Original Contributions of Latin-Ameri- cans to Anesthesia

A H A
VOLUME 20, NUMBER 2
Original Contributions of Latin-Americans
to Anesthesia
By J. Antonio Aldrete, M.D., M.S.
Clinical Professor, Department of Anesthesiology, University of South Florida,
Tampa, FL and Aldrete Pain Care Center, Chipley, FL
and
Carlos P. Parsloe, M.D.
Former President World Federation of Societies of Anesthesiologists,
Hospital Samaritano, São Paulo, Brasil
APRIL, 2002
Most Chapters in text books of Anesthesia
dealing with the history of this
specialty include the same events told in a
different manner with certain emphasis on
certain regions of the world, the country on
which language the book is written and/
or the special subject of interest to the author.
Since most books in Anesthesia have
been written in the English language, by
English speaking authors, there has been
a certain tendency to have certain origins
of this specialty emphasized; after all the
first anesthetics were given in Georgia and
Massachusetts 1,2 , followed by its application
and ample promotion in the United Kingdom
as John Snow administered ether and
chloroform within a month. 3
Nevertheless, there is a considerable
number of important and original contributions
made by non-English speaking
authors dispersed among the non-English
medical literature that deserves recognition,
debate and consideration as to the role they
might have had on the advancement of this
our beloved Specialty. With this preamble,
we would like to describe some events that
merit acknowledgement not only because
they were innovations at the time, but also
because some of them were conducted under
hardship, the participants had limited
economical resources and little technological
support but that also suggests that the
protagonists had a great deal of ingenuity,
courage, clear thinking and perseverance.
Specifically, these events were carried on by
colleagues from Latin American countries,
most of their deeds were published in nonindexed
journals and therefore many of
them were forgotten or ignored.
First Anesthetics in a War
An important historical event needs mentioning
as a point of clarification since prior
to its finding it was thought that the first
anesthetic in a war conflict was administered
in the Crimean War in 1854. 4 Nevertheless,
historical data revealed otherwise. When
WGT Morton administered in Boston the
first public ether anesthetic on October 16,
1846 1 , the United States and the Republic
of Mexico were engaged in a war initiated
about seven months earlier by the separation
of Texas from the latter and its recent
admission as a State into the former. Soon
thereafter Morton offered to train military
surgeons on etherisation. On the other hand,
once the news of the first successful ether
application was known, a military surgeon
in semiretirement in New Orleans, Dr. Edward
H. Barton (Figure 1) proposed to the
War Department the possible application of
ether in the battle field and requested full
reinstatement; by December President Polk
had approved the request so Barton would
receive instruction on the use of Letheon and
could then administer it to injured soldiers.
Since the land campaign commanded by
General Zachary Taylor, through Texas, and
northern Mexico appeared to be slow and
costly in supplies and casualties as demonstrated
from the fierce battles of Palo Alto,
Resaca de la Palma, Buena Vista (Angostura)
and Monterrey, President Polk and the War
Department agreed that General Winfield
Scott would initiate what appeared to be a
shorter campaign by landing in Vera Cruz
and advancing toward the capital.
On February of 1847, Barton was sent by
Figure 1: Military surgeon Edward H.
Barton commissioned by the U.S. War
Department to use Letheon on injured soldiers
undergoing surgery.
way of La Havana, to join the fleet blockading
the central part of the Mexican Gulf
under Scott’s command. On early March,
the first American troops landed south of
the port and entered Vera Cruz after running
into mild resistance. In the process of
disembarking, a German porter recently
recruited, was accidentally shot in his legs
when a musket discharged spontaneously
while he was unloading a wagon. After attempts
to save the porter’s legs failed,
Continued on page 4

2 BULLETIN OF ANESTHESIA HISTORY
Anesthesia Foundation
Book/Multimedia Education Award
The Anesthesia Foundation announces the Book/Multimedia Education Award to be presented 2003 at the American Society
of Anesthesiologists Annual Meeting.
This prestigious award will be awarded tri-yearly for excellence and innovation in books or multimedia with significant impact
on the science and practice of anesthesiology, critical care, or pain medicine. Multiple authors are eligible with the stipend being
divided between the first and senior authors.
The award is $10,000, plus expenses for winners and guests to attend the Academy of Anesthesiology 2004 Spring meeting in
Victoria Island, Canada.
Deadline for receipt of contributions is November 15, 2002.
For further information and specific criterion please contact:
Doris K. Cope, M.D.
UPMC St. Margaret Pain Medicine Center
200 Delafield Avenue, Suite 2070
Pittsburgh, PA 15215
412-784-5343 (phone)
412-784-5350 (fax)
Anesthesia History Association
Sixth Annual Resident Essay Contest
The Anesthesia History Association (AHA) sponsors an annual Resident Essay Contest with the prize presented at
the ASA Annual Meeting.
A 1,500-3,000-word essay related to the history of anesthesia, pain management or critical care should be submitted to:
William D. Hammonds, M.D., M.P.H.
Chair, AHA Resident Essay Contest
University of Iowa
School of Medicine
Dept. of Anesthesia
200 Hawkins Drive, 6 JCP
Iowa City, IA 52242-1079
U.S.A.
The entrant must have written the essay either during his/her residency or within one year of completion of residency.
Residents/Fellows in any nation are eligible, but the essay MUST be submitted in English. All submissions
must be typewritten.
An honorarium of $500.00 and a certificate will be awarded at the AHA’s annual dinner meeting at the ASA.
The award-winning residents will be invited to present their essays in person at the annual spring meeting of the
AHA and their work will be published in the Bulletin of Anesthesia History.
All entries must be received on or before August 15, 2002.

BULLETIN OF ANESTHESIA HISTORY 3
Letter to the Editor
Dear Dr. Cope:
Recently I received from a friend anesthesiologist, a donation for the Museum
of the History of Anesthesiology of Puerto Rico and the Caribbean two interesting
articles:
1. A Squibb ether can (see photo). Used many years ago for administering open
drop ether anesthesia. It is unopened and still full of ether.
2) An interesting device I had not seen before or read about. It looks and could
be a precursor of the presently used LMA Device.
Perhaps the photo enclosed if published in the Newsletter requesting readers to
send any information or reference they might have concerning its inventor and use
might be obtained from them.
Looking forward to meeting you again, with my best wishes.
Cordially yours,
Miguel Colon-Morales, M.D.
Bulletin of Anesthesia History (ISSN 1522-
8649) is published four times a year as a joint
effort of the Anesthesia History Association and
the Wood-Library Museum of Anesthesiology.
The Bulletin was published as Anesthesia History
Association Newsletter through Vol. 13, No. 3,
July 1995.
The Bulletin, formerly indexed in Histline, is
now indexed in several databases maintained by
the U.S. National Library of Medicine as follows:
1. Monographs: Old citations to historical
monographs (including books, audiovisuals,
serials, book chapters, and meeting papers) are
now in LOCATORplus (http://locatorplus.gov),
NLM’s web-based online public access catalog,
where they may be searched separately from now
on, along with newly created citations.
2. Journal Articles: Old citations to journals
have been moved to PubMed (http://www.
ncbi.nlm.nih.gov/PubMed), NLM’s web-based
retrieval system, where they may be searched
separately along with newly created citations.
3. Integrated History Searches: NLM has online
citations to both types of historical literature
-- journal articles as well as monographs -- again
accessible through a single search location, The
Gateway (http://gateway.nlm.nih.gov).
C.R. Stephen, MD, Senior Editor
Doris K. Cope, MD, Editor
Donald Caton, MD, Associate Editor
A.J. Wright, MLS, Associate Editor
Fred Spielman, MD, Associate Editor
Douglas Bacon, MD, Associate Editor
Peter McDermott, MD, Book Review Editor
Deborah Bloomberg, Editorial Staff
Editorial, Reprint, and Circulation matters
should be addressed to:
Editor
Bulletin of Anesthesia History
200 Delafield Avenue, Suite 2070
Pittsburgh, PA 15215 U.S.A.
Telephone (412) 784-5343
Fax (412) 784-5350
bloombergdj@anes.upmc.edu
Manuscripts may be submitted on disk using
Word for Windows or other PC text program.
Please save files in RICH TEXT FORMAT (.rtf)
if possible and submit a hard copy printout in
addition to the disk. All illustrations/photos
MUST be submitted as original hard copy, not
electronically. Photographs should be original
glossy prints, NOT photocopies, laser prints or
slides. Photocopies of line drawings or other
artwork are NOT acceptable for publication.

4 BULLETIN OF ANESTHESIA HISTORY
Contributions. . .Continued from page 1
it was decided to amputate both. It was
reported that in spite of the surgeon’s skills
and expediency, the porter screamed, cried
and swore throughout the first amputation
so the second was postponed. On the next
day, the 29th of March, Barton assisted by
military surgeons Drs. Harney, Porter and
Laub, proceeded to administer the first anesthetic
in a war according to the technique
he had been instructed on with an inhaler
similar to the one Morton used in Boston six
months earlier. It was noted that the porter
slept through the whole operation, “without
moving one muscle” under the effects of
Letheon and woke up cheerful and without
a complaint at the end of it. 5
John Porter wrote a treatise on military
medicine 6 at the end of the war, since he
apparently acquired more experience with
ether during the remaining of the War his
comments were not encouraging since he
stated that anesthesia was dangerous and
unnecessary in injured soldiers who were
expected to tolerate the pain and suffering of
these brief procedures. He reported several
near lethal experiences in injured hypovolemic
soldiers probably from overdose as
ether would vaporize more readily in warm
Vera Cruz in the Spring and in the Summer
of 1847 in the Mexican altiplano at 7400
feet high, than at sea level in Boston, in the
Winter of 1846. 5
Scott’s army moved westward to the next
largest city, Xalapa where General Antonio
Lopez de Santanna, by then the Mexican
president, had fortified two promontories
that dominated the road where the troops
had to go through. On one, Cerro Gordo,
seven gun batteries were in place to bombard
the approaching invading army. At
night an American battalion led by captain
Robert E. Lee, commander of engineers,
circumvented the promontories and climbed
Cerro Gordo rushing the batteries and turning
them against the Mexican army camped
before Xalapa. A fierce battle followed in
which lieutenant George B. McCleland and
captain P.G.T. Beauregard distinguished
themselves in action (Figure 2). Eventually
the American forces entered Xalapa on April
18. Porter described that nearly a dozen of
injured soldiers had surgical procedures
under letheon.
Of interest was the finding of a daguerreotype
published in the Xalapa’s newspaper
showing the Mexican military surgeon Pedro
Van der Linden about to start a leg amputation
in a Mexican soldier that appears
asleep, while the group is taken prisoner
as bayonets (supposedly in the hands of
American soldiers) guard them, implying
Figure 2: Civil War leaders to be, Captain Robert E. Lee, St. George B. McCleland
and Captain P.G.T. Beauregard distinguished themselves at the battle of Cerro
Gordo.
that Van der Linden, a bright young surgeon
of Dutch descent had administered ether
to the soldier about to be operated 7 (Figure
3). He eventually was freed and rejoined
the Mexican army caring for soldiers in the
battles of Padierna , Molino del Rey and
Chapultepec along with other distinguished
physicians such as Jose Pablo Martinez
del Rio y Miguel Jimenez who apparently
also gave ether inhalation for amputations.
Whether they obtained the ether from their
American counterparts or they had it send
from abroad, is not known, but Martinez
del Rio (Figure 4) later on claimed that he
had received bottles of ether and chloroform
from the United Kingdom and had trained
other military doctors to administer it with
a handkerchief 8,9 ; though this fact has not
been confirmed.
Important Anesthetic Experiences in
the XIX Century
Initially, advances were prevalent in two
countries, whether this was due to daring
physicians willing to undertake new approaches
or simply that the events were duly
recorded either in newspapers or medical
publications. Specifically in Brazil two adventurous
surgical interventions presented
challenges far out of the ordinary anesthetic
techniques to facilitate the performance of
these unusual operations.
In 1866, Pacifico Pereira 10 , a surgeon in
Bahia, excised a sublingual osteoma of the
mandible using ether applied topically over
the mucosa producing local frosting and
vasoconstriction.
Notoriety to medical advances came
about, this time when the parents of xyphopagous
sisters asked the distinguished
surgeon of the times Alvaro Ramos, to
separate them (Figure 5). Realizing that
this was a major undertaking, Dr. Ramos
requested four “narcotiza-dores” as those
Figure 3: Daguerreotype of an amputation just completed on an
apparently asleep injured Mexican soldier. Mexican Military Surgeon
Pedro Van der Linden faces the camera and bayonets of American
soldiers about to take him and his assistants prisoner.

Figure 4: Dr. Jose Pablo Martinez del Rio
who joined the Mexican forces when hostilities
broke, claimed to have received ether and
chloroform from abroad in early 1847.
experienced on anesthesia were called in
similarity to the German term “narcosis”
attributed for anesthesia. In 1899 Rosalina
and Maria underwent chloroform anesthesia
for the operation. Drs. Miguel Couto and
Antonio Leal anesthetized Rosalina, while
Drs. Fajardo and Miguel Pereira took care
of Maria. 11
Recognizing the importance to keep
a record of changes of vital signs during
surgery and anesthesia, a form of anesthetic
record was first used in 1903 at the Hospital
da Santa Casa da Misericordia in Rio de
Janeiro on a patient by the name of Cristina
da Costa Rezende who received a general
anesthetic with sulphuric ether; there was
no mention of who was the surgeon, nor
who the “narcotizer” was, but it did indicate
that the operation had lasted one hour and
13 minutes. 11
The other country where records have
been available was Colombia. Interesting
findings related to resuscitative events seem
to predate others reported. Records show
that D. Restrepo of Medellin, Colombia in
1882 performed the first mouth to mouth
respiration on a patient anesthetized with
chloroform that had stopped breathing, then
proceeded to introduce a rubber catheter in
the trachea, alternating mouth to tube respirations
with bilateral external compression
of the ribs, sternum and epigastrium. 12 The
patient recovered.
In 1891 a senior medical student Teodoro
Castrillon 13 from Bogotá measured the barometric
pressure in Bogotá and estimated the
partial pressure of oxygen, noticing that the
former was only 540 mmHg and the latter
108 mmHg; he then proceeded to write his
thesis entitled “Anesthesia in Altitude”
determining that anesthetics such as ether
and chloroform should be given with oxygen
or air flow in cities like Bogotá located at
nearly 8000 feet high (2700 m). Later on,
once graduated, Castrillon also described
a case in which he was able to electrically
stimulate the phrenic nerves in a patient
that had become apneic under anesthesia
with chloroform for a “supracondilear”
amputation. The patient breathed during
the apneic period and woke up as the
depth of anesthesia was lightened, again
with complete recovery. Also a well-known
anesthetist from Medellin, Luis F. Bernal 12
proposed to set up a protocol with the following
steps in case of cardiac arrest during
anesthesia:
a) Cease to administer the anesthetic
b) Place the patient in a Trendelenburg
position
Figure 5: The xyphopagous sisters Rosalina
and Maria separated in Rio de Janeiro by
surgeon Alvaro Ramos who requested four
“narcotizers” on March 30, 1899 in Sao
Paulo, Brazil: Drs. F. Fajardo and Miguel
Pereira anesthetized Maria and Drs Miguel
Couto and Antonio Leao Rosalina with
chloroform.
c) Reinitiate breathing through a rubber
tube placed in the trachea,
7-10/min
d) Open the left chest and massage
the left ventricle
e) Eliminate the secretions from the
airway
BULLETIN OF ANESTHESIA HISTORY 5
f) Inject stimulants, like caffeine
g) Administer saline solution intravenously.
Undoubtedly this was an advanced protocol
for 1900.
The Birth of Intravenous Anesthesia by
Infusion
Watching the perilous inductions of
ether or chloroform anesthesia in the teaching
hospital “Hospital Juarez”, Miguel
Garcia Marin, a 3 rd year medical student at
the National University of Mexico figured
that there had to be a better way. He set
up to find it. Intravenous administration
of fluids was being discussed as possible
treatment for dehydration from diarrheas,
so metal needles were available. He figured
that alcohol, perhaps one of the oldest fluids
that put people to sleep, could be used
as a drug to produce anesthesia so surgery
could be performed. In his own home he
set up a small animal laboratory and began
to administer intravenous infusions, using
needles connected to a rubber IV tubing
coming from a bifurcated “Y” one attached
to a bottle containing 50% alcohol diluted
in 25% glucose and the other 5% dextrose
in distilled water (Figure 6). Early in the
experiments he noted hematuria, which
subsided when he diluted the ethanol in
25% dextrose. He established protocols to
administer different rates into 90 doves, 17
hens, 72 dogs, 8 turkeys and eventually two
monkeys ( Figure 7) while measuring vital
signs, urine output and any other event. 14
He determined the required flow rates to
produce sedation, light anesthesia and profound
level of anesthesia. Eventually when
Garcia Marin was on the fifth (last) year of
medical school, through the recommendation
of one of his professors Dr. Ulrich and
his uncle who was a representative in the
Mexican Congress, he was allowed to give
a demonstration on a volunteer, but only a
prisoner from the Lecumberri Penitenciary,
who had a death sentence, was willing. With
the promise of an indult if he survived, he
agreed to undergo the test with IV alcohol.
The young student demonstrated his abilities
and the judge let the surviving prisoner
go free.
Next, Garcia Marin went on to give 53
anesthetics for major surgical procedures
(Figure 8) while studying the effects of IV
alcohol on renal and hepatic functions as
well as on the vital signs. 15 Moreover, by
securing an intravenous line to administer
Continued on next page

6 BULLETIN OF ANESTHESIA HISTORY
Contributions. . .Continued from page 5
Figure 6: Schematic representation of the IV pole with two
bottles connected to a bifurcated “Y” line and into a single
rubber tubing, a stopcock attached to the needle for infusion
of alcohol by Garcia Marin.
the alcohol, it became evident that it was
helpful to administer intravenous fluids and
to have rapid access to the circulation for the
administration of resuscitative medications.
From his initial experience he learned the
value of giving atropine and morphine IM
as premedication that made the induction
smoother; he also determined the dose of
indifference to be1 ml/kg and to achieve
anesthesia patients usually required 2 to 3
ml/kg. From the observations in animals he
determined the lethal dose to be 5 to 6 ml/
kg of the above noted solution. For patients
he mixed 40ml of 96 proof alcohol in 40ml
of 25% dextrose in water, alternating with
the flow of the other bottle that contained
5% dextrose in water.
Through his influential uncle the recent
graduate received a government grant to
travel abroad. He chose to go to London and
Paris where he demonstrated his technique,
most of the time successfully. Eventually
the young physician returned to Mexico in
1931 to find his technique in the midst of a
bitter controversy. 16 A few months after receiving
a medal of praise from the Mexican
Congress, Luis Garcia Marin found himself
in the midst of a turbulent debate, which
ended with one of the least wise decision
that the Mexican Academy of Surgery has
ever handed down which banned Intravenous
Anesthesia with Alcohol because
it produced thrombophlebitis. Although
alcohol at the concentrations used by Garcia
Marin has the potential to produce irritation
of the veins endothelium, one can not
help but to think, what a waste of talent;
if he would have been encouraged to learn
other anesthesia techniques or to improve
his approach, instead of running him out of
town, his experience acquired before the age
of 33 years could have been
very valuable as intravenous
anesthesia with thiopental
and other agents was about
to be introduced.
Peridural Anesthesia
Next, a phase of fascination
with regional anesthesia,
more specifically with
peridural anesthesia as it is
called in most of the Spanish
speaking countries based
on the fact that the so called
epidural space surrounds the
dural sac brought about a
series of observations on this
anesthetic technique. The
most recognized contributor
was Alberto Gutierrez (Figure
9), an accomplished surgeon
Figure 7: Table listing the experiments done in
animals by Miguel Garcia Marin in 1928 who
administered IV alcohol to 90 doves, 17 hens, 8
turkeys, 72 dogs. The concentration of alcohol
used, the dosages, mixtures with hypertonic
(25%) glucose are shown. The number of deaths
and unsatisfactory anesthetics are depicted, as
well as the numbers of dogs in whom observation
on respiration, circulation and renal function
were made.
from Buenos Aires, who taught Anatomy
at the University; as many other surgeons
like Bier, Matas, Crile, etc. let their curiosity
lead them to the obvious mystery over
which they frequently had to depend on
others, pain and anesthesia. In his earlier
professional years as a surgeon along with
surgical themes, he wrote on approaches to
the brachial plexus, “splanchnic anesthesia”,
local anesthesia for biliary surgery,
and ablation of the II and III divisions of
the trigeminal nerve, calcaneous spurs and
local anesthesia for abdominal surgery. In
the early 1930’s he began to give anesthesia
for his own operations following Pages and
Dogliotti’s technique. 17,18
Realizing that sometimes the “loss of
resistance approach” was misleading or
not easy to locate precisely where the epidural
space (ES) was he decided to look for
another method. Based on his expertise in
anatomy he explored the precise
identification of the negative
pressure in the epidural
compartment. By introducing
the needle tip very slowly, he
punctured first the peridural
space, injected about 4/5 of
the dose and then continued
to advance the needle into the
subarachnoid space where he
injected the remaining 1/5.
He then reversed the order,
injecting into the intrathecal
space first, and then gradually
withdrew the needle until the
flow of CSF stopped, there he
injected the respective dosage
of anesthetic. So he developed
a precise skill to identify one or
the other space at will. Then
conceived the idea of advancing
the needle with a drop hanging
from the hub through the ligamentum
flavum and watching
it get “sucked” as the peridural
space was entered. 20
So the “hanging drop”
method was created (Figure
10) and in a way the Combined
Spinal-Epidural technique
with one needle was also designed.
Even today, many
colleagues consider it to be
the safest approach to identify
the ES, although it requires
precision and skill. Gradually
his interest shifted toward anesthesia,
though he continued
to have a busy surgical practice,
Gutierrez went on to report
large series of cases totaling
over 12000 epidural anesthetics

Figure 8: Specimen of a hip desarticulation performed by
Dr. E. Ulrich under general anesthesia with intravenous
alcohol administered by Miguel Garcia Marin.
that he himself performed 21 and operated on
most of the patients, too. In the process,
he compared different local anesthetics,
though he preferred procaine 2%. He also
measured the negative pressure in the ES,
Figure 9: Dr.Alberto Gutierrez, a surgeon
intrigued by epidural anesthesia conducted
numerous observations on the topic and
founded the first anesthesia journal in Latin
America (1939).
as well as the difference at the thoracic and
lumbar levels and determined the distance
from the skin to the point at which the
ligamentum flavum was penetrated in over
2000 cases noting than in 90% of patients it
was shorter than 6 cm. Other observations
made by Gutierrez included the gradual
progression of the onset of sensory and motor
blockade, as well as the demonstration
that epidurally injected procaine was found
in the subarachnoid space 2 to 4 hours later.
He also developed a simple but effective
device (Figure 11) to accomplish infiltration
of local anesthetics, rapidly, for major
surgery. 22 With other collaborators,
he founded the first
anesthesia journal in Latin
America; the Revista Argentina
de Anestesia y Analgesia
which has been published
since 1939, until today with
the new title of Revista Argentina
de Anestesiologia. It
is worth mentioning that the
first issue had abstracts of the
articles published in English,
German, French and Italian
languages with international
editors and plenty of advertisements.
In his editorial
Professor Alberto Gutierrez 23 addressed the
ever-present issue “On the relationship between
the anesthesiologist and the surgeon”;
he remained editor of the Revista until his
death in 1945.
Several of Gutierrez disciples took to
epidural anesthesia and increased its popularity
in South America. One, Vicente Ruiz
also worked in the Spanish Hospital and was
a ”hanging drop “ fan 24 ; in 1939 he wrote a
report of 3,826 cases performed by himself
that was published in the journal Minnesota
Medicine. 25 Other anesthetists became
enchanted with the technique; Ontaneda 26
in 1933,also from Buenos Aires, measured
more exactly the negative pressure in the
epidural space using an aneroid manometer
determining a range from –3 cm H20 distally
to –9 cm H2O at the mid-thoracic spine.
Murillo Braga from São Paulo, Brazil 11
noted that the first sign of the onset of
epidural anesthesia was fasciculation of
the latissimus dorsi muscle
occurring 2 to 3 minutes after
the injection of the anesthetic
which were attributed to the
cold fluid injected into the
epidural compartment.
A fascinating description of
a balloon adapted to a threeway
stopcock and connected
to the hub of the needle was
described by De Souza 27 from
Rio de Janeiro in 1943. Thus,
preceding the McIntosh balloon
by about 7 years. 28 The
balloon was supposed to deflate
immediately upon entry
of the needle’s bevel into the
ES.
With the same pursuit,
Almeida (11) from Sao Paulo in 1945 adapted
a tight rubber band to the plunger of the
syringe that contained saline solution; the
plunger was advanced promptly as the tip
of the needle entered the peridural compartment.
Another surgeon from the same city,
BULLETIN OF ANESTHESIA HISTORY 7
Figure 10: The hanging drop method designed
by Gutierrez on his own needle that allowed it
to be advanced gradually with the thumb and
the index finger of both hands.
Edmundo Vasconcelos ( 29) reported in 1944
a large series of thoracic operations including
esophagectomies, pneumonectomies,
lobectomies and thoracoplasties mostly for
patients with tuberculosis, under thoracic
epidural anesthesia.
As the complexity of the operations
demanded longer periods of anesthesia,
Lemmon 30 designed the continuous spinal
anesthesia using a malleable needle that
required special mattresses to accommodate
it. Miguel Martinez Curbelo from La
Havana, Cuba, in 1945 first introduced a
ureteral catheter into the lumbar ES for
prolonged operations with repeated dosing
with procaine. Eventually he was invited
by Lundy to the Mayo Clinic in Rochester
MN where he was able to demonstrate his
method culminating with a publication in
Anesthesia and Analgesia in 1949. 31
Figure 11: Apparatus designed by Gutierrez to load and
reload rapidly a syringe for infiltration or nerve block
anesthesia.
With the ever present desire to find
easier approaches to identify the ES, Juan
Nesi 32 from Buenos Aires and later in Caracas
described the technique of the “bubble
in the syringe” in 1958. He noted that the
Continued on next page

8 BULLETIN OF ANESTHESIA HISTORY
Contributions. . .Continued from page 7
shape of a small bubble in a syringe containing
fluid will change its shape when pressure
is exerted on the plunger and the tip of the
needle is in the ligamentum flavum, but the
fluid will leave the syringe without changing
the shape of the bubble as soon as the bevel
was in the ES (Figure 12). Bustos 33 , also
from Buenos Aires, in 1964 described the
“sign of the foam” to the joint return of bubbles
and fluid appearing at the hub of the
needle when the bevel was in the ES, after
the fluid in the loss of resistance syringe had
been injected. Plaza Quijada 34 from Caracas,
in 1967 reproduced the same sign of the
foam but coming through the proximal end
of the catheter that had been placed in the
ES after the test dose was given. That same
year, Ricardo Sanchez and co-workers 35 from
the IMSS in Mexico observed the direction
taken by lumbar epidural catheters when
advanced 20 cms cephalad. Injecting a small
amount of contrast media, they noted that
48% followed a cephalad direction, 33%
curled up, 12% bent over and went caudad
and the remaining 6% left the spinal canal
through one of the lateral foramen. These
observations confirmed the unwritten rule
of not inserting catheters more than 4 cm
otherwise no one can predict where they will
end up. Llerena 36 also from Mexico City in
1969, ingeniously described an alternative to
identify the ES without a syringe by inserting,
into the hub of a needle the distal tip of
an intravenous fluid line, curled into a role
and fixed with a plastic tie so as to leave
the proximal end vertically upward. Partly
filled with saline, the tip was attached to the
hub, the needle is advanced gradually and
the column of saline fell as soon as the tip
of the needle entered the ES.
In the absence of a “glucostix strip”, Andrade-Marcano
37 from Maracay, Venezuela
in 1969 suggested to aspirate with a syringe
whatever fluid came out of the needle and
inject it intradermically; if it produced
numbness it was local anesthetic, if not, it
most likely was CSF. The same author 38 in
1972 measured the changes in ES pressure
that occurred with changes of position (sitting
up, supine, flexion and extension of the
spine). In 1971, Castaños y Sagarnaga 39 from
La Paz, Bolivia, auscultated, recorded and
amplified the click heard at the moment of
penetration of the ligamentum flavum as a
needle entered the ES. Anibal Galindo et
al 40 , then in Bogotá, in 1975 correlated the
dermatomal onset of epidural anesthesia
with the diameter of the corresponding
sacral nerve root, demonstrating that the
thickest root S1 had the longest onset.
In the late 50s, Jose Usubiaga a young,
Figure 12: Schematic representation of the sign of the
“bubble” in a syringe method to find the epidural space
described by Juan Nesi.
brilliant anesthesiologist from Buenos Aires
assembled a group of investigators that
conducted a variety of remarkable clinical
studies including the treatment of postdural
puncture headache with large volumes of
epidural saline 41 , quantified the transfer
of local anesthetics across the placenta 42
and from the peridural to the intrathecal
space 43 ; Wikinski, Usubiaga and Morales
also described the mechanism for the appearance
of convulsions from excessive
dosages of local anesthetics in man. 44 With
great interest on regional anesthesia Jose
also wrote the most extensive review of the
complications of epidural anesthesia 45 as a
warning for improvement in the technique.
Regional Anesthesia
In the meantime other advances were
taking place in other aspects of Regional
Anesthesia. In 1931, the same Miguel
Martinez Curbelo 46 in la Havana performed
a series of supraclavicular blocks of the
brachial plexus, with patients in the sitting
position (Figure 13); in this position, the
shoulder drops making the nerve trunks
more superficial and the lung more distant,
allowing easier access to the perineurovascular
sheath. In 1939 Alfonso Albanes 47
from Rosario, Argentina treated a number
of patients that had shoulder
arthritis with repeated blocks
of the cervicothoracic sympathetic
ganglion. Bertola 48
modified the interpleural block
for biliary surgery, injecting the
local anesthetic in the thoracic
paravertebral compartment
demonstrating the parallel continuity
of the retrocostal space
along the spine using a radio
opaque resin to demonstrate it
(Figure 14).
Though Bier’s technique of
intravenous regional anesthesia
(IVA) 49 was introduced in
1908, after a certain period of
popularity it had fallen into inertia, until
1945 when Luis Garcia Herreros, a Mexican
Military physician reported 104 cases
of upper and lower extremity blocks using
procaine and tetracaine without apparent
complications. 50 Enzo Mourigan Canale 51
from Montevideo in 1946 described 55
cases treated with 0.5% procaine and in
1954, Flavio Kroeff Pires from Porto Alegre,
Brazil proposed to re-inflate and deflate the
cuff repeatedly to prevent complications at
the end of the procedure 52 preceding the
usually quoted publication in English. 53
Zerkinatti 54 in 1972 proposed the use of a
double cuff to prevent the pain from the one
single tourniquet. Subsequently, Almiro Dos
Reies from São Paulo studied extensively
this technique, describing the effects of
ischemia and the pharmacokinetics and
pharmacodynamics of several local anesthetics
55 ; he also published a comprehensive
monograph on IRA 56 followed by another on
the proper use of limb tourniquets and their
possible complications. 57 The first application
of epidural blood patch was reported
by Gormley 58 in three patients that had
developed post dural puncture headache
in 1960. Soon thereafter, Edgar Martinez
Aguirre 59 from Caracas reported a series of
100 patients that developed
this complication with high
rate of success. Spiegel from
Rio de Janeiro 60 , Baquero y
Vasquez from Mexico City 61
and Fortuna from Santos 62
published their experience
with caudal anesthesia in
children in the 60’s; Estela
Melman and her group 63 published
a large series of epidural
and regional blocks in infants
Figure 13: Supraclavicular
brachial plexus block on a sitting
patient by Miguel Martinez
Curbelo.

and children in 1975 though they seldom
receive recognition in pediatric regional
anesthesia reviews. 64
Since then this technique has been used
in millions of patients.
In 1989 Jorge Barrios-Alarcon et al 65 ,
from São Paulo, Brazil proposed the alternative
use of dextran 40 for the treatment
of PDPH with a similar rate of success
and without the potential hazards of the
injection of autologous blood in to the ES.
Castaños et al 66 also showed that hemodilution
and epidural anesthesia would reduce
the blood viscosity and increased the PaO2
of patients having hematocrit levels above
70% in La Paz, Bolivia, at 14,000 feet high.
Alberto Torrieri from Buenos Aires et
Figure 14: Multiple paravertebral nerve block approached
retrocostally to allow cholecystectomy and biliary surgery.
al 67 described the first single-double lumen
needle (Figure 15) used to provide Combined
spinal-epidural anesthesia to patients
undergoing major orthopedic procedures.
Ricardo Plancarte et al 68 from Mexico City
demonstrated in 1989, the feasibility and
effectiveness of performing the superior
hypogastric plexus block for the treatment
of severe chronic pelvic pain. A year later,
the same group 69 described the approach to
block the ganglion of Wharton (impar) for
the treatment of intractable perineal pain.
Other related contributions have explained
unilateral epidural blocks by the misplacement
of catheters 70 and the application of
peridural anesthesia in Bernard-Horner
syndrome. 71
Other Contributions
Luis Agote 72 described in Buenos Aires
the technique of clotting prevention by a
precisely titrated dosification of Na citrate
facilitating the development of blood banking
making blood transfusions available
to every one that needed them. On what
appears to be the premier recommendation
for moment to moment monitoring of
patients under anesthesia, the picturesque
and flamboyant Juan Marin from Bogotá
Colombia, in 1934 insisted that the precordial
stethoscope should be used to listen
continuously to the heart and lung sounds
of pediatric patients undergoing anesthesia
so “cardiac arrhythmias and cardiac arrest
can be identified as they happen.” 73
Jose C. Delorme assembled the first
anesthesia machine built in Argentina that
included vaporizers for ether, chloroform
and ethyl chloride and tanks for oxygen and
CO2 as well as a soda lime absorber used for
the first time in the Italian Hospital in Buenos
Aires in late 1934. 74 Later on, Kentaro
Takaoka 75 from São Paulo, Brazil designed
the portable Takaoka ventilator that could
be held in one hand; it was used extensively
as anesthesiologists went from
clinic to clinic to give anesthetics,
for resuscitation and
even prolonged mechanical
ventilation. The same author
developed an universal ventilator
that could be used for all
inhalation anesthetics available
in 1965 76 and a breathing
anesthetic circuit that could
be used for children and
adults in 1968 77 predating the
Bain 78 circle by over a decade.
The Takaoka family has expanded
as manufacturer of
equipment from incubators,
to ventilators, to anesthetic
machines and everything else
in between providing reliable equipment,
instruction and maintenance, at reasonable
cost for nearly 50 years.
In 1949, Aranes and Blusque Castellanos
added intermittent boluses of thiopental and
meperidine to an intravenous infusion of
procaine 79 creating another attempt to total
intravenous anesthesia. This work was presented
at the 1 st Latin American Congress
Figure 15: Distal portion of the Torrieri-Aldrete double
lumen needle for Combined Spinal-Epidural Anesthesia
(1984).
BULLETIN OF ANESTHESIA HISTORY 9
of Anesthesiology in Buenos Aires, at what
turned out to be the first true international
congress in Anesthesiology preceding the
Paris International Congress held in 1951.
Two novel ideas were proposed at that meeting
a “consultation room” and a “recovery
room.” Later on Wikinski et al 80 studied the
pharmacokinetics and pharmacodynamics
of procaine IV and related them to the levels
of anesthesia obtained. This technique
became very popular in Argentina and other
South American countries where millions
of anesthetics were administered with
“Procaine a la Argentine,” until the 1980s
when fluorinated hydrocarbon anesthetics
were introduced. It is worth mentioning that
only one case of malignant hyperthermia
was reported during this period. R. Caldero-
Barcia and his associates 81 in the Hospital de
Clinicas in Montevideo studied the physiology
of uterine contractions by cannulating
the uterine cavity and vessels of mothers in
labor. They also observed the effects of regional
anesthesia and magnesium sulfate on
uterine contractility as well as on maternal
and neonatal vital signs (Figure 16).
The Postanesthetic Recovery Score first
proposed in 1970 82 , in its original form or
in one of its modifications has become the
standard of care in nearly all of the American
continent and other countries in establishing
the physical condition of patients
recovering from anesthesia and surgery as
well as their discharge eligibility.
Preoccupation with the prevention of the
undesirable effects from ketamine, as well
as unconventional indications have motivated
a number of investigations. Albin
et al 83 prevented the psychogenic disturbances
with tetrahy-droamiquidinic acid
(THA), while Martinez Aguirre claimed to
reverse them with 4-aminopiridine 84 ; the
same group 85 demonstrated that ketamine
produced adequate analgesia and muscle
relaxation when used with
the technique of regional IV
anesthesia and Jose Islas et
al 86 demonstrated the central
analgesic effects of ketamine
when administered by the
epidural route to patients in
the postoperative period.
On a similar vein, A. Oswaldo
Auad 87 , from Buenos
Aires, showed in 1985 that
epidural clonidine potentiated
morphine analgesia in
the treatment of patients with
recalcitrant chronic pain.
Del Castillo and Katz described
the location and expanded
the understanding of
Continued on next page

10 BULLETIN OF ANESTHESIA HISTORY
Contributions. . .Continued from page 9
Figure 16: Monitor tracing of the effects of 2 gm of MgSO4
on intrauterine pressure, intensity and frequency of contraction
and on arterial blood pressure obtained by Caldero Barcia
(circa 1958).
the acetylcholine receptors 88 , Usubiaga et
al 89 described the interaction of neuromuscular
relaxants drugs and local anesthetic
agents in 1965. First Galindo 90 in 1974, then
Kennedy and Galindo 91 suggested the concept
of presensitiz-ation with non-depolarizing
agents before giving succinyl-cholina
and later and later Kelly and collaborators 92,
93
confirmed some of their interactions
with inhalation and intravenous anesthetic
agents.
Undoubtedly there are other contributions
from Latin American physicians to
Anesthesia, but for the reasons already mentioned
they might not have been recorded
or by being published in obscure periodicals
or because the authors were not properly
listed, they remained unknown. Our intent
has been to include those aportations that
to our knowledge could be documented and
that in our understanding, were innovative
at the time of publication or presentation
at meetings. If any has been omitted, it was
certainly not intentional, though we accept
responsibility for the data; it is also feasible,
as it has occurred for centuries that the same
innovation might have been presented prior
or simultaneously by another author. Our
anticipated apologies for such not purposed
oversight. This is a recognized hazard and a
challenge in history of Medicine research.
So we recognize that this data is subject to
corrections and changes as more is known
about these fascinating and exciting times
in Anesthesia. May this manuscript be a
stimulating curiosity for future generations
of anesthesiologists interested to search for
their roots since finding about our past allows
us to learn more about ourselves. We
hope that this review may also serve as an
inspiration for those with new ideas, willing
to apply them for the benefit of all patients.
References 1. Bigelow HJ: Insensitivity
during surgical operations
produced by inhalation. Boston
Med Surg J 1846, 35:309-317.
2. Sykes WS: Essays on
the first hundred years of
anaesthesia. R.H. Ellis (ed),
Edinburgh; E S Livingstone,
Ltd 1961, vol 1.
3. Snow J: On the inhalation
of chloroform and ether.
Lancet 1848, I:177-180.
4. Pirogoff, Nikolai Ivanovich
in Foundations of Anesthesiology
A. Faulconer Jr and
T.E. Keys (eds) C.C. Thomas,
Springfield 1965: pp. ;725-727.
5. Aldrete JA, Marron GA,
Wright AJ: The first administration
of anesthesia in military
surgery. On occasion of the
Mexican-American War. Anesthesiology
1984, 61:585-588.
6. Porter J: Surgical notes
on the Mexican War. Amer J of
Med Sci 1852, vol 23.
7. Alcantara-Herrera J: Anotaciones historicas
con motivo del primer centenario de anesthesia por
el éter y cloroformo. Medicina 1946, 26.
8. Fernandez del Castillo F: ¿Cuando y por quilen
se aplicó por primera vez en Mexico la anestesia por
inhalación Gaceta Medica, Mexico 1947:58:265.
9. Panorama Histórico de la Medicina en México.
(1. a ed.). México: Editorial Talleres de la Nación
1985:2.
10. Pereira P: Reseçsão de tumor mandibular.
Gaceta Médica da Bahía, 1866.
11. Meira DG: Origens e evolução da anestesiologia
brasileira. Gráfica Editora da Arte Moderno,
Río de Janeiro, 1981.
12. Alvarez T: Anotaciones para una historia de la
Anestesia y Reanimación in Colombia. Universidad
de Antioquia, Medellin, 1984.
13. Castrillón T: Contribución al estudio de la
anestesia en las alturas. Contraindicacion del cloroformo
en la altiplanicie de Bogotá (tesis professional).
Universidad de Santa Fé, Bogotá, Colombia, 1891.
14. Aldrete JA, Aldrete-Velasco J: The use of
alcohol for anesthesia by Miguel Garcia Marin. In
Anaesthesia Essays on its History: J Rupreth, JD
Van Lieburg, JA Lee and W. Erdman (eds) Springer
Verlag, Berlin-Heidelberg, 1985:pp79-87.
15. García Marín M: Anestesia con alcol intravenoso.
Tesis Professional, Universidad Nacional
Autónoma de México, 1929.
16. Aldrete JA: Una contribución original: Anestesia
por alcol endovenoso por Miguel García-Marín.
Rev. Mex. Anestesiol 1985, 8:169-174.
17. Gutiérrez A. Anestesia metamérica epidural.
Rev Cirugía Buenos Aires 1932, 1:665-685.
18. Gutiérrez A, Lopez-Rubido M: Resultados
obtenidos con la anesthesia peridural. Rev Cirugía
Buenos Aires 1933, 12:93-101.
19. Gutiérrez A: Anestesia extradural. Revista
de Cirugía de Buenos Aires 1939, 16:52-58.
20. Gutiérrez A: Valor de la aspiración líquida en
el espacio peridural en la anestesia peridural. Revista
de Cirugía de Buenos Aires 1933, 12:225-230.
21. Gutiérrez A. Anestesia Peridural. Congreso de
la Asociación Argentina de Cirugia. Nov. 14, 1938,
Buenos Aires, Argentina.
22. Gutiérrez A: La anestesia local en cirugia del
abdomen. Tesis, Amorrurta 1932.
23. Gutiérrez A: Sobré la relación entre el anestesiologo
y el cirujano. Revista Argentina de Anestesia
y Analgesia 1939, 1:5.
24. Ruiz V: La anestesia peridural de Pagés en
Ginecologia. Rev Med Latino Amer 1935, 20:509-517.
25. Ruiz V. Pagés Peridural anesthesia. A report of
3826 cases. Minnesota Med 1939, 22:363-368.
26. Ontaneda LE: Tensión del espacio epidural.
Su importancia práctica en la anestesia epidural
metamérica. Rev Argent Circ 1933, 12:588-597.
27. De Souza E: Punção extradural; tecnica de
un novo sinal. Rev. Bra. Circ 1943, 12:120.
28. Macintosh RR: Extradural space indicator.
Anaesthesia 1950, 5:98-100.
29. Vasconcelos E: Thoracic operations with
epidural anesthesia. Dis Chest 1944, 10:471-473.
30. Lemmon WT: A method of continuous spinal
anesthesia. A preliminary report. Am Surg 1940,
111:141-144.
31. Martinez-Curbelo M: Continuous peridural
segmental anesthesia by means of a ureteral catheter.
Anesth Analg 1949, 28:1-4.
32. Andrade Marcano D: Anestesia peridural, in
Texto de Anestesiologia Teórico-Práctica, JA Aldrete
(ed). Salvat Mexicana de Ediciones, S.A. de C.V.
Mexico City: Vol I, p. 675-756.1, 1986.
33. Bustos F: El signo de la burbuja o de la
espuma en la anestesia peridural. Rev Argent Anest
1964, 24:147-150.
34. Plaza-Quijada RJ: Proposición de un signo
para identificar la colocación correcta de un catéter
en el espacio peridural. Rev Venez Anest 1967,
2:57-62.
35. Sanchez R, Acuña L, Rocha F: An analysis of
the radiological visualization of the catheters placed
in the epidural space. Brit J Anesth 1967, 49:485-490.
36. Llerena M: Un recurso más para localizar el
espacio extradural. Rev Mex Anest 1969, 18:353-354.
37. Andrade Marcano D: Bibliografia Anestesica
Venezolana. Actas del VIII Congreso Latinoamericano
y II Venezolano de Anestesiologia, 1966,
2:393-413.
38. Andrade Marcano D, Gutierrez H, Espinal
M: Registo y modernas interpretaciones de la presion
negativa del espacio peridural. Mem Congreso
Venezolano Anest., p. 148-154, 1972.
39. Castaños C, Sagarnaga A: Sinal acustico para
identificação da espacio extradural. Rev Bras Anest
1971, 21:886-889.
40. Galindo A, Hernandez J, Benavides O, et al:
Quality of spinal extradural anesthesia: The influence
of spinal nerve root diameter. Br J Anaesth
1975, 47:41-47.
41. Usubiaga JE, Usubiaga LE, Brea L: Effect
of saline injections on epidural and subarachnoid
space pressures and relation to post spinal anesthesia
headache. Anesth Analg 1967, 46:293-296.
42. Usubiaga JE, Wikinski JA, Usubiaga LE:
Passage of procaine and paramino benzoic acid
across the human placenta. Am J Obstet Gynecol
1968, 100:918-921.
43. Usubiaga JE, Wikinski JA, Wikinski A, et
al: Transfer of local anesthetics to the subarachnoid
space and mechanisms of epidural block. Anesthesiology
1964, 25:752-759.
44. Wikinski JA, Usubiaga JE, Morales RL
et al: Mechanism of convulsions elicited by local
anesthetic agents. I local anesthetic depression of
electrically induced seizures in man. Anesth Analg,
1970, 49:504-508.
45. Usubiaga JE: Neurologic complications after
epidural anesthesia. Anesthesiol Clin 1977, 1:1-123.
46. Martínez Curbelo M: Nueva técnica de
la anestesia del plexo braquial: Ventajas de esta
anestesia regional en cliníca ortopédica. Rev Med
Cubana 1933.
47. Albanes A. Periartritis – escapulo humeral.
Tratamiento por las anestesias del simpatico cervicotoracico.
Dia Medico 1939:1.
48. Bertola V: Anestesia de la vesícula biliar y de
las vías biliares. Rev Arg Anest Analg 1939, 1:18-40.
49. Bier A: Ueber einen neuen Weg Localanaesthesie
und den gliedmasse zu erzeugen. Verbr Dtch
Ges Chir 1908, 37:204-208.
50. Garcia Herreros L: Regional Anesthesia by
the intravenous route. Anesthesiology 1946, 7:558-560.
51. Pernin A y Vega DE: Historia de la anestesia
en el Uruguray, 1981.
52. Pires FK: metodo de “Bier” para anestesia
regional dos membros (diversos). Rev Bras Anest
1954, 4:21-24.

BULLETIN OF ANESTHESIA HISTORY 11
53. Holmes CM: Intravenous regional analgesia:
a useful method of producing analgesia of the limbs.
Lancet 1963, 1:245-247.
54. Zerkinatti PV: Anestesia venosa regional:
confeção simples do duplo manguito. Rev Bras Anest
1972, 22:238-240.
55. Reis Júnior A dos: Anestesia venosa regional:
latencia e analgesia pos-isquemica. Estudio comparativo
utilizando bupivacaina, etidocaina, lidocaína e
prilocaina. Rev Bras Anest 1975, 25:558-586.
56. Reis Júnior A dos: Anestesia Regional Intravenosa.
Atheneua, São Paulo, 1996.
57. Reis Júnior A dos: Dessangramento e Garroteamento
de Membros Com Finalidade Cirúrgica.
Atheneu, São Paulo, 1998.
58. Gormley JB. Treatment of postspinal headache.
Anesthesiology 1960, 21:565-566.
59. Martinez Aguirre, E: La inyección peridural
de sangre como tratamiento de la cefalea post punción
lumbar. Pub Centro Medico de Caracas 1963,
2:81-83.
60. Spiegel P: Caudal anestesia in pediatric
surgery. Anesth Analg 1962, 41:218-221.
61. Baquero PO, Vásquez OF: Anestesia caudal
en pediatría. Rev Mexicana de Anestesiología 1965,
244:101-117.
62. Fortuna A: Caudal Analgesia in Pediatric
Surgery. Brit J Anaesth 1967, 39:165-170.
63. Melman E, Peñuelas JA, Marrufo JE: Regional
anesthesia in children. Anesth Analg 1975,
54:387-398.
64. Dalens BJ, Monnet JP, Harmand Y: Pediatric
Regional Anesthesia. CRC Press Boca Raton, Florida
1990: pp 352-374.
65. Barrios-Alarcon J, Aldrete JA: Relief of postdural
puncture headaches with epidural dextran-40.
A preliminary report. Reg Anest 1989, 14:78-80.
66. Castaños CC, Aldrete JA: Hemodilution in
surgical patients with hematocrit over 70%. Phillip
J. Anesth 1982, 6:30-34.
67. Torrieri A, Aldrete JA: The T-A epidural
spinal needle (Letter). Acta Anaesthesiol Belg 1988,
39:65-66.
68. Plancarte R, Amezcua C, Patt RB, Aldrete JA:
Superior hypogastric plexus block for pelvic cancer
pain. Anesthesiology 1990, 73:236-239.
69. Plancarte R, Amezcua C, Patt RB, Lema
MW: Prescaral blockade of de ganglion of Walther.
Anesthesiology 1990, 73:A751.
70. Usubiaga JE, Dos Reis Jr A, Usubiaga L:
Epidural Misplacement of Catheters and Mechanisms
of Unilateral Blockade. Anesthesiology 1970,
32(2):158-161.
71. Dos Reis Júnior A, Loreno AV, Slitka Filho J:
Anestesia Peridural e Síndrome de Claude-Bernard-
Horner. Rev Bras Anest 1977, 27(4):413-424.
72. Casais de Corne AE, Ferandez FA, Lardies-
Gonzalez J: Panorama Historico de la Medicina Argentina.
Todo es Historia, Buenos Aires 1977, pp.130.
73. Herrera Pontón J: Historia de la anestesia en
Colombia. Rev Col Anes 1974, 2:155-161.
74. Venturini AH, Fuentes OA: Historia de la
Anestesiologia en la Republica Argentina. Rev. Arg.
Anes 1979, 37:139-154.
75. Takaoka K: Respirador automático de
Takaoka. Rev Bras Anest 1964, 14:380-386.
76. Takaoka K: Vaporizador Universal de
Takaoka. Rev Bras Anest 1965, 15:18-24.
77. Takaoka K: Novo circuito avalvular e com
circulacao de gases (Miscelanea). Rev Bras Anest
1968, 18:478.
78. Bain JA, Spoerel WE: A streamlined anaesthetic
system. Can Anaesth Soc J 1972: 19:26-428.
79. Aranes GM, Bluske Castellanos L: Breves cousideraciones
sobre la anestesia con pentotal sódico y
procaina. II Congreso Argentino y I Latinoamericano
de Anestesiol Oct 1949.
80. Wikinski JA, Wikinski RL, Ceraso OL, Arlia
R, Torrieri A: General anesthesia with intravenous
procaine. In Aldrete JA, Stanley TH (eds.): Trends in
intravenous anesthesia. Year Book Medical Publishers,
Chicago, p. 189-215, 1980.
81. Caldero-Barcia R, Posseiro JJ: Physiology
of uterine contraction. Clin Obstet Gynecol 1960,
3:386-399.
82. Aldrete JA, Kroulik D: A postanesthetic
recovery score. Anesth Analg 1970, 49:924-934.
83. Albin MS, Martinez Aguirre E, Albin RL:
Tetrahydroamine (THA) modifications of postanesthetic
emergence responses and anesthesia sleep
times after ketamine HCL in the human. Proc. VI
European Congress of Anaesthesiology. Amsterdam:
Excerpta Medic 1974, 347:147-149.
84. Martinez Aguirre E: 4 aminopyridine antagonism
of ketamine-diazepam anaesthesia in children.
7th World Congress of Anaesthesiology. Excerpta
Medica 1980, p 416.
85. Martinez Aguirre E, Wikinski J: Regional
intravenous ketamine induced depression of neuromuscular
transmission in man. Acta Anaesth Belg
1979, 30:183-188.
86. Islas JA, Astorga J, Loredo M: Epidural
ketamine for control of postoperative pain. Anesth
Analg 1985, 64:1161-1162.
87. Auad AO: Clonidina peridural asociada a la
morfina en el tratamiento del dolor rebelde. Rev Arg
Anest 1985, 43:27-34.
88. Del Castillo J, Katz B: On the localization of
acetylcholine receptors. J Physiol 1955, 128:157-161.
89. Usubiaga JE, et al: Prevention of succinylcholine
fasciculation by local anesthetic agents.
Anesthesiology 1965, 26:3-6.
90. Galindo A: Depolarizing neuromuscular
block. J Pharm Exp Ther 1971, 178:339-342.
91. Kennedy R, Galindo A: Comparative sites
of action of various anaesthetic agents at the mammalian
myoneural junction. Br J Anaesth 1975,
47:533-535.
92. Kelly PJ: Precurazacion: potencia relativa
y periodo de latencia del cloruro de tubocurarina,
triyoduro de galamina y bromuro de pancuronio
sobre la actividad de succinilcolina. Rev Arg Anest
1976, 34:1-8.
93. Kelly PJ, Pavon J, Mileta S, Farias H, Maguiro
G: Interacción de anestesicos inhalatorios y endovenosos
con fazadinio: efectos sobre el cronotropismo
cardíaco. Rev Arg Anest 1983, 41:1-6.

12 BULLETIN OF ANESTHESIA HISTORY
From the Literature
by A.J. Wright, M.L.S.
Department of Anesthesiology Library, University of Alabama at Birmingham
Note: In general, I have not examined articles
that do not include a notation for the number
of references, illustrations, etc. I do examine
most books and book chapters. Books can be
listed in this column more than once as new
reviews appear. Older articles are included
as I work through a large backlog of materials.
Some listings are not directly related to
anesthesia, pain or critical care but concern
individuals important in the history of the
specialty [i.e., Harvey Cushing or William
Halsted]. Non-English articles are so indicated.
Columns for the past several years are available
in the “Anesthesia History Files” at
http://www.anes.uab.edu/aneshist/aneshist.
htm as “Recent Articles on Anesthesia History.”
I urge readers to send me any citations,
especially those not in English, that I may otherwise
miss!—A.J. Wright ajwright@uab.edu
Books
Barr M. Surgery, Sand and Saigon Tea. An
Australian Army Doctor in Vietnam. Allen and
Unwin, 2001. 252pp. [rev. Boulton TB. Anaesthesia
57: 104, 316, 2002; Gray D. Br J Anaesth
88:464-465, 2002]
Blaufox MD. An Ear to the Chest: An Illustrated
History of the Evolution of the Stethoscope.
CRC Press, 2001. 120pp.
Curtis JR, Rubenfeld GD. Managing Death
in the Intensive Care Unit: The Transition from
Cure to Comfort. Oxford University Press, 2001.
388pp. [rev. Ware LR. NEJM 346:542, February
14, 2002]
Fenster JM. Ether Day: The Strange Tale of
America’s Greatest Medical Discovery and the
Haunted Men Who Made It. New York: Harper
Collins, 2001. 278pp. [rev. Samuels SI. JAMA
286:2877-2878, 2001]
Fink BR, McGoldrick KE, eds. Careers in
Anesthesiology, Autobiographical Memoirs, Volume
3. Park Ridge, Ill.: Wood Library-Museum,
1999. 214pp. [rev. Calmes S. Bull Hist Med
75:831-832, 2001]
Fink BR, McGoldrick KE, eds. Careers in
Anesthesiology, Autobiographical Memoirs, Volume
4. Park Ridge, Ill.: Wood Library-Museum,
2000. 181pp. [rev. Maltby JR. Can J Anesth
48:1172, 2001; Bailey RJ. Anaesth Intens Care
29:675, 2001]
Hodgson B. In the Arms of Morpheus: The
Tragic History of Laudanum, Morphine, and
Patent Medicines. Firefly, 2001. 160pp. [rev.
Arsenault K. Library Journal January 2002 pp
141, 144]
Owen, Charles A., Jr. A History of Blood
Coagulation. Mayo Foundation, 2001. 355pp.
[rev. Kwaan HC. JAMA 287:1051-1052, February
27, 2002]
Pain and Suffering in History: Narratives of
Science, Medicine and Culture. Papers Presented
March 13-14, 1998, at the History of Pain Symposium,
University of California, Los Angeles. The
University, 1999
Safar P. Careers in Anesthesiology: An Autobiographical
Memoir, Volume 5. Park Ridge, Ill.:
Wood Library-Museum, 2000. 397pp. [rev. Reilly
PF. Anaesth Intens Care 29:675-676, 2001]
Standl T, Goerig M, Schulte am Esch J. 35
Jahre Lehrstuhl fur Anasthesiologie am Universitatsklinikum
Hamburg-Eppendorf. Zur Entwicklung
einer anasthesiologischen Einrichtung.
Hamburg: The Department, 2001. 67pp. Illus.
Trubuhovich RV, Judson JA. Intensive Care
in New Zealand. A History of the New Zealand
Region of ANZICS. privately printed, 2001 ().
150pp. [rev. Winship S, Wang J. Br J Anaesth
87:946, 2001
Wolfe RJ. Tarnished Idol: William T.G.
Morton and the Introduction of Surgical Anesthesia.
Norman, 2001. 672pp. [rev. Caton D.
NEJM 346:70, January 3, 2002; Torpy JM. JAMA
287:1327-1328, March 13, 2002]
Articles and Book Chapters
Ball C, Westhorpe R. Intravneous induction
agents: benzodiazepines. Anaesth Intens Care 30:3,
2002 [cover note; 1 illus., 7 refs.]
Ball C, Westhorpe R. Induction agents:
“Avertin.” Anaesth Intens Care 29:571, 2001 [cover
note; 1 illus., 5 refs.]
Bollet AJ. Civil War Medicine: Challenges and
Triumphs. Galen Press, 2002. [Has some material
on anethesia pp 76-81; blood transfusions pp
185-186; and opium and morphine pp 238-242]
Bracourt H. First intravenous injections:
the infusions of the 17th century. Rev Prat
51(14):1519-1523, September 15, 2001 [French]
Brown T. Popular Patents: America’s First
Inventions from the Airplane to the Zipper.
Scarecrow Press, 2000. [Includes Jackson and
Morton’s patent for anesthesia, pp 27-28; and
two other inventions Jackson tried to claim for
himself: Schonbein’s guncotton pp 98-99 and
Morse’s telegraph, pp 176-178]
Buzello TF, van der Schyff SG. Curare in
medicine: in search of a disease (a historical
perspective). Eur J Anaesthesiol 18, suppl 23: 106,
2001 [abstract; 1 table, 8 refs.]
Caponi G. Claude Bernard and the boundaries
of experimental physiology. Hist Cienc Saude
Manguinhis 8:375-406, 2001 [Portuguese]
Chaloner EJ, Ham RJ. Amputations at the
London Hospital 1852-1857. J Roy Soc Med
94:409-412, 2001 [Notes results of amputations
under ether vs. under chloroform. 1 chart, 3 tables,
12 refs. Response by Howat DDC. J Roy Soc Med
94:657, 2001]
Charlton E. Patrick David Wall FRS, DM,
FRCP. Honorary member AAGBI, 1925-2001.
Anaesthesia 56:1202, 2001 [Obituary]
Cope DK. Mortality during the first 25 years
of general anesthesia in America: contemporary
outcome studies. Am J Anesthesiol 28:455-460,
2001 [Rep. Bull Anesth Hist 17(3):12-17, 1999; 5
illus., 21 refs.]
Crenner C. Organizational reform and professional
dissent in the careers of Richard Cabot and
Ernest Amory Codman, 1900-1920. J Hist Med
Allied Sci 56:211-237, 2001
Diaz JH. Call all anesthetists to service in
World War II. Anesthesiology 96:776-777, 2001
[Correspondence; response to Waisel DB. Anesthesiology
94:907-914, 2001. 2 refs. Waisel DB.
Response. Anesthesiology 96:777, 2002. 1 ref.]
Egger EI II. A brief history of the origin of
minimum alveolar concentration (MAC). Anesthesiology
96:238-239, 2002 [Classic Papers Revisted
series; 8 refs.]
Ekiert LJ. The history of tranquilizing and
sleeping drugs. Arch Hist Filoz Med 63(3-4):126-
128, 2000 [Polish]
50th anniversary volume of the Japanese
Journal of Anesthesiology. Masui 50 suppl:1-289,
September 2001. [Japanese]
Hanson III CW, Durbin CG Jr, Maccioli GA,
et al. The anesthesiologist in critical care medicine:
past, present and future. Anesthesiology 95:
781-788, 2001 [4 illus., 41 refs.]
Hart GD. Description of blood and blood disorders
before the advent of laboratory studies. Br
J Haematol 115: 719-728, 2001 [10 illus., 25 refs.]
Hawkes E, Leafty C, Ruth C, Scott R, Sharp L.
Nurse anesthesia: the silent profession. Windows
in Time 9(2): 5-6, November 2001
Horvitz LA. Eureka! Scientific Breaththroughs
that Changed the World. Wiley, 2002.
256pp. [includes Joseph Priestley’s isolation of
oxygen]
Howat DDC. Amputations at the London
Hospital, 1852-1857. J Roy Soc Med 94:657, 2001
[Correspondence. 3 refs. Response to Chaloner
EJ. J Roy Soc Med 94:409-412, 2001]
Hyson JM Jr. Man and pain: eternal partners.
J History Dent 49(3):115-121, November 2001
[38 refs.]
Jones JT. Brian Francis Horan: editor 1982-
1988. Anaesth Intens Care 29:461-462, 2001 [Obituary.
Portrait.]
Kiss I. From anaesthesia for neurosurgery to
neuroanaesthesia. A historical note. Acta Neurochir
(Wien) 142:1391-1395, 2000 [3 illus., 25 refs.]
Koehler PJ, van de Wiel TWM. Aretaeus on
migraine and headache. J Hist Neurosci 10:253-
261, 2001 [27 refs.]
Kopp VJ. World War II and physician specialization.
Anesthesiology 96:776, 2002 [Correspondence;
response to Waisel DB. Anesthesiology
94:907-914, 2001. 10 refs. Waisel DB. Response.
Anesthesiology 96:777, 2002. 1 ref.]
Kotiniemi L, Autio S, Hyrynkangas K. Anaesthetic
history of a patient: 250 anaesthetics
in 30 years. Anaesthesia 57:207-208, 2002 [correspondence;
3 refs.]
Kuhlen FJ. History of pain and pain treatment.
Pharm Unserer Zeit 31(!):13-22, 2002
Continued on next page

BULLETIN OF ANESTHESIA HISTORY 13
MedNuggets
by Fred J. Spielman, M.D.
Department of Anesthesiology, University of North Carolina
An examination of the literature on the
subject reveals that a number of workers
have come to the conclusion that there is
some peculiarity in the physiology of the
pregnant woman which renders her unsuitable
for the induction of spinal anesthesia.
— F. Barnett Mallinson
British Journal of Anaesthesia 16:22,
1938-9
The anesthetist has a useful role in the
diagnosis and treatment of coma. Coma is
not unlike surgical anesthesia; in fact anesthesia
is correctly defined as a state of coma.
— E.A. Rovenstine
Anesthesiology 6:1, 1945
The more you use it (spinal anesthesia)
the less confidence you have in it.
— Harold Wellington Jones
Annals of Surgery 96:85, 1932
The mistake lay in the assumption that
fatalities under anaesthesia must be due to
excess of the anaesthetic. This is an error
which it seems extremely difficult to overcome
in the minds of surgeons.
—Yandell Henderson
Surgery, Gynecology, Obstetrics 19:386,
1914
Somewhere there is a paradox in the fact
that to take out a lung requires more training
and experience and learning and judgment
than it does to take away consciousness, yet
the loss of consciousness has immeasurably
greater effect on the individual.
— Henry K. Beecher
Surgical Forum 5:679, 1954
The choice of anaesthesia and the technique
of the actual operations are matters
which must always be largely governed by
personal preference and by local conditions.
— Reginald Payne
British Journal of Surgery 27:740, 1939-
40
The surgeon who has not tasted anesthesia
for his surgery under the best possible
auspices has something to look forward to,
the value of which he perhaps does not yet
appreciate. A higher quality in anesthesia
than the present best is surely still to be
attained and never before has there been
such active effort in seeking it.
— Ralph T. Knight
Surgery 18:130, 1945
Anesthetics are among the most potent
and dangerous drugs used in the practice of
medicine; they penetrate to every cell and
organ of the body and may cause almost instant
or delayed death by their toxic effects.
— Frank H. McMechan
Journal of the American Medical Association
104:1428, 1935
Today’s widening scope of surgery, allowing
help to even the poorest of “risks”
depends on team-work. The problems are
discussed by all who can bring their special
knowledge into play. The anaesthetist
should not and cannot be missing from
this team and must be as conversant in
present-day medical knowledge as the best
on the team.
— Stanislaw B. Donigiewicz
Canadian Anaesthetists’ Society Journal
5:75, 1958
The first problem for both the anesthetist
and the surgeon to work out after the operation
is decided upon, is to determine what
anesthetic is to be used, in the particular
case at the time. Here the anesthetist should
be consulted and his experience becomes
invaluable to the surgeon in making this
determination.
— A.R. DaCosta
Current Researches in Anesthesia and
Analgesia 16:18, 1938
The condemnation of an agent as the
cause of death is still too frequently quoted
as the responsible offender. Such condemnation
of agents is unjustified and the responsbilitiy
should be placed upon the person at
the head of the table.
— Paul H. Lorhan
The American Surgeon 18:727, 1952
On no account should a practitioner endeavour
to administer an anaesthetic whilst
acting as operator also.
— William W. Mushin
Anaesthesia 9:232, 1954
The leaders of medicine and surgery today
realize the seriousness of carrying a living
being to that level of insensibility which,
in many respects, simulates death, and also
recognize that the anesthesia is, in most
instances as important as the operation.
— Sidney Cushing Wiggen
New England Journal of Medicine
204:1283, 1931
For the surgeon, then, the question has
come to be not “what anesthetic” but “ what
anesthetist”
— Edward M. Livingstone
American Journal of Surgery 19:67, 1933
Many other similar types of work no
doubt exist in other spheres of medicine
where by reason of his special knowledge
or technical skill the anaesthetist is the
person best qualified to take charge. It is of
great importance that we should take every
opportunity to extend these sections of our
specialty as it may well be that before long
our standing in the medical world will be
judged rather by the quality of our clinical
work than by our technical skill.
— A.R. Hunter
Anesthesiology 13:108, 1952
Literature. . .Continued from page 12
[German]
Mathews TP. Vietnam vet gives anesthesia history
lesson. ASA Newsletter 66(2):37-38, February
2002 [correspondence]
Morell J. Aspirina: 100 anos de publicidad
(1899-1999). BSAHCFC: butlleti de la Societat
d’Amics de la Historia i de la Ciencia Farmaceutica
Catalana 10(26):36, May-August 2001 [Spanish]
Newson AJ. All here are agog with the chloroform.
Aust NZ J Surg 70:862-869, 2000 [2 illus.,
21 refs.]
Norman J. The British Journal of Anaesthesia:
an informal history of the first 25 years. Br J
Anaesth 88:445-450, 2002
O’Dowd MJ. “Anesthesia and analgesia and
the curse of Eve. In: The History of Medications
for Women: Materia medica woman. Parthenon,
2001, pp 275-295 [18 illus., numerous refs.]
Patterson R. Charles Thomas Jackson, MD,
Vesuvius, and the idea of surgical anaesthesia. J
Continued on page 16

14 BULLETIN OF ANESTHESIA HISTORY
The Wood Library-Museum Book
Signing at the ASA Annual Meeting
in New Orleans
October 15, 2001
From left to right: Dr. Kathryn McGoldrick,
Dr. John Steinhaus, Dr. Eli Brown, Mrs. Peggy
Fink, Dr. Carlos Parsloe, and Dr. Thomas T.
McGranahan.
Mrs. Peggy Fink autographs Careers VI for
Dr. William Hammonds.
Dr. Thomas McGranahan and Mrs. Peggy Fink sign
copies of Careers VI for Dr. John Neeld and Dr. John
Steinhaus.
Dale C. Smith, Ph.D., 2001 Lewis
H. Wright Memorial Lecturer,
accepts appreciation scroll from Dr.
Kathryn McGoldrick.

BULLETIN OF ANESTHESIA HISTORY 15

16 BULLETIN OF ANESTHESIA HISTORY
Literature. . .Continued from page 13
Med Biog 9:220-225, 2001 [2 illus., 20 refs.]
Pelis K. Blood standards and failed fluids:
clinic, lab, and transfusion solutions in London,
1868-1916. Hist Sci 39:185-213, 2001 [131 refs.]
Plourde G. Claude Bernard, the spinal cord,
and anesthesia. Anesthesiology 95:1542, 2001 [Correspondence;
8 refs.]
Prout G. Seishu Hanaoka. Medifila nos. 42-
43: 44, 2001
Riess KO, Millman-Guller L. MHAUS celebrates
the 20th anniversary of its founding. Am
J Anesthesiol 28:461-462, 2001
Shealy CN, Cady RK. Historical perspective
of pain management. In: Weiner RS, ed. Pain
Management: A Practical Guide for Clinicians.
6th ed. CRC Press, 2001, pp 9-16 [1 illus., 2 tables,
references, annotated bibliography]
Shephard DAE. John Snow and resuscitation.
Resuscitation 49:3-7, 2001 [3 illus., 16 refs.]
Simpson P, Popat M. “Anaesthesia: history and
introduction. In: Understanding Anaesthesia. 4th
ed. Butterworth Heinemann, 2002, pp 1-5
Takeda F. The development of use of oral
morphine within the last 10 years in Japan. Eur
J Pain 5(a):79-82, December 2001
von Hintzenstern U, Petermann H, Schwarz
W. Early contributions from Erlangen to the
theory and practice of general anesthsia with
ether and chloroform. 2. The animal experiments
of Ernst von Bibra and Emil Harless. Anaesthesist
50:869-880, 2001 [German; 6 illus., 31 refs. ]
WLM Board of Trustees Meeting, October 15, 2001 in New Orleans. From left to right, seated: Dr. Charles
Tandy, Mr. Patrick Sim, Dr. Kathyrn McGoldrick, Dr. Donald Caton, Dr. Dale Smith, Dr. Jonathan Berman,
and Dr. Doris Cope. From left to right, standing: Dr. Elliott Miller, Dr. Selma Calmes, Dr. Douglas Bacon,
Dr. Lydia Conlay, Dr. George Bause, Dr. Jeffrey Cusick, Dr. William Hammonds, Dr. George Sheplock, Dr.
SusanVassallo, Dr. Mary Ellen Warner, and Dr. Adolph Giesecke.
Bulletin of Anesthesia History
Doris K. Cope, M.D., Editor
200 Delafield Avenue, Suite 2070
Pittsburgh, PA 15215