April 2011 - Anesthesia History Association
April 2011 - Anesthesia History Association
April 2011 - Anesthesia History Association
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.