24.12.2012 Views

April 2011 - Anesthesia History Association

April 2011 - Anesthesia History Association

April 2011 - Anesthesia History Association

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

AHA<br />

VOL VOLUME VOL UME 29, 29, 29, NUMBER NUMBER 2<br />

2<br />

An American in Paris in 1846 and 1847:<br />

F. W. Fisher (1821-1877)<br />

By Ray J. Defalque, MD<br />

Professor, Emeritus<br />

Department of Anesthesiology<br />

University of Alabama at Birmingham<br />

and<br />

Amos J. Wright, MLS<br />

Associate Professor<br />

Department of Anesthesiology<br />

University of Alabama at Birmingham<br />

This article has been peer reviewed for publication in the <strong>April</strong> <strong>2011</strong> issue of the Bulletin of <strong>Anesthesia</strong> <strong>History</strong>.<br />

Introduction<br />

Reviewing the introduction of ether in<br />

Paris in 1846, we recently suggested (1) that<br />

Francis Willis Fisher’s role in the event<br />

was less significant that he had claimed in<br />

his letter to the editor of the Boston Medical<br />

and Surgical Journal.(2) As little is known<br />

of Fisher’s life besides his sojourn in Paris,<br />

we researched various Boston and New<br />

York sources for biographical data. Our<br />

search yielded a little new information, so<br />

Fisher’s life remains largely a mystery. We<br />

would like to report our new findings here.<br />

Early Years (1821-1848)<br />

F.W. Fisher was born on September 21,<br />

1821, in Dedham, Massachusetts, (3-5) not<br />

in New York City, as has been claimed.(6)<br />

He was the son of the second marriage of<br />

Freeman Fisher (1787-1869), a cloth manufacturer,<br />

and Mary G. Bronson (1802-<br />

1885), both of Dedham. The Fishers were<br />

an old Massachusetts family descending<br />

from Anthony Fisher, a 1635 Puritan immigrant<br />

from Suffolk County, England,<br />

and a signer of the 1635 Dedham Covenant.<br />

For unspecified reasons, Francis<br />

was baptized long after his birth, on June<br />

9, 1822. He was the nephew of John Dix<br />

Fisher (1797-1850), a renowned professor<br />

of medicine at the Harvard Medical<br />

School, and of the latter’s brother Alvan<br />

Fisher (1792-1863), a gifted painter.<br />

Francis graduated from Harvard Col-<br />

lege in 1842 and from Harvard Medical<br />

School in the spring of 1845.(3,6) Upon his<br />

graduation, he joined the Massachusetts<br />

Medical Society (7) but resigned a few<br />

months later when he left Boston. Like<br />

many young American physicians of<br />

wealthy families, he sailed for Paris in 1846.<br />

A letter to the editor of the Boston Medical<br />

and Surgical Journal (8) hints that he may<br />

have been seasick during the crossing.<br />

How long Fisher remained in France is<br />

unknown but his letters to the editor of the<br />

Boston Medical and Surgical Journal (2,8)<br />

show that he was in Paris at least from<br />

October 1846 until June 1847. He probably<br />

spent two years there, as did most American<br />

physicians of that period.(9, 10) John<br />

Collins Warren wrongly thought that he<br />

had been a medical student while in Paris<br />

(11) and the famous French surgeon<br />

Velpeau remembered him as “Dr<br />

White.”(12)<br />

There is no evidence that Fisher visited<br />

other European medical centers, as was<br />

then the custom. The Lancet (13) reports a<br />

Dr. Fisher attending some operations at the<br />

Westminster Hospital of London on January<br />

11, 1847, but unfortunately omits his<br />

first name; Fisher, of course, is a common<br />

British name.<br />

Fisher probably returned to the U.S. in<br />

the spring or the summer of 1848. He immediately<br />

joined the Boston Medical <strong>Association</strong><br />

(14) but resigned the same year<br />

APRIL APRIL <strong>2011</strong><br />

<strong>2011</strong><br />

when he left for New York City.<br />

Fisher in New York City (1848-1877)<br />

Fisher’s professional life in New York<br />

remains obscure. His 1877 obituary (15)<br />

reports that he had been a police surgeon<br />

but a diligent search of the files of the New<br />

York Police Department and of its museum<br />

failed to elicit his name. The extensive literature<br />

on the history of that department<br />

does not mention him.<br />

On November 15, 1855, in New York<br />

City, Fisher, then 34, married in Jane<br />

(Jennie) Fairbanks, the 21-year-old daughter<br />

of Dexter and Lucretia Fairbanks, two<br />

prominent New York socialites.(16) The<br />

Fairbanks, natives of Dedham, also descended<br />

from Puritan immigrants who<br />

landed in Massachusetts in 1835. At the<br />

time of his marriage, Fisher was president<br />

of the New England Young Men’s <strong>Association</strong>.(17)<br />

The Federal Census of 1860 (4) records<br />

Fisher as living in the 16 th Ward of New<br />

York City with his wife Jane, aged 26, his<br />

in-laws the Fairbanks and four Irish servants.<br />

No children are mentioned. However,<br />

the Fisher genealogy (3) reports that<br />

the couple had two children, John and<br />

Minnie who resided in New York. They may<br />

have been born after 1860. In 1860 Fisher<br />

was 39, not 37 as recorded in the Census.<br />

Continued on Page 20


18 18<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY<br />

HISTORY


The <strong>Anesthesia</strong> <strong>History</strong><br />

<strong>Association</strong> (AHA)<br />

Announces<br />

the <strong>2011</strong> C. R. Stephen<br />

Essay Contest<br />

for Residents and Fellows<br />

The C. Ronald Stephen Essay Contest is open to<br />

all completing the essay during Residency or Fellowship.<br />

Essays can be on any topic related to anesthesia,<br />

pain medicine or critical care, and must<br />

be less than 5000 words. “Finalists” (up to three)<br />

are announced during the October, <strong>2011</strong> Annual<br />

Meeting of the American Society of Anesthesiologists.<br />

“Finalists” must present 20 minute oral versions<br />

of their essays in person at the spring annual<br />

meeting of the AHA in 2012. Judging is by an expert<br />

panel based on the appropriateness and originality<br />

and of the subject, the quality of the research,<br />

the writing, the bibliography, and the quality of<br />

the oral presentation.<br />

All finalists must agree to submit their essays to<br />

be considered by the Bulletin of <strong>Anesthesia</strong> <strong>History</strong><br />

(peer reviewed, listed in PubMed) for possible<br />

publication.<br />

Prizes will be $500, $200, and $100 for first, second,<br />

and third place.<br />

Entries in the current contest must be RECEIVED<br />

before midnight September 10, <strong>2011</strong>. Submissions<br />

should be as attachments to an email, in Microsoft<br />

Word 2003 to 2007.<br />

For a complete prospectus:<br />

http://www.anesthesia.wisc.edu/AHA/Essay.php<br />

Correspondence:<br />

Bradley E. Smith, M. D., Chair,<br />

C. R. Stephen Essay Contest<br />

bradley.smith@vanderbilt.edu<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY HISTORY 19<br />

19<br />

Bulletin of <strong>Anesthesia</strong> <strong>History</strong> (ISSN 1522-8649) is published<br />

four times a year as a joint effort of the <strong>Anesthesia</strong> <strong>History</strong><br />

<strong>Association</strong> and the Wood-Library Museum of Anesthesiology.<br />

The Bulletin was published as <strong>Anesthesia</strong><br />

<strong>History</strong> <strong>Association</strong> Newsletter through Vol. 13, No. 3, July<br />

1995.<br />

The Bulletin, formerly indexed in Histline, is now indexed<br />

in several databases maintained by the U.S. National<br />

Library of Medicine as follows:<br />

1. Monographs: Old citations to historical monographs<br />

(including books, audiovisuals, serials, book chapters,<br />

and meeting papers) are now in LOCATORplus<br />

(locatorplus.gov), NLM's web-based online public access<br />

catalog, where they may be searched separately from now<br />

on, along with newly created citations.<br />

2. Journal Articles: Old citations to journals have been<br />

moved to PubMed (www.ncbi.nlm.nih.gov/PubMed),<br />

NLM's web-based retrieval system, where they may be<br />

searched separately along with newly created citations.<br />

3. Integrated <strong>History</strong> Searches: NLM has online citations<br />

to both types of historical literature -- journal articles as<br />

well as monographs -- again accessible through a single<br />

search location, The Gateway (gateway.nlm.nih.gov).<br />

Doris K. Cope, MD, Editor in Chief<br />

Douglas Bacon, MD, Associate Editor<br />

David Waisel, MD, Associate Editor<br />

A.J. Wright, MLS, Associate Editor<br />

Assistant Editors<br />

Book Review: Theodore Alston, MD<br />

Peer Review: Adolph H. Giesecke, Jr., MD<br />

Fall ASA Forums/Panels: Selma Calmes, MD<br />

Spring Meeting Papers: Bradley Smith, MD<br />

Deborah Bloomberg, Editorial Staff<br />

Editorial, Reprint, and Circulation matters should be<br />

addressed to:<br />

Editor<br />

Bulletin of <strong>Anesthesia</strong> <strong>History</strong><br />

200 Delafield Avenue, Suite 2070<br />

Pittsburgh, PA 15215 U.S.A.<br />

Telephone (412) 784-5343<br />

Fax (412) 784-5350<br />

bloombergdj@upmc.edu<br />

Manuscripts may be submitted on disk using Word for<br />

Windows or other PC text program. Please save files in<br />

RICH TEXT FORMAT (.rtf) if possible and submit a<br />

hard copy printout in addition to the disk. Illustrations/<br />

photos may be submitted as original hard copy or electronically.<br />

Photographs should be original glossy prints,<br />

NOT NOT photocopies, photocopies, laser laser laser prints prints prints or or or slides. slides<br />

slides If submitted<br />

electronically, images must be at least 300 dpi and<br />

saved as tif files. Photocopies of line drawings or other<br />

artwork are NOT NOT acceptable for publication. Copyright<br />

and reprint permission statements must be included with<br />

all images.


20 20<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY<br />

HISTORY<br />

Fisher. .. Continued from Page 17<br />

According to the Census, both Fishers and<br />

the Fairbanks were Massachusetts natives.<br />

On May 27, 1861, Fisher enlisted as a<br />

surgeon in the 9 th Regiment of the N.Y. militia<br />

(18-20). The regiment was heavily engaged<br />

in the battles of Fredericksburg,<br />

Gettysburg and the Wilderness, but<br />

Fisher’s medical activities are not mentioned<br />

in the regiment detailed histories.(18-20)<br />

A Dr. Fisher (without a first<br />

name) is listed elsewhere (21) as working<br />

at the Chester Hospital during the battle<br />

of Gettysburg.<br />

The date of Fisher’s discharge from the<br />

service is unknown but must have been in<br />

early 1864 as he was a member of the reception<br />

committee when the regiment returned<br />

to New York City on June 11, 1864,(19)<br />

shortly before its demobilization on June<br />

23, 1864.(18-20) The same year Fisher became<br />

president of the New York Union Veterans<br />

Club. (22)<br />

In the early 1870s, Fisher moved to the<br />

Grand Central Hotel (now the Broadway<br />

Central Hotel) at 670, Broadway where he<br />

worked as hotel physician.(23) While living<br />

there he became involved in the fatal<br />

shooting of “Colonel” James “Diamond<br />

Jim” Fisk, Jr., the crooked financier and<br />

crony of Jay Gould and Tammany boss<br />

Tweed.(24) At the time of his death Fisk<br />

was entangled in long and complex legal<br />

proceedings against his previous business<br />

partner Edward S. “Ned” Stokes (1841-<br />

1901) and his ex-mistress Helen Josephine<br />

“Josie” Mansfield, who had left Fisk for<br />

Stokes.<br />

On the morning of January 6, 1872,<br />

Fisk’s lawyers obtained a grand jury indictment<br />

against Stokes on charge of<br />

blackmail. Hearing the news during his<br />

lunch, an enraged Stokes ran to the Grand<br />

Central Hotel after learning that Fisk was<br />

returning there from a visit to his friends,<br />

the Morses. Stokes reached the hotel<br />

around 400 PM, shortly before Fisk, and<br />

waited for him at the top of the stairway.<br />

As Fisk climbed the stairs, Stokes fired two<br />

pistol shots: the first entered Fisk’s abdomen,<br />

the second one pierced his left arm as<br />

he turned around to escape. Stokes tried to<br />

flee but was caught by the hotel staff and<br />

later jailed at the Tombs.<br />

Fisher arrived at the hotel around 4:45<br />

PM, shortly after the shooting. Entering<br />

his suite he found a note summoning him<br />

to room 212 where Fisk had been taken.<br />

Fisher’s testimony at Stokes’ first trial (23)<br />

gives a detailed, although at times confusing,<br />

account of Fisk’s last 18 hours. Except<br />

for a few brief absences, Fisher remained<br />

with the victim until the latter’s death.<br />

Entering room 212, Fisher found the<br />

patient pale and slightly tachypneic, conversing<br />

with two physicians, Dr Thomas,<br />

the main hotel physician, and Dr John P.<br />

White, Fisk’s personal doctor, whom Fisher<br />

remembered as “Dr Wood.” Fisk complained<br />

of severe abdominal pain. His<br />

physicians found a large gunshot wound<br />

in the right abdomen. Around 6:00 PM the<br />

wound was probed after the patient had<br />

inhaled one drachm (3.7 ml) of chloroform<br />

but the bullet was not found. Fisk continued<br />

to complain of severe pain and received<br />

several large draughts of morphine and at<br />

least two subcutaneous injections of<br />

Magendie’s solution (injectable morphine).<br />

The wound was again probed twice but<br />

without success. At Stokes’ trial, the coroner<br />

E.Y.T Manse explained that the bullet<br />

had entered the right abdomen, six inches<br />

above the navel, traveled through the ileum<br />

and the colon and lodged itself in the<br />

left thigh muscles. He felt that Fisk had<br />

died from shock.<br />

A total of seven physicians attended<br />

Fisk, limiting themselves to multiple consultations,<br />

observations of the vital signs<br />

and reluctant administration of morphine.<br />

Fisher simply reassured the patient,<br />

helped him to walk to the more comfortable<br />

room 214, repeatedly sponged his face<br />

with cold water and catheterized his bladder<br />

at 3:00 PM. When Fisk sank into coma<br />

at 5:00 the next morning, Fisher made futile<br />

attempts to arouse him with inhalations<br />

and frictions of ammonias.<br />

Fisk’s wife Lucy arrived from Boston<br />

at 6:30 AM but was unable to talk with her<br />

comatose husband. Turning to Fisher, she<br />

asked him if anything could be done to<br />

save her husband. Fisher loftily answered,<br />

“Alas, Madam, I fear not.” The forgiving<br />

Lucy, kissing her dying husband’s lips,<br />

murmured, “He was such a good boy.” Fisk<br />

died around 11:00 AM on January 7, 1872.<br />

Stokes’s first trial ended with a hung<br />

jury and a mistrial.(24) Fisher does not<br />

seem to have testified in the two subsequent<br />

trials. In February 1874, Stokes was sentenced<br />

to death but was reprieved by the<br />

Court of Appeals which declared a mistrial.<br />

After a third trial, Stokes served four<br />

years at Sing Sing.<br />

Fisher’s Death (January 20, 1877)<br />

Fisher died in 1877 under strange circumstances.(15)<br />

He resided at the time at<br />

49 South Washington Square.(5) On January<br />

19, 1877, at 10:00 PM, he visited the<br />

Cooper Drug Store on Sixth Avenue and<br />

prescribed for himself ten drops of tincture<br />

of digitalis and two drops of aconite<br />

that he swallowed on the spot. Upon leaving<br />

the pharmacy, he became dizzy, vomited<br />

and went to bed as soon as he got home.<br />

His condition worsened and at 3:00 AM<br />

his family called Drs. Clarke and Knox.<br />

They found the patient alert but very dyspneic.<br />

They diagnosed cardiac or renal failure<br />

but Fisher suspected poisoning from<br />

an overdose caused by a pharmacist’s error.<br />

Fisher died at 9:00 on the morning of<br />

Saturday 20, 1877. Dr. Clarke refused to<br />

sign the death certificate and requested an<br />

autopsy. This was performed at the<br />

deceased’s home on the morning of Sunday,<br />

January 21, 1877, by Dr. Henry<br />

Woltman, coroner, and his deputy, Dr. Joseph<br />

Cushman.(5) Dr. Woltman found<br />

thickening and stenosis of the mitral valve,<br />

myocardial hypertrophy and pulmonary<br />

edema. He attributed the death to heart<br />

disease. His report wrongly described<br />

Fisher as being 51 year old and a resident<br />

of New York for 35 years. Fisher was buried<br />

in Dedham, Massachusetts, on January<br />

22, 1877.(5)<br />

Fisher’s prescription of digitalis suggests<br />

that he thought he had congestive<br />

heart failure. Aconite was widely used at<br />

the time for various neurological and arthritic<br />

conditions and, more rarely, for<br />

heart failure and edema. At Stokes’ trial<br />

(23) Fisher had mentioned that his right<br />

hand was partially paralyzed, following<br />

what he called a “heat stroke” but may have<br />

been a cerebral embolism, a complication<br />

of his valvular disease.<br />

Conclusions<br />

We have found it curious that a doctor<br />

described by the New York Times as “well<br />

known” and a “society physician” left so<br />

few traces of his professional life after his<br />

return to the United States. He did not belong<br />

to the A.M.A. or any of the New York<br />

or Massachusetts medical societies and<br />

joined the Boston Medical <strong>Association</strong> for<br />

a few months only.<br />

Odd, also, is Fisher’s change of first<br />

name over the years: from Francis Willis<br />

to F. Willis then to Francis W. and finally<br />

Frank W. We were unable to find a photograph<br />

or portrait. Thus most of Fisher’s<br />

life remains a mystery.<br />

References<br />

(1) Defalque RJ, Wright AJ. The introduction<br />

of ether in Paris revisited. Bull Anesth Hist<br />

2008;26:10-12.<br />

(2) Fisher FW. The ether inhalation in Paris.<br />

Boston Med Surg J 1847;36:109-113.<br />

(3)Fisher PA. The Fisher Genealogy: Records<br />

of the Descendants of Joshua, Anthony and<br />

Continued on Page 32


BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

21<br />

21<br />

Methamphetamine for Hitler’s Germany: 1937 to 1945<br />

By Ray J. Defalque, MD<br />

Professor, Emeritus<br />

Department of Anesthesiology<br />

University of Alabama at Birmingham<br />

and<br />

Amos J. Wright, MLS<br />

Associate Professor<br />

Department of Anesthesiology<br />

University of Alabama at Birmingham<br />

This article has been peer reviewed for publication in the <strong>April</strong> <strong>2011</strong> issue of the Bulletin of <strong>Anesthesia</strong> <strong>History</strong>.<br />

Introduction<br />

Methamphetamine, developed in Berlin<br />

in 1937-38, was widely used by the German<br />

civilians and armed forces personnel<br />

until 1945 despite the authorities’ efforts<br />

to curb its abuse. Neither physicians nor<br />

researchers could agree on its physical or<br />

mental effects or on its medical indications.<br />

Some German authors (1-3) suggested<br />

after the war that the drug had been encouraged<br />

by the Nazi regime to help create<br />

a “superman” hero. However, we found no<br />

grounds for that claim; in fact, the Health<br />

“Leader” and the military’s medical authorities<br />

repeatedly tried to curtail its use.<br />

We hope this article dispels many legends<br />

that have grown up around the Nazis and<br />

“speed.”<br />

The Discovery of Methamphetamine<br />

Working on the formula of ephedrine<br />

discovered in 1887, the Japanese A. Ogata<br />

(4) in 1919 synthesized methyl-amphetamine<br />

by replacing ephedrine’s OH radical<br />

by a CH3 chain. German and Swiss<br />

chemists (5) in the 1920s showed some interest<br />

in the compound, but only from a<br />

chemical point of view.<br />

In 1937, Fritz Hauschild (1908- 1974),<br />

a young physician and chemist with the<br />

firm Temmler in Berlin, rediscovered<br />

methamphetamine, while synthesizing<br />

over 50 ephedrine derivatives to study their<br />

pharmacological actions. Experimenting<br />

on small mammals and on himself and<br />

his co-workers, he found that methamphetamine<br />

was more potent than ephedrine as<br />

a stimulant of the central nervous and cardiovascular<br />

systems. It also was active<br />

when taken orally. In rodents, cats and<br />

rabbits it caused hyperactivity and excitement<br />

and reversed barbiturate sleep. In<br />

men it stimulated mental activity, caused<br />

euphoria, and hindered fatigue.<br />

Central nervous-active doses only<br />

caused minimum cardiovascular stimulation.<br />

Hauschild immediately reported his<br />

findings at two medical meetings and in<br />

four medical journals in 1938.(6,7) Gener-<br />

ally ignored is the fact that scientists in<br />

Copenhagen in the late 1930s had made<br />

the same discovery, as acknowledged by<br />

Hauschild in one of his articles.(7)<br />

The firm Temmler, anxious to exploit<br />

Hauschild’s discovery before the entry of<br />

Benzedrine (amphetamine) on the German<br />

market, applied for a patent in early 1937<br />

and it was granted on October 31, 1937.<br />

(Reich Patent No 767-186). In March, 1938,<br />

Temmler released methyl-amphetamine<br />

hydrochloride commercially under the<br />

trade name of Pervitin in 3mg tablets and<br />

15mg ampules. The drug was inexpensive<br />

and available without prescription.<br />

Pervitin in Civilian Practice<br />

Pervitin tablets became immediately<br />

popular with tired night workers (nurses,<br />

phone operators, watchmen) and with<br />

young people seeking cocaine-like euphoria<br />

and heightened sexual pleasure.(1,8)<br />

Temmler also launched an intensive advertising<br />

campaign among German physicians,<br />

flooding their offices with samples<br />

and literature quoting amphetamine’s success<br />

in the U.S. and offering them financial<br />

incentives to publish their findings.<br />

By the end of 1939, over 100 clinical studies,<br />

most of them laudatory, had been published.<br />

All were uncontrolled trials of little<br />

scientific value. They claimed successes in<br />

a variety of conditions:<br />

a) Surgery: cure of surgical and anesthetic<br />

collapse; quicker recovery<br />

from anesthesia; enhanced convalescence;<br />

well-being and euphoria<br />

in inoperable cancer patients. The<br />

influential surgeons of Leipzig<br />

University were especially enthusiastic<br />

about the drug.<br />

b) Medicine: treatment of asthma and<br />

hay fever; reversal of barbiturate<br />

coma; weaning of morphine and<br />

alcohol addicts; weight gain in<br />

debilitated patients.<br />

c) Obstetrics: infant resuscitation.<br />

d) Neurology: migraine and other<br />

headaches; apathy; post-encephalopathic<br />

Pakinson’s syndrome.<br />

e) Psychiatrists reported the best successes<br />

in schizophrenia; depressions;<br />

phobias, anxiety and sexual<br />

deficiencies.<br />

There were, however, a few reports of<br />

addiction and chronic abuse with personality<br />

changes or collapse.<br />

Pervitin was more critically studied at<br />

the Dortmund Institute of Work Physiology<br />

on alert and tired volunteers.(9,10) The<br />

results were inconsistent or conflicting but<br />

the investigators agreed that Pervitin did<br />

not increase the metabolism but simply<br />

induced the subjects to produce more work.<br />

They warned against the danger of continuing<br />

working over the physiological<br />

limits. The Dortmund research was closely<br />

watched by another work physiologist, Dr.<br />

Otto F. Ranke (1899-1959) in Berlin, as<br />

mentioned below.<br />

Dr. Leonardo Conti (1900-1945) and<br />

Pervitin<br />

The reports of chronic abuse and addiction<br />

started to raise some concern by<br />

the end of 1939.(11) In an influential medical<br />

journal (12) F. Haeffner, a renowned<br />

pharmacologist, warned against the use of<br />

stimulants and recommended government<br />

control. Some academic psychiatric departments<br />

and the Berlin criminal police reported<br />

a disturbing increase in the number<br />

of Pervitin addicts. Dr. Leonardo Conti,<br />

the Reich Health Leader, a physician obsessed<br />

with the health of the German<br />

“Volk” (community), was informed of these<br />

problems, and on November 11, 1939, ordered<br />

Pervitin to be sold only with a doctor’s<br />

prescription. This order, however, did not<br />

Continued on Page 22


22 22<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY<br />

HISTORY<br />

Germany. .. Continued from Page 21<br />

curb the abuse; physicians now prescribed<br />

Pervitin for various vague or trivial indications.<br />

In a March 1940 speech to the Nazi<br />

Medical <strong>Association</strong> in Berlin, Conti<br />

warned his colleagues that their laxity seriously<br />

threatened the “Volk’s” health. In<br />

early 1941, German newspapers quoted reports<br />

in the British press and from the BBC<br />

attributing the brilliant German military<br />

successes to the use of stimulants and<br />

claiming that German pilots captured in<br />

England carried Pervitin. There were stories<br />

of German soldiers taking Pervitin<br />

before visiting French brothels where the<br />

girls used the “love pill” Maxiton (amphetamine).<br />

In the spring of 1941, the Berlin<br />

police uncovered a large black market of<br />

Pervitin, including deliveries to a popular<br />

brothel.<br />

At Conti’s prompting, Ernst Speer<br />

(1889-1964), a noted psychiatrist and director<br />

of the Lindau Institute of Psychiatry,<br />

reviewed the literature on, and his experience<br />

with, Pervitin. He published his<br />

conclusions in the January 1941 issue of a<br />

prominent medical journal.(13) He had<br />

found no sound medical indications for the<br />

drug, not even in psychiatry, and knew of<br />

numerous cases of true addiction or chronic<br />

abuse. For Speer, the drug’s only indication<br />

was life-threatening exhaustion, as in<br />

military drivers or motorcycle riders. A few<br />

physicians objected to Speer’s conclusions<br />

and felt that he exaggerated the drug’s dangers<br />

and ignored some sound indications.<br />

Conti, however, accepted Speer’s recommendations<br />

and in mid-June 1941 asked the<br />

Interior Minister to place Pervitin under<br />

the “Opium Law” (the German equivalent<br />

of regulations for controlled substances).<br />

The decree, published on July 1, 1941,<br />

threatened severe penalties but exempted<br />

the research institutions, and, implicitly,<br />

the armed forces. Conti’s decision was<br />

clearly detailed by his assistants Kaerber<br />

(14) and Gruenwald (15) who insisted that<br />

the drug should never be prescribed for<br />

healthy subjects and that other, safer drugs<br />

were available for true medical indications.<br />

The abuse of Pervitin by civilians markedly<br />

decreased after 1941 because of the new<br />

law, but also because of competition with<br />

the military and difficulties in production<br />

and distribution caused by the Allied bombings.<br />

However, physicians still occasionally<br />

prescribed it for depression, narcolepsy,<br />

apathy and Parkinson’s syndrome. Towards<br />

the end of the war, large amounts of Pervitin<br />

were distributed to the armament workers<br />

to increase their output during the night<br />

shifts.(2)<br />

Pervitin in the Armed Forces<br />

(Wehrmacht)<br />

1. Army (Heer)(2,3,16-18)<br />

As the Army, especially its motorized<br />

divisions, expanded after 1935, the German<br />

drug companies saw a large potential market<br />

for their stimulants. In October 1938,<br />

Boehringer and Knoll, and in early 1939,<br />

Temmler, recommended their stimulants<br />

Benzedrine and Pervitin respectively, to<br />

General Dr A. Waldman, the Army’s Medical<br />

Inspector (the highest medical officer).<br />

Up to May 1939, Dr Waldman had refused<br />

to introduce stimulants in the service, but<br />

he, however, asked Dr O. Ranke to study<br />

the matter. In May 1937, Ranke had become<br />

chairman of the Department of Physiology<br />

at the Berlin Medico-Military Academy,<br />

the Army’s medical school and research<br />

center. An aggressive scientist interested<br />

in work physiology, Ranke had read<br />

Hauschild’s papers and was in close contact<br />

with his colleagues at the Dortmund<br />

Institute of Work Physiology. In the last<br />

week of September 1938, he started studying<br />

Pervitin’s effects on the physical and<br />

mental activity of sleep-deprived cadets. He<br />

could not complete his experiments as some<br />

of his subjects developed cardiac<br />

arrhythmias or abused the drug to “cram”<br />

for their examinations. He resumed his<br />

experiments in <strong>April</strong> and May 1939 testing<br />

Pervitin, Benzedrine and caffeine against<br />

a control (dextrose) and adding a psychiatrist<br />

to test the cadets’ mental and motor<br />

skills. Because of side-effects (attributed to<br />

overdose) and again because of abuse by<br />

the “cramming” students, Ranke again did<br />

not finish his study. He, however, reached<br />

some conclusions that he sent to the Medical<br />

Inspector:<br />

1. As stimulants, Pervitin and Benzedrine<br />

were equipotent but superior<br />

to caffeine.<br />

2. Pervitin in 3-6 mg doses maintained<br />

alertness and good mental<br />

and motor skills for up to eight<br />

hours.<br />

3. It could cause physical collapse if<br />

used over 24-36 hours. Its use<br />

should always be followed by a long<br />

restorative sleep.<br />

4. It should always be given under<br />

medical supervision.<br />

5. It would not reverse alcohol intoxication.<br />

From May through August 1939, i.e.,<br />

immediately before the onset of the Polish<br />

campaign (September 1, 1939), Ranke distributed<br />

large amounts of Pervitin to the<br />

medical officers of motorized units to test<br />

it against fatigue. In October 1939 at Dr<br />

Waldman’s request, he interviewed the physicians<br />

who had been in Poland. They had<br />

taken Pervitin themselves or given it to officers<br />

and soldiers exhausted by the long<br />

and rapid advances. All were enthusiastic:<br />

Pervitin had kept them alert, clear-thinking<br />

and proficient and it had saved many<br />

lives by preventing accidents with tired<br />

drivers and motorcycle riders.<br />

Visiting the Western front the same<br />

month, Ranke found that many overworked<br />

junior officers carried Pervitin in<br />

their briefcases, using it frequently and<br />

with excellent results. Ranke reported his<br />

findings to the Inspector while deploring<br />

the lack of good control studies, repeating<br />

his previous guidelines and warning of the<br />

danger of addiction and chronic abuse. In<br />

fact, in November 1939, Ranke wrote to the<br />

Health Leader Conti recommending that<br />

Pervitin become a controlled substance.<br />

In early 1940, Inspector Waldman sent<br />

Dr Krueger, an assistant of Ranke’s at the<br />

Medico-Military Academy, to interview the<br />

medical officers who had served in Poland<br />

to obtain another, unbiased opinion. In his<br />

<strong>April</strong> 1940 report, Krueger confirmed the<br />

enthusiasm for Pervitin but noted that<br />

some interviewees had misgivings about<br />

its abuse. The same month Ranke recommended<br />

that the Army adopt Pervitin, provided<br />

administration was done by a medical<br />

officer and only in exceptional cases of<br />

life-threatening exhaustion.<br />

Informed of these reports (possibly by<br />

Ranke himself), the firm Temmler then resubmitted<br />

its request for the adoption of<br />

Pervitin into the service. In late <strong>April</strong> 1940,<br />

General Waldman issued a directive, written<br />

with Ranke’s help, accepting the drug<br />

in the Army, provided it be used as recommended<br />

by Ranke. Tubes of 30 tablets of 3<br />

mg were added to the units’ medical packs.<br />

Waldman’s directive was complemented by<br />

an ordinance of General v. Brauchitsch,<br />

the Army’s Commander in Chief, extolling<br />

Pervitin as a boon for fighting Germany.<br />

Pervitin was thus officially available<br />

during the Western campaign of May-June<br />

1940. From <strong>April</strong> through December 1940,<br />

the military medical depots dispensed 30<br />

million Pervitin tablets. Ranke was attached<br />

to General v. Kleist’s Army Corps,<br />

which included many motorized divisions,<br />

during its rapid advances across France<br />

of May 1940. Reviewing the use of Pervitin


after the armistice in June-July 1940,<br />

Ranke found that large amounts of the drug<br />

had been distributed to the troops, sometimes<br />

for 24 to 36 hour periods by the units’<br />

physicians at the urging of their commanding<br />

officers. Again Pervitin was hailed as<br />

saving the life of many exhausted men.<br />

Ranke also discovered that some officers<br />

had taken it as an aid in their drinking<br />

binges or to treat hangovers. Some senior<br />

officers while on Pervitin had suffered<br />

myocardial infarcts (occasionally fatal)<br />

while swimming or during drinking bouts.<br />

In his post-campaign report Ranke again<br />

deplored the lack of controlled studies and<br />

insisted on his previous guidelines.<br />

In February and September 1941, General<br />

Dr S. Handloser (1885-1954), the new<br />

Medical Inspector, issued two directives on<br />

the use of stimulants in the Army, insisting<br />

on Ranke’s strict guidelines. The ordinances<br />

were probably prompted by letters<br />

from Dr Conti complaining of Pervitin<br />

abuse in the service (see below). These directives<br />

may have curtailed the abuse of<br />

Pervitin as the medical depots only dispensed<br />

10 million tablets in 1941.<br />

The military use of Pervitin after 1942<br />

is poorly documented as most of the<br />

records after that date were lost.(16,17) But<br />

there is evidence that the drug continued<br />

to be widely used. The Deutsche Militaerarzt,<br />

the official journal of the military physicians,<br />

in 1942 and 1943 published letters<br />

from medical officers reporting that they<br />

had been ordered by their commanding<br />

officers to distribute the drug to the troops.<br />

The memoirs of senior commanders and<br />

soldiers statements to newspapers after the<br />

war suggest a large use of Pervitin by the<br />

soldiers to help them escape the enemy<br />

encirclements during the harsh Russian<br />

winters.<br />

The pharmaceutical companies continued<br />

to encourage the Army’s use of<br />

Pervitin. The medical Inspector denied the<br />

requests of two firms to add Pervitin to<br />

their products such as Energetika (dextrose<br />

tablets) and the firm Sarotti’s Moka<br />

Glycolade (cocoa, caffeine and dextrose).<br />

In 1942-3, the firm Temmler recommended<br />

its Pervitin to the Army for the management<br />

of surgical shock and to produce<br />

shorter anesthesia recovery time. Temmler<br />

also released a morphine-Pervitin preparation<br />

(morphine 20 mg, Pervitin 7.5 mg)<br />

to prevent morphine’s somnolence and cardiovascular<br />

depression during the protracted<br />

evacuations of the wounded in the<br />

cold Russian winters and thus avoid frostbites.<br />

Experiments at the Berlin Medicomilitary<br />

Academy in 1944 also suggested<br />

that Pervitin enhanced morphine’s anal-<br />

gesic action. The Army also occasionally<br />

used Pervitin on its exhausted horses in<br />

the Soviet Union.<br />

Conti and the Wehrmacht: A Power<br />

Struggle<br />

Between January 1940 and December<br />

1941, Dr Conti sent at least four letters to<br />

the Inspectors Waldman and Handloser<br />

to complain of Pervitin abuse in the Army;<br />

he saw it as a threat to Germany’s health<br />

after the soldiers’ demobilization at the end<br />

of the war. In their delayed answers, the<br />

Inspectors refuted these accusations and<br />

claimed that the Army strictly followed<br />

Ranke’s and Speer’s recommendations.<br />

The correspondence prompted General<br />

Handloser’s two directive mentioned<br />

above. These exchanges probably were a<br />

power struggle between a Nazi agency and<br />

the fiercely independent armed services.<br />

2. Pervitin in the Air Force<br />

(Luftwaffe)(19)<br />

The Luftwaffe’s medical authorities rejected<br />

Pervitin because of its danger of pilots’<br />

hypoxia and hyperventilation and the<br />

need for long restorative sleep after its use.<br />

Pilots on long flights used hot coffee or tea<br />

and the “Fliegers Chocolate” (flyers’ candy<br />

bar, Sho-Ka-Kola, a mixture of cocoa, dextrose,<br />

caffeine and extract of kola nut) made<br />

by the firm Hildebrand. However, Pervitin<br />

tablets were included in the bail-out kits<br />

of flyers shot over the sea or behind enemy<br />

lines. Towards the end of the war, faced<br />

with exhausted, overworked fighter pilots,<br />

the Luftwaffe’s medical authorities held<br />

several conferences to discuss the advantages<br />

of Pervitin over caffeine but reached<br />

no decision.<br />

3. Pervitin in the Navy<br />

(Kriegsmarine)(20-22)<br />

A directive issued by the Navy’s chief<br />

medical officer in early 1941 introduced<br />

Pervitin in his service, with the same guidelines<br />

as in the Army. Ships’ pharmacies<br />

stored Pervitin tablets to be administered<br />

by a physician only in extreme cases of exhaustion.<br />

In submarines, which rarely had<br />

a doctor aboard, Pervitin was controlled<br />

by the captain. In all ships the use of the<br />

drug had to be recorded in the medical log.<br />

However, many ship captains distributed<br />

Pervitin during long, tiring missions, such<br />

as long convoy battles. During the “Channel<br />

Dash” of February 11-13, 1942, when<br />

the cruiser “Prinz Eugen” and her sister<br />

ships escaped from their French port of<br />

Brest to return to their Baltic bases, the<br />

sailors received Pervitin to maintain their<br />

seven hour “high alert” watches. The crews<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

23<br />

23<br />

of the small “Schnell Boote” (small,fast<br />

torpedo boats) who were on 12 hour duty<br />

also received Pervitin. At the end of the<br />

war, tablets containing Pervitin, cocaine<br />

and hydro- or oxycodone were tested on<br />

the crews of the “one-man torpedoes” during<br />

trials in the frigid Baltic Sea. The large<br />

amounts of Pervitin found in the<br />

Kriegsmarine’s medical depots after the<br />

war suggest an intensive use of the drug.<br />

D. Pervitin in the S.S. Forces(1,2,22,23)<br />

Tablets containing Pervitin, cocaine<br />

and oxycodone were provided to Colonel<br />

O. Skorzeny’s S.S. commandos trying to<br />

capture Tito in the rugged Serbian mountains<br />

during the winter of 1944-45. S.S.<br />

physicians also tested Pervitin on concentration<br />

camp inmates:<br />

a) Hunger experiments in Buchenwald<br />

and Matthausen.<br />

b) Marches of 60 miles with a heavy<br />

backpack after a three hour sleep<br />

in Sachsenhausen.<br />

c) In Dachau in May 1942, the infamous<br />

Dr Raschner administered<br />

Pervitin to his victims to test their<br />

resistance to low atmospheric pressure<br />

(68 mm Hg).<br />

Notorious German Pervitin Addicts in<br />

World War II<br />

1. Heinrich Boell (1917-1985). The prolific<br />

novelist, winner of several German<br />

literary awards and of the 1972 Nobel prize<br />

for literature, became addicted to Pervitin<br />

while a soldier in Poland in 1932, an addiction<br />

which persisted after the war.<br />

2. Ernst Udet (1896-1941). An air ace in<br />

the Red Baron’s squadron, Udet after<br />

World War I became a flamboyant stunt<br />

pilot, movie star, playboy and popular idol.<br />

Commissioned general in the Luftwaffe in<br />

1935 he directed the department of research<br />

and development. He introduced the dive<br />

bombers, including the famous Stuka, in<br />

his service after visiting the Curtis plants<br />

in the U.S. Heavily addicted to Pervitin<br />

and alcohol, he became depressed in the<br />

fall of 1941 after his chief Goering blamed<br />

him for the Luftwaffe’s defeats and shot<br />

himself in November 1941.<br />

3. Adolf Hitler (1889-1945). L.L.<br />

Heston, an American academic psychiatrist,<br />

concluded, without good evidence,<br />

that Hitler had become addicted to Pervitin.<br />

This addiction would have explained his<br />

physical and mental deterioration at the<br />

Continued on Page 24


24 24<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY<br />

HISTORY<br />

Germany. .. Continued from Page 23<br />

end of his life.(24) E.G. Schenck, a German<br />

physician who had met Hitler and<br />

became an expert on his health,(25) rejected<br />

Heston’s suggestion and felt that<br />

Pervitin, on rare occasions, had been added<br />

to the multiple vitamins prescribed for<br />

the Fuehrer, probably without his knowledge<br />

or even that of his physician Morell.<br />

Pervitin Outside of Germany during<br />

World War II<br />

Small clinical trials of Pervitin were<br />

carried out on Swiss, Swedish and Italian<br />

military personnel from 1938 to the early<br />

1940s. Although Pervitin was known in the<br />

U.S. at the time it was never used by the<br />

military.(26) Benzedrine, of course, was<br />

extensively used in the U.S. and British<br />

armed forces during the war.<br />

Conclusions<br />

Pervitin was widely used in Germany,<br />

by civilians until 1941 and by the<br />

Wehrmacht from 1938 to 1945, mainly as a<br />

stimulant to prevent or treat fatigue. Its<br />

medical indications were never clearly defined<br />

and it was rarely used clinically after<br />

1941. Studies of its mental and physical<br />

action gave inconclusive or inconsistent<br />

results. Its potential for abuse and<br />

addiction was recognized but thought to<br />

be rare and to occur only in subjects with<br />

personality disorders. Some German writers<br />

after the war (1-3) claimed that the use<br />

of Pervitin had been encouraged by the<br />

government to create a Nazi “superman.”<br />

Our extensive review of the literature, however,<br />

does not support this view. On the<br />

contrary, the over-zealous Health Leader<br />

Conti consistently attempted to curtail the<br />

use of Pervitin and other stimulants. The<br />

abuse of Pervitin in the Wehrmacht resulted<br />

from efforts to prevent or treat physical<br />

and mental fatigue during exhausting<br />

battles and thus save soldiers’ lives.<br />

Summary<br />

Methamphetamine was synthesized in<br />

Germany in 1937 and commercially released<br />

in 1938. It became a popular stimulant<br />

for tired night workers and a recreational<br />

drug for young people until mid-<br />

1941 when it became a controlled substance.<br />

It was abused by the armed forces during<br />

World War II when it was distributed by<br />

some commanding officers (occasionally<br />

over the objections of the units’ physicians)<br />

to prevent or treat the fatigue of exhausted<br />

troops and thus allow them to survive, despite<br />

the strict restrictions issued by the<br />

Army Inspectorate. There is no evidence<br />

for the claim that the use of Pervitin was<br />

encouraged by the Nazi government to create<br />

a “superman.” In fact the Health Leader<br />

L. Conti strongly discouraged its use.<br />

Cast of Characters<br />

1. The firm Temmler was founded in<br />

1937. Its Berlin plant was bombed in 1943-<br />

44 and occupied by the Russians in May,<br />

1945. It was re-established in West-Berlin<br />

then moved to Marburg. It is now one of<br />

the major German drug companies with<br />

seven plants in Germany, Switzerland and<br />

Ireland. Temmler stopped the production<br />

of Pervitin in May 1988 and renounced its<br />

patent in December of the same year for<br />

undisclosed reasons.<br />

2. Fritz Hauschild (1908-1974). He studied<br />

in Munich, Berlin and Goettingen, obtaining<br />

a PhD in Chemistry in 1932 and<br />

his medical diploma in 1934. He joined<br />

the firm Temmler in early 1937, and in<br />

1939 became professor of pharmacology at<br />

the Berlin Faculty of Medicine. He left the<br />

firm Temmler in 1941 and taught at the<br />

Universities of Heidelberg and Frankfurt/<br />

Main. He was drafted in the Army in February<br />

1943 and served on the Eastern front<br />

as a medical officer until May 1945. In June<br />

1946, he returned to East-Germany and<br />

became a dedicated member of the Communist<br />

party. Made chairman of the Department<br />

of Pharmacology at the Karl<br />

Marx University in Leipzig in October<br />

1947, he taught, did research and published<br />

a highly regarded textbook of pharmacology<br />

and toxicology. He was a member<br />

of various committees and a scientific<br />

adviser to the East-German government<br />

which often praised him and decorated him<br />

twice despite his harsh criticism of the<br />

Party’s research policies. He died from<br />

cancer in Leipzig in 1974.(27)<br />

3. Leonardo Conti (1900-1945). Born in<br />

Lugano (Switzerland) from an Italian father<br />

and a German mother (a midwife),<br />

Conti moved to Germany and became naturalized<br />

in 1915. He received his medical<br />

diploma in 1925 after studying in Berlin<br />

and Erlangen. A zealous Nazi, he chaired<br />

various medical groups and in early 1939<br />

became “Reich Health Fuehrer,” the<br />

regime’s highest medical authority. Put on<br />

trial by the US Army in 1945 for his role in<br />

the euthanasia program and the<br />

Buchenwald typhus human experiments,<br />

he hanged himself in his cell in Nuremberg<br />

on October 6, 1945.<br />

4. Siegfried Handloser (1885-1954).<br />

General Dr Handloser became the Army<br />

Medical Inspector (chief medical officer)<br />

in January 1941 shortly after the death of<br />

his predecessor Waldman. In June 1942,<br />

Hitler made him Chief Medical Officer of<br />

all the German armed forces (Wehrmacht),<br />

including the S.S. medical service. He was<br />

tried in Nuremberg in December 1946 for<br />

condoning the S.S. human experiments<br />

and sentenced to life imprisonment. His<br />

sentence was reduced to twenty years by<br />

the U.S. High Commissioner John J. Mc<br />

Cloy in 1951. Diagnosed with terminal<br />

cancer in early 1954, he was released from<br />

prison and died in a Munich hospital in<br />

July 1954 from surgical complications.<br />

5. Otto F. Ranke (1899-1959). Born in<br />

Munich in 1899, Ranke studied in Munich,<br />

Freiburg/Br and Heidelberg. He received<br />

his medical diploma in 1923 and a PhD<br />

degree in Physiology in 1935. A captain in<br />

the Luftwaffe in 1935, he transferred as a<br />

colonel in the Army in 1937 to chair the<br />

Department of Physiology at the Berlin<br />

Medico-Military Academy. In March, 1939,<br />

he also became professor at the Berlin Medical<br />

Faculty. He directed various<br />

Wehrmacht’s research programs during<br />

the war and in 1946 became professor of<br />

physiology at the University of Erlangen<br />

where he taught, did research and published<br />

until his November 1959, death from<br />

heart failure following a myocardial infarct.<br />

His colleagues described Ranke as a<br />

rigorous, obsessive scientist but also as<br />

intolerant, quarrelsome and bigoted.(17)<br />

References<br />

(1) Roth KH. Leistungsmedizin : Das Beispiel<br />

Pervitin. In: Aerzte in Nazionalsocialismus. Edit<br />

F. Kudien. Koeln, Kiepenhauer & Witsch Verlag,<br />

1985:167-184.<br />

(2) Kemper WH. Pervitin. Die end-Sieg Droge?<br />

In: Nazis on Speed. Drogen im 3. Reich Volume<br />

1 Edit W Pieper Lohrbach (Germany) Gruene<br />

Kraft Verlag, 2002:122-133.<br />

(3) Baader G. Menschenversuch in der<br />

deutsche Wehrmacht In: Wissenschaft im Krieg.<br />

Krieg in der Wissenschaft, Edit M Tschir-merm &<br />

HW Goebel. Marburg, Eigen Verlag, 1990:258-<br />

266.<br />

(4) Ogata A. Constitution of ephedrinedesoxyephedrine<br />

(In Japanese) Yakugaki Zasshi<br />

(J Jap Phamacol Soc) 1919;451:751-764. Also in<br />

Chem Abstracts 1920;14:475.<br />

(5) Emde H. Ueber Diastereometrie. I.<br />

Konfiguration des Ephedrins. Helvet Chim Acta<br />

1929;12:365-376.<br />

(6)Hauschild F. Pharmakologische Wirkungen<br />

nach Abaenderungen am Ephedrinmolekuel.<br />

Naunyn-Schmiedeberg Arch fuer exp Pathologie<br />

Pharmakologie 1938;190:177-178.<br />

(7) Hauschild F. Tierexperimentelles ueber<br />

eine peroral wirksamend zentralanaleptische<br />

Substanz mit peripherer Kreislaufwirkung. Klin<br />

Wochenschr 1938;17:1257-1258.<br />

(8) Grunske F. Gesundheitliche Gefahren der<br />

Genuss-und Reizmitteln bei der Ermuedungsbekaempfung<br />

und Leistungssteigerung. In:<br />

Wehrmedizin. Edit S. Handloser & W. Hofman.<br />

Berlin, Springer Verlag, 1944:226-236.<br />

(9) Lehmann G, Staub H, Szakall A. Pervitin<br />

als Leistungssteigerendes Mittel. Arbeitsphysiologie<br />

Continued on Page 32


Ray J. Defalque, M.D., 1932-<strong>2011</strong><br />

By Mark Mandabach, MD<br />

Associate Director<br />

The Chestnut Section on the <strong>History</strong> of Anesthesiology<br />

Anesthesiology Department<br />

University of Alabama at Birmingham<br />

and<br />

Amos J. Wright, MLS<br />

Director<br />

The Chestnut Section on the <strong>History</strong> of Anesthesiology<br />

Anesthesiology Department<br />

University of Alabama at Birmingham<br />

Our friend and colleague Dr. Ray<br />

Defalque died on March 11, <strong>2011</strong>, when he<br />

succumbed to an aggressive recurrence of<br />

head and neck cancer. More than a year<br />

ago, after extensive surgery, a remarkable<br />

recovery and return to a productive and<br />

comfortable life, his perseverance served<br />

as a wonderful example for all who knew<br />

him.<br />

Personally and professionally, he preferred<br />

the humble nomenclature of “Ray.”<br />

Ray was born on March 8, 1932, in Belgium;<br />

his siblings were Pierre and Arnold.<br />

His childhood was interrupted by World<br />

War II, when the family moved to the Belgian<br />

Congo. After the family returned to<br />

Belgium, Ray received his undergraduate<br />

degree in 1952 and his medical degree at<br />

the University of Louvain in 1957. He then<br />

came to the U.S. and completed an internship<br />

at hospitals in New York City in 1957-<br />

1958 and an OB-GYN fellowship in 1958-<br />

1959 at the University of Wisconsin Hospitals.<br />

[Figure 1] His anesthesia residency<br />

followed at the University of Iowa and by<br />

1961 he was back in Belgium as Chief of<br />

the <strong>Anesthesia</strong> Section at the Naval Hospital<br />

in Ostend. He returned to the United<br />

States in 1965 as Chief of the <strong>Anesthesia</strong><br />

Section at the Indianapolis VA, a position<br />

he held until 1988. [Figure 2] Dr. Defalque<br />

was named Professor in the <strong>Anesthesia</strong><br />

Department at Indiana University School<br />

of Medicine in 1975.<br />

His next move was to Birmingham, Alabama.<br />

On July 1, 1988, he joined the University<br />

of Alabama at Birmingham Department<br />

of Anesthesiology at the rank of full<br />

Professor, serving in the VA/Cooper Green<br />

Division. Later he worked at University<br />

Hospital and staffed the pain clinic. During<br />

his long career he specialized in regional<br />

anesthesia for orthopedics and pain<br />

management and published a number of<br />

articles in that area. In 1988 and 1989 he<br />

was voted Teacher of the Year in our department.<br />

Ray retired in 1999 and was sub-<br />

Fig. 1. Dr. Defalque at the University of<br />

Wisconsin during his OB-GYN fellowship in<br />

1958-1959.<br />

sequently awarded Professor Emeritus status<br />

by UAB. Our department’s Defalque<br />

Award was established in his honor. As the<br />

plaque notes, “The Ray J. Defalque Award<br />

for Outstanding Performance in Regional<br />

<strong>Anesthesia</strong> is awarded annually to an anesthesiology<br />

resident. This award was established<br />

in 1999 and is given in honor of<br />

Dr. Ray Defalque who, before his retirement<br />

in 1999, was a steadfast advocate of<br />

resident education and was widely known<br />

for his skill in the administration of regional<br />

anesthesia.” One of our history colleagues,<br />

Dr. Jason McKeown, was the recipient<br />

of this award in 2002.<br />

After retirement, Ray spent four to six<br />

weeks a year for several years in Vietnam<br />

teaching regional anesthesia. These trips<br />

to an orthopedic hospital in Ho Chi Minh<br />

City were taken under the auspices of<br />

Health Volunteers Overseas [HVO]. In the<br />

spring of 2006 Dr. Defalque was named<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

25<br />

25<br />

one of the first winners of the Golden Apple<br />

Award by HVO as part of their observance<br />

of World Health Day 2006. “Dr. Defalque<br />

is a remarkable educator, devoted to sharing<br />

his knowledge and skills at the sites,”<br />

stated Nancy Kelly, MHS, Executive Director<br />

of HVO. “He was selected for this<br />

recognition by his peers for his work in<br />

both Vietnam (to which he has traveled 5<br />

times) and Peru training anesthesiologists.<br />

His input was critical not only in the design<br />

of the training program, but also in<br />

terms of teaching and clinical supervision<br />

of the students. He is spoken of by staff at<br />

the Hospital of Traumatology and Orthopedics<br />

in Ho Chi Minh City as having<br />

‘lots of energy’ and is credited for contributing<br />

long days and weekend hours in the<br />

hospital teaching and mentoring. He is<br />

known for this same passion and dedication<br />

in both Lima and Arequipa, Peru,<br />

where he has made significant contributions<br />

to HVO’s educational programs and<br />

has established ongoing relationships with<br />

Fig. 2. Dr. Defalque in Indianapolis, 1972.<br />

Continued on Page 26


26 26 BULLETIN BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

HISTORY<br />

Defalque. .. Continued from Page 25<br />

Fig. 3. Dr. Defalque at the AHA 2008<br />

Spring Meeting in Pittsburgh.<br />

Peruvian colleagues.” [UAB Anesthesiology<br />

Tuesday Report, May 16, 2006] Shortly<br />

after receiving this award, he returned to<br />

Peru for a second time. In this period, Ray<br />

also pursued locum tenens in Alabama and<br />

seemed to never tire in his energy and enthusiasm<br />

for life in general and anesthesia<br />

in particular.<br />

Well before his retirement, Dr. Defalque<br />

developed a deep interest in the history of<br />

anesthesiology and began to publish what<br />

has become a long series of articles in that<br />

area. He was especially interested in the<br />

history of chloroform and the status of<br />

anesthesia in Germany under the Nazis.<br />

Some of the other topics that attracted his<br />

interest over the years included the histories<br />

of chloric ether, scophedal, and methadone;<br />

such nineteenth century figures with<br />

interesting roles in the history of anesthe-<br />

Fig. 4. Dr. Defalque speaks at the AHA<br />

2005 Spring Meeting in Birmingham,<br />

Alabama.<br />

sia as Robert Glover and Francis Fisher;<br />

and the treatment of frostbite by German<br />

and Allied forces in World War II. He was<br />

active for many years in the <strong>Anesthesia</strong><br />

<strong>History</strong> <strong>Association</strong> [Figures 3-4] and a<br />

member of our Department’s <strong>History</strong> Section<br />

from its beginnings in 2002.<br />

More than a decade ago, Dr. Defalque<br />

began donating research materials to the<br />

Wood Library-Museum [WLM]. He started<br />

Fig. 5. Dr.<br />

Defalque<br />

examines a<br />

poster at the<br />

department’s<br />

60th<br />

anniversary<br />

celebration,<br />

June 2008<br />

(photo by<br />

Steve Pearce).<br />

with materials that he had annotated for a<br />

bibliography on chloroform. Many years<br />

earlier he had started a quixotic journey to<br />

create a bibliography of everything ever<br />

published on that agent—medical, environmental,<br />

industrial, etc. Needless to say,<br />

this bibliography was never completed, but<br />

his thousands of annotations will be preserved<br />

at the WLM, along with what has<br />

become the Defalque Chloroform Collection.<br />

Judith A. Robins, WLM Collections<br />

Supervisor, noted in an email to one of us<br />

[AJW] that “I enjoyed assisting Dr.<br />

Defalque in his efforts to compile a definitive<br />

bibliography of all publications relating<br />

to chloroform. I corresponded often<br />

with Dr. Defalque as he regularly added to<br />

the collection, and I had the pleasure to<br />

meet him in person. The Defalque Chloroform<br />

Collection is an extensive resource<br />

for anyone who wishes to study this fascinating<br />

topic. The materials range in date<br />

from the 1830s to the present, including<br />

newspaper accounts, scholarly articles,<br />

and doctoral dissertations. These relate to<br />

every aspect of the subject, from chemistry<br />

to complications, criminal history, and its<br />

environmental impact. While the bulk of<br />

the collection is in English, it also includes<br />

materials in French, German, and many<br />

other languages. The Defalque Collection<br />

is available for research use on request.”<br />

Other friends have come forth with personal<br />

recollections, and we would like to<br />

share a few of these.<br />

Dr. Marie Therese Cousin in France<br />

I met R. Defalque in Hamburg at the<br />

international Meeting of <strong>History</strong> of <strong>Anesthesia</strong>.<br />

He spoke French perfectly and seeing<br />

my embarrassment when questions<br />

were asked, he helped me with spontane-<br />

ous translations. Since this moment we became<br />

friends and when I wrote my book (a<br />

history of anesthesia and critical care in<br />

France ( L’anesthésie et la réanimation en<br />

France , des origines à 1965, L’Harmattan,<br />

publisher, 2005) he made a report about<br />

this work in an issue… (of the Bulletin); he<br />

was enthusiastic and proposed to translate<br />

the book. Ray Defalque was generous<br />

and always attentive to others, he never<br />

forgot me and always found friendly<br />

words. I felt very sad when I (heard) this<br />

new(s), last month he said that he was OK<br />

Fig. 6. Dr. Defalque in 2008.


with his health. [email to AJW, 25 March<br />

<strong>2011</strong>]<br />

Dr. Bernhard Panning in Germany<br />

Thank you for your e-mail which is written<br />

due to the very sad occasion of the death<br />

of our friend Ray Defalque. I think you<br />

Fig. 7. Dr. Defalque in 2008.<br />

know how I came into contact with Ray.<br />

This is perhaps a typical story which describes<br />

his uncomplicated way to get contact<br />

and his broad interests in many topics.<br />

Ray wrote in 1991 a note to me concerning<br />

an article in a very local Austrian journal<br />

(Wiener Medizinische Wochenschrift). He<br />

asked for an offprint of my paper and he<br />

was of course able to read and to understand<br />

it in German. By the way there was<br />

only one other request for an offprint of<br />

this paper. From this time we had a very<br />

intensive contact. You know that we published<br />

several papers together also with<br />

yourself as a coauthor and I always felt<br />

Fig. 8. Dr. Defalque on a trip to Greece with<br />

his wife Druscilla in 2006.<br />

very honoured and happy about this. I saw<br />

Ray personally only once which was in 1997<br />

in Hamburg at the international Symposium<br />

on the <strong>History</strong> of Anaesthesia and I<br />

regret very much that he never had time to<br />

follow my invitations to visit Hannover. I<br />

am very sad that Ray has now passed in<br />

another world and I will miss him very<br />

much. [email to AJW, 28 March <strong>2011</strong>]<br />

Theresa Kindt Kulb, MSN, CNOR,<br />

Indianapolis, Indiana, U.S.A.<br />

I met Dr. Defalque in 1984 at the VA<br />

Hospital in Indianapolis, Indiana. I had<br />

transferred in from the Nursing Home<br />

Care Unit where I was awaiting a position<br />

in the Operating Room. One day, the anesthesia<br />

tech became ill and was gone for two<br />

weeks. In her absence, I was assigned the<br />

technician job. What this entailed was to<br />

be the assistant of the dreaded Dr.<br />

Defalque, other anesthesia staff and residents.<br />

I was to do the organizing and stocking<br />

of the anesthesia carts, checking out<br />

drugs, ordering supplies; basically EV-<br />

ERYTHING. I am sure the administration<br />

put me in there to hang myself, knowing<br />

someone new would just be destroyed.<br />

While I tore apart the <strong>Anesthesia</strong> room,<br />

trying to organize the room and carts and<br />

throwing away all the trash, in walked Dr.<br />

Defalque. Not yelling, but speaking very<br />

loudly, ‘Oh, my Gott, what are you doing?<br />

Where is my tech?’ Sheepishly, I answered,<br />

‘(W)ell, she is gone and you have me for at<br />

least two weeks’. Out he walked. Saying<br />

nothing and telling me nothing. So there I<br />

was, did not know what to do, did not know<br />

what to set up—and he did not come back.<br />

So out I went to find him. And find him I<br />

did. I just followed him for the next full<br />

week. Day by day as I anticipated his<br />

needs, he taught me. As it turns out, Dr. D.<br />

and I had many things in common, Belgian<br />

blood—my great, great grandfather<br />

built several buildings in the city of Ghent,<br />

many of which still stand today, the love<br />

of Indiana and Alabama sports teams and<br />

the turmoil of their coaches, the love of<br />

our families and their talents. He was very<br />

proud of his boys and his grandchildren.<br />

We also shared the love of travel and photography,<br />

and lastly, the love of great tireless<br />

teachers. As my life continued and I<br />

was forced to quit working, we still kept in<br />

touch and wrote and e-mailed routinely. I<br />

talked to him on e-mail 10 days before he<br />

passed, asking the temperature of<br />

Santiago, Chile this time year and what to<br />

take with me to wear at night. He was off<br />

by one degree. One of my favorite things to<br />

do was to send Dr. D. the new Notre Dame<br />

Football shirt. I sent him one every year<br />

BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY 27<br />

27<br />

they came out after the annual Blue/Gold<br />

game. He must have 25 of them by now. He<br />

was always so thankful. I shall miss that<br />

and his wealth of all things I ever wanted<br />

to know about. [e-mail to AJW, 29 March<br />

<strong>2011</strong>]<br />

J. Antonio Aldrete, M.D., M.S., Birmingham,<br />

Alabama, U.S.A.<br />

We were almost the same age and had<br />

in a way what may be called ‘parallel professional<br />

lives.’ Beginning in the 1960s, Ray<br />

and I met at the reunions of the chiefs of<br />

anesthesia at Veterans Administration hospitals.<br />

These sessions would take place each<br />

year at the ASA annual meeting, lasting<br />

for about three hours usually on a Saturday<br />

morning. We met to discuss the good<br />

news, bad aspects and the ugly events that<br />

used to occur at each of our hospitals. Ray<br />

was Chief at the VA Hospital in Indianapolis<br />

while I had the same position at<br />

the VA Hospital in Denver. After 1970 we<br />

saw each other less often, mostly at meetings.<br />

When I returned to Birmingham in<br />

Fig. 9. Dr. Defalque on a trip to Russia with<br />

Druscilla in 2008.<br />

2002, he was still very active and we began<br />

to share our passion for the history of anesthesia.<br />

We did some translating for each<br />

other, he from French or German for me<br />

and I from Spanish for him. We both did<br />

volunteer teaching, he in Vietnam and later<br />

Peru and I in South America. I can say<br />

without exception that every encounter that<br />

we had was pleasant, positive, and very<br />

friendly. I felt I could always rely on and<br />

trust Ray. I will remember him, not only<br />

Continued on Page 28


28 28 BULLETIN BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

HISTORY<br />

Defalque. .. Continued from Page 27<br />

when I need an article translated, but also<br />

in conferences where we saw each other off<br />

and on. So many of us will miss him. [letter<br />

to AJW, 30 March <strong>2011</strong>]<br />

Under his sometimes gruff exterior, we<br />

found Ray to be a warm and funny man<br />

who knew so much about so many things<br />

and was always ready to share that knowledge.<br />

Ray has been a friend and mentor,<br />

always willing to listen and help. He translated<br />

numerous articles for us in a variety<br />

of languages, including German, French,<br />

Italian, Spanish, Portuguese and Latin. A<br />

major example was the first translation into<br />

English of Johannes Quistorp’s Die<br />

Anaesthesie, a German medical school dissertation<br />

written in Latin in 1718. [See<br />

Defalque RJ, Wright AJ. Quistorp and<br />

“Anaesthesia” in 1718. Bull Anesth Hist<br />

24(1):5-8, January 2006] Ray was a scholar<br />

in the classical sense and soft spoken and<br />

kind. We will miss him very much. [Figures<br />

5-9] He is survived by his wife<br />

Druscilla, sons James (and wife Kristi) and<br />

Jeff, and two grandchildren, Grant and<br />

Gillian. [Figures 10-11] He is also survived<br />

by a brother, Arnold, living in Nontron,<br />

France.<br />

Personal photos courtesy of the Defalque<br />

family.<br />

Fig. 10. Dr. Defalque with<br />

grandson Grant and flanked by<br />

sons Jeff (left) and James,<br />

Thanksgiving in Atlanta, 2007.<br />

Fig. 11. Dr. Defalque with daughter-in-law Kristi, sons James and Jeff,<br />

Druscilla and grandchildren Gillian and Grant, 2007.


From Amsterdam to Leeds: The Travels of<br />

the Dutch Liquid<br />

By Ray J. Defalque, MD<br />

Professor, Emeritus<br />

Department of Anesthesiology<br />

University of Alabama at Birmingham<br />

and<br />

Amos J. Wright, MLS<br />

Associate Professor<br />

Department of Anesthesiology<br />

University of Alabama at Birmingham<br />

Introduction<br />

The main events of the history of the<br />

Dutch liquid of chloride of olefiant gas<br />

are well known.(1) Our review presents<br />

lesser known details of that history and<br />

also addresses the confusion existing in<br />

the 1830-40s between Thomson’s and<br />

Guthrie’s chloric ethers. We also suggest<br />

that J. Y. Simpson’s introduction of chloroform<br />

in anesthesia was not directly related<br />

to the Dutch liquid.<br />

Discovered in Amsterdam in 1794 the<br />

compound travelled to Paris, Glascow and<br />

North America, then returned to Liverpool<br />

and from there to London, Edinburgh and<br />

Leeds. It disappeared from clinical practice<br />

in the 1850s, but continued being studied<br />

in laboratory animals in the 1880s. It<br />

remains today an industrial toxic and carcinogen.<br />

From Amsterdam to Paris (1794-1812)<br />

The Batavian Society or Society of the<br />

Dutch Chemists, an informal group of<br />

amateur chemists, was founded in<br />

Amsterdam in the winter of 1790-1 to<br />

study and expand the recent discoveries in<br />

chemistry, especially those of Antoine<br />

Lavoisier (1745-1794) and his antiphlogistic<br />

theory.(2,3) In 1794 the group included<br />

Adriaen Paets van Trostwijck (1750-1837),<br />

a wealthy merchant and the society’s dominant<br />

scientist; Johan R. Deiman (1743-<br />

1808), a physician; Nicholas Bondt (1765-<br />

1796), another physician; and Anthoni<br />

Lauwerenburgh (1758-1820), a pharmacist.<br />

In 1794 these four chemists created a<br />

dark-greenish explosive gas by heating<br />

equal volumes of alcohol and concentrated<br />

sulfuric acid. Using Lavoisier’s new nomenclature<br />

they gave it the French name<br />

of “gaz hydrogene carbone huileux” (oily<br />

hydrogenated carbonated gas). This was<br />

our present ethylene (C2H4). They were<br />

unaware that the gas had already been discovered<br />

by Anae and Cuthberton in<br />

Amsterdam in 1777 (4) and in 1789 by Carl<br />

W. Scheele (1742-1786) in Sweden.(5) They<br />

called the gas “oily” because when they<br />

combined it with an equal volume of chlorine<br />

(Cl2) they obtained a thick, heavy and<br />

whitish liquid “of pleasant odor and sweet<br />

taste” which the French chemists later<br />

called “liqueur ou huile des hollandais”<br />

(Dutch liquid or oil). Later the British<br />

chemists also named it “chloride of olefiant<br />

gas.” It is our modern 1,2 dichloroethane<br />

or ethylene dichloride (C2H4Cl2).<br />

The manuscript of the four Dutch chemists<br />

describing their discovery reached the<br />

French chemist Antoine Fourcroy (1755-<br />

1809), a friend of Lavoisier and an influential<br />

member of the “Institut de France”<br />

via Jean Baptiste van Mons (1765-1892) a<br />

chemist and botanist in Brussels and a<br />

corresponding member of the “Institut de<br />

France.” The bilingual van Mons probably<br />

translated or corrected the text. Fourcroy<br />

received it in Paris in August of 1796 and<br />

presented it to the “Institut” in December<br />

of the same year.(6) It was published in a<br />

1794 issue of The Journal de Physique et de<br />

Chimie.(7) (Political troubles in Paris prevented<br />

publication of The Journal from 1795<br />

to 1799 and the article was postdated to<br />

1794). The same manuscript was published<br />

in a 1795 issue of the influential German<br />

Chemische Annalen (8) and in several Dutch<br />

scientific journals.(2.3) Despite<br />

Trostwijck’s primary role in the research,<br />

Deiman was the publication’s first author,<br />

probably because of Trostwijck’s lack of<br />

academic titles.(2,3)<br />

In 1816 two Parisian pharmacists,<br />

Pierre Robiquet (1780-1860) and Jean<br />

Colin (1784-1865) undertook the difficult<br />

purification of the gas and of its oil and<br />

elucidated their formulas.(9,10) They were<br />

the first to suggest a possible medical indication<br />

for the liquid but gave no details.<br />

An Unlikely Medical Viennese Interlude<br />

in 1771<br />

Three articles (11-13) cite a professor<br />

Franck, of Leiden (Netherlands) without<br />

providing a reference. According to<br />

BULLETIN BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY HISTORY 29<br />

29<br />

Franck, three young Dutch physicians visited<br />

the renowned Gerard van Swieten<br />

(1700-1772) in Vienna in 1771. Van Swieten<br />

was then the personal physician of Maria<br />

Theresa, the Austrian Empress. They made<br />

a dog inhale the Dutch liquid and induced<br />

a deep, short anesthesia. Van Swieten volunteered<br />

to be the next subject but the<br />

Empress forbade the trial.<br />

The story is probably apocryphal. Van<br />

Swieten died in 1772, 22 years before the<br />

compound’s discovery; extensive inquiries<br />

in Leiden failed to discover a professor<br />

Franck; and the incident is not mentioned<br />

in any of the numerous van Swieten’s biographies.<br />

From Paris to Glascow (1796-1820)<br />

In 1820 Thomas Thomson (1773-1852),<br />

a prominent professor of chemistry at the<br />

University of Glascow, described the properties<br />

and the formula of the chloride of<br />

the olefiant gas (Dutch liquid) that he had<br />

studied since 1810.(14) He gave it the name<br />

of “chloric ether,” an abbreviation for hydrochloric<br />

ether. This was the first appearance<br />

of the name “chloric ether” in the literature.<br />

From Glasgow to North America (1820-<br />

1832)<br />

Thomson’s name of “chloric ether” for<br />

the Dutch liquid was adopted by<br />

BenjaminStilliman, Jr. (1816-1865), the<br />

Yale professor of chemistry. In the 1831<br />

edition of his “Elements of Chemistry,”(15)<br />

he suggested that its alcoholic solution<br />

might be an excellent medical “diffusible<br />

stimulant.” His suggestion prompted<br />

Samuel Guthrie (1782-1848), a physician<br />

and amateur chemist in Sackets Harbor<br />

(New York) to find an easier and cheaper<br />

way of making the product for medical use.<br />

Distilling a mixture of chloride of lime<br />

and alcohol he unwittingly obtained an<br />

alcoholic solution of what would be called<br />

Continued on Page 30


30 30 BULLETIN BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

HISTORY<br />

Dutch. . . Continued from Page 29<br />

later chloroform. Unaware of the error,<br />

Silliman accepted Guthrie’s “sweet whiskey”<br />

as a cheaper chloric ether and gave it<br />

to his Yale colleagues, the physicians Eli<br />

Ives (1776-1861) and his son Nathan, to<br />

try it as a “diffusible stimulant” in lung<br />

diseases. They used it in inhalation, ingestion<br />

and even injection for various respiratory<br />

and infectious conditions.(16)<br />

From 1831-2 on, the name of “chloric<br />

ether” in North America and shortly later<br />

in Great Britain, signified Guthrie’s compound,<br />

but there were exceptions, however.<br />

Daniel B. Smith (1792-1883), a professor<br />

of chemistry at the Philadelphia College<br />

of Pharmacy, aware of Eugene Soubeiran’s<br />

(1797-1859) discovery of “bichloric ether”<br />

(an impure chloroform) in 1831 clearly<br />

distinguished between Thomson’s Dutch<br />

liquid and Guthrie’s solution of chloroform.(17)<br />

Justus von Liebig (1803-1873) in<br />

Giessen (Germany) made a similar distinction<br />

in 1832.(18) As will be mentioned below,<br />

some confusion also existed in London<br />

in the early 1840s.<br />

From North America to Leeeds (1832-<br />

1852)<br />

The American chloric ether soon<br />

reached Great Britain. In 1833, a Dr. J.<br />

Black, of Bolton (North England), after<br />

hearing of it from American colleagues,<br />

prescribed it for asthma and asthaenia.(19)<br />

In 1838 or 1839 a prescription for chloric<br />

ether was brought to Dr. Brett, the head<br />

chemist at the Liverpool Apothecary<br />

Hall.(20,21) Brett did not find its name in<br />

any British compendium but he did in the<br />

1834 edition of the United States Dispensatory.(22)<br />

The prescription’s writer may<br />

have been Dr. Richard Formby (1790-1865),<br />

a prominent Liverpool physician and<br />

friend of J. Y. Simpson. He had heard of it<br />

from American visitors.(23) Many prescriptions<br />

for chloric ether were later filled<br />

for him and other local physicians.(20,21)<br />

How the drug reached London from<br />

Liverpool is unknown, but it was used there<br />

in the early 1840s as an oral medication<br />

for bronchitis (24) and as a topical analgesic<br />

and deodorant in ulcers, ulcerated cancers<br />

and noma.(25-27) It was generally<br />

known as per- (or ter-) chloride of carbon.<br />

The latter’s nature (chloride of olefiant gas<br />

vs. American chloric ether) was often unclear.(25,28)<br />

The use of chloric ether as an<br />

alcoholic solution of chloroform as an inhalation<br />

anesthetic in two London hospitals<br />

in early and mid-1847 is well<br />

known.(29,30)<br />

David Waldie (1813-1889), Brett’s col-<br />

league in Liverpool, who had refined an<br />

alcoholic solution of chloroform, suggested<br />

to his friend J. Y. Simpson in October 1847<br />

that he try chloroform as an inhalation<br />

anesthetic.(20,21) It is doubtful, however,<br />

that Simpson was swayed by Waldie’s advice.<br />

His account (31) and and that of his<br />

assistant James Matthews Duncan (32,33)<br />

show that Simpson inhaled chloroform on<br />

November 4, 1847, at the suggestion of<br />

Duncan who had inhaled it a few hours<br />

before. They had obtained a sample of pure<br />

chloroform (among several other compounds)<br />

from Dr. William Gregory (1803-<br />

1858), professor of chemistry at the University<br />

of Edinburgh. Gregory, who had<br />

studied under von Liebig in Giessen was<br />

well aware of the nature and formula of<br />

chloroform in 1847.<br />

The success of chloroform renewed<br />

clinical interest in the chloride of olefiant<br />

gas (as the Dutch liquid was then commonly<br />

called in Great Britain). Simpson<br />

saw it induce anesthesia in several subjects<br />

but when he inhaled it himself it<br />

caused him a severe and prolonged sore<br />

throat.(34) He had probably used an impure<br />

product.(35) Allegedly, Lyon Playfair<br />

(1818-1898), a professor of chemistry in<br />

Manchester, suggested the Dutch liquid as<br />

an anesthetic to Simpson but prevented<br />

him from inhaling it it; they gave it to a<br />

rabbit which immediately died.(36)<br />

John Snow (1818-1858) purified the<br />

product and tried it on mice and on nine<br />

patients.(35) He found it to be a good anesthetic<br />

but slower and less potent (and hence<br />

safer) than chloroform but very expensive,<br />

Robert M. Glover (1815-1849) in 1840<br />

had given it to dogs by ingestion and intravenous<br />

injection without causing anesthesia.(37)<br />

In 1848, however, he used it on<br />

a few patients and found it to be a good<br />

anesthetic but without marked advantage<br />

over chloroform. He also found it difficult<br />

and expensive to manufacture.(38,39)<br />

The main advocate of the chloride of<br />

olefiant gas was Thomas Nunneley (1809-<br />

1856), a Leeds surgeon who wrote several<br />

laudatory papers about it, based on his<br />

extensive animal experiments (40) and his<br />

trials on seven subjects.(41) He had used a<br />

purified product, that he claimed to be<br />

cheaper than chloroform. He failed to convince<br />

his colleagues, however, and the compound<br />

soon disappeared from British surgical<br />

practice.<br />

The Dutch Liquid after 1852<br />

Abandoned by physicians, the compound<br />

continued to be studied in the laboratory.<br />

In 1881, Edward T. Reichert (1855-<br />

1931) a noted physiologist at the Univer-<br />

sity of Pennsylvania in Philadelphia described<br />

it as potent as chloroform in rabbits<br />

but a severe cardiac depressant.(42,43)<br />

It was also tested in rats and frogs in France<br />

(44-46) and in cats (47) and mice (48) in<br />

Germany. It generally was found to be equipotent<br />

to chloroform. An exception was the<br />

Glascow Committee of the British Medical<br />

<strong>Association</strong>: in rabbits and dogs it produced<br />

no anesthesia but only convulsions<br />

and death.(49) French chemists found it<br />

to be an excellent preservative for meat and<br />

produce.(50)<br />

In 1850 the French chemist Henri Victor<br />

Regnault (1810-1878) prepared a chlorinated<br />

derivative of the Dutch liquid that<br />

he named “chlorinated chlorhydric ether.”<br />

It was successfully tested in France (51)<br />

and in Germany (52) as a topical analgesic<br />

for neuralgias and abdominal cramps.<br />

However, Johann F. Heyfelder (1798-1869)<br />

the famous Erlangen (Gernany) surgeon<br />

found it to be ineffective as a topical analgesic<br />

although he induced anesthesia in<br />

two patients who inhaled it.(53)<br />

The Dutch Liquid Today<br />

1,2 dichloroethane or ethylene dichloride<br />

is still extensively used in industry as<br />

a solvent, degreaser, fumigant and precursor<br />

of various chemicals. Twelve tons are<br />

manufactured yearly, made like in 1794 by<br />

chlorination of ethylene. It has been found<br />

to be toxic to humans in factories and as<br />

an environmental contaminant from industrial<br />

discharges, damaging the central<br />

nervous system, the lungs, the liver and<br />

the kidneys and being a carcinogen.(54-<br />

56)<br />

Acknowledgments<br />

The authors gratefully acknowledge the<br />

valuable help of Professor Bernhard Panning,<br />

of Hanover (Germany) and of Professors<br />

Marie Therese Cousin and Jean<br />

Bernard Cazalaa, of Paris (France).<br />

References<br />

(1) Duncum BM. The Development of Inhalation<br />

Anaesthetics. London, Royal Society of<br />

Medicine Press, 1994:171-2, 209-12.<br />

(2) Snelders HAM. Het Gezelschap der<br />

Hollandsche Scheikunden. Amsterdam, Rodiolpi,<br />

1980; 84-88.<br />

(3) Snelders HAM. New chemistry in the Netherlands.<br />

Osiris 1988;4(2 nd Series):121-45.<br />

(4) Ingen-Housz J. Account of a new kind of<br />

inflammable gass, which can be made in a moment<br />

without apparatus, and is as fit for explosion<br />

as other inflammable gases in use for that<br />

purpose; together with a new theory of gun-powder.<br />

Philosophical Transactions of the Royal Society of<br />

London 1779;69:376-418.<br />

(5) Scheele CW. De Aethere (Volume 2).<br />

Opuscula Chemica et Chemica. Leipzig, 1789;<br />

134-5.<br />

(6) Fourcroy AF. Extrait d’un mémoire sur<br />

trois espèces de gaz hydrogènes chlores, retirées


de l’ether et de l’alcool par differents procédés,<br />

envoyé à l’Institut par la Société des Chimistes<br />

Hollandais, tiré d’un rapport lu à la première<br />

classe de l’Institut de France par le citoyen<br />

Fourcroy, séance du 26 Frimaire an 5 (16<br />

Decembre 1796). Annales de Chimie et de Physique<br />

1797;21:43-71.<br />

(7) Deiman JR, Paets van Trostwijck A, Bondt<br />

N, Lauwerenburgh A. Recherches sur les diverses<br />

espèces des gaz qu’on obtient en melant de l’acide<br />

sulfurique concentré avec l’alcool. Journal de<br />

Physique,de Chimie, d’Histoire Naturelle et des Arts<br />

1794;4(2):178-91.<br />

(8) Deiman, Van Trostwijck, Bondt,<br />

Lauwerenburgh. Ueber die Gasarten, welche man<br />

aus Verbindungen von starken Vitriolsaeure<br />

erhalt. Chemische Annalen 1795;2:195-205, 310-6,<br />

430-40.<br />

(9) Robiquet P. Colin J. Recherches sur la nature<br />

de la matière huileuse des Chimistes<br />

Hollandais. Annales de Chimie et de Physique<br />

1816;1:337-56.<br />

(10) Robiquet P, Colin J. Note sur l’huile du<br />

gaz oléfiant. Annales de Chimie et de Physique<br />

1816;2:206-9.<br />

(11) Berthoud SH. L’huile des hollandaise,<br />

ou chlorure d’hydrogène bicarbone. Petites<br />

Chroniques de la Science 1869;8:189-95.<br />

(12) Wootton AC. Chronicles of Pharmacy, volume<br />

2, London, Mc Millan & Co, 1910; 254-6.<br />

(13) Juhn B. Die erste Narkose in Wien. Wiener<br />

Medizinische Wochenschrift 1953;103:694-5.<br />

(14)Thomson T. A System of Chemistry, 6 th<br />

Edition. Edinburgh, Blackwood, Bell & Bradfure.<br />

1820; 237-8.<br />

(15) Silliman B. Jr. Elements of Chemistry,<br />

Volume 2. New Haven, CT, H. Howe, 1831; 20-2.<br />

(16) Ives E, Ives NB. Statement of Prof. Ives.<br />

American Journal of the Sciences and the Arts 1832;21<br />

(Appendix):406-8.<br />

(17) Smith DB. On certain compounds of carburetted<br />

hydrogen. American Journal of Pharmacy<br />

1832;4:114-21.<br />

(18) Liebig v. J. Ueber die Verbindungen<br />

welche durch die Einwirkung des Chlors auf Alcohol,<br />

Aether, Oelbildendes Gas und Eissiggeist<br />

entstehen. Justus Liebig Annalen 1832;1:182-230.<br />

(19) Black J. Chloric ether, new remedy in<br />

spasmodic asthma. London Medical Gazette<br />

1833;12:865-6.<br />

(20) Waldie D. Chloroform, the new agent for<br />

producing insensitivity to pain by inhalation. Pharmaceutical<br />

Times 1848;3:201-3.<br />

(21) Waldie D. The True Story of the Introduction<br />

of Chloroform into Anesthetics. Linlithgow<br />

& Edinburrgh, Boyd & Oliver, 1870.<br />

(22) Wood GT, Bache F. The Dispensatory of<br />

the United States of America. Philadelphia, Grigg<br />

& Eliot, 1834; 1077.<br />

(23) Gray TC. Little Known Liverpool Contributions.<br />

In: Atkinson RS, Boulton TB, eds. The<br />

<strong>History</strong> of Anaesthesia. London, New York, Royal<br />

Society Medical Services, Ltd. 1989; 518-9.<br />

(24) Cattell T. On the anaesthetic use of<br />

terchloride and perchloride of carbon, and the<br />

utility of oxygen as a corrector and modificator of<br />

the action of anesthetic agents on the system. Lancet<br />

1848;2:522.<br />

(25) Ure. On the nature and properties of a<br />

liquid sold under the name of terchloride of carbon.<br />

Pharmaceutical Journal and Transactions<br />

1843;3:170-2.<br />

(26) Tuson EW. On the effect of the ter-chloride<br />

of formyle, commonly called chloric ether, or<br />

terchloride of carbon. Pharmaceutical Journal and<br />

Transactions 1845;5:412-4.<br />

(27) Robinson (no first name given).<br />

Perchloride of carbon in cancrum oris. Medical<br />

Times Gazette 1845;11:463.<br />

(28) Pereira J. Historical notice on the chloride<br />

of formyle, commonly called chloric ether, or<br />

terchloride of carbon. Pharmaceutical Journal and<br />

Transactions 1845;5:412-4.<br />

(29) Dinnick OP. Jacob Bell and his trial of<br />

chloric ether at the Middlesex Hospital. Pharmacy<br />

in <strong>History</strong> 1991;33:70-5.<br />

(30) Sykes ES. Essays on the First Hundred<br />

Years of Anaesthesia. Chloroform before Simpson.<br />

Volume 2. Huntington, NY. Krieger, 1973; 168-77.<br />

(31) Simpson JY. Account of a New Anaesthetic<br />

Agent, as a Substitute for Sulfuric Ether in<br />

Surgery and in Midwifery. Edinburgh,<br />

Sunderland and Knox, 1847; 8.<br />

(32) The Life of Sir Robert Christison, Bart.<br />

Edited by his Sons. Memoirs (Volume 2).<br />

Edinburgh, London. W Blackwood & Sons 1855;<br />

352-3.<br />

(33) Duncan JHM. The Jubilee of Anaesthesia.<br />

British Medical Journal 1896;2:1413.<br />

(34) Simpson JY. Note on the anaesthetic effects<br />

of chloride of hydrocarbon, nitrate of ethyle,<br />

benzin, aldehyde and bisulphuret of carbon.<br />

Monthly Journal of the Medical Sciences 1847;2 (2 nd<br />

series):415-7.<br />

(35) Snow J. On narcotism by the inhalations<br />

of vapours. London Medical Gazette 1849;44:272-7.<br />

(36) Duns J. Memoirs of Sir James Y Simpson.<br />

Edinburgh, Edmonton & Douglas, 1873; 231.<br />

(37) Glover RM. On the physiological and<br />

medicinal properties of bromine and its compounds.<br />

Edinburgh Medical Surgical Journal<br />

1842;58:120-41, 335-64.<br />

(38) Glover RM. Anaesthetic properties of the<br />

Dutch Liquid. London Lancet 1851;1:15.<br />

(39) Glover RM. Report on anaesthesia and<br />

anaesthetic agents. Lancet 1858;2:468-70.<br />

(40) Nunneley T. On anaesthesia and anaesthetic<br />

substances generally. Edinburgh Medical<br />

Surgical Journal 1849;72:343-95.<br />

(41) Nunneley T. On common coal gas and<br />

Dutch oil as anaesthetics. Retrospective of Medicine<br />

and Surgery 1849;19:340-1.<br />

(42) Reichert ET. Ethylene bichloride as an<br />

anaesthetic agent; with a consideration of ethylene<br />

methylate, ethylene ethylate, ethyl nitrate,<br />

and ethylidene bichloride. Philadelphia Medical<br />

Times 1881;11:490-2, 518-22, 553-7.<br />

(43) Reichert ET. Are all anaesthetics dangerous<br />

which contain chlorine, bromine, or iodine?<br />

American Medical Times 1881;82:50-65.<br />

(44) Rabuteau A. Recherches sur les effets du<br />

chlorure d’éthylène, du tétrachlorure de carbone<br />

et du chlorure d’éthylidène. Comptes Rendus des<br />

Seances de la Societe de Biologie 1885;37:377-81.<br />

(45 ) Dubois R. Étude comparative des<br />

propriétés physiologiques des composés chlorés<br />

de l’éthane. Archives de Physiologie Normale et<br />

Pathologique 1888;20(4):298-310.<br />

(46) Dubois R, Roux P. Action du chlorure<br />

d’éthylène sur la cornée. Comptes Rendus des Séances<br />

de la Société de Biologie 1887;39:584-5.<br />

(47) Franz M. Studien ueber die Wirkung<br />

der Einatmung von Daempfen von<br />

Pentachloraether, Perchloraethylen und<br />

Dichloraethylen. Inaugural Dissertation.<br />

Universitaet Wuezrburg, Wuerzburg, 1909.<br />

(48) Mueller J. Vergleichende<br />

Untersuchungen ueber die narkotische und<br />

toxische Wirkung einiger Halogen-<br />

Kohlenwasserstoffe. Naunyn-Schmiedeberg Archiv<br />

Pharmacologie 1925;109:276-94.<br />

(49) McKendrick JG, Coates J, Newman D.<br />

Report on the action of anaesthetics to the Scientific<br />

Grants Committee of the British Medical <strong>Association</strong>.<br />

British Medical Journal 1880;2:957-78.<br />

(50) Robin E. Memoire sur de nouveaux<br />

procedes et de nouveaux agents de conservation<br />

des matieres animales et vegetales. Comptes Rendus<br />

des Séances de l’Académie des Sciences 1850;31:720-<br />

2.<br />

(51) Aran FA. Medication anesthetique locale.<br />

Archives Générales de Médecine 1851;4 Series:245-<br />

9.<br />

(52) Uhle C. De Aethere Chlorio. Inaugural<br />

Dissertation, Fakultaet Medizin, Universitaet<br />

Leipzig. Leipzig, G. Kreisig. 1860:10-13.<br />

BULLETIN BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA HISTORY HISTORY HISTORY 31<br />

31<br />

(53) Heyfelder JF. Versuche mit dem Aether<br />

muriaticus transchloratus (Ether chlorhydrique<br />

chlore, Liqueur des Hollandais Chlorée) in der<br />

chirurgische Klinik zu Erlangen. Deutsche Klinik<br />

1851;3:353-4.<br />

(54) ATSDR (Agency for Toxic Substances and<br />

Diseases Registry) 1,2 Dichoroethane. Atlanta,<br />

GA. US Department of Health and Human Services,<br />

1992.<br />

(55) US Department of Health and Human<br />

Services. Report on Carcinogenesis. National Toxicology<br />

Program. 8 th Edition. Research Triangle<br />

Park, NC, 1998; 95-7.<br />

(56) National Cancer Institute. Technical Report<br />

No 37. Bioassay of 1,2 dichloroethane for<br />

possible carcinogenicity. CAS No 107-06-2. National<br />

Institute of Health Publications 18-1361.<br />

Bethesda, MD, 1978.<br />

<strong>History</strong> Matters!<br />

International<br />

Symposium<br />

on the<br />

<strong>History</strong> of<br />

Anaesthesia<br />

January 22-25, 2013<br />

Sydney, Australia<br />

isha2013.wordpress.com/


32 32 BULLETIN BULLETIN BULLETIN OF OF ANESTHESIA ANESTHESIA ANESTHESIA HISTORY HISTORY<br />

HISTORY<br />

Fisher. .. Continued from Page 20<br />

Cornelius Fisher of Dedham, Mass, 1860-1840.<br />

Everett, MA, Massachusetts Publishing Co., 1898:<br />

272.<br />

(4) Federal Census Index, 1860. New York<br />

City, 16 th Ward, District 4, page 1.<br />

(5) New York City Coroners’ Day Book. Entry<br />

256385, January 21, 1877.<br />

(6) Harrington TF. The Harvard Medical<br />

School: A <strong>History</strong>, Narrative, and Documentary.<br />

New York, Chicago. Lewis Publishers, 1905, vol.<br />

3:1476.<br />

(7) Fellows of the Massachusetts Medical Society<br />

1787-21854. Boston, J Wilson & Sons,<br />

1855:16.<br />

(8) Fisher FW. The nature and treatment of<br />

seasickness. Boston Med Surg J 1847;38:513-518<br />

(9) Jones RM. American doctors in Paris 1820-<br />

1861. J Hist Med Allied Sci 1970;25:142-157.<br />

(10) Warner JH. Against the Spirit of the System:<br />

The French Impulse in Nineteenth-Century<br />

American Medicine. Princeton, NJ, Princeton<br />

University Press, 1995.<br />

(11) Warren JC. The influence of anaesthesia<br />

Germany. .. Continued from Page 25<br />

1939;10:680-691.<br />

(10) Graf 0. Ueber den Einfluss von Pervitin<br />

auf einige psychische und psychomotorische<br />

Funktionen. Arbeitsphysiologie 1939;10:692-705.<br />

(11) Steinkamp P. Pervitin(methamphetamine)<br />

experiments and its use in the German Wehrmacht<br />

1939-1945. Conference on the <strong>History</strong> of Medicine.<br />

Section Military Medicine. Heidelberg, July<br />

15, 2004.<br />

(12) Haeffner F. Zur Pharmakologie und Praxis<br />

der Stimulanten. Klin Wochenschr 1938;17:1300-<br />

1311.<br />

(13) Speer E. Das Pervitinproblem. Deutsche<br />

Arbeitblatt 1941;71:46, 15-19.<br />

(14) Kaerber G. Unterstellung von Dolantin,<br />

Pervitin und Benzedrin unter der Opiumgesetz.<br />

Deutsche Aerztenblatt 1941;260-262.<br />

(15) Gruenwald (no first name). Die Loesung<br />

des Pervitins Problem. Gesundheitsfuehrung “Ziel<br />

und Weg” 1941;315-319.<br />

Bulletin of <strong>Anesthesia</strong> <strong>History</strong><br />

Doris K. Cope, M.D., Editor<br />

200 Delafield Road, Suite 2070<br />

Pittsburgh, PA 15215<br />

U.S.A.<br />

on the surgery in the nineteenth century. Trans<br />

Amer Surg Assoc 1897;15:18.<br />

(12) Velpeau A. De l’etherization. Union<br />

Medicale 1850;4:121-122.<br />

(13)Westminster Hospital. Operations under<br />

the influence of ether. Lancet 1847;1:78-79.<br />

(14) Medical Police and Rules of Regulations<br />

of the Boston Medical <strong>Association</strong>, with a Catalogue<br />

of the Officers and Members. Boston, J.<br />

Wilson & Sons, 1852:35.<br />

(15) Sudden death of a physician. New York<br />

Times, January 21, 1877, page 12.<br />

(16) Married. New York Times, November 17,<br />

1855, page 8.<br />

(17) Special Notices. New York Times, February<br />

22, 1855, page 5.<br />

(18) Phisterer F. New York in the War of the<br />

Rebellion, 1861 to 1865. Third Edition, Albany,<br />

NY, JB Lyon & Co., 1912:2913-2915.<br />

(19) Hussey GA, Todd W. <strong>History</strong> of the Ninth<br />

Regiment, NYSM, NGSNY (Eighty-Third NY<br />

Volunteers), 1845-1888. New York, JS Ogilvie,<br />

1889:354; 562; 714.<br />

(20) Society of the War Veterans. Ninth Regiment,<br />

New York State Militia (83 rd New York Vol-<br />

(16) Unger F. Einsatz von Pervitin im deutschen<br />

Heer im 2.Weltkrieg und dessen Vorbereitung seit<br />

1937. Wehrmed Monatschr 1994;38:374-381.<br />

(17) Unger F. Das Institut fuer Allgemeine<br />

und Wehrphysiologie an der militaer-aerztliche<br />

Akademie in Berlin (1937-1945). Dissertation,<br />

Medizinische Hochschule, Hannover, 1991.<br />

(18) Neumann A. Arztum ist immer<br />

Kaempfertum. Duesseldorf, Droste Verlag,<br />

2005:260-266.<br />

(19) Luft U. Wachsmittel im Flugbetrieb. In:<br />

Wehrhygiene. Edit S. Hand-loser & W. Hoffman,<br />

Berlin, Springer Verlag 1944:492-493.<br />

(20) Hartmann V. Pervitin. Vom Gebrauch und<br />

Misbrauch einer Droge in der Kriegsmarine.<br />

Wehrmed Monatschr 1994;38:137-142.<br />

(21) Noeldeke H, Hartmann V. Der<br />

Sanitaetsdienst in der deutsche U-Boot-Waffe.<br />

Hamburg, ES Mittler & Sohn Verlag, 1996:207-<br />

219.<br />

(22) Noeldeke H. Einsatz von<br />

Leistungsteigererenden Medikamenten.<br />

unteers). Hartford, CT, Star Printing Co., 1887.<br />

(21) The Medical and Surgical <strong>History</strong> of the<br />

Civil War. Wilmington, NC, Broadfoot Publisher,<br />

1992, vol. 10:513.<br />

(22) Another Rally of the Veterans. New York<br />

Times, <strong>April</strong> 11, 1884, page 8.<br />

(23). The Fisk murder. The testimony of the<br />

hotel doctor. New York Times, July 4, 1872.<br />

(24) Swanberg WA. The Career of an Improbable<br />

Rascal. New York, Charles Scribner & Sons,<br />

1959:272-278<br />

Acknowedgments<br />

We deeply appreciate the great help<br />

provided by the staffs of the Countway Library<br />

of Medicine at Harvard University<br />

and the New York Public Library; by the<br />

office of New York Senator Charles<br />

Schumer; and by Jeff S. Defalque.<br />

Einfuehrung. Erfahrungen bei Heer und<br />

Kriegsmarine. In: Nazis on Speed. Drogen im 3.<br />

Reich. Volume 1 Lohrbach (Germany), Gruene<br />

Kraft Verlag, 2002:134-142.<br />

(23) Klee E. Auschwitz, die NS-Medizin und<br />

ihre Opfer. Frankfurt/Main, S Fischer<br />

Taschenbuch Verlag, 1997:225.<br />

(24) Heston LL. The Medical Case Book of<br />

Adolf Hitler. Lincoln (Nebraska) iUniverse,<br />

2007:71-85.<br />

(25) Schenck EG. Patient Hitler. Duesseldorf,<br />

Droste Verlag, 1989:203-205, 447-449.<br />

(26) Ivy AC, Goetzl FR. D-desoxyephedrine.<br />

A review. War Med 1943;3:60-77.<br />

(27) Meyer U. Man sollte die Entwicklung<br />

nicht hemmen. Fritz Hauschild (1908-1974) und<br />

die Arzneimittelforschung in der DDR. Pharmazie<br />

2005;60:468- 472.

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!