a salary that was insufficient for the last year of medical school tuition. Lucien shared his difficult financial situation with the Athletic Director at Case, who made arrangements to pay the last year of tuition. With the addition of other part-time work, including guiding a previously scheduled canoe trip to the Temagami Lake district of Canada, Lucien was able to complete the year. Because of the wartime expedited schedule, Lucien was graduated in February 1943. In April, Lucien began his internship at Grasslands Hospital in Valhalla, New York. By coincidence, the superintendent of the hospital had been a biochemistry student of Lucien’s father and was helpful in providing married living quarters and facilitating a job for Jean. While Lucien had seen surgery and
The field of anesthesiology has changed dramatically from its humble beginnings. Rags of ether and the art of monitoring blood color for oxygenation have been replaced with precise concentrations of inhaled anesthetic and continuous pulse oximetry. It is on the shoulders of our predecessors that we stand today as anesthesiologists. We must constantly evolve to adapt to an ever-changing medical profession. It is this spirit and mind-set that will allow the field of anesthesiology to continue to advance and improve the care of our patients.
Many clinicians have made significant contributions to medical knowledge and practice; few have a procedure, a syndrome, a sign, an instrument, or other term named after them.1,2 Every medical specialty has common eponyms, and anesthesiology is no exception. In an earlier report, we examined the careers of six eponymous European physicians—Sydney Ringer (1835-1910), Friedrich Trendelenburg (1844-1924), August Karl Bier (1861-1949), Sir Ivan Whiteside Magill (1888-1986), Sir Robert Macintosh (1897-1990), and Brian Arthur Sellick (1918-1996).3 From the scores of individuals who have advanced our knowledge of anaesthesia and laid the foundations of our specialty,4 we have selected a few names that are used very commonly in operating rooms in the United States. We examine the lives and careers of these individuals to explore the circumstances that led to their contributions. We also comment on how and why their achievements continue to play such an important role in the daily practice of clinical anesthesiology the world over.
