January 1997, Vol 15 (1) - Anesthesia History Association

BULLETIN OF
ANESTHESIA.HISTORY
VOLUME 15, NUMBER 1
JANUARY, 1997
The Lewis H. Wright Memorial Lecture
From Symmetrical to Asymmetrical :
A Historical Perspective
by Joseph F. Artusio, J1:, M.D.
October 22, 1996-New Orleans, Louisiana
We are here today to honor Dr. Lewis H.
Wright, an anesthesiologist who was known
by many of us as a warm, quiet, reserved physician.
Lew Wright was a great collector, and
much of the early collection of the Wood Library-Museum
was collected by him. He was
a huge man, but gentle in manner. He was
always interested in what was new, and I remember
him vividly, on many occasions, stopping
me at meetings with a warm greeting. I
distinctly remember that, in my early days as
an anesthesiologist when I was attending the
early meetings of the American Society and
the Post-Graduate Assembly, Lew Wright was
always there. He was walking the hall, greeting
people, and made one feel needed in this
young and growing specialty. Lew Wright,
those who knew you, miss you!
In the first half of this century, most anesthesia
was administered by nurses or interns.
However, there was a nucleus, a handful of
dedicated pioneers in the 1920s, '30s, and
'40s, who saw the dire need to provide safe
anesthesia for surgical procedures. All of us
are descendants from that fantastic nucleus.
They saw the need for physician administered
anesthetics and devoted most of their practice
to the administration of anesthetics. They
were mostly self-taught and then taught others
by the apprentice system. They visited in
each other's hospital, from which evolved the
Travel Club, now the prestigious Academy
of Anesthesiology. The early anesthetists frequently
transported their own machines,
crude as they were by today's standards, to
administer anesthesia from hospital to hospital.
There was no certifying board to establish
an examination system to test competence.
There was no norm for quality of care,
and yet thousands upon thousands of people
were anesthetized with the symmetrical diethyl
ether. Fortunately, this marvelous anesthetic
had a sufficiently high aqueous solubility
and fat solubility so that cardiac overdose
was not readily produced, and usually
respiration would stop associated with deep
anesthesia prior to cardiac arrest. In spite of
the relative safety of this drug, people died
during surgery from improper administration
of the anesthetic, mostly associated with airway
obstruction. Today, unfortunately, the major
causes of deaths associated with anesthesia,
although relatively small, are still related
to various forms of airway obstruction. Little
was kilOwn of the detailed pharmacology of diethyl
ether, other than it produced unconsciousness,
analgesia and amnesia, and stimulated
respiration. When patients died on the
operating table, even during the most minor
of surgical procedures, if no direct cause could
be found the death was attributed to a vague
etiology called status thymaco lymphaticus. I
find that no one really knew what that diagnosis
meant, other than that the heart stopped in
the anesthetized patient and the patient died
on the operating room table during surgery. Attempts
at resuscitation were at best feeble, so
to administer these pain relieving inhalants it
took courage and dedication.
The anesthesia machines or'the day were
simple. The fail-safe systems had not arrived.
The closed circle system held sway and the rag
and bottle, or open drop method used with
room air, or supplemental 0 2 by placing an 0
2
catheter under the mask, was the technique
used for the millions of anesthetics administered
in this country, particularly for the pediatric
patient. One could give hours of anesthesia
for a dollar or two. (Diethyl Ether, the symmetrical
anesthetic, was 30 cents for a quarter
of a pound.)
How would you like to begin your day in
the operating room with a can of ether, a mask,
a towel and a supply of oxygen I entered the
field of anesthesia in January, 1944. The
influence of Arthur Guedel was in vogue
and his short monograph on Inhalation
Anesthesia was a classic of its time. However,
it was Ralph Waters of Madison, Wisconsin,
who made the greatest impact in the
development of anesthesiology, and his academic
residency training program was one
of the first in this country. He introduced
the to-and-fro system of delivering anesthetic
gases to man. He further improved
on carbon dioxide absorption and completed
the clinical work on the new symmetrical
hydrocarbon anesthetic agent, cyclopropane,
in conjunction with Emory
Rovenstine and Bill Neff. This was the beginning
of modern academic anesthesia.
The last diethyl ether induction administered
at The New York Hospital occurred
in 1984. [At this time Dr. Artusio presented
the video record of this anesthetic.]
There were few endotracheal tubes available
prior to World War II. Various types of
airways were used to maintain the patency
of the airway during the anesthetized state.
The first endotracheal tubes were placed for
intrathoracic procedures in order that the
patients' lungs could be ventilated without
inflating the stomach, and incidently, to
prevent the aspiration of gastric contents
into the tracheobronchial tree. The early
tubes had no cuffs. The pharynx was packed
with saline soaked gauze to provide a fairly
tight fit to maintain the closed system. The
endotracheal cuff came later and most of
the early cuffs were hand made.
We were taught and we taught others
that the inhalational anesthetics were exhaled
metabolically unchanged from the
lungs, with some unchanged drug escaping
in the urine. However, our research during
Continued on Page 5

BULLETIN OF ANESTHESIA HISTORY
Presidential Retroprospectrum
The insignia of the Association now residing on my desk at the University of Washington accentuate
my trepidation at becoming president of the Association. Emblems of friendship and confidence,
they challenge my determination to serve your interests as assiduously and effectively as have
my predecessors. Fortunately, a dedicated Council and numerous enthusiastic members virtually
guarantee the success of forthcoming meetings, to be graced by many worthwhile and thoughtful
explorations of our past. There will be talks, posters, writings and feasts. What our story lacks in
theoretic foundations, it more than makes up for with a sesquicentury of relief to physical and
mental suffering.
But a new volume is open. On page one, technical progress presents a large and perplexing area
of concern, where action or inaction involves extremely complicated considerations whose resolution
can be greatly assisted by history and debate. Anesthesiologic practice increasingly involves
multi-faceted dilemmas-private, public and professional-arising out of modern medical dominion
over life and death: one recent example is the careful discussion by R.D. Bastro of ethical concerns
in anesthetic care for patients with do-not-resuscitate orders 0nesthesiology 1996; 85:1190-3).
The background and history of biomedical ethics embraces some of the most sensitive personal
and societal issues of our times, where fateful decisions call alike on the mature judgment of anesthesiologists
who are physicians and (perhaps less frequently) on that of anesthetists who are not. The
information and broad experience required for judicious resolution of such matters demand careful
advance study and debate, in which recent history can actually benefit from a "whiggish" approach.
The ability to see today's winning or losing side, as a culmination of a past supplied by historians
such as us in the form of past and present case-studies, can provide instructive guidance to thought
and deed. Who shall live-perhaps against their will Who shall be allowed to die Whose brain is
dead enough for the rest of the body to follow Who shall receive or be denied the vital transplant, the
cardio-pulmonary resuscitation, the life-saving or life-ending prenatal or neonatal intervention
There are any number of acute problems where timely and considered responses require advance
exploration and study. Bioethics is becoming a province of anesthesiology and intensive care, where
digested knowledge of the past provides essential illumination for the present, and as such is of equal
relevance and potential appeal to the resident in training and the qualified specialist.
Almost suddenly, we are asked to explore a new sector of history and to devise a new instrument
for that purpose, a retroprospectroscope with objectives fixed simultaneously on the past, the present
and the future. The territory is exciting and proclaimed recently enough for all to be equal starters.
It calls for a broad perspective in the service of society, infused with history, philosophy, medical
science and wide anesthesiologic know-how-a fascinating and relevant field for the Anesthesia
History Association.
-E. RaJimol1dFink,ESc, ME, FRCA
HELP!!
One of our correspondents needs assistance. Although the following quotations are
well-known, their original authors are not. If any of our readers can cite their origin, a great
service would be done. The first quotation is:
"There is minor surgery, but there is no minor anesthesia."
The second is:
"There is no minor surgery, there are only minor surgeons."
Please send your replies to the Editor.
PAUL M. WOOD
FELLOWSH IP
AWARDS
The Wood Library-Museum of Anesthesiology
(WLM) each year offers four Fellowship
Awards to residents in training in anesthesiology,
physicians in other disciplines,
historians, graduate students of the history
of medicine and other individuals with a developed
interest in libraty and museum research.
Prospective candidates may request appli
cation information from Mr. Patrick Sim,
Librarian; Wood Library-Museum of Anesthesiology;
520 N. Northwest Highway; Park
Ridge, IL 60068-2573. The completed application
should be returned to Mr. Sim with a
current curriculum vitae, reprints of no more
than five prior publications and a research
proposal not exceeding eight double-spaced
pages. Four copies of the application and each
supporting document should be returned
before January 31, 1997. All applications will
be judged by a committee of the Board of
Trustees of the WLM. The Fellowships will
be awarded before April 1, 1997.
Fellows will receive a grant of $500.00 to
support their work at the WLM or elsewhere.
In addition, individuals who must travel more
than 100 miles to the WLM will receive funds
equal to one round-trip economy class trip
by air to and from their residence. Fellows
who are obliged to stay near the WLM during
the term of their Fellowship shall be eligible
for per diem support of;$125.00 for a
period not to exceed fifteen working days.
The WLM Librarian will supervise the
Fellow's use of the facilities and will provide
an office or appropriate working space. Archival
material selected for duplication will
be reproduced without cost by the library
staff. The Board of ll'ustees requires that a
Fellow present the Librarian with copy of any
manuscript that incorporates information
gained during the course of the Fellowship.
"
Annual Resident Essay Award
The Anesthesia History Association announces the second annual Resident Essay Award
to be presented at the History Association Dinner in conjunction with the American Society of
Anesthesiologists 1997 Annual Meeting in San Diego, California .
. A 1500-3000 word essay related to the history of anesthesia, pain management or critical
care should be submitted to: Doris K. Cope, M.D., University of South Alabama, Department
of Anesthesiology, 2451 Fillingim Street/MSTN 610, Mobile, Alabama 36617 USA.
The entrant must have written the essay either during his/her residency or within one year
of completion of residency. The recipient of the Resident Essay Award will receive a $500.00
honorarium and the manuscript will be presented at the Meeting of the Anesthesia History
Association and subsequently published in the Bulletin of Anesthesia History.
Entries must be received on or before September 1, 1997.
The Bulletin of Anesthesia Histol)' is published
four times a year as a joint effort of
the Anesthesia History Association and
the Wood-Library Museum of Anesthesiology.
C.R. Stephen, M.D., Editor
Doris K. Cope, M.D.,
Associate Editor
Donald Caton, M.D.,
Associate Editor
Debra Lipscomb, Editorial Staff
Editorial, Reprint, and Circulation matters
should be addressed to the Editor,
15801 Harris Ridge Court, Chesterfield,
MO 63017 U.S.A.

BULLETIN OF ANESTHESIA HISTORY
Annual Dinner and Meeting
Anesthesia History Association
Approximately 75 guests and members
of the Anesthesia History Association had
a most enjoyable meeting and dinner at the
Westin Canal Plaza in New Orleans on October
22, 1996, at the Annual ASA meeting.
(See photos on pages 11-14)
Guests at the dinner introduced by the
President, Dr. Lucien E. Morris, included
Dr: Gwenifer Wilson, 1996 Laureate of the
History of Anesthesia, Dr. J ochon Schulte­
Am-Esch, and the winner and runners-up
of the First Resident Essay Award.
Dr. Schulte-Am-Esch spoke briefly
about the forthcoming Fourth International
Symposium on the History of Anaesthesia,
to be held at the Congress Centrum in
Hamburg, Germany, from April 26-29,
1997. He urged that we all plan to attend
and/or present a paper at this Symposium.
Abstract forms and further information
may be obtained by writing to: Prof. Dr. J.
Schulte-Am-Esch, Department of
Anaesthesiology, University Hospital
Eppendorf, Martinistrasse 52, D-20246,
Hamburg, Germany.
Dr. Doris Cope presented the First Resident
Essay Award to Major Eric A. Schoenberg,
M.D., Eglin Air Force Base Hospital,
Ether and Chloroform­
The First 20 Years­
Sesquicentennial Meeting
On Thursday, January 16, 1997, at the
Queen Elizabeth II Conference Centre, Broad
Sanctuary, Westminster, London, the Association
of Anaesthetists of Great Britain and
Ireland, the History of Anaesthesia Society,
and the Sections on Anaesthesia and History
of Medicine of the Royal Society of Medicine
are sponsoring a Sesquicentennial Meeting
on "Ether and Chloroform-The First 20
Years." The all-day program features outstanding
presentations, culminated by a celebration
dinner on Friday, January 17, at the
Dorchester Hotel, Park Lane, London.
The Winter Scientific Meeting of the Association
of Anaesthetists will follow the Sesquicentennial
meeting on January 17 and 18,
1997.
Further information concerning these
meetings may be obtained from The Ohmeda
Educational Co-ordinator, Association of
Anaesthetists of Great Britain and Ireland, 9
Bedford Square, London WCIB 3RA. Tel:
0171 631 1650.
for his submission titled, "The Birth of Scientific
Pain Control: S. Weir Mitchell and
the Turner's Lane Military Hospital." Certificates
were presented also to the two second-place
winners, Dr. Mark A. Postler,
Wilford Hall Medical Center, for his presentation
titled, ''An Historic Perspective
on Opium and its Therapeutic Uses
Throughout the 18th and 19th Centuries,"
and to Dr. Warren S. Sandberg, Massachusetts
General Hospital, for "Legends and
Fish Stories: Oral History in Anesthesiology."
These and the other 13 papers submitted
will be published in the Bulletin of
Anesthesia History.
The first R.K. Calverley Memorial Lecture
was presented by Selma H. Calmes,
co-founder with Dr. Calverley of the Anesthesia
History Association. She presented
an excellent historical review of
"The Economic Basis of Anesthesia."
Dr. Lucien Morris announced that the
incoming President of the A.H.A. is Dr. B.
Raymond Fink. In his unavoidable absence
from the meeting, Dr. Morris turned the
gavel over to the incoming Vice-President,
Dr. C. Ronald Stephen, who adjourned the
meeting.
Newsletters 1982-1995
of the
Anesthesia History
Association
Through the assiduous work of Dr. Doris
Cope and under the joint sponsorship of the
Wood Library-Museum (WLM) and the
Anesthesia History Association (AHA), the
first 13 years of the Newsletter of the AHA
have been reprinted in a large volume now
available at the WLM.
A comprehensive index has been prepared
by Miss Sally Graham so that historical
articles and references in the Newsletter
may be found easily.
This valuable book may be obtained at a
cost of $50.00 postpaid by writing to:
Wood Library-Museum
of Anesthesiology
520 N. Northwest Highway
Park Ridge, IL 60068-2573
Annual Spring Meeting
of the
Anesthesia History
Association
WHERE: The Anesthesia History
Association's fifth annual Spring Meeting will
be held April 3, 1997, at the Woodlands Inn,
Colonial Williamsburg, Virginia.
WHAT: The opening plenary address will
be delivered by Audrey C. Shafer, MD., Assistant
Professor of Anesthesia, Stanford University
School of Medicine and the author of "Metaphor
and Anesthesia" (Anesthesiology
83:1331-1342, 1995). The title of her talk is,
"Reading Between the Lines: The Language of
Anesthesia."
Abstracts for twenty-minute papers are invited
on historical aspects of anesthesia, critical
care medicine and pain management. Abstracts
on medical humanities and/or ethical topics that
relate to the history of one or more of those broad
areas are also invited.
Abstracts should be no longer than one 8ljz"
by 11" sheet of paper. If possible, abstracts should
indicate the research problem, sources used,
methodological approach and may contain no
more than 10 references.
HOW: Abstracts may be submitted by mail,
fax or electronic mail (in plain text format). Disc
submission in DOS-compatible form is also permitted.
Abstracts submitted in electronic format
may be made available to registrants in advance
of the meeting and at various Internet sites
as chosen by the Organizing Committee. ALL
accepted abstracts will be included in the abstract
book distributed to meeting registrants.
Individuals who wish to organize a paper
session around a theme should contact the committee.
WHEN: Deadline for submission of all abstracts
is 31 January 1997.
Address inquiries and abstracts to: A.J.
Wright, MLS, Chair; AHA97 Spring Organizing
Committee; Department of Anesthesiology
Library; University of Alabama at Birmingham;
619 19th Street South JT965; Birmingham, AL
35233-6810.
205/975-5114, ext. 304 (voice); 205/975-5963
(fax); meds002@uabdpo.dpo.uab.edu OR
awright@ms.jt.anes.uahedu
Anesthesia History Association
1997 Annual Spring Meeting
Program to Date
Wednesday, April 2, 1997; Woodlands Inn,
Colonial Williamsburg, Virginia, USA
Opening Reception 5:30-7:30 pm
Continued on Page 10

4 BULLETIN OF ANESTHESIA HISTORY
Gwenifer C.M. Wilson,
M.B., B.S., D.A., M.D., RA.N.Z.C.A.
In 1995, under the Chairmanship of
Nicolas M. Greene, M.D., the seven members
of the Laureate Committee of the Wood
Library-Museum of Anesthesiology-one
from the United Kingdom, one from Germany,
one from the Netherlands and four
from the United States-received 14 nominations,
six from overseas (Australia, Italy,
Lebanon, Russia and the United Kingdom)
and eight from the United States, to become
Laureate of the History of Anesthesia. It was
with great pleasure that the Laureate Committee
announced at the October 1995 ASA
Annual Meeting tha t Dr. Gwenifer C .M. Wilson
was designated as the first Wood
Library-Museum Laureate.
On October 22, 1996, just prior to the
Annual Lewis H. Wright Memorial Lecture
at the Annual A.S.A. meeting in New Orleans,
Dr. Wilson was presented by Dr. Greene to
an appreciative audience with the medal of
the Laureate of History of Anesthesia and a
scroll so designating her.
A short history of the career of Dr. Wilson
was included in the brochure accompanying
the presentation. It reads as follows:
Born in Australia, Dr. Wilson graduated
from the University of Sydney Medical
School in 1939 and started her clinical and
anesthesia training at the Balmain Hospital
in suburban Sydney. In 1956, she transferred
to Sydney Hospital and St. George Hospital.
There, she served as Honorary Anaesthetist
from 1956 to 1968 and continues to serve
there as Honorary Consultant Anaesthetist.
In 1961, Dr. Wilson began her study of
the history of anesthesia by probing deeply
into the fascinating story about how the news
of anesthesia got to Australia in 1847. She
also found, during her review of early Australian
medical journals, that the word anesthesia
never appeared in any of the early indexes
of medical literature. This she compensated
for by creating her own index, later
published, of citations dealing with anesthesia
in all early Australian medical journals.
She has presented 42 invited lectures, has
published 43 articles on the history of anesthesia
and, for many years, has provided a
striking visual history of anesthesia on the
front cover of the Australian anesthesia journal
Anaesthesia and Intensive Care. Now, we
have the culmination of all her studies and
all her work throughout the years with the
publication of the first volume of her magnum
opus, the 690-page One Grand Chain, A
History of Anaesthesia in Australia, 1846-1962.
In her career, Dr. Wilson has been afforded
many richly deserved honors and
has occupied many prestigious positions
in anesthesia and related organizations.
These include a Doctorate of Medicine
postgraduate degree awarded by the University
of Sydney in 1995 for her thesis
on the history of the Australian Society
of Anaesthetists 1934-1984 and her Bibliography
of References to Anesthesia
and Related Subjects in Australasian
Medical Publications 1846-1962. This
was the first postgraduate Doctorate of
Medicine degree awarded in Australia
for medical history. She was a founding
member of the Faculty of Anaesthetists
of the Royal Australasian College of Surgeons
in 1952 and became a Fellow of
the Faculty of Anaesthetists, Royal
Australasian College of Surgeons in 1956
and a Fellow of the Australian and New
Zealand College of Anaesthetists in
1992.
Dr. Wilson also served as Secretary
of the Australian Society of Anaesthetists
(1954-56), as a member of the Executive
Committee of the Australian Society of
Anaesthetists (1951-56), as Honorary
Historian of the Faculty of Anaesthetists,
Royal Australasian College of Surgeons
(1966-92) and as Honorary Historian and
then Historian Emeritus of the Australian
and New Zealand College of Anaesthetists.
Dr. Wilson also served as Postgraduate Lecturer
in the history of anaesthesia in the
Nuffield Department of Anaesthetics of the
University of Sydney (1962-82).
Dr. Wilson's career reflects the thoroughness,
scholarship, meticulousness and dedication
needed to produce definitive studies
of the history of anesthesia. We thank her for
her contributions to the specialty of anesthesiology
as well as for the intellectual and academic
example she has set.
-Nicholas M. Greene, M.D.
Abstracted from the journal
Anesthesiology with permission
vol. 85, No. 1 0, October 1996
There follows in the brochure some information
about the genesis of the Laureate
program:
The Wood Library-Museum of Anesthesiology
Laureate of the History of Anesthesia
was created to honor those who have made
singular contributions to the history of anesthesiology
and to increase interest in the
study of the history of anesthesiology. The
award is to be presented every four years.
Eligible for the award are all physicians and
historians, regardless of nationality, who have
made seminal contributions to the history of
anesthesia, as evidenced by publication of
books, monographs or articles in
peer-reviewed journals. Nominations for the
award can be offered by anyone and are solicited
by mail sent throughout the world
more than a year in advance by an internationally
constituted Wood Library-Museum
Laureate Committee. The entire program is
international in scope and design.
Details of the nomination process and
how the Laureate Committee elects the Laurea,te
can be obtained by mail: Laureate of
the History of Anesthesia Committee, Wood
Library-Museum of Anesthesiology, 520 N.
Northwest Highway, Park Ridge, IL
60068-2573; e-mail: ; or
telephone (847) 825-5586.
The Wood Libraty-Museum of Anesthesiology
is a nonprofit foundation of the
American Society of Anesthesiologists, dedicated
to maintaining one of the world's largest
collections of anesthesia-related publications,
periodicals, rare books, equipment and
artifacts. It is located in the headquarters
building of the American Society of Anesthesiologists
in Park Ridge, Illinois.

Symmetrical. . . Continued from Page 1
the development of methoxyflurane showed
that in fact the inhalational anesthetics were
metabolized and the nature of the metabolic
fragments formed would be the key to understanding
the nature of inhalation anesthetic
toxicity. From that knowledge came the
development of methodology to produce inhalation
anesthetics of minimal toxicity.
Anesthetics were administered following
the Guedel signs of anesthetic depth. The
only control of respiration was depth of anesthesia,
whether the patient was light and
stimulated by the sensory input of the surgery,
or depressed from the effect of the anesthetic
on the respiratory mechanism. Assisted
or controlled respiration was frowned
upon as spontaneous respiration using die thy
ether was used as one of the guides to depth
of anesthesia. Assisted respiration came into
vogue when the respiratory depressant, cyclopropane,
was introduced. With the advent
of "Muscle Relaxants," controlled ventilation
became a necessity. There was a time when
the educated hand was favored over the "ventilator."
But when the volume controlled ventilator
superseded the pressure controlled
ventilator, mechanical ventilation was here
to stay. The only monitors of depth were the
character of respiration, the blood pressure
cuff, and a finger on the pulse. However, I
want to impress upon you that there was constant
contact with the patient to observe the color
of the skin and also to determine whether the
skin was wet or dry. Pupillary size and intercostal
activity was watched to judge the depth of
anesthesia and to provide necessalY relaxation
for intra-abdominal procedures.
The ECGs had not arrived in the operating
room. Eventually, the cardioscope was
available in the operating room, but ECG
monitoring was used only for the most seriously
ill. Induction of anesthesia was slow and
tedious and special induction rooms were
used prior to entrance into the operating
room. Absolute silence was mandated during
the induction of the nitrous oxide to ether
sequence, as it was believed that there was
great danger that hyperreflex irritability during
anesthetic induction would produce ventricular
fibrillation. Nitrous oxide helped
smooth the induction of the ether anesthetic,
using the second gas effect and the concentration
effect. Often, the induction of anesthesia
was associated with the so-called second
stage of anesthesia, which was marked
by movements of the. patient, athetoid movement
and sometimes severe muscle activity.
Surgical anesthesia of the day was a state of
so-called physiological well-being. The patient
was quiet. Muscle activity had ceased
and the patient's blood pressure and pulse
rate, which had been elevated during the excitement
stage, had returned to near
pre-anesthesia levels.
Interestingly, this state of hyperactivity
did not reappear during emergence from anesthesia.
Suffice it to say that the anesthesiologist
of that period felt quite secure with a
quiet, relaxed patient in so-called "surgical
anesthesia." One must remember that the anesthesiologist
was not challenged by the precarious
cardiac patient. Millions of patients
underwent surgery with application of these
fundamental Guedel principles.
Today, we rarely look at the pupil. Most
anesthetic agents today produce a pinpoint
pupil which only dilates during profound
depth of anesthesia. The anesthesiologist of
today, using an adequate dose of a peripheral
muscle relaxant, must depend on signs
of depth completely limited to whether unblocked
sensory input produces a systolic
hypertension and tachycardia, or anesthetic
overdose produces hypotension.
During that period, there were patients
who were considered unfit for surgery and
anesthesia. Many procedures were done in
several stages. It was believed that such patients
could not tolera te anesthesia and surgelY.
Perhaps a little of that concern might
be advantageous today. The current opinion
seems to be that, with judicious management,
there is no patient who is in too precarious a
state to receive an anesthetic, or too ill to have
an extensive surgical procedure.
Curare, a symmetrical compound,
through the clinical demonstration of Harold
Griffith, became available to aid in tracheal
intubation and to open and close the abdomen.
Scott Smith allowed himself to be paralyzed,
intubated and ventilated to demonstrate
that, in man, curare was without central
effect. The neuromuscular blockade
could be antagonized by neostigmine or by
edrophonium, the anti-curare that Riker,
Wescoe and I developed in the 1960s known
as "Tensilon." The British introduced us to
the symmetrical decamethonium and Francis
Foldes to the symmetrical succinylcholine.
By the 1960s, studies in the animal laboratory
by Brazier, Magoun and others provided
the experimental setting to observe
evoked potentials from implanted electrodes
in various portions of the central nervous system.
These studies indicated that there were
areas of the brain which had specific sensitivities
to depression produced by pharmacological
agents. Dose-response curves were
constructed and the evoked potentials were
followed to electrical silence by the graded
dose-response technique. Gradual recoveries
of specific areas of the brain under observation
would occur as the anesthetic agent was
decreased. It became obvious that sensory
input to the central nervous system came not
only through the large spinothalamic tracts,
BUllETIN OF ANESTHESIA HISTORY
but also through extrasensory pathways
through areas of the reticular formation
which, when stimulated, produced arousal,
and when depressed by an anesthetic agent
produced a state wherein arousal of the experimental
animal was lost. The brain, previously
well-described anatomically, now was
being dissected physiologically.
In this lecture, I would like to review with
you some clinical research done many years
ago which should now be a most fertile area
for more specific and definitive study with
the halogenated asymmetrical ethers. Some
years ago, while tlying to anesthetize the early
cardiorespiratory cripple for what was a
rather simple cardiac procedure; mitral valvulotomy,
using a level of central nervous
system depression that would be tolerated by
these seriously ill cardiac patients, one of our
patients opened her eyes while the chest was
open. [Video recording shown of this patient
during and after surgery.] She looked around,
and then quietly closed her eyes. A very
startled anesthesiologist added anesthetic to
the breathing mixture to achieve unconsciousness.
Questioning of the patient during
the postoperative period proved that she
had no recollection of the experience. She had
no me mOlY of it: amnesia; no perception of
pain: analgesia; she was totally unaware that
in the middle of a surgical procedure she had
opened her eyes and looked around the operating
room. After extensive discussion
withy colleagues, it was decided to see if we
could reproduce this. Gingerly, we began to
see if we could establish various levels of depression
during which consciousness or
awareness of environment was present at a
time when the patient obviously was not perceiving
pain from sensory input and had no
recollection of the experience. By judicious
use of the symmetrical general anesthetic,
diethyl ether, in conjunction with topical
anesthesia to the upper airway, larynx and
trachea (to obliterate upper airway reflexes),
a dose-response study was done. This investigation
was embarked on to test the age-old
concept that the neocortex was depressed
first, and then the more resistant lower centers,
until the only remaining functional units
were the brain stem and spinal cord.
The data indicated that, at the lowest dose
level, patients were not able to recall rather
long question-and-answer sessions done during
a surgical procedure. Some of these amnesic
patients perceived pain in various degrees,
and some perceived no pain. But during
a level of central nervous system depression
at a time when the patient was amnesic
and analgesic, cerebral cognitive function was
present. The patients were able to cerebrate
Comillued 011 Next Page

6 BULLETIN OF ANESTHESIA HISTORY
Symmetrical. . . Comilll/ed from Page 5
and do simple mathematical problems. They
were not confused when misinformation was
presented to them. They were able to see, and
to distinguish color and taste. Interestingly,
recall of recent events was depressed much
earlier than memory for past events.
Let's look at the possible areas of depression.
Until the patient lost consciousness, or more
precisely our ability to arouse the patient by the
spoken voice was lost, many neocortical nmctions
were active. The temporal lobe and the
parietal lobe certainly were functioning in the
interpretation of questions and the response.
The patients understood speech and responded
with appropriate nodding of the head. Unfortunately,
they could not vocalize because the
endotracheal tube was in place.
Speculations on these observations, beginning
with the minimal dose, can only be made
for diethyl ether, as it still is the only drug
studied in this manner. The limbic structures
appear to be the central complex most vulnerable
to anesthetic depression by diethyl
ether. These patients were quiet and manifested
no aggressive behavior. Evidently, the
limbic system had been depressed because
patients showed neither fear nor rage, but had
lost recent memory. Thalamic reception of
noxious sensory input was also depressed at
minimal levels of anesthesia. The observation
that was remarkable to us was that the
cortex was virtually intact. The patient had
significant cognitive function, language was
interpreted correctly, and the response to
color and taste was correct.
The conclusion was obvious. The cortex
is not the first portion of the central nervous
system to be depressed. The cortex functions
quite well until we can no longer arouse the
patient. Communication stops only when the
extra-sensory pathways throughout the reticular
formation are blocked, disconnection
of the old and new brain occurs and the patient
can no longer be aroused to respond. It
is hard for us to imagine that, during the state
of unawareness that we call anesthesia, significant
cerebral function must continue. Although
cortical neurons continue to receive
tactile, auditory and visual stimuli, we cannot
follow the processing of these inputs because
the reticular arousal system is blocked.
By the 1950s, the cautelyhad become part
of operative surgery, and at that time the nonflammable
asymmetrical halogenated anesthetics
were introduced, first in England and
then in this country. Halothane was a great
advance in the nonflammable anesthetic series
and out of circle vaporization became a
realitywith Lucien Morris' "Copper Kettle."
There were also several compounds of the
ether series studied, but it was not until the
design, animal research and clinical use of
methoxyflurane by Dr. Alan Van Poznak and
myself, that the nonflammable ethers had
widespread clinical use. Methoxyflurane, the
first asymmetrical ether, is the parent compound
of the new halogenated asymmetrical
ethers----enflurane, isoflurane, desflurane and
sevoflurane-which have low aqueous and
low fat solubility and minimal
bio-transformation, and allow us to produce
a delicate balance between dose-related central
nervous system depression dictated by
the moment-to-moment intensity of the sensory
input.
These ethers produce little cardiac irregularity,
which is not true of either straight chain
or cyclic hydrocarbons. Straight chain or cyclic
hydrocarbons produced significant degrees
of ventricular irritability and thus
proved not to be ideal anesthetic agents. The
ethers, however, with an oxygen bridge separating
the two carbons, depress ventricular
irritability. Today, it appears that the asymmetrical
halogenated ethers used for inhalation
anesthesia are going to be our mainstay
for the foreseeable future.
We indeed have come a long way since the
"rag and bottles" days of ether and chloroform
anesthesia. My presentation today
points out how our practice and patient management
have changed in only SO years, indicating
that this is not a stagnant specialty,
but a dynamic and vibrant one. I wonder what
methods will be designed to produce the anesthetic
state in the 21st Century. Our techniques,
which we so prize today, and the anesthetic
agents of which we are so proud, will
seem as outdated as techniques such as bloodletting
or the mustard plaster.
REFERENCES
1. Snow, J: On the Inhalation of the Vapour of
Ether in Surgical Operations. John Churchill, London,
1847.
2. Guedel, AE: Inhalation Anesthesia. The
Macmillian Company, New York, 1937.
3. Courtin, RF, Bickford, RG, Faulconer, A: Classification
and Significance ofEEG Patterns Produced
by Ether Anesthesia During Surgical Operation. Proc.
Staff Meet. Mayo CHn., 25: 197, 1950.
4. Faulconer, A: Correlation of Concentration of
Ether in Arterial Blood with EEG Patterns of Human
Surgical Patients. Anesthesiology, 13: 361, 1952.
5. Harris, TAB: The Mode of Action of
Anaesthetics. E.&S. Livingstone, Ltd., Edinburgh,
1951.
6. Artusio, JF, Jr., Riker, WF, Jr., Wescoe, WC:
Studies on the Inter-relationship of Certain
Cholisurgic compounds IV Anti-Curare Action in
Anesthetized Man. J. Pharmcol. Exp. Therap. 100:
227,1950.
7. Artusio, JF, Jr.: Di-ethyl Ether Analgesia: A
Detailed Description of the First Stage of Ether In
Man. J. Pharmacol . Exp. Therap. 111: 343, 1954.
8. Artusio, JF: Ether Analgesia During Major
Surgery. J.A.M.A. 157: 33, 1955.
9. VanPoznak, A, Artusio, JF, Jr.: Laboratory and
Clinical Studies with 1, 1, 2. trifluoro-2-bromo
ethyl-methyl ether (DA-893) Fed. Proc. 20: 312, 1961.
10. Artusio, JF Jr., VanPoznak, A, Hunt, RE,
Tiers, F, Alexander, M: A Clinical Evaluation of Methoxyflurane
in Man. Anesthesiology 21: 512, 1960.
Correspondence
The Editor, Bulletin of Anesthesia History
Dear Sir:
Re "One Grand Chain" by Gwen Wilson,
launched April 15, 1996 at the Wor,ld
Congress in Sydney.
Having read this rather weighty tome,
(certainly not a book for reading in bed!) I
felt admiration for the work involved and
the style, which had a bit of humour for
clinically involved scanners of history, but
I was slightly puzzled about the rather large
sections of some chapters which did not
relate directly to anaesthesia.
I therefore phoned the author, and after
congratulating someone who had read
all the medical publications in Australia
from 1846-1962, asked my question and
received my answer which was most satisfactory.
It appears that Dr. Wilson, having personally
discovered the work involved, was
recording for future historians, as well as
current readers, in order to save them some
of her struggles. The book is meant as a
background, and as a starting point for research
in the 21st century.
I do agree that study of the history of
anaesthesia, unlike that of most medical
specialties, involves many aspects of history
in medicine as a whole. After all,
post-graduate students of anaesthesia must
attend lectures and answer examination
questions on pharmacology, physiology,
anatomy, monitors and monitoring and all
aspects of intensive care, as well as agents
and techniques involved in their future
daily work Thus, a history of the specialty
must contain references to development in
these areas.
I also asked why the politics of Australia
were involved in anaesthetic history,
although I could already see that the general
history of-a relatively newly established
country was certainly related. The answer
to my question (and the lady laughed) was,
"read the newspapers and journals from
1980 to 1996, and Volume II of ' One Grand
Chain,' and you'll realise our long battle
for recognition is only just beginning to be
won."
I'll do that, if I can find the time, now
that this book has performed another of its
purposes. Namely, to arouse in me an interest
in anaesthetic history and its uses in
daily working pursuits. If I do any research,
I'll certainly look up the history of my subject!
-Anonymous

BULLETIN OF ANESTHESIA HISTORY
Frederick Hall Van Bergen, M.D. 1914-1996
One of the anesthesiologists who contributed
much to make the profession what it is today
passed away quietly at his home in Minneapolis
on September 11, 1996.
A graduate of the University of Minnesota
Medical School in 1942, Van, as his many colleagues
called him, immediately joined the Navy
where he served with distinction until 1946.
Returning to Minneapolis, he joined the residency
training program at the University of Minnesota
under the aegis of Dr. Ralph Knight. He
then remained on the faculty of the anesthesia
department, becoming Professor and Chairman
of the Department of Anesthesiology in 1957,
where he served in that capacity until his retirement
in 1978.
Throughout his career he participated in
numerous clinical and laboratory investigations
with colleagues such as J.J. Buckley, D.S.P'
Weatherhead, J.R. Gordon and J.H. Matthews.
With J.W Baird he published a clinical investigation
of the combined Pentothal-Curare solution,
known as Baird's solution. A portable mass
spectrometer was described for continuous alveolar
gas analysis. He described a new respirator
which achieved a considerable degree of success.
Van Bergen was an active member of the
Association of U niversity Anesthetists, the Academy
of Anesthesiology, and for a number of years
Grete Teutsch, M.D. 1912-1996
was an Associate Editor ofSUlvey of Anesthesiology.
In addition, he was an avid sportsman and
delighted in wildlife photography.
He is survived by his loving wife Nancy, four
sons, nine grandchildren and seven
grea t -grandchildren.
Memorials may be sent to the Minnesota
Medical Foundation or to the donor's choice.
It is with sadness that we report the sudden
death of our dear friend and esteemed
colleague, Dr. Grete Teutsch, one of the first
female heads of an anesthesia department
with a residency training program.
Grete was born in Germany, the youngest
of four accomplished sisters. Early in life she
decided to become a physician. When she was
ready for medical school, the political circumstances
made matriculation in Italy a superior
choice. After receiving her medical degree
in 1939, Grete immigrated to the United
States. She quickly passed the licensing exams,
served an internship in Elizabeth, New
Jersey, a residency in Anesthesiology at the
Brooklyn Jewish Hospital, and proceeded to
accept an Attending's position at the Bronx
Veterans Hospital where she remained active
for the remainder of her productive life. In
due time, she advanced to Assistant Chief and
then Chief of the Department of Anesthesiology,
a position she held until her retirement
in 1988. Retirement, however, did not include
loss of interest in either Anesthesiology or her
beloved hospital. Grete continued to teach
and do administrative work as a "volunteer"
one to three days a week.
An accomplished clinician, Grete's greatest
asset was her expertise in the administration
of nerve blocks for both surgical anesthesia
and pain relief. While an assistant clinical
professor of anesthesiology at the Albert
Einstein College of Medicine during her
department's affiliation with this medical
school, she spent two days every month in
the Jacobi Hospital's operating room to demonstrate
nerve blocks to attendings and residents.
After the affiliation changed to the
Mount Sinai Medical School, she attained the
rank of Assistant Clinical Professor there.
Grete was a devoted teacher. Residents
were not only fond of her, they adored her.
Description of her special qualifications included
integrity, unselfishness, and dedication
to students, patients, and teaching.
In recent years, Grete's interest in the history
of anesthesia prompted her to assemble
an exhibit of anesthesia equipment of the
1940s and 1950s. This exhibit, which will be
displayed at the 50th Postgraduate Assembly
in December, 1996, will remain at the
Bronx Veterans Hospital as a memorial to an
outstanding physician.
- Gertie R Marx, M.D.
andJeffl'ey H. Silverstein, M.D.
Robert H.
Haralson, Jr., M.D.
1910-1986
Physician, anesthesiologist and community
leader, Dr. Robert H. Haralson, Jr. died quietly
at his home in Maryville, TN on October 22,
1996.
A native of Laban on, TN, he was born in the
Wilson County Jail, where his father was sheriff,
on JanualY 3, 1910! He received his MD.
degree from the University of Tennessee School
of Medicine in Memphis in 1936. While a medical
student he met and married his wife of 50
years, Dora T. Haralson.
After internship at the Nashville General
Hospital, he began practice in public health in
Tifton, GA.
In 1939 he moved to Maryville and was a
private practitioner until he enlisted in the U.S.
Army Medical Corps in 1942. A crack shot, he
was first in charge of riflery training at Ft. Lewis
in Washington. After being assigned to the 119th
Medical Battalion, he served with distinction in
North Africa, the Anzio invasion of Italy, the
Normandy invasion, and in France and Germany,
being awarded the Bronze Star.
On his return to Maryville in 1945, he was
one of the first physicians on the staff at the
Blount Memorial Hospital when it opened
its doors in 1947. It was his medical home
for the rest of his life. Recognizing the lack
of trained anesthesiologists in his area, he
completed a two-year residency in this specialty
in 1947 with Dr. Ralph Tovell in Hartford
Hospital, CT. He became Chief of Anesthesia
at the 300 bed Blount Memorial Hospital
and also through the years served as
Chief of Staff and Chairman of the Credentials
Committee. In 1952 he instituted the
post-anesthesia Recovery Room, reputedly
the first in Tennessee. He was a member of
the Anesthesia History Association.
His community interests were wide and varied.
He was most active in supporting the Boys
Club of Blount County, organizing a benefit
annual golf tournament in its support and acting
as Chairman of its trust fund. He was a
Trustee of Cumberland University, a member
of the Maryville Kiwanis Club and served on
the board of the Blount National Bank.
A valued friend of the undersigned since
1947, Dr. Haralson portrayed all the elements
of character that made him a true gentleman.
He will be sorely missed.
He is sUlvived by two sons, one an orthopedic
surgeon in Maryville and one who heads a
Respiratory Therapy Program in Knoxville and
Maryville; one daughter in Chile, nine grandchildren
and two great-grandchildren. Memorials
may be sent to the Boys Club of Blount
County.
C. R. Stephen, M.D.

BULLETIN OF ANESTHESIA HISTORY
Residents' Essay Award
In 1995 DI: Doris Cope initiated the idea of having an annual Resident Essay Contest, with the essays to be judged by a Committee of the Anesthesia Hist01Y
Association (AHA) and an award to be presented at the Annual Meeting and Dinner of the AHA. In 1996 a total of 13 essays were submitted alld the most
outstanding one by D,: Eric Schoenberg received the award all October 22, 1996, at the Annual Meeting. His essay follows. Other essays submitted will be
published infutul'e issues of the Bulletin.
-Editor
The Birth of Scientific Pain Control:
S. Weir Mitchell and the Turner's Lane Military Hospital
by Eric A. Schoenberg, M.D.
Research supported by the WOod LibraJy-Museum the American Society of Anesthesiologists during the term of a WOod Fellowship.
The first applications of the scientific method to problems of pain management were performed during the American Civil War by a U.S.
Army contract physician and his colleagues at the Turner's Lane Hospital in Philadelphia. Their studies reflected the social and intellectual
changes of the age, and their approach parallels that of pain practitioners of today.
"I most conscientiously believe that the proud mission of the physician is distinctly twofold-namely, to alleviate human suffering, as
well as to preserve human life."
-James Y Simpson
In 1862 a young physician working under
contract to the US Army initiated his research
into injuries of nerves and related conditions
that would lay the foundation, not only for
his future as a famous clinician and the father
of American neurology, but also for the
practice of scientific pain control as we recognize
it today. That physician, Silas Weir
Mitchell, and his colleagues at the special
hospitals for nerves established in Philadelphia
during the American Civil War, for the
first time approached pain and nervous disorders
as manageable and understandable
conditions amenable to medical therapy.
Thus they reinforced the idea that pain might
be, and should be, medically controlled. This
paper explores some thoughts as to why this
concept was brought forward at this time, in
this fashion, and by these particular men.
The work performed by Mitchell and his
principal co-investigators, George Morehouse
and William W. Keen, first at the Filbert
Street Hospital and then at the Christian
Street and later at the Turner's Lane Hospitals
in Philadelphia, consisted largely of observing,
recording and selectively intervening
in numerous cases of traumatic injuries
of nerves. As detailed in the initial publication
of their work, Gunshot WOunds and Other
Injuries of Nerves, in 1864, these cases consisted
largely of injuries to peripheral nerves,
but also included significant trauma to the
facial and trigeminal nerves, as well as to the
spinal cord itself. Detailed histories were
obtained, examinations performed and, most
importantly, recorded despite the laxity of the
currently-prevailing system of medical
record-keeping. Prolonged follow-up was actively
sought and careful notes made as to
the temporal progressions in patient status
and complaints. Finally, the doctors attempted,
through the information thus obtained,
to reconstruct the mechanism and
pinpoint the site of injury to specific nerves,
to identify the clinically observable effects
that could reasonably be attributed to that
injury, to prognosticate on the likely progression
of the individual patient based on their
clinical experience, and to modify that progression
using techniques which they adapted
or developed to direct specifically at neurologic
conditions. Today we might find this
approach routine, but in that era it was clearly
extraordinaty.
The actual therapeutic procedures developed
and applied at Turner's Lane were relatively
ineffective by today's standards. Some
of the theoretical bases upon which they were
founded have proven wrong, but they were
usually better than the absolute neglect of
such conditions, which was the standard of
the day. In 1822 Charles Bell had commented,
"The endless confusion of the subject induces
the physician, instead of taking the nervous
system as the secure ground of his practice,
to dismiss it from his course of study as a
subject presenting too great irregularity for
legitimate investigation or reliance." Their
techniques focused largely on the use of "faradization,"
or the application of an electric
current across the affected area, both for diagnosis
and treatment. Repeated stimulations
were performed with the belief that these enhanced
the regeneration of damaged nerve
tissue and stimulated the reversal of the frequently
associated muscular atrophy.
Other forms of therapy, often applied in
addition to faradization, included continuous
water irrigation, various forms of physical
therapy aimed at strengthening both the
affected part and the whole body, local injections
of morphine and atropine subcutaneously
using the relatively new hypodermic
needles and syringes, and the provision of a
healthy environment for rehabilitation, including
good wholesome food, clean air and
gardens for taking exercise or meditation.
Rarely an attempt at therapeutic surgery was
made, but Mitchell and his colleagues recognized
that these procedures, such as excision
of stump neuroma ta and partial resection of
the median nerve for neuralgia, were usually
ineffective after they had observed and recorded
a number of similar patients.
Why, then, would this innovative approach
to neurologic problems have developed
in a relatively small military hospital
directed by relatively junior physicians The
answer to this question is certainly complex,
but clearly involves a number of social, professional
and personal factors that comprised
the context of the pioneering work.
Many authors have written on the societal
changes that were taking place in the
early 19th century that contributed to and
even allowed the introduction of surgical
anesthesia. It is logical to extend some of their
arguments to the efforts at providing pain
control in a non-operative setting. These
changes in the fabric of society, more pronounced
in the United States than in Victorian
England or Europe, were comprehensive
and, by affecting people's thinking, allowed
altogether new views of old problems.
This evolution occurred not only in medicine
and science, but in literature, the arts, and
everyday living for the common man. Thus
the rise of humanitarianism, individualism
and comprehensive egalitarianism, the softening
of religious predeterminism, the influence
of Romanticism in the arts, and the vast
sweeping social reforms associated with the
maturation of the Industrial Revolution all
factor into the equation. The influence of each
of these broad issues is difficult to define, but
the stage was set and the players prepared to
perform their roles. We may view the Civil
War as the final catalyst in this sequence
which dramatically and thoroughly crystallized
these changes, translating them from
thought into action while simultaneously
changing them in subtle but practical ways.
To briefly overview the aforementioned
social transitions, we can start with the shift
toward an acceptance of the concept of the

greater worth of the individual, and the corresponding
feeling of absolute egalitarianism
that paralleled this acceptance. As people
developed their individual identities separate
from the corporate and social whole, they
began to lessen the social value of the experience
of pain. Pain no longer had the meaning
it once did as a sacrifice for the common
good and thus it became acceptable to seek
to control it. The egalitarian thinking which
led to the creation of the abolition and labor
reform movements of the period was directly
in keeping with this shift, as the pain that
was suffered by the whipped slaves and the
indentured child laborers lost its meaning or
was viewed as a clear injustice rather than as
a social reinforcement. It is no coincidence
that the first patent medicine marketed directly
as a "pain killer" was produced in this
time frame and was a huge success.
In religion there was a noticeable softening
of Calvinist predeterminism, which had
previously drawn strong parallels between
free choice and the experience of worldly discomforts.
The notion that one could be relieved
of some of the adverse consequences
of one's actions had previously been seen as
cheapening man's free will and robbing his
pain of meaning. The move toward a more
benevolent divinity who had no interest in
seeing His creatures suffer was thus instrumental.
And in the arts the rise of Romanticism,
as best exemplified by Coleridge,
Shelley and Wordsworth, reflected the change
in attitudes toward pain as an individual subjective
experience that had little societal
worth and could thus be approached with a
view toward control or elimination. This concept
contrasted starkly with the notions of
some of the Sentimentalists and classical writers
who largely held the view that pain and
suffering were somehow ennobling and thus
procrea tive; or even with the writings oU ohn
Donne, who accepted pain as an inevitable
consequence of living and of man's original
sin. One might use the change in political
thought as an example: the move from Andrew
Jackson's frontier machismo to
Abraham Lincoln's simple compassion and
sympathy exemplifies the subliminal alterations
in thought of this period. While both
choices adhere to strongly populist notions, the
character of the decision has markedly changed.
Finally, the Civil War, with its introduction of
essentially modern technology into warfare,
complete with a corresponding dehumanization
of the process, further robbed the resulting pain
of much of its meaning, as the glOly of war was
replaced largely by impersonal and methodical
butchery.
The medical environment of the mid-19th
century also underwent significant transformations
corresponding to those of society at
large. Whereas previously the medical profession
had been constrained by religious connotations
of disease as divinely mandated, and
restricted even further by practice based on
study of ancient texts, the slow progress
brought about through the Enlightenment
and Age of Reason eventually began to manifest
itself in clinical advancement. The study
of the biological sciences moved from a process
of revelation of divine beneficence
through natural order to a rational approach
as to how that order might be understood and
modified in a purely secular context. This
great application of rational science to clinical
practice only became truly manifest in the
first half of the 19th century. The previous
system of "heroic medicine," which emphasized
the importance of physician interventions
such as bleeding, cupping, purging and
blistering, as based on the notions of all dis
eases being manifestations of systemic derangemen
ts was challenged, and new systems
more reliant on natural healing and new
physiologic concepts were becoming widely
acceptable. There were clearly extremes to
these new systems of medicine, ranging from
the Hydropaths who advocated no artificial
interventions in favor of abstinence from all
worldly vices, to Eclectics who maintained
many of the old heroic treatments and decried
the treatment of pain as defeating the "counterirritant
theory" of healing. This concept
held that pain itself was a disease that, if induced
strongly enough, could overcome a
patient's coexistent disease. This was in direct
contrast to the view of conservative medicine
which had come to see pain as harmful
in that it might predispose to "shock," decrease
the "vital energies" of the patient, or
function as a precursor to inflammation. The
extremist schools of medical practice were
outside the norm of medical thought, however,
and allopathic medicine, as we envision
it, slowly began to take shape.
The development of modern medicine, of
which the efforts of Mitchell, Morehouse and
Keen may be considered a part, relied on some
basic investigations into the structure and
fUllction of living things, and these researches
were just beginning to reach the level of clinical
applicability in the mid 19th century. The
pioneering work of Bichat in histology and
his theory of organ specificity, the development
of physical diagnosis with anatomical
correlation by Laennec, and the concepts of
cellular pathology as defined by Virchow, all
were necessary steps toward the later work,
as specifically were the neurologic investigations
of Bell, Miller and others. Additionally,
with the refinement of knowledge of discrete
systems within the larger framework of
anatomy and physiology, came an increase in
specialization within the medical world. This
trend was in its early stages at the time of the
Civil War, but had already led to the creation
BULLETIN OF ANESTHESIA HISTORY 9
of specialized hospitals for conditions such
as blindness and deafness.
Further conditions necessary for the advent
of the kind of work done at Turner's
Lane were the technological and methodological
developments of the early 19th century.
From the purely technical standpoint,
the experimental work, particularly as related
to therapeutics, could not be envisioned without
the concept of using specific drugs for
specific conditions, the ability to isolate or
manufacture such compounds, and the creation
of effective means to deliver those compounds.
The work of Serturner in isolating
morphine from opium in 1809, and the development
of the first hollow metal needle
by Alexander Wood in 1853, are the most
obvious examples of technical advancement
as it relates to pain control in the 19th century.
The idea that specific agents might be
used in the treatment of a particular condition
could not exist until the concept of disease
had changed from the whole-body "congestive"
theories of heroic medicine to the
more organ and system-specific maladies of
allopathic medicine. This transition was a
particularly difficult one, as the pharmacopoeia
of the day included few compounds
with real clinical potency and the techniques
of physical diagnosis were largely unable to
distinguish between diseases with similar
clinical presentations.
The moral and professional approach to
patients and disease must be examined to
fully reconstruct the milieu that allowed the
Turner's Lane work to be undertaken. Mainstream
medical thought, as characterized in
the term "professional conservatism," had
recently reached a level of development that
approximates that of today as regards the
physician's responsibility to the patient in the
professional setting. The wave of egalitarianism
which dominated intellectual life, the
direct effect of the Age of Revolution enhanced
by the "frontier" attitudes of the
United States, combined with the new scientific
analyses as conceived by Pierre Louis in
his work on medical statistics, created what
Pernick calls "the calculus of suffering." Essentially,
this amounts to the modern concept
of a risk/benefit ratio, particularly as
applied to the relief of pain and suffering, in
which the best outcome is sought by whatever
means are considered reasonable and not
unduly perilous. This "nice balancing of
probabilities," as Worthington Hooker
phrased it, allowed physicians the middle
course between completely "natural" healing
and the old heroic techniques. This idea
of assisting natural healing while "doing no
harm" was central to the neurologic studies
at Turner's Lane. Furthermore, the rational
Continued on Next Page

10 BULLETIN OF ANESTHESIA HISTORY
Pain Control. . . COlltiJluedji'olll Page 9
application of this new "calculus" on a wide
scale demanded some mechanism for data
collection and dissemination. The Civil War
provided this mechanism, as the Army Medical
Corps undelwent a thoroughgoing process
of bureaucratization and centralization
previously unparalleled. Only through this
agency could sufficient cases be collected and
examined, continuing contact be assured, and
the information thus gathered be codified and
circulated. The practical application of the
work during the actual conflict was minimal,
but the possibility of "real world" clinical utility,
particularly in light of the spirit of "Yankee
ingenuity," was paramount.
Finally, we must examine the people involved
in the research to understand their
perspective and motivations. Foremost
among these were S. Weir Mitchell and William
W Keen, both of whom pursued related
studies for the remainder of their lives.
S. Weir Mitchell was born in 1829 into a
medical family, the son of a professor of medicine
at Jefferson Medical College, and received
his medical degree in 1850. Subsequently,
he traveled to Paris and studied with
Claude Bernard, the greatest physiologist of
the age. Upon his return from Paris, he established
himself in general practice in Philadelphia
and was functioning in that role until
1862, at which time he entered service with
the US Army.
WW Keen, who was to become a pioneer
in neurological surgery, was only 25 years old
at the time of his assignment to the Turner's
Lane Hospital, and had only graduated from
medical school earlier that year. He had, however,
distinguished himself while a student
at Jefferson by working with Dr. Mitchell in
his early researches, and subsequently during
his first assignment as an assistant surgeon
in the field with the Union Army.
Both of these men were clearly of outstanding
intellect and undeniably products
of the social revolutions previously discussed.
Their youth, combined with their academic
curiosity, allowed them to step out into previously
unexplored areas without hesitation,
and permitted them the energy to pursue
these investigations exhaustingly despite the
enormous amount of labor involved with a
velY limited staff. Both men were demonstrably
superior administrators in an era when
medical bureaucracy was-in its infancy and
medical record-keeping was unstandardized
and often haphazard. Mitchell had antebellum
professional ties with William
Hammond, the Surgeon General of the Army,
from whom he received full cooperation in
the founding and continued support of activities
at Turner's Lane. And possibly most
importantly, these men had a strong sense of
humanitarianism injected into their personalities
which reflected itselfin their later thoughts,
papers and literary works. In this capacity
Mitchell was particularly noteworthy, as he
achieved fame as much for his literary efforts as
for his medical accomplishments.
Especially revealing in this context are
Mitchell's novels of realistic fiction which
explore his and his patients' psychological,
emotional and spiritual reactions to their
conditions, as well as their physiological derangements.
It is possible that Mitchell used
this vehicle as a mechanism for commenting
on his society as a whole and the altered morality
of that society during and after the national
trauma of the war. Certainly, however,
no practltlOner of state-of-the-art
multidisciplinary pain control today can fail
to see the underlying truths of his observations,
or fail to validate the necessity of the
recognition of such factors in the complete
care of the pain patient. The progressiveness
of this "whole person" approach under the
guidance of Mitchell, in an era that was still
attempting to reconcile ancient dogma with
modern physiology, was, if not unique, clearly
unusual and definitely personality-dependent.
In summary, the Turner's Lane Hospital,
the neurologic studies undertaken there, the
men who conceived of and performed these
studies, and the American Civil War which
provided the raw material of human pain and
suffering, were all reflective of the vast upheavals
in society that transformed the
United States in the early 19th century. The
great reform movements, the rationalization
of science and secondarily of common
thought, and the industrialization and standardization
of society all provided a backdrop
for the birth of scientific pain control just as
they did for the introduction of surgical anesthesia.
Whether we believe that these events
were inevitable or not, we must acknowledge
the outstanding contributions of such personalities
as Mitchell and Keen, alongside Long
and Morton, as pioneers in our expanding field
of practice. Betteryet, we should reflect on their
activities and their feelings as revealed in their
professional and secular writings and try to apply
them to our own practices in today's rapidly
evolving social context.
Bibliography
1. Adams, A.W., Doctors in Blue, New York,
Henry Khuman Inc., 1952.
2. Brooks, S.M., Civil IVaI' Medicine, Springfield,
IL., Charles C. Thomas, Publishers, 1966.
3. Caton, D., The poem in the pain, the social
significance of pain in western civilization.
Anesthesiology 81 (4): 1044-52, 1994.
4. Caton D., The secularization of pain. Anesthesiology
62 (4): 493-501, 1985.
5. Davis, D.A., Ed.,Historical Vignettes of Model'll
Anesthesia, Clinical Anesthesia Series, 2/1968,
Philadelphia, PA., Davis Co., 1968.
6. Gillet, M.C., TIle Army Medical Department
1818-1865, Washington, DC., Center of Military
History, 1987.
7. Greene, N.M., A consideration of factors
in the discovery of anesthesia and their effects on
its development.Anesthesiology 35 (5): 515-22, 1971.
8. Hume, E.E., Victories ofArmy Medicine-Scientific
Accomplishments of the Medical Department of
the U. S. Army, Philadelphia, JB .Lippincott Co.,
1943.
9. Mann, R.D., Ed., TIle HistOlY of the Management
of Pain, Park Ridge, NJ, The Parthenon
Publishing Group, 1988.
10. Melzack, R. TIle Puzzle of Pa in, New York,
Basic Books Inc., 1973.
11. Mitchell, S.W., TIle Autobiography of a
Quack and the Case of George Dedlow, Upper Saddle
River, NJ, The Gregg Press, 1968.
12. Morris, D.B., TIle Cullure of Pain, Berkeley,
CA., University of California Press, 1991.
13. Otis, G.A., Huntington, D.L., TIle Medical
and Surgical HistOlY of the IVaI' of the Rebellioll,
Part II, Vol. 2, Washington, DC, Government Printing
Office, 1883.
14. Papper, E.M., The influence of romantic
literature on the medical understanding of pain
and suffering-The stimulus to the discovery of
anesthesia. Prospect in Biology alld Medicine, 35(3):
401-15, 1992.
15. Pernick, M.S.,A Calculus of Suffe ring, New
York, Columbia University Press, 1985.
AHA Meeting. . . COlltilluedji'om Page 3
Thursday, April 3, 1997; Woodlands Inn,
Colonial Williamsburg, Virginia, USA
7:00-8:00 am: Registration and Continental
Breakfast
8:00-8:30 am: Opening Plenary Session.
Audrey Shafer, MD, "Reading Between the
Lines: The Language of Anesthesia"
8:30-10:00 am: Concurrent Session A
8:30-10:00 am: Concurrent Session B
10:00-10:30 am: Coffee Break
1O:30-Noon: Concurrent Session C
1O:30-Noon: Concurrent Session D
Noon-l:30 pm: Luncheon PlenalY Session.
"Historical Treasures from the National Library
of Medicine." NLM/HistOlY of Medicine Staff
Member
1:30-2:30 pm: Mternoon Plenary Session.
"Doing Anesthesia History" panel
'slzing the Right Questions." Doug Bacon,
MD
"Where to Find Source Material." Patrick
Sim, MLS
"Secondary Source Material." Don Caton,
MD
"Presenting Your Findings." A.I. Wright,
MLS ()
2:30-3:00 pm: Coffee Break
3:00-4:30 pm: Concurrent Session E
3:00-4:30 pm: Concurrent Session F

BULLETIN OF ANESTHESIA HISTORY
I I
Annual Meeting and Dinner
Anesthesia History Association
October 22, 1996
Westin Canal Plaza Hotel
New Orleans, Louisiana
Photography by Miguel Colon-Morales, M.D.
DI: Gwen Wilson and daughtel, with DI: Carlos Parsloe
John Rowlingson
Bill Hammonds
DI: & Mrs. EdJohnson, TerTence Bogard
A
DI: & Mrs.Phillip Gordon, Mark Rockoff
DI: Doris Cope
Dr. Laura Wolf & DI: Geofft'ey Wolf
Continued on Next Page

12 BULLETIN OF ANESTHESIA HISTORY
Annual Dinner and Meeting. . . Continued from Page 11
Selma Calmes
Joan & Ron Stephen
Laureate Gwen Wilson & Daughter
Clyde JOlles,,Doris Cope
Norma Jones, Alan Sesslel, John Steinhaus
Ron Stephen
President Lucien Morris
Trudy Betchel, Jean Steinhaus, Elizabeth Lee
Leroy vandam
Dl: Valencia (Medellin, Colombia), Lucien Morris, Ron Stephen

BULLETIN OF ANESTHESIA HISTORY 13
Elliott Miller (President, WLM); Lucien Morris (President,
AHA); Maj. Eric Schoenberg (lst Prize, Resident
Essay Contest); Doris Cope
Gertie Marx, Patrick Sim (WLM), Alberto Jose DeArmendi
Frank McKechnie, Bill Pendel; Susan Schipper-Smith, Ted Smith
Joe Artusio
Nick Greene
Leslie Rendell-Bakel; Douglas Bacon
Ted Smith, Secretmy-Treasurer
Betty Bamforth
Philip Rosene, DI: Hollinger
DI: & Mrs. valencia, Edith & Carlos Parsloe, Miguel Colon-Morales
Lucien Morris
Colltillued 011 Next Page

14 BULLETIN OF ANESTHESIA HISTORY
Annual Dinner and Meeting . . . COlltilluedfrolll Page 13
D,: & Mrs. N. Va lencia, D,: & Mrs. Carlos Parsloe, Pa trick Sim
Betty Bam/orth, Brad Smith
Albert Betcher
Doris Cope
Bill Pender
Elliott Millel; Lucien Morris
Frank McKechnie, D,: & Mrs Phillip Gordon
D,: Alberto Jose DeArmendi, D,: Nacianceno Va lencia
Lucien Morris, Ron Stephen

BULLETIN OF ANESTHESIA HISTORY
IS
The Discovery of Curare
are much indebted to the Royal College of Physicians and Surgeons of Canada, the Editor of the Annals of the R.C.P'S.C., and to Roy Kim, a medical
student, and JR. Maltby, MB., an anaesthetist at University of CalgaJ)" Alberta, fo r their peJ1nissiolls to republish the fo llowing historical account of
Charles waterton and the naming of the waterton Lakes National Park, which adjoins the Glacier National Park in Montana. One should note that D,;
Maltby, a member of the Anesthesia HistOl)' Association, is also somewhat of an explorer himself, having recentlY been in Ethiopia and having ill the past
established anesthesia teaching programs in Nepal.
Charles Waterton (1782-1865), Curare, and
Waterton Lakes National Park
by Roy Kim; J.R. Maltby ME, FRCA, FRCPC*
Annals RCPSC 28:359-362, 1995
Introduction
Charles Waterton was a 19th-century explorer,
naturalist and taxidermist.I-4 He was
born on June 3, 1782, at Walton Hall near
Wakefield, Yorkshire in northern England,
and died there on May 27, 1865. When he
was sent to a Catholic boarding school at the
age of nine, he was already a keen tree-climber
and birds' nester. This led him into repeated
conflict with the priests. While he was still a
boy, his habits could be excused as youthful
energy, but when he continued the activities
until the age of 80, Waterton was characterized
as an eccentric. At the age of 14, he
moved to a newly founded Jesuit school,
Stonyhurst College in Lancashire, where the
priests appointed him rat-catcher and foxtaker
to give him a legitimate reason for being
out of bounds on his nature studies.
Waterton left England in 1804 to manage
family estates in Demerara, now Guyana.
After eight years, he gave up management of
the estates, and travelled inland by canoe and
on footS on his first wandering "to collect a
quantity of the strongest wourali [curare]
poison and to reach the inland frontier fort
of Portuguese Guyana." He succeeded, although
he was ill with tertian malaria on the
return journey, and took three years to make
a full recovery after his return to England.
Waterton left England again in 1816, 1820
and 1824 for South America,5 where he collected
the skins of many birds and animals,
including that of a cayman that he rode for
40 yards during its capture. He took the skins
back to England and became an expert taxidermist,
achieving results that were superior
to those of his contemporaries. He soaked the
skins in bichloride of mercury, and moulded
them into lifelike poses over several days as
the skins dried.6 Two examples are seen in
his portrait (Figure 1), painted in 1824 by
Charles Willson Peale in Philadelphia when
Waterton also travelled to Montreal and Quebec
City.7
Waterton's most enduring achievement
was the early example he set in wildlife protection.
From 1821 to 1826, he created a wildlife
sanctuary by enclosing the 260-acre estate
around Walton Hall with a
nine-foot high wall, and by providing
trees, bushes and structures
for wild birds. They were
never disturbed by the sound of
a gun, however much they multiplied.8
Vermin, except for the
brown rat, were never trapped.
There had been menageries before
this time to preserve game,
but nothing for the protection of
native wild birds. This is why
Waterton has been called the father
of British bird protection. He
disagreed with his American contemporary,
J ohnJ ames Audubon,
about conservation. Audubon
had a frontiersman's approach to
nature. He participated in hunting
sprees during which hundreds
of birds were shot and piled in a heap.
Audubon once said, "1 call birds few when I
shoot less than a hundred a day." In contrast,
Waterton said that the rain forest had taught
him mercy, and he opposed mass hunting. It
is ironic that today Audubon is better remembered
as a conservationist.
Waterton also fought against industrial
pollution of the environment. He won a legal
action against a neighboring industrialist,
whose soap factory fumes killed fish in a
nearby stream, damaged trees on Waterton's
estate, and almost destroyed a heronry.3
Despite many illnesses and accidents,
some natural, others due to his carelessness,
Waterton lived to the age of 83. He died in
May 1865, and is buried in the grounds of
Walton Hall.
Curare
When Waterton sailed from England in
1804, he was aware of curare's poisonous effects.
Before his departure, he dined with Sir
Joseph Banks, president of the Royal Society,
and told him of the Indian poison and
how they used it for hunting. According to
the contents of a letter from Waterton to the
mayor of Nottingham in 1839 (The Richard
Owen Collection: Letters, British Museum of
Figure 1. Charles Wa terton (by courtesy of
the National Portrait Gallel)" London,
England).
Natural History, London), Banks replied:
"I have been a great traveller; and all
the investigation which I have been
able to make concerning the nature of
the poison, tends to convince me that
it is not sufficiently strong to kill the
larger animals, such as men and cattle;
but it may answer very well in the ordinary
pursuit of winged game and in
that of minor quadrupeds. When you
yourself have witnessed its deadly effects
on man or cattle, we will no longer
doubt its deadly virulence."
Waterton's first opportunity to take up the
challenge came in 1812, when he gave up
management of the family estates and embarked
on his first "wandering." In a letter
to Reverend Charles Wright, Stonyhurst College,
in 1813 (Stonyhurst College archives),
he wrote:
" .. .I left the town of Stabroek [now
Georgetown] on the 26th of April
Continued 011 Next Page

16 BULLETIN O F ANESTHESIA HISTORY
Curare. . . Continued from Page 15
[1812], . . . proceeded up the
Demerara in a canoe with six savages
for about 400 miles and then crossed
overland to the Essequibo from which
river I passed into the Apoura-Poura.
From the banks of this river I had
seven days march by land, thr' swamps
and forests and over mountains. I then
got into the river Pirarara, from that
into the Tacaton, from the Tacaton to
the Maon, from that into the Branco
where I found Fort St. Joachim. I had
tough work of it on account of the periodic
rains, and intervals of intense
heat. I collected a considerable quantity
of the famous vegetable poison and
tried it on an ox 960 lbs weight. I had
no idea it was so strong and fatal. I
narrowly watched all the symptoms in
the ox and saw him die. . . I have also
about 150 of the most rare and beautiful
birds and fine blowpipes for the
poisoned arrows."
The journey took four months. By the time
his party reached Fort S t. Joachim, Wa terton
was ill with malaria.s His first experiment
with curare was conducted with a small quantity
obtained from an Indian who claimed to
have killed several wild hogs and two tapirs
with it. He tested its potency by wounding a
dog in the thigh. Symptoms appeared in three
or four minutes. The dog staggered, lay down,
fell on its side, and in 15 minutes was inert.
Its heart continued beating faintly for several
minutes after its respiration had ceased.
Waterton found the Macusi Indians with
their potent curare in the upper reaches of
the Essequibo. He described how they went
into the forest to obtain a wild vine a day or
two before preparing their curare. He recognized
that this was the main ingredient, but
he also recorded the addition of large black
ants, small red ants, snakes' fangs and pepper.
Water was poured over shavings of the
wourali vine into a pot, a glutinous juice was
squeezed from the bulbous stalk of two
plants, and the mixture boiled to form a
brown syrup. A few arrows were poisoned
with it to test its strength, presumably by
observing its effect on a convenient animal.
If it was potent enough, it was poured into a
calabash and kept in the driest part of the
hut.
The Indians used blowpipe arrows to kill
birds. The blowpipe was made from a reed
that was 10 to 11 feet long, from which an
arrow, nine to 10 inches long, could be shot
as far as 300 feet (Figure 2).
"The Indians have shown ingenuity in
making a quiver to hold the arrows. It
will contain from 500 to 600.
It is generally from 12 to 14
inches long and in shape resembles
a dice box used at
backgammon. . . Before he
puts the arrows into the quiver,
he links them together by two
strings of cotton, one string at
each end, and then folds them
around a stick which is nearly
the length of the quiver. The
end of the stick, which is at uppermost,
is guarded by two
little pieces of wood crosswise,
with a hoop round their extremities,
which appears
something like a wheel; and
this saves the hand from being
wounded when the quiver
is reversed in order to let the
bunch of arrows drop out."
Waterton observed that birds wounded by
curare-tipped blowpipe arrows fell to the
ground in three minutes. He described his
experiment on a fowl:
"By the termination of the third
minute, it had sat down, scarce able to
support its head, which nodded, and
then recovered itself, and nodded
again, lower and lower every time, like
that of a weary traveller slumbering in
an erect position; the eyes alternatively
open and shut. The fourth minute
brought on convulsions, and life and
the fifth terminated together."
The Indians used bows and arrows to kill
deer and tapirs. The arrows were four to five
feet long, and made from a hollow reed. The
arrow tips were curare-coated spikes of
coucourite wood cut half through near their
bases to break off when they entered an animal.
For the experiment on the ox, Waterton
used three large curare-covered wild hog arrows.
The ox staggered and fell after 14 minutes,
its heart continued beating after respiration
had ceased, death occurred in 25 minutes,
and "his flesh was sweet and savory at
dinner." Waterton thought that the ox took
longer to die because, allowing for its weight,
it received proportionately less curare than
the fowl. Thus, he recognized that curare's
effect was dose-related, and that it was inactive
by mouth. He also tested the traditional
Indian antidotes of pouring sugar water or
salt down the throat of a fowl, or holding it
in water up to its neck, but they always failed.
Waterton returned to England in the
spring of 1813. In 1814, an experiment was
performed in London by Sir Benjamin Brodie
and himself, assisted by Professor Sewell of
the Veterinaty College, using curare supplied
by Waterton:
Figure 2. Wa terton's blowpipe alTOWS and
quivel: The cap has a label, thought to be in
waterton's handwriting; "Quiver with
poisoned arrow for the blowpipe fi'on!
Guiana, 1812" (by courtesy of Wa kefield
Museum and Galleries).
''A she-ass received the wourali poison
in the shoulder, and died apparently
in 10 minutes. An incision was then
made in its windpipe, and through it
the lungs were regularly inflated for
two hours with a pair of bellows. Suspended
animation returned. The ass
held up her head and looked around;
but the inflating being discontinued,
she sank once more in apparent death.
The artificial breathing was immediately
recommenced, and continued
without intermission for two hours.
This saved the ass from final dissolution.
She rose up and walked about;
she seemed neither in agitation nor in
pain . . . The kind-hearted reader will
rejoice on learning that Earl Percy,
pitying her misfortunes, sent her down
from London to Walton Hall, near
Wakefield. There she goes by the name
of Wouralia. Wouralia shall be sheltered
from the win try storm, and when
summer comes she shall feed in the
finest pasture. No burden shall be
placed upon her, and she shall end her
days in peace."s
A footnote in later editions of the book
records that "Poor Wouralia breathed her last
on Saturday, the 15th of February, 1839, having
survived the operation nearly five and
twenty years."
In 1839, Waterton was summoned to
Nottingham, 40 miles from Walton Hall in

the hope that curare could be used to control the
convulsions of a policeman who had developed
hydrophobia after a dog bite.9 By the time he arrived,
the policeman had died. Waterton returned
afterwards, and with the aid of Sibson, a leading
Nottingham physician,lO repeated the Wouralia
experiment on two donkeys to prove that curare
would be safe to use in cases of hydrophobia and
tetanus. Waterton believed that its "sedative and
narcotic qualities" would render death calm, composed,
and free from pain. He, Brodiell and
Sibsonl2 were all under the mistaken impression
that curare produced unconsciousness with paralysis
of the voluntary muscles.
The history of curare13-15 goes back to Peter
Martyr d'Anghera'sI6 account in 1516. It was not
until the early 19th century, however, that more
careful observations were made. Humboldt1 provided
the first eyewitness account of curare's
preparation in 1807; Brodiel8 showed in 1812 that
artificial respiration could keep small animals
alive until spontaneous respiration returned;
Waterton5 provided detailed accounts of curare's
effect in 1825; and Martiusl9 1830 recognized that
plants other than the Strychnos species provided
the main component in some curares. In 1856,
Bernard20 proved that curare acted only at the
neuromuscular junction; and in 1935, King21 isolated
tubocurarine and elucidated its chemical
structure.
Intermittent attempts to treat tetanus with
curare were made in the 19th22 and early 20th
century.23 Sibson24 observed in 1859 that artificial
respiration would be essential if enough
curare was used to control the convulsions. The
total paralysis regime for the treatment of severe
tetanus25 was eventually introduced in Denmark
in the 1950s.
Waterton's curare experiments occurred before
the discovelY of general anesthesia in the
1840s. The modern era of neuromuscular blockade
dawned in Montreal on January 23, 1942,
when Harold Griffith and Enid Johnson26 introduced
curare into clinical anesthesia. Since then,
many neuromuscular-blocking drugs have been
synthesized in the laboratory, but the d-tubocurarine
in clinical use today is still extracted
from curare resin prepared by Indians2 in the
wilds of Peru mid Brazil near the headwaters of
the Amazon and Orinoco rivers as in the days of
Waterton. It is transported by mule to an airstrip
in the jungle, and thence to the manufacturer
for isolation and purification of tubocurarine. An
ultraviolet assay method is used for the British
Pharmacopoeia. In the United States, the powdered
drug is assayed spectrophotometric ally, and
potency is measured using the rabbit head-drop
assay,28,29 which is similar in principle to
Waterton's head-drop observation on the fowl.
Waterton Lakes National Park
The Palliser expedition (1857-1860) explored
western Canada from Lake Superior to the
Rockies. In 1858, Thomas Blakiston led
the party that explored possible railway
routes through the Canadian Rockies
south of the existing fur-trading routes
in what is now southwestern Alberta.
They proceeded south from the Bow
River, west through the North Kootenay
Pass, and returned by the South Kootenay
Pass to descend through Blakiston Valley,
which leads to the largest of a chain
of three lakes. A footnote in the Palliser
papers30 records that Blakiston (1832-
189 1)31 called these lovely lakes after
Charles Waterton.
Water ton Lakes National Park was
Canada's fourth national park. It was established
in 1895 as Kootenay Lakes Forest
Park and renamed Waterton Lakes
Dominion (later National) Park in 1911.32
Its international border is contiguous
with Glacier National Park in Montana.
In 1932, after a resolution by the
Rotarians of Alberta and Montana for the
establishment of an international peace
park the previous year, legislation was
approved by the U.S. Congress and by the
Canadian Parliament. Dedication ceremonies
for Waterton-Glacier International
Peace Park were held in East Glaciel
Montana, and at the Prince of Wales
Hotel, Waterton, the same summer. In
1979, Water ton Lakes National Park became
the first Canadian national park to
be part of a biosphere reserve. It is one of
12 such reserves in Canada, and represents
the border range mountain and
bunch grass prairie landscape.
Waterton Lakes is the least commercialized
of the Rocky Mountain national
parks. In wintel it is almost deserted except
for park employees. In summer,
when visitors include hikers, campers,
fishermen and naturalists, most animals
stay in remote areas, but deer and bighorn
sheep wander in the small town,
grazing or lying on the lawns. It is a wildlife
sanctualY of which Charles Waterton
would have approved.
References
1. Hobson R. Charles Waterton: his home,
habits and handiwork. London: Whittaker,
1866.
2. Aidington R. The strange life of
Charles Waterton. London: Evans Brothers,
1949.
3. Blackburn J. Charles Waterton 1782-
1865: traveller and conservationist. London:
The Bodley Head, 1989.
4. Edgington BW. Charles Waterton: a biography.
Cambridge: Butterworth. In press.
5. Waterton C. Wanderings in South
America, the north-west of the United States
and the Antilles in the years 1812, 1816, 1820
and 1824. London: Mawman 1825:1-84.
6. Logan BM. Charles Waterton's method
of taxidermy. Br J Anaesth 1983;55:229-30.
BULLETIN OF ANESTHESIA HISTORY 17
7. Watertan C. Wanderings in South America,
the north-west of the United States and the Antilles
in the years 1812, 1816, 1820 and 1824. London:
Mawman 1825:250-6.
8. Head G. A home tour through the manufacturing
districts of England in the summer of
1835. 2nd ed. London: Cass, 1968:153-71.
9. Waterton C. Essays on natural history: second
series, 2nd ed. London: Longman, Brown,
Green and Longmans 1844:xiv-xxiii.
10. Maltby JR. Francis Sibson, 1814-1876:
pioneer and prophet in anesthesia. Anaesthesia
1977;33:53-62.
11. Brodie BC. Physiological researches. London:
Longman, Brown, Green and Longmans,
1851:142.
12. Sibson F. On pericarditis. London J Med
1849;1:893. Reprinted in: Ord WM, ed. Collected
works of Francis Sibson, vol. II. London:
MacMillan, 1881:1-29.
13. McIntyre AR. Curare: its history, nature,
and clinical use. Chicago: The University of Chicago
Press, 1947:5-19.
14. Jones R. Development of skeletal muscle
relaxants from the curare arrow poisons. In:
Atkinson RS, Boulton TB, eds. The history of anesthesia.
London: Royal Society of Medicine,
1989:257-67.
15. Sykes K. The Griffith legacy. CanJ Anesth
1993;40:365-74.
16. D'Anghera PM. De orbe novo (1516).
MacNutt FA, trans. New York: Putmans Sons, 1912.
17. Von Humboldt A, BonplandA. Voyage aux
regions equinoxiales du nouveau continent.
1807;5:ii.
18. Brodie BC. Further experiments and observations
on the action of poisons on the animal
system, part 1. Phil Trans R Soc 1812; 102:205-7.
19. Von Martius CF. Ueber die Bereitung des
Pfeilgiftes Urari bei den Indianem Juris am Rio
Yupura in Nordbrasilien. In: von Buchner, ed.
Repertorium fuel' die Pharmacie. Nuremberg:
Schrag 1830;36:337-53.
20. Bernard C. Lec;ons sur les effets des substances
toxiques et medicamenteuses. Paris:
Balliere et Fils 1857:311-25.
21. King H. Curare alkaloids. I Tu bocurarine.
J Chern Soc 1935;57:1381-9.
22. Sayre LA, Buffall FA. Two cases of traumatic
tetanus. N Y State J Med 1858;4:250-3.
23. Cole LB. Tetanus treated with curare.
Lancet 1934;2:475-7.
24. Reports of societies. Medical Times and
Gazette 1859; 10:564.
25. Lassen HCA, Bjorneboe M, Ibsen B,
Neukirch F. Treatment of tetanus with curare, general
anesthesia and intratracheal positive pressure
ventilation. Lancet 1954;ii: 1040-4.
26. Griffith HR, Johnson GE. The use of
curare in general anesthesia. Anesthesiology
1942;3:418-20.
27. Reader JA. Curare: manufacture and quality
control. Br J Anaesth 1983;55:227.
28. Varney RF, Linegr CR, Holaday HA. The
assay of curare by the rabbit "head-drop" method.
J Pharm Exp Ther 1949;97:72-83.
29. McEvoy GK, ed. AHFS drug information
1994. Society of Hospital Pharmacists Inc.,
1994:831.
30. Spry 1M. The papers of the Palliser expedition
1857-1860. Toronto: The Champlain Society,
1968:578.
31. H.E.D.E. Blackiston, Thomas Wright. In:
Lee G. Dictionary of national biography, vol. xxii
(suppl). London: Smith, Elder, 1909:2l4-5.
32. Pole G. Canadian Rockies, 3rd ed. Banff.
Altitude 1993:310-21.

18 BULLETIN OF ANESTHESIA HISTORY
WLM History Review :
Spirits of Anesthesia
SUBJECT: Laureate of the History of Anesthesia
The Wood Library-Museum is pleased to
announce the appointment of Dr. Gwenifer
Wilson as the first Laureate of the History of
Anesthesia. Dr. Wilson was selected from a list
of distinguished nominees by an international
panel of medical historians.
Australian-born, Dr. Wilson practiced anesthesia
for almost SO years. Coincidentally she
developed a distinguished list of publications
dealing with the history of anesthesia, the history
of medicine in Australia, and most recently,
the history of the transmission of news of anesthesia
from Boston to Australia in 1846. In the
process of preparing this material she became a
recognized expert on Australian Medical journals,
as well as commercial shipping practices
during the nineteenth century. In 1995 she was
awarded a Doctorate of Medicine from the University
of Sydney for her thesis "Fifty Years: The
History of the Australian Society ofAnaesthetists
1934-1984." It was the first Post-Graduate Doctorate
of Medicine in Australia, awarded for
medical history. Dr. Wilson has given numerous
eponymous lectures and has received many
awards for her work.
Dr. Wilson will be inducted as the first Laureate
of the History of Anesthesia at a special
ceremony following the Lewis Wright Memorial
Lecture at the 1996 meeting of the American
Society of Anesthesiologists in New Orleans.
References:
*Wilson G. One Grand Chain: The Histmy of
Anaesthesia in Australia 1846-1962. Sydney:
Bridge Printery Pty Ltd., 1995. (This book is DJ:
Wtlson most recent work, in time fm' the 150th anniversmy
of the first successful public demonstration
of a modern surgical anesthetic.)
*Wilson G. The impact of the introduction
of Curare in Australia. In: Rupreht J, van
Lieburg MJ, Lee JA, et al.Anaesthesia: Essays on
Its Hist01Y. Berlin: Springer-Verlag. 1985, 212-
216.
*Wilson G. The First Anaesthetics in New
South Wales.Anaesthesia & Intensive Care. 1979;
7(3):278-280.
*Wilson G. The Introduction of Local Anaesthesia
in Australia, January 19, 1885. Anaesthesia
& Intensive Care. 1985; 13(1):71-78.
*Wilson G. The Pioneer Anaesthetists of
Australia. In: Rupreht J, van Lieburg MJ, Lee
JA, et al. Anaesthesia: Essays on Its Hist01Y. Berlin:
Springer-Verlag. 1985, 59-64.
*Loan or photocopy available from WLM
Compiled and edited by Donald Caton, M.D.
SUBJECT: Blood Gas Analysis
In 1669, Robert Boyle (1627-1691) used a
vacuum pump, previously developed by Robert
Hooke, to demonstrate that blood contained
enormous amounts of gas. Subsequent
identification of components of that gas by
Joseph Black (C02, 1754), and by Scheele,
Priestley, and Lavoisier (02' 1772-1775), initiated
two centuries of improvements in
methods of gas analysis. Those who contributed
to these developments include R.WE.
Bunt and G.R. Kirchoff (spectroscopy), S.
Arrhenius (ionization), W Ostwald (hydrogen
ions), S.P.L. Srensen (pH and buffers),
L.J. Henderson (mass law and HC0 3
buffering),
KA. Hasselbalch (blood pH measurement),
C. Bohr and J.S. Haldane (Hemoglobin
02-C02 interactions), S.A.S. Krogh (precise
measurement that ruled out 02 secretion),
D.D. VanSlyke (manometric gas analysis),
L.C. Clark (02 electrode), RW Stow
(C02 electrode), and P. Astrup and 0.
Siggaard-Andersen (acid-base definition and
precise pH measurement).
In a letter that appeared in JAMA (1991;
266:2559) entitled "Removing pH from
pHysician's pHrases," R.E. Neiberger advocates
abolition of pH. He writes "In the days of
Arrhenius, Severinghaus and Henderson-Hasselbalch.
. . pH once served a useful
purpose, like the horse and buggy, logarithms
and the slide rule." This elicited several replies
("More RIpH" JAMA 1992, 267:2035) including:
a letter by Anchi Wu who suggested that
Neiberger mean "Srensen" not "Severinghaus";
a letter by Severinghaus, who appreciated the
pHlattery but defended pH, which noted that
Neiberger's third historic figure,
"Henderson-Hasselbalch," never met to consummate
their hyphen; and an apology to all
concerned, by a slightly red-faced editor.
Books:
Astrup P, Severinghaus JW The Histmy of
Blood Gases and Acid-Base Balance.
Copenhagen: MunksgaardlRadiometer Co.,
1986. (As an outgrowth of the first international
congress on history of anesthesia, held in
Rotterdam in 1982, Astrup invited Severinghaus
to collaborate writing a histmy of blood gas analysis.
A new edition of that book is now . in preparation.)
Astrup P, Severinghaus JW. History of
blood gas analysis. In: West, IB. ed.Histmy of
Respiratmy Physiology: Lung Biology in Health
and Disease. New York Marcel Dekker (in
press).
Haldane JS.Respiration. New Haven: Yale
University Press, 1922.
Barcroft J. TIle Respirat01Y Function of the
Blood. New York: Cambridge University
Press, 1914 (2nd ed., 1968).
*Severinghaus Jw, Astrup P. History of
Blood Gas Analysis.IntAnesthesiol Clin. 1987.
(Seven articles on the hist01Y of blood gas methodology,
originally published in the J. CZin. Moni-
toring, have been re-assembled as a book, and
published in celebration of the centenmy of founding
of Physical Chemist/y.)
Other Resources:
Clark LC, Jr. Measurement of Oxygen
Tension: A Historical Perspective. Crit Care
Med. 1981;9:960-962.
Roughton FJW Transport of oxygen and
carbon dioxide. In: Handbook of Respiration.
Washington, DC: Amer. Physiol. Soc., 1964;
1:767-825.
Severinghaus JW History and Recent
Developments in Pulse Oximetry.Acta Physiol
Scand. 1992; 53:S214, 105-112.
*Severinghaus JW. Acid-base Balance
Controversy. J Clin Monit. 1991; 7:274-279.
(Important and interesting controversies related
to blood gas analysis include debates about O 2 secretion
by Ludwig and Pfluger in the 1870s, and
by Krogh, Haldane and Bohr early in this centU1Y,
and, most recently, the transatlantic acid
base debate (s). As an outgrowth of historical
conpHusion, recent letters engage in some lighthearted
antilogarithmic jesting and jostling.)
Severinghaus JW Siggaard Andersen and
the Great TransAltantic Acid Base debate.
Acta Physiol Scand. 1992; 53:S214, 99-104.
*loan or photocopy available from WLM
Compiled by John W. Severinghaus, M.D. Edited by
Donald Caton, M.D.

BULLETIN OF ANESTHESIA HISTORY 19
The Life and Times of the Snake(s):
Our Medical Heritage
by James J. Wi ley, M.D. , F.R. C.S. C. *
One of our Canadian colleagues, DI: James J. Wiley, has presented in a clear manner the derivations and differences between the staff of Aesculapius and the.
Caduceus. we are mllch indebted to him and to the Editor of the Annals of the Royal College of Physicians and Surgeons of Canadafor theirpemlissions
to repl'int this paper in the Bulletin. It appeared originally in the Annals RCPSC 29:231-233,Juue 1996.
-Editor
Editor's note: The author has used both
Latinized and Grecian versions of names
and places, but the material is based only
on Greek mythology. Either version is considered
correct, the choice being the more
popular or familiar.
Introduction
From ancient times, the snake has been
the emblem of the medical profession.
Bearing none of the current sinister reputation,
the snake of antiquity was a symbol
of divinity, a companion of the gods, a symbol
of healing and life, even a renewal of
life (not unlike the shedding of the reptilian
skin-a rebirth). And so the snake became
the mystical emblem in ancient medical
history.
Family Tree in This Historical Background
Consider the Hippocratic oath written
2,400 years ago. Steeped in early Grecian
mythology, its opening sentences refer to
Apollo, Aesculapius, Hygieia, Panacea,
plus "all the gods and goddesses." This introduction
reveals the antiquity of our
medical profession. Recorded ancient history
has unveiled the ancient Grecian period
(approximately 2000 BC), which had
been cloaked in mythology and mysticism,
to expose fact versus fiction and Greek folklore
as it related to medical practices.1-7 It
was the era of the gods and goddesses.
Apollo was not only the son of Jupiter,
king of the gods, but he was also the god of
music, light, youth and healing in the
Greek pantheon. It was Apollo who gave
the caduceus to Mercury, another son of
Jupiter. It eventually became the symbol
of ambassadorial status, even of the postal
service and commerce in general (Mercury
was the god of the "fat purse," messenger
to the gods, patron of merchants and travelers).
Aesculapius (Latin), or Asclepios
(Greek), was the son of Apollo and Coronis,
a mortal of questionable repute. Apollo
arranged for the demise of the unfaithful
Coronis, and transferred the care of AescUlapius
to the centaur Chiron. Chi ron had
acquired some knowledge of medicine from
Apollo, and promptly versed Aesculapius
in the art of healing using herbs, potions
Jupiter (Leto)
I
Apollo (Coronis)
I
Aesculapius (Eplone)
I
Panaceia Hygieia Machaon Podalirius
and incantations. Aesculapius mastered
these skills to such an extent that he not
only saved lives but reportedly raised a man
from the dead. Pluto, the god of the underworld
(Hades) and enemy of the living,
accused Aesculapius of diminishing the
number of souls entering his kingdom.
Pluto complained to Jupiter, who promptly
struck Aesculapius dead with a stroke of
lightning. Aesculapius was resurrected,
however, to fulfil his destiny as a demi-god
of healing.
Aesculapius and his wife, Epione, had
five children (Figure 1), all with medical
leanings-Panacea (goddess of cures, and
caretaker of the sacred snakes in the Greek
temples of healing), Hygieia (goddess of
public health and prevention of disease),
Telesphorus (god of convalescents),
Machaon and Podalirius. The latter two
sons achieved fame as military medics during
the seige of Troy (1180 BC).
Centuries later, from the ancestral lineage
of Aesculapius on one side and
Hercules on the other, came
Hippocrates (400 BC), the father of
the golden age of scientific medicine.8,9
The Origins of the
Symbolic Snake(s)
The snake first appeared in
Babylonian times as a phallic symbol,
represented as dual
female-male heads with one body.
Later, it became known as a "caduceus"
from the Greek word
"karykeion." This symbol was composed
of two serpents entwining a
staff (a herald's wand or olive
branch), representing a benevolent,
mediating god. It was not merely an
!
Artemus
Telesphorus
Figure 1. The family tree
of Aesculapius.
emblem.10-1 2
The sacred asp, called the uraeus, was a
single serpent figure embodied in the
crown of the Pharaohs. The Babylonians
revered a single snake known as "the great
earth snake" or source of life. It also symbolized
the sun god, fertility, wisdom,
learning and healing. With the Greco-Roman
era came the true Aesculapian snake,
known as Elaphe longissima. A similar species
wasElaphe quatuol'lineata; as the name
implies, this snake had four dark stripes
extending the length of its body. The snake
was a constrictor that was approximately
five feet long and harmless to humans. It
was a mysterious sign of godliness, and
thought to be the dwelling place of the sou!.
It was also recognized for its healing power,
Cominued 011 Next Page
Figure 2. The Aesculapian symbol and the
caduceus.

20 BULLETIN OF ANESTHESIA HISTORY
Snake(s) . . . COlltilllledjrom Page 19
The caduceus was reputed to be a symbol
of truce and neutrality. It as not until
the 16th century that Johannes Froben, a
Swiss publisher, introduced the caduceus
as a medical symbol. It was displayed as a
rod with the entwined serpents, surmounted
by a dove. This symbol was then
perpetuated by Sir William Butts, physician
to Henry VIII. Butts, however, added
wings to the top of the staff in recognition
of Mercury.
Besides the legends of one snake on the
staff of Aesculapius and the two snakes of
the caduceus came a third possible legend.13
In this instance, the serpen t was a parasite
known as Dracunculus medinensis, a guinea
worm found in Asia, Africa, southern Russia,
and later, South America. It may have
had its ancestral origins in the biblical fiery
serpent. The traditional healers extracted
the worm from the patient's body
by rolling it into a coil on a stick. In spite
of the analogy to the serpent on the staff,
this legend never contested the role of a
symbol for the medical profession.
The Snakes and the Temples of Healing
With the era of emerging scientific
medicine, a religious medical cult (1200
BC) evolved to venerate Aesculapius. Certain
Greek physicians identified themselves
as Asclepiads ("son of " or "family of" Aesculapius).
Some 300 healing temples
known as ''Asklepieia'' were built in his
honor, the greatest at Epidaurus, where
Aesculapius had worked.14 An Asklepieion
was not one temple, but a group of buildings.
One was a temple to Asklepios, another
was for sleeping and bathing, and
Ta ble 1. Institutions displaying the staff of
Aesculapius.
0 Medical Corps U.S. Air Force
0 All French military medical
insignia
0 German military physicians
0 Royal Army Medical Corps
of England
0 World Medical Association
0 Canadian Medical Association
0 Royal Canadian Army
Medical Corps
0 American Medical Association
0 World Health Organization
0 American Air Force
Medical Service
0 British Orthopaedic Association
0 The Coat of Arms-U.S. Army
Medical Corps
0 British Medical Association
others were for physical therapy. These
temples were managed by physician-priests,
as medicine and religion,
physical factors and psychic factors became
inseparable.
There were three phases in the healing
process. The "cleansing rite" involved a
perfumed bath in the waters of the sacred
spring, before submission of a token admission
payment (animals or cakes). After a
solemn procession accompanied by music,
incense and pomp, the patient entered the
central temple, where sacrifices were offered
to the sacred snakes, followed by a
visit to the holy fountains. Eventually, the
patients were called to an adjacent building
(Abaton) to enter a hypnotic state called
"dream sleep" or incubation. During this .
sta te, the priests and gods visi ted while the
sacred snakes were allowed to crawl among
the patients. The snakes either induced this
dream sleep or healed by direct touch, for
example, healing an ulcer with snake saliva.
The cult of Aesculapius spread throughout
the Grecian empire. By 200 BC, however,
the Asklepieia ceased to be temples
and became fashionable sanitaria that were
similar to modern spas.
The Western Parallel
Although Roman medicine had its origins
in Greece, it was a fortuitous bonding
of knowledge, medicine and religion from
many continents. At the beginning of the
Christian era, the devotion to Aesculapius
was retained for six centuries on the basis
of scientific merit. As ancient mysticism
and mythology were abandoned,IS Christ
assumed the work of Aesculapius as a
healer, aided by a cadre of saints, includ-
Ta ble 2. Institutions displaying the caduceus.
0 Royal College of Physicians
(London)
0 Royal College of Physicians
(Canada)
0 Medical Corps of U.S. Navy
0 British Royal Aii' Force
0 U.S. Public Health Service
0 RCAF Medical Corp
(collar badge)
0 American College of Physicians
0 The Society for Computer
Medicine (Washington)
0 The Insignia-U.S. Army
Medical Corps
0 Arm Insignia for U.S.
Military Hospital Stewards
0 Bank of Commerce
0 Sun Oil Co.
ing Sebastian, Cosmas and Damien. Although
purging, bleeding and fasting became
therapeutic modalities, the art and
science of healing were reaching for new
horizons. The practice and teaching of
Hippocrates, then Galen, then the Arabic
school (Avicenna and Rhazes), and later,
the prominent medieval physicians (de
Mondeville, de Chouliac, de Saliceto,
Mundinus) fostered many early scientific
advances. The major accomplishments
awai ted the arrival of the Renaissance and
the work of Paracelsus, Ambrose Pare,
Andreas Vesalius, Nicolas Andry, John
Hunter and others. Science relegated the
healing snakes to the tomes of ancient history.
The Survival of the Symbolic Snake(s)
Somehow the serpent figure has survived
our tumultuous medical history. It
continues to appear as the Aesculapian
snake encircling a staff, or the caducean
entwined snakes on a rod. Even the healing
factor in snake saliva has never been
forgotten (and has even been subjected to
biochemical study). Today, one still finds
some deference to the association of the
snake, any snake, with tender, loving care.
One snake Would two or more be better
One snake entwined around a pole (the
Aesculapian staff) is the emblem (seal,
crest, insignia, armorial bearing) of many
institutions (Table 1). The caduceus, two
or more snakes entwined on a staff, has
symbolized both medical and non-medical
institutions (Table 2). The president of the
Royal College of Physicians (London) carries
a staff of distinction bearing four entwined
snakes. This staff was presented to
the College in 1556 by its president, Dr.
John Caius, who was also the founder of
Caius College in Cambridge. A similar staff
was recently presented to the President of
The Royal College of Physicians and Surgeons
of Canada. The symbolic snake is
included on the armorial bearings of two
of the 16 Canadian medical faculties. The
faculty of medicine of the University of
Toronto displays the staff of Aesculapius
with the single snake. The armorial bearings
of the medical faculty of the University
of Ottawa includes three snakes. These
three snakes represent the three programs
of the faculty, namely undergraduate,
graduate and postgraduate. One snake is
red; the second is white; the third is represen
ted in coun terchanged colours
(red-white), indicating that the faculty is a
meeting-ground for Canadians speaking
ei ther or both of the two official languages,
be they students or teachers. Each snake is
Continued on Page 24
.'

BULLETIN OF ANESTHESIA HISTORY 21
From the Literature
A,J. Wr ight, MLS Clinical Librarian Department of Anesthesiology Librmy University of Alabama at Birmingham
Bacon DR. Iconography in anesthesiology: the
importance of society seals in the 1920s and 1930s.
Anesthesiology 85:414-419, 1996
Another in Dr. Bacon's fascinating series of
articles on academic anesthesia in the United
States between the world wars. This article
discusses the "physicians [who] created
dynamic seals to explain who they were and
their work to professional and lay audiences
alike." (p. 419). 7 illus., 12 refs.
Bacon DR. Regional anesthesia and chronic pain
therapy: a history. In: Brown DL, ed. Regional
Anesthesia and Analgesia. Philadelphia: w'B.
Saunders, 1996, p. 10-22
Excellent overview of this topic. 19 ilIus., 2
tables, 43 refs.
Bacon DR, Ament R, Morris L. In defense of
Waters, Blalock, and Taylor. Anesthesiology
85:442-443, 1996
This letter responds to an article by Muravick
et ai, Austin Lamont and the evolution of
modern academic anesthesiology.
Anesthesiology 84:436-441, 1996. 3 refs.
Bailey BJ. Looking back at a century of cocaine-use
and abuse. Laryngoscope 106:681-683, 1996
Brief history of the drug's use and regulation.
1 illus., 9 refs.
Balcells M. Historical aspects and synonymy of
cluster headache. Rev Neurol 23(suppl
.
4):s473-478, 1995
This Spanish-language article has not been
examined.
Ball C. Murray's chloroform mask. Anaesth Intens
Care 23:135, 1995
Brief description of the life and career of John
Murray (1843-1873), an Englishman who
"described his wire mask in 1868 when he was
a young chloroformist at the Middlesex
Hospital. 1 illus., 4 refs.
Ball C. Hewitt's nitrous oxide-oxygen inhaler.
Anaesth Intens Care 21:733, 1993
Describes Frederick William Hewitt's research
which began in 1886 and resulted in this
inhaler in 1892. I illus., 4 refs.
Ball C, Westhorpe R. Crawford Williamson Long
(1815-1878). Anaesth Intens Care 24:303, 1996
Brief account of Long's career and use of ether
in surgery. 3 illus., 3 refs.
Benumof JL. History of anesthesia for thoracic
surgery. In: BenumofJL. Anesthesia for Thoracic
Surgery. 2nd ed. Philadelphia: w'B. Saunders,
1994, p. 14
Describes developments by decades, beginning
with "pre-1910." Includes useful timeline.
Good overview of the topic. 2 illus., 3 tables,
48 refs.
Bowring D. History of infection control in
anaesthesia. Anaesth Intens Care 24(2):150-153,
April 1996
Brief overview of the topic, beginning with
Thomas Skinner's "first published reference
to cross infection in anaesthesia, while
promoting his own cloth-covered wire-frame
chloroform mask" in 1873 in Liverpool,
England. 40 refs.
Brown DL. Observations on regional anesthesia. In:
Brown DL, ed. Regional Anesthesia and Analgesia.
Philadelphia: w,E. Saunders, 1996, p. 3-9
Includes some material on historical aspects.
12 illus., 42 refs.
Calder I, Pearce A, Towey R. Classic paper: a
fiberoptic endoscope used for tracheal intubation.
Anaesthesia 51(6):602, June 1996
This letter comments on a paper published by
the journal in 1967 and authored by Dr. P.
Murphy which the writers consider a "classic."
Includes material from Dr. Murphy. 7 refs.
Caton D. "In the present state of our knowledge:"
early use of opioids in obstetrics. Anesthesiology
82:779-784, 1995
Concentrates on twilight steep in the early 20th
century. 70 refs.
Caton D. The poem in the pain: the social
significance of pain in western civilization.
Anesthesiology 81:1044-1052, 1994
Examines the place of pain before and after
the "discovery" of anesthesia. Excellent
overview of this very broad topic. 62 refs.
Cohn OF, Rabey MJ. One hundred years oflumbar
puncture. Korot 10:162-16S, 1993-94
This article has not been examined.
Colon-Morales MA. Trivia on the history of the
anesthesia screen. ASA Newsletter 60(8):24,
August 1996
Brief account of the "ether screen" and Dr.
Colon-Morales' modern adaptation. 2 illus.
Dobell ARC. The origins of endotracheal
ventilation. Ann Thorac Surg 58:578-584, 1994
Good overview from the thoracic surgeon's
viewpoint. 9 illus., 33 refs.
Donahue KES. The creation of a new collection
documenting the history of pain studies in the
History and Special Collections Division of the
Louise Darling Biomedical Library, UCLA.
Watermark 19(3):80-83, 1996
Describes the genesis of the collection in the
oral history work of John Liebeskind in the
early 1990s.
Donovan A. Antoine Lavoisier: Science,
Administration and Revolution. London:
Blackwell, 1993
This excellent book on the French chemist
includes the chapter Mesmerism and Public
Opinion (pp. 211-234). Illus., references,
bibliography, index.
Ernst W, 'Under the influence' in British India:
James Esdaile's mesmeric hospital in Calcutta,
and its critics. Psychol Med 25: 1113-1123, 1995
Fascinating study ofEsdaile's background, his
work with mesmerism in Calcutta in the
mid-1840s, his supporters and critics and the
social and medical context of his efforts.
Extensive reference list, 88 refs.
Feldman S. History. In: Neuromuscular Block.
Stoneham, Mass.: Butterworth-Heinemann, 1996,
pp. I-6.
Brief overview of the topic. 3 illus., 21 refs.
Fenster JM. How nobody invented anesthesia.
Amer Herit Invent Te chnoI 12(1):24-35, summer
1996
Popularized history of anesthesia's
development from Davy to Long/Morton/
Wells/Jackson. Includes sidebars on anesthetic
practice today and an explanation of how
anesthesia works. "The achievement in the
development of anesthesia was neither lofty
nor scientific; it was only in bringing a fresh
perspective to an unhappy, old problem (pain
relief). Noble as that is, anyone could have
done it. But no one did until 1846 ... " (p. 26)
I'm pleased to note that so many are blessed
with such "fresh perspective." Article is
generally accurte, although it does contain
such zingers as the characterization of Davy's
582-page opus on nitrous oxide as a "booklet."
(p. 24) 10 illus., no references.
Firlik KS, Firlik AD. Harvey Cushing, M.D.: A
Clevelander. Neurosurgery 37(6): 1178-1186,
December 1995
Documents the great surgeon's connections
with his home town. 13 illus., 20 refs.
Fischer JL. Roselyne Rey (1951 -1995), historienne
des sciences du Siecle des lumieres. Rev Hist Sci
[Paris] 48(3):233-239
Rey authored the brilliant "History of Pain"
(Harvard University Press, 1995) . This
French-language tribute has not been
examined.
Florey E. Ars Magnetica: Franz Anton Mesmer,
1734-1815, Magier vom Bodensee. Konstanz:
UVK, Universitatsverlag Konstanz, 1995. 286p.
This German-language monograph has not
been examined.
Fosburgh LC, Koch E. The AANA archives:
documenting a distinguished past. AANA J
63:88-93, 1995
History and collections of the formal AANA
archival program. 9 illus., 6 refs.
Galletti PM, Mora CT. Cardiopulmonary bypass:
the historical foundation, the future promise. In:
Mora CT, ed. Cardiopulmonary Bypass: Principles
and Techniques of Extracorporeal Circulation.
New York: Springer-Verlag, 1994, p3-18
Overview of the topic. 16 illus., 2 tables, 95
refs.
Goerig M, Beck H. Priority conflict concerning
the discovery oflumbar anesthesia between August
Bier and August Hildebrandt. Anasthesiol
Continued on Next Page

22 BULLETIN OF ANESTHESIA HISTORY
Literature . . . Continued/rom Page 21
Intensivmed Notfallmed Schmerzther 31:111-1 19,
1996
This German-language article discusses the
quarrel Hildebrandt began with his former
surgical colleague over whether Bier or James
Corning developed spinal anesthesia.
Goerig M, Schulte am Esch J. Otto Kappeler-a
pioneer in anesthesia in German-speaking regions.
Anasthesiol Intensivmed N otfallmed Schmerzther
30(7):426-435, November 1995
This German-language article has not been
examined.
Gottlieb AM. A Pictorial History of Blood
Practices and Tr ansfusion. Scottsdale, Arizona:
Arcane Publications, 1992, 372p.
This marvelous book is an extensive
compendium of illustrations from medieval
times to the present. 400 refs.
Gourevitch D, Chouillet AM, Fagot-Largeault A.
Roselyne Rey (1951-1995). Rev Hist Sci [Pari;]
48(3):351-363, 1995
Rey authored the brilliant "History of Pain"
(Harvard University Press, 1995). This
French-language tribute has not been
examined.
Jack Moyers, MD, 1921-1996. ASA Newsletter
.
60(6):37, 1996
Brief obituary. 1 portrait.
Healy TEJ. In memoriam: Burnell R. Brown, Jr.
Surv AnesthesioI 40:131-132, 1996
Brief remembrance presented to members of
the Council of the Royal College of
Anaesthetists.
Landauer B. Taeger U. Probster U. The 25th
anniversary of the Bayerischer Anasthesistentag.
Anasthesiol Intensivmed 36(10):289, 1995
This German language article has not been
examined.
Lewis O. Stephen Hales and the measurement of
blood pressure. J Human Hypertens 8:865-871,
1994
Describes the series of experiments on animals
documented in Hams' classic Haemastaticks
(1733). Hales (1677-1761) was a natural
philosopher and inventor. 1 portrait, 2 illus., 1
table, 17 refs.
MacDonald A, Pearn J. Pioneer dental anesthesia:
the contributions, in Scotland and Australia, of
John Henry Hill Llewellin. In: Pearn J. ed.
Outback Medicine: Some Vignettes of Pioneering
Medicine. Brisbane: Amphion Press, 1994, pp
287-298
This book chapter has not been examined.
Marx OF. In memoriam ... Grete Teutsch, MD. 1/
17/1912-7/1 8/1996. NYSSA Sphere 483:35,
July-October 1996
Brief obituary. 1 portrait.
McGoldrick KE. Lewis H. Wright Memorial
Lecture: 'From Symmetrical to Asymmetrical: An
Historical Perspective.' ASA Newsletter 60(7):
10-11, 1996
Brief biography of Joseph F. Artusio, Jr., MD,
who delivered the 35th lecture at the ASA 1996
annual meeting in New Orleans in October,
1996.
McIntyre JWR. Oropharyngeal and
nasopharyngeal airways: I (1880-1995). Can J
Anaesth 43(6):629-635, 1996
Noting the vast literature on the laryngeal mask
airway (LMA) over the past decade, Dr. McIntyre
asks whether the "clearly defined clinical
objectives" met by the LMA "were described
collectively with reference to earlier airway
designs" [from the abstract] . 10 illus., 46 refs.
Merits of cocaine. Laryngoscope 106:680, 1996
Reproduces an advertisement from the back
cover of the journal's first issue in July 1896.
Migraine. J Neurol Neurosurg Psychiat 60:338,
1996
Brief selections from various literary authors,
including Kipling, Eliot, Pope and Gilbert.
Miller EV. Ether day 150th anniversary celebration
set for October. ASANewsletter 60(8):25, August
1996
Describes the Boston, Massachusetts, meeting
October 15-17, 1996.
Morgan M. The Epstein-Macintosh-Oxford
(EMO) inhaler. Anaesthesia 50:239-242, 1995
Reprint of article by H.G. Epstein and Robert
Macintosh first published in 1956. Brief
introduction by Dr. Morgan.
Panning B. Comment on: Legal outcome of crime
under anesthesia. Anasthesiol Intensivmed
Notfallmed Schmerzther 30(7):461, November
1995
This German-language article has not been
examined.
Panning B, Klos H-G, Piepenbrock S. Das
barenmarchen von Berlin. Bongo Berlin 26:67-70,
1995
This German-language article describes the
curious story of one of the earliest chloroform
deaths in Germany-a bear at the Berlin Zoo
that underwent cataract surgery on May 12,
1851. 1 illus., 4 refs.
Papper EM. Education and the development of
anaesthesia. Bailliere's Clin AnesthesioI 8:529-547,
1994
Examines the creation of anesthesia societies,
academic departments, certification
procedures, journals and other aspects in both
Great Britain and the United States. 9 refs.
Parbhoo N. The South African Society of
Anaesthetists, 1943-1993. Adler Museum Bull
201 1:16-17, April 1994
This article has not been examined.
Petrovskii BV. N.r. Pirogov-the sun of Russian
surgery. Vestn Khir 1m II Grek 151(7-12):4-8,
July-Dec 1993
This Russian-language article has not been
examined.
Pierce EC Jr. 40 years behind the mask: safety
revisited. Anesthesiology 84:965-975, 1996
In the 34th Rovenstine Lecture delivered at
the 1995 annual meeting of the American
Society of Anesthesiologists in Atlanta,
Georgia, Dr. Pierce reflects of the safety of
anesthesia over the past four decades. 37 refs.
Ridgeway ES. John Elliotson (1791-1868): a bitter
enemy of legitimate medicine J Med Biog
1:191-198, 1993; 2:1-7, 1994
Part 1 is subtitled "Earlier years and the
introduction to mesmerism"; part 2 is subtitled
"The mesmeric scandal and later years." Due
to his support of many things controversial,
including mesmerism, Dr. Elliotson "lost his
reputation, position, fortune and friends." A
fascinating story, to say the least. Part 1 has 5
illus., 34 refs.; part 2, 2 illus., 34 refs.
Rose W. The narcotization statistics of Ernst Julius
Gurit of 1895-an early contribution to quality
control in anesthesia. Anaesthesiol Reanim
20:157-161, 1995
German-language article describing survey of
78 surgical hospital departments involving
more than 55,000 anesthetic procedures.
Rusham GB, Davies NJ, Atkinson RS. A Short
History of Anaesthesia: The First 150 Ye ars.
Boston: Butterworth-Heinemann, 1996
This monograph has not yet been examined.
Rutkow 1M. William Halsted, his family, and 'queer
business methods.' Arch Surg 131:123-127, 1996
Explores the "independent wealth" of Halsted
that allowed him to accept a full-time faculty
position at Johns Hopkins in the late 1890s.
That wealth was apparently based on his
father's embezzlement. 3 illus., 23 refs.
Safer P. On the history of modern resuscitation.
Crit Care Med 24(2, suppl.): s3-s11, 1996
Adapted from two previous publications in
1989 and 1995 by Dr. Safar on this topic. 1
illus., 1 table, III refs.
Sandison Jw, Weeks SK. Canadian Anaesthetists'
Society Gold Medal. Can J Anaesth 42: I 060-1062,
1995
Briefly describes the life and career of winner
Dr. Philip Raikes Bromage. 1 portrait.
Sands RP J r, Bacon DR. To save a child: the career
of James O. Elam, MD . NYSSA Sphere
47(13):22-23, July-October 1996
Brief account of the career of Dr. Elam, who
died in July, 1995. 1 illus.
Shepherd DAE. John Snow: Anaesthetist to a
Queen and Epidemiologist to a Nation. Cornwall,
Prince Edward Island, Canada: Yo rk Point, 1995.
Dr. Shepherd's biography has recently been
reviewed in Anaesth Intens Care
24(2):292-293, April 1996 and Anaesthesia
51:519, 1996.
Shepherd DAE. Donal A. Warren (1899-1971).
Can J Anaesth 42:358, 1995
Brief account of Dr. Warren's life and career. 1
portrait.
Shepherd DAE. William Marsden (1807-1885).
Can J Anaesth 39:512, 1992
This brief profile notes tha t Marsden "was one
of the first physicians in Canada to administer
chloroform." 1 portrait.
Spielman FJ. Nitrous oxide: from laughing gas to
anesthetic. Am J AnesthesioI 23:142-144, 1996

BULLETIN OF ANESTHESIA HISTORY 23
Another entry in Dr. Spielman's "Art and
Anesthesia" series in this journal. Reproduces
James Gillray's famous caricature of Davy's
nitrous oxide demonstrations at the Royal
Institution in London in 1801. 3 refs.
Stoeckel H, Schulte am Esch I. 150 years ether
narcosis (1846-1996). Anasthesiol Intensivmed
Notfallmed Schmerzther 31:61, 1996
This German-language editorial has not been
examined.
Sykes MK. Intermittent positive pressure respiration
in tetanus. Anaesthesia 50:332-337, 1995
Reprint of a paper originally published in
1960. Brief introduction by Dr. Sykes.
Wa ters DJ, Mapleson \Y/\'\f. Exponentials and the
anaesthetist. Anaesthesia 50:879-889, 1995
Part of the journal's "Classic Paper" reprints.
The original 1964 paper is reprinted and
features an introduction by Dr. Mapleson.
Wenzel M. Migrane: die Kleine HoUe: zur
Symptomatik und Therapie der Migrane in der
Medizingeschichte. Frankfurt am Main: lOnsel
Ve rlag, 1995
This German-language monograph has not
been examined.
West JB, ed. Respiratory Physiology: People and
Ideas. Oxford: Oxford University Press, 1996.
340p.
A collection of 12 essays devoted primarily to
20th century developments in the field. Each
chapter has extensive references. 182 illus.
Westhorpe R. Skinner's chloroform mask. Anaesth
Intens Care 23:3, 1995
Describes the mask of Thoinas Skinner, "who
was Obstetric Physician to the Dispensaries,
Liverpool, [when he] published his account of
a new device, the first of the 'wire masks.' " 1
ill us., 2 refs.
Westhorpe R. Chevalier Jackson's 1alyngoscope.
Anaesth Intens Care 20: 3, 1992
Describes the work and device of Jackson
(1865-1958). 1 illus., 5 refs.
Westhorpe R. Ethyl chloride. Anaesth Intens Care
22:3, 1994
Describes discovery and use of this agent and
three containers from early in the twentieth
century. 1 illus., 3 refs.
Westhorpe R. Catdin's bag and Clover's facepiece
for nitrous oxide anaesthesia. Anaesth Intens Care
21:3, 1993
Describes this device and nitrous oxide
anesthesia in the second half of the nineteenth
century. 1 illus., 2 refs.
Westhorpe R. Ke1ene (ethyl chloride) inhaler.
Anaesth Intens Care 22: 133, 1994
Describes use of ethyl chloride for anesthesia
and this inhalel; which is French in origin.
Designer and manufacturer are unknown. 1
illus., 2 refs.
Westhorpe R. The De Ford Somnoform inhaler.
Anaesth Intens Care 22:513, 1994.
Describes this inhaler for Somnoform (a
mixture of ethyl chloride, methyl chloride and
ethyl bromide), introduced in 1901 by Georges
Rolland. Inhaler was developed by William
Harper De Ford (1858-1932). 1 illus., 3 refs.
Wilson Gw, One Grand Chain. The History of
Anaesthesia in Australia, 1846-1962. Volume 1:
1846-1934. Melbourne: Australian and New
Zealand College of Anaesthetists, 1996
This monumental work from the new Laureate
in Anesthesia History has been reviewed in
Anaesth Intens Care 24(2):294, April 1996 by
Dr. Michael G. Cooper.
Winter A. Mesmerism and popular culture in early
Victorian England. Hist Sci 32:317-343, 1994
Fascinating article on this topic; "Mesmerism
was not an interloper which was ejected from
Britain by the powers of the orthodoxies of
science and medicine; rather, it helped to
explore and shape what form those orthodoxies
should take." (p. 317). 2 illus., 65 notes.
Wright AI. Davy comes to America: Woodhouse,
Barton and the nitrous oxide crossing. J Clin
Anesth 7:347-355, 1995
Describes the first experimentation with
nitrous oxide in America by James Woodhouse
and his U niversi ty of Pennsylvania chemistry
students, including William Barton. Also
covers knowledge of ni trous oxide in America
between Woodhouse and Barton and the
experimentation by Horace Wells beginning
in late 1844. 1 illus., 82 refs.
Wright AJ. Humphry Davy's small circle of Bristol
friends. Middle East J Anesthesiol 13:233-279,
1995
Examines the work with nitrous oxide of Davy
and Thomas Beddoes at the Bristol Pneumatic
Institute in the late eighteenth century and the
various individuals who also participated in
the trials of the gas. 5 tables, 218 refs.
Wright AI. Self-experimentation in anesthesia: a
preliminary inventory. Middle East J Anesthesiol
12:431-442, 1994
Groups more than 150 examples by
chronological or topical categories. 89 refs.
Wylie WD. Deaths associated with anaesthesia.
Anaesthesia 50:439-453, 1995
Reprints an article by Edwards, Morton, Pask,
& Wylie first published in 1956. Brief
introduction by Dr. Wylie.
Wynands JE. History of cardiac anesthesia: the
contribution of Canadian anaesthetists to the
evolution of cardiac surgery. Can J Anaesth
43(5):518-534, 1996
Excellen t overview ' of the topic. This article is
available on the World-Wide Web portion of
the Internet (URL: http://www.achilles.net/
izunder). 25 illus., 24 refs.
Zanchin G, Rossi P, Isler H, Maggioni F. Headache
as an occupational illness in the treatise De Morbis
Artificum Diatriba of Bernardino Ramazzini.
Cephalalgia 16:79-86, 1996
Italian Ramazzini's 1700 work is "considered
to be the first text to specifically deal with
occupational illnesses. It was also the last for
over 150 years." [from the abstract] The book
describes 69 occupations, 12 of which often
produced headaches.
Robert Andrew Hingson,
M.D.
1913-1996
Physician, innovator and humanitarian,
Dr. Hingson received his M.D. degree from
Emory University in 1938. He interned at
the U.S. Marine Hospital on Staten Island
and then was Director of Anesthesia there
until 1943, serving during one of those
years as a Fellow in Anesthesiology at the
Mayo Clinic. From 1943-45 he was Director
of Anesthesia at the Philadelphia
Lying-In Hospital and then was Professor
of Anesthesia at the University of Tennessee
from 1945-48. From 1948-51 he was
Associate Professor of Anesthesia and
Co-director of Anesthesia Research at
Johns Hopkins University. From 1951 until
his retirement he was Director and Professor
of Anesthesiology at University Hospitals,
Western Reserve University in
Cleveland, Ohio.
While at the Marine Hospital on Staten
Island, he introduced the continuous caudal
technique for obstetrical delivery, publishing
a landmark article on this technique
in theAm. J. SUl'gelY in 1942. Later this was
modified to the continuous epidural technique.
During his career he coauthored
some 150 scientific papers and wrote two
textbooks on anesthesia in obstetrical practice.
In 1958, Dr. Hingson founded the
Brother's Brother Foundation and also developed
for clinical use the hypospray "jet"
injector, with which he and colleagues were
able to successfully immunize over a million
people in Liberia and Costa Rica
against smallpox. Later his group also carried
out mass immunizations against poliomyelitis
and measles in Nicaragua, Honduras
and Panama. Through the years the
Foundation, in broadening its scope, has
distributed to our 100 countries on five
continents some $560 million in medical
supplies, textbooks, seeds and other assistance
to over 40 million people.
In 1987 Dr. Hingson received the U.S.
President's Award for International
Volunteerism for his work in promoting
international health. In his generation he
was truly a pioneer and humanitarian of
the first order.
He is survived by his wife of 56 years, a
daughter, four sons of whom one, Luke L.
Hingson, now heads the Brother's Brother
Foundation in Pittsburgh, Pennsylvania,
one brother and four grandchildren.
Memorials may be sent to the Brother's
Brother Foundation, 1501 Reedsdale St.,
Suite 305, Pittsburgh, PA 15233-2341.

24 BULLETIN OF ANESTHESIA HISTORY
Snake(s) . . . Continued/roln Page 20
depicted minus a staff, and loosely knotted
on itself, a setting reminiscent of other
ancient presentations. The University of
Ottawa faculty of medicine crest bears the
Aesculapian staff, similar to the medical
crest of the medical faculty of Calgary.
Other items, including postage stamps,
coins, armorial bearings, staffs, emblems,
seals and crests have included either the
staff of Aesculapius or the caduceus. Queen
Anne and King George I included the caduceus
in their medallions. Military units
in both Canada and the United States use
either symbol. Military medals display one
or the other. Thus, the snake continues to
enjoy the status of an icon in its symbolic
presentation.
Dare one ask then, which symbol correctly
represents the art and science of healing
By history alone, the staff of Aescu-
lapius is the legitimate medical symbol, at
least to the historical purists. Lest there be
any remaining doubt, this author is one of
those purists!
Acknowledgment
The author wishes to acknowledge the invaluable
aid of Mrs. Patricia Johnston, director of library
services, Children's Hospital of Eastern
Ontario.
References
1. Frey EF. The caduceus and the staff of
Aesculapius from antiquity to the present. Tex
Rep Bioi Med 1978;36:1-15.
2. Metzer WS. The caduceus and the Aesculapian
staff: ancient eastern origins, evolution
and western parallels. South Med J
1989;82(6):743-8. .
3. MacKenzie KR. Are you a caducean or
an aesculapian Univ Manitoba Med J
1932-33;4:74-5. Republished in Can Doc 1978
Dec;90-7.
4. Still HC. A crash of symbols. Letter to
editor. Can Med Assoc J 1973;109:1078-9.
5. Kelly AD. A crash of symbols. Can Med
Assoc J 1973;109:515-8.
6. Marketos SO, Papaeconomou C. Medicine,
magic and religion in ancient Greece. Humane
Med 1992;8(1) :41-4.
7. Sigerist HE. The great doctors: a biographical
history of medicine. New York:
Doubleday and Co. Inc., 1958.
8. Williams C. The medical legacy of
Apollo: AesCUlapius and Hippocrates. South Med
J 1976;69(11):1496-501.
9. Bruner M. The birth of medicine.
Doctor's Rev 1989 Nov;129-35.
10. Hart GD. The earliest medical use of the
caduceus. Can Med Assoc J 1972;107:1107-10.
11. Manjo G. The healing hand. Cambridge:
Harvard University Press, 1975.
12. Angeletti LR, Agrimi U, Curia C,
French D, Mariani-Constantini R. Healing rituals
and sacred serpents. Lancet 1992;340:223-5.
13. Katz M, Despommier DD, Gwadz R.
Parasitic diseases, second edition. New York:
Springer-Verlag, 1988.
14. Sakula A. In search of Hippocrates: a
visit to Kos. J R Soc Med 1984;77:682-8.
15. Diamandopoulos A, Marketos SG. Votive
offerings and other magicoreligious practices
in modern Greece. Humane Med
1993;9(4) :296-302.
Bulletin of Anesthesia History
C. Ronald Stephen, M.D., C.M., Newsletter Editor
15801 Harris Ridge Court
Chesterfield, MO 63017 U.S.A.
American society of Anesthesiologists
520 N. Northwest Highway
Park Ridge IL 60068-2573
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