BULLETIN OF
ANESTHESIA
I STORY
OCTOBER,
VOLUME 15, NUMBER 4
1997
A History of Missed Opportunities
TIle following paper was presented by DI: Elizabeth Frost at the Fourth International Symposium on the' History of Anesthesia in Hamburg, Ger­
many, in April, 1997. DI: Frost is a former President of the A nesthesia HistOlY Association and a n active member of the Association.
Misleading Developments in Anesthesia Techniques as an
Impediment of Progress in Surgical Anesthesia
by Elizabeth A.M. Frost, M.D.
New York Medical College, Valhalla, New York
It is not difficult to realize how little real
progress was made in surgery before the dis­
covery and application of anesthesia in the
19th century. Prior to 200 years ago, methods
Anesthesia is not, however, an unmixed
good. . .We cannot purchase immunity from
suffering without incurring a certain degree of
danger. . . many of the deaths that have fol­
(boquet) with a double series of charged
bottles that converged upon a steel rod, from
which conductors extended to the painful
or afflicted part of the body. He devised
lowed the inhalation of anesthetics have re­
other means of mass healing, including
sulted from want of knowledge or of due care
on the part of the administrators."
magnetizing mirrors, wash basins, gardens,
However, over the past 200 years it is inter­
Lafayette went t o America at the end o f the
ders exceedingly . . ." The rationale was that
esting and even comical to see how some
18th century, told Washington that, besides
pain, associated only with an injury, could
strange developments, often heralded as ma­
jor anesthetic advances, either did not work or
to alleviate pain differed greatly.Around the
time of the writing of the Edwin Smith papy­
rus (c. 3,000 B. C.) the physician was advised
"to palpate . . . wound, although he shud­
not be intensified by anything the surgeon
did and therefore could not be relieved by
him.The ancient Greeks suggested that pres­
sure on the carotid arteries (Karoun
=
caused such major complications that success­
ful surgery was not possible.
surgeon from Bologna in the 13th century
described a soporific sponge of opium, un­
ripe mulberry, hyoscyamus, hemlock, man­
dragora, wood ivy, and dock and water hemlock
seeds.However, the surgeon himself apparently
had little faith in his concoction and advised
that the patient be firmly tied down.
Throughout the middle ages little refer­
ence is made to anesthesia because pain is
mentioned so frequently in religious teach­
ings and is envisioned somewhat akin to a
"noble " state. Rather, theological doctrine
held that pain serves God's purpose and
should not be alleviated.
munitions of war, he was bringing the
United States a most important gift known
as mesmerism, "a marvellous weapon
against illness and pain."
Despite Mesmer's enormous popularity,
to
plunge into sleep) caused unconsciousness.
Paul of Aegina (625-690 A.D.) advised stuff­
ing the patient's ears with wool.Theodoric, a
parks and even whole forests. W he n
Mesmerism
Heralded as the "last of the magicians, "
Franz Friedrich Anton Mesmer, a sometime
student of divinity, law and medicine, claimed
the power of working miracles with his "vital
most physicians in France refused to ac­
knowledge his claims as scientific. King
Louis XVI persuaded the Medical Society
to hold an enquiry. A committee was ap­
pointed that included Guillotin, Benjamin
energy." Born in Germany in 1734, Mesmer was
Franklin, Lavoisier (the chemist) and
educated mainly at the University in Vienna
where he lived affluently, counting such court
Jussieux (the botanist) to investigate ani­
figures as Mozart, Gluck and Hayden among
his friends.Through his association with a Je­
cluded that Mesmer's activities were inex­
suit priest, Pater Hell, who was professor of
astronomy at the University, Mesmer became
ence could not approve what it could not
convinced that the lodestone was useful in the
treatment of certain ailments.He believed that
mal magnetism. The commission con­
plicable and not devoid of value, but sci­
explain.Mesmer retired to Lake Constance
where he died in 1815.
One of his disciples, Count Maxime de
the magnet could attract human ills as it at­
tracted iron. After much experimentation, he
Puyseger of Busancy, had a lime tree mag­
applied his theories to patients and apparently
came to it regularly for cures of whatever
netized in his park by Mesmer. Peasants
And so it was difficult, even with the
had some miraculous cures by placing two
ailed them. On one occasion, a 23-year-old
dawning of anesthesia in the 19th century, to
magnets in contact with the body. He was
lauded by the Augsburg Academy in 1776 and
man had been tied to the tree. The Count,
generally realise the potential for surgical ad­
vance. Dr. John Erichsen from University
College Hospital in London wrote in his
textbook,
TIze Science and Art of Surgery, in
1869: "The employment of anesthetics in
surgery is undoubtedly one of the greatest
bonuses ever conferred upon mankind. . .
was made a member of the Academy of Sci­
in an attempt to increase the magnetic in­
fluence of the tree, passed his hands over
ence of Electoral Bavaria.However, the medi­
cal profession was less convinced and withheld
its recognition.He left Vienna for Paris in 1778,
the body.A hypnotic trance was induced in
where his animal magnetism continued to
made his discovery of this state of unaware-
cause controversy. He built a wooden tub
Continued on Page 4
the young man.Puyseger repeated the pro­
cess on many other individuals before he
BULLETIN OF ANESTHESIA H ISTORY
John S. Lundy Collection Made Available to Researchers
b.y Lee C. FosbUlgh, MLIS, lHA, AANA Archivist
The John S. Lundy (1894-1973) Anesthe­
Inventory ofthe John S. Lundy Collection
sia Book Collection, 1847-1959, contains 69
Title: The centennial of surgical anesthesia
rare anesthesia books collected by the pio­
/ compiled by John E Fulton and Madeline E.
Stanton.
neer anesthesiologist, John S. Lundy, MD.
Author: Clement, Frederick Walter
Title: Nitrous oxide-oxygen anesthesia:
McKesson-Clement viewpoint and technique
Published: Philadelphia: Lea & Febiger,1945
John C.Lundy, son of the late anesthesiolo­
Published: New York: Schuman,1946
Edition: 2nd ed.
gist, donated 65 volumes of his father's anes­
Notes: Book signed by JS Lundy, 1946
Added Entries: Fulton, John R; Stanton,
Notes: Book signed by JS Lundy 9-4-45
thesia book collection to the American Asso­
ciation of Nurse Anesthetists (AANA) Ar­
Author: Colton, GQ
Title: Anaesthesia: who made and developed
Madeline E.
chives on May 8, 1997.The books document
subjects, such as anesthesia, anesthetics, and
substance abuse.Many of the books are first
editions signed by the authors to Dr.Lundy.
Four of the books were donated by Dr.Lundy
to the AANA Library at an earlier undeter­
Author: Adams,Richard Charles
Title: Intravenous anesthesia
Published: New York: Hoebel; 1944
Dr. Lundy's relationship with the AANA
twentieth century. In the late 1940s, Dr.
Lundy lobbied for Mayo nurse anesthetist,
Florence A. McQuillen, CRNA, to become
the first Executive Director of the AANA.It
Author: Alfred Hospital.Anesthesia dept.
Title: Practical anaesthesia/ foreword by EH.
McMechan
Published: Glebe, NSW: Australian Medi­
cal Publishing, 1932
Added Entries: McMechan, EH.
is well known that Dr. Lundy and Ms.
McQuillen published Anesthesia Abstracts, al­
though Dl: Lundy gave most of the credit to
Ms.McQuillen,to whom he referred as "the best
read person on the literature of anesthesia."
Title: Local and regional anesthesia; with
of local and regional anesthesia to the surgery
of the eye, eat; nose and throat, and to dental
practice
the University of the City of N ew York " from
the
New York Medical Journal (October 25,
Published: New York: Appleton & Lange,
1886
Author: DeFord,William Harpter
Title: Lectures on general anaesthetics in
dentistry
Published: Pittsburgh: Lee S.Smith & Sons,
1912
Edition: 2nd ed.
chapters on spinal, epidural, paravertebral and
parasacral anesthesia,and on other applications
Of the John C. Lundy donation, all but
Medical College and Medical Department of
Title: Local anaesthesia in general medicine
and surgery, being the practical application of
the author's recent discoveries
Author: Allen, Carroll Woolsey, 1874-
two books, W S Playfair, "Observations ad­
dressed to the students of Bellevue Hospital
Author: Corning, J.Leonard
Notes: Book signed by the author to JS
Lundy 5-3-44
mined date.
can be traced to the middle decades of the
this great discovery?
Published: New York: A.G.Sherwood, 1886
Published: Philadelphia: WB. Saunders,
1918
Notes: Book signed by A.c.Fawcett, 1912
Author: Dogliotti, Achille M.
Title: Anesthesia: narcosis, local, regional,
spinal
Published: Chicago: Debom; 1939
Edition: 2nd ed.
Author: Dumont, EL.
1884) and Wilder D. Bancroft, George H.
Richter, "The chemistry of anesthesia "
(1931) , are individually cataloged in the
AANA Archives-Library data base (see the
inventory listed below).Items, such as corre­
found in many of the books.A transcription
of a radio interview, "Safe Relief From Pain
Lundy, Jan.1945
During Labor," done by Dr. J.T. Gwathmey
(1936), was found in
Anesthesia (1914).The
collection also contains a number of letters
between Chester A. Beatty (UK) and Dr.
Author: Bigelow, Hemy Jacob,1818-1890
Title: Surgical and anaesthesia; addresses
Published: Boston: Little, Brown, 1900
pat1icipation inWorld War II (1941).All of these
Author: Braun, Heinrich
Title: Local anesthesia; its scientific basis and
served and put into a protective box.
Researchers interested in photographs of
John S.Lundy, Florence A. McQuillen, Mayo
practical use / Heinrich Braun; translated by
Malcolm L.Harris
Clinic, or the AANA and its predecessor Asso­
Published: Philadelphia: Lea & Febigel; 1924
Edition: 2nd ed.
ciation should consult the Archives Photograph
Added Entries: Harris, Malcolm L.
Collection.For more information about the John
S.Lundy or other collections in AANA Archives,
please contact Lee C. Fosburgh, AANA Ar­
chives, 222 South Prospect Avenue, Park Ridge,
IL 60068-4001, (847) 692-7050, x3006, or by
E-Mai1 [email protected]
Call for
Charter Members of the
Friends of the
Wood Library-Museum
and other papers
Lundy concerning work on Clinical Anesthe­
sia, Asiatic Medicine and anesthesia, and U.S.
materials were separated from the books, con­
Continued on Page 15
coverer of anesthesia
Published: Chicago: American College of
Dentists, 1944
Notes: Book signed by the author to JS
spondence, photographs, and document were
Title: HandbuCh der allgemeinen und
Author: Archer, WHarry
Title: Life and letters of Horace Wells, dis­
•
Updates of W LM acquisitions and pa-
pers
•
Discounts on WLM products
•
Annual Appreciation Tea at the ASA
•
Charter membership $40.00
Leroy D. Vandam, M.D. watercolor
note cards $6.00 (Y2 price)
•
Send name, address, phone, fax, E-mail
to:
Patrick Sim, Librarian
Wood Libraly-Museum
Author: Burridge, W
Title: Alcohol and anaesthesia
Published: London: Williams & Norgate
Ltd., 1934
520 N.Northwest Hwy.
Park Ridge, IL 60068-2573
Make
check
payable
to:
Wood
Libraly-Museum or send Visa/MC# with sig­
nature
BULLETIN OF ANESTHESIA H ISTORY
Gone but Not Forgotten
by CR. Stephen, M.D.
In 1929, as the result of the industry of Dr.
completed his residency training at Bellevue
2. American Board of Anesthesiology.Mem­
John Silas Lundy of the Mayo Clinic, with the
help of Dr.Ralph Waters of Wisconsin, the Anes­
Hospital under Emery A. Rovenstine in 1937.
Beginning in 1954 and for the rest of his life he
ber, 1960; President, 1968.
3. Food and Drug Administration.Advisory
thetists' 1i'avel Club was born, the first meeting
being held in Rochester, New York.It flourished
was a Professor at Louisiana State University
and Director of the Department of Anesthesia
Drugs, 1966 - .
until the beginning of World War II, when travel
restrictions forced its temporary abandonment.
at Charity Hospital in New Orleans. To say that
his contributions to the art and science of anes­
man, Section on Anesthesiology, 1958 -; Chair­
The stmy of the Travel Club and its member­
ship has been told in a brief monograph pub­
lished in 1989 by the subsequent Academy of
thesia have been manifold is to grossly under­
man, Council on Drugs, 1968 - .
estimate the accomplishments of this
workaholic.Not a blade of grass grew under his
5. Distinguished Service Award, American
Society of Anesthesiologists, 1949.
Anesthesiology, which held its first meeting in
feet.
1952 in Cleveland.
Since that time many distinguished teach­
ers, scholars, investigators and practitioners of
anesthesiology have been admitted to member­
ship in the Academy. It is the intent of this col­
Through the years 1938 to 1970, he pub­
lished some 400 scientific papers which together
embraced every aspect of the emerging aspects
of the specialty.Moreover, he authored 14 books
during his career which were avidly read and
umn, on a per issue basis of the Bulletin, to pro­
absorbed by residents and practitioners of the
file members of the Academy who made signifi­
cant contributions to the specialty, but who are
day.He had no peer in these accomplishments.
Honors and awards were not long in being
bestowed on this distinguished personage.A few
no longer with us.
John Adriani, M.D. (1907-1988) is the first
of these giants in anesthesiology. Born in Bridge­
port, Connecticut, he attended medical school
Committee on Anesthetics and Respiratory
4. American Medical Association. Chair­
6. Southern Society of Anesthesiologists,
Co-founder with Dr.Perry Volpitto, 1948; Presi­
dent, 1952.
7. Spare time interests fishing and photog­
raphy, WHEN?
On his demise in 1988, Dl� Adriani was sur­
vived by his wife, Irene, a former nurse anesthe­
tist.Through the years Irene was a prime sup­
porter of John and did much to fulfil his
never-ending support of the specialty.Irene was
of these will be listed.
a most gracious hostess to the many visitors who
1. Diplomate American Board of Anesthe­
sia, 1940.
came to observe John's work.We salute Dr.John
Adriani and his superb accomplishments.
at Columbia University, graduating in 1930, and
Max Samuel Sadove, M.D. - 1 9 14- 1 997
Born and brought up by his parents, Harry
covery rooms and intensive care units. He also
and Rebecca (Must), Max Sadove originally had
continued his interest in pain management for
or contributed to some 20 textbooks, including
the ambition to be a pharmacist. After under­
chronic pain syndromes and for local and re­
graduate training at the Baltimore City College
gional operative techniques. His interest in fluo­
rocarbon anesthetics led to work with Dr.
Recave1Y Room - Immediate Postoperative Man­
agement (1956), Cardiavascular Collapse in the
Operating Room (1958), Halothane (1962), and
Electroencephalography jor Anesthesiologists and
Surgeons (1967).
that he wrote or co-authored, Dr. Sadove wrote
he attended the University of Maryland School
of Pharmacy where one of his professors was
Krantz, who administered to Sadove the first
Dr.John Krantz, who later was to have a lead­
ing role in his life.Then he entered the Univer­
Because of his interest in self-experimentation,
As final tributes to his many achievements,
he was a member of and President of the Walter
Reed Society (1954-57).
members of the Department of Anesthesiology
sity of Maryland School of Medicine, obtaining
his M.D. in 1939. He then had a one-year in­
anesthetic performed on man with Fluroxene.
at Rush and former students established an en­
ternship at St.Agnes Hospital in Baltimore.
In 1941 he enlisted in the Medical Corps of
the U.S. Army and spent the next six years in
the European theater in Great Britain where his
In 1971 Dr. Sadove became Professor and
Chairman of the Department of Anesthesiol­
ogy at Rush-Presbyterian-St. Luke's Medical
Center (RPSLMC). He continued in this role
sic and clinical research. In addition, in 1986
principal Consultant was Dr. Ralph M.Tovel!.
While in the Army he developed an interest in
as teacher and researcher until 1979. He con­
the anesthesiology department at the Univer­
ulty and Alumni Award, citing his role in the
dowed professorship in 1984-the Max S.
Sadove, M.D.Professorship in Anesthesiology­
to support educational initiatives as well as ba­
When Dl� Sadove returned to civilian life in
tinued to conduct research and directed the
clinical program at the Rush Pain Center, where
acupuncture and other techniques were used
1946, he settled in Chicago where he spent the
to help patients with chronic pain. He retired
remainder of his professional life.From 1946 to
1947 he completed his residency under Dr.
from the Pain Center in 1992.
Dr. Sadove participated in many extracur­
Segall), three children, Ellen, Dr. Michael and
Cassels at the V.A. Hospital in Hines, Illinois.
ricular professional activities during his career.
D[ Richard, and six grandchildren. He is also
Dr. Sadove then joined the faculty at the
University of Illinois and in 1950 was named
Professor and Chairman of the Department of
In 1950-51 he was President of the Chicago
Society of Anesthesiologists.In 1963-64 he was
ter, Mrs.Mary Bm'ban.
regional nerve block techniques.
Anesthesiology at the University of Illinois
Abraham Lincoln School of Medicine and asso­
ciated hospitals.
At the University of Illinois hospitals Dr.
Sadove gradually introduced the concept of re-
sity of Illinois gave him its Distinguished Fac­
training of hundreds of anesthesiologists around
the world.
Dl� Sadove is survived by his wife Ethel (nee
survived by a brother, Aaron Sadove, and a sis­
President of Illinois Society of Anesthesiologists,
Memorials are appreciated for anesthesia
a role that he assumed again in 1968-69. This
group honored him in 1970 with the Outstand­
research at Rush (1700 W Van Buren, Rm 250,
Chicago, IL 60612) or to the Wood
ing Service Award.
In addition to numerous scientific papers
Northwest Highway, Park Ridge, IL 60068).
Library-Museum of Anesthesiology (520 N.
4
BULLETIN OF ANESTHESIA HISTORY
Missed
Opportunities. .
of bringing to light one truth more, especially
. ContilllledJrolll Page 1
as it will free them from the drudgery required
to induce mesmeric insensibility to pain." And
the gas. By inhalation, after he had dipped
his finger in it and had suffered no ill effects,
he felt many pleasurable sensations, includ­
ness known. Baron de Potel, a surgeon and
so, apparently, Esdaile not only realized but was
ing relaxation, an acuity of hearing and a
one of his friends, tried the technique for
prepared to admit that mesmerism was not al­
ways conveniently successful.
desire to laugh.Later he used the inhalation
painless operations. His example was fol­
lowed by Recamier in France and by Jules
Cloquet, who performed a mastectomy on
Nevertheless, during his six-year tour in
India, Esdaile, according to his reports, per­
April 12, 1829.Somnambulism was born and
formed some 7,000 operations under mesmer­
heralded as a new era for surgery.
ism.On his return to Scotland, the local cli­
entele appeared to be less amenable subjects.
In the same year, 1829, John Elliotson
became interested in mesmerism through the
of nitrous oxide to relieve the pain he suf­
fered when he cut his wisdom teeth. In his
book, Medical ThpOlO', he wrote later-''As ni­
trous oxide in its extensive operation appears
capable of destroying physical pain, it may
be used with advantage during surgical op­
Attempts to achieve similar pain free surgery
erations in which no great effusion of blood
influence of Chenevix, who had practiced in
by Strohmeyer in Vienna, Auguste Nelaton
takes place."
Paris and later given demonstrations in Lon­
in France and John Collins Warren in Bos­
ton all failed.
much use of nitrous oxide.He and later his
tended St. Thomas's Hospital. Some years
One last variation in mesmerism in
master, Bolase, inhaled it rather frequently
later, in 1837, Dupotet, who had long used
anesthesia came about later, during the 1840s.
James Braid, an Edinburgh surgeon, while
and afterwards tended to patients with more
don. At Elliotson's invitation, the latter at­
mesmerism in Paris, also came to London and
Unfortunately, Davy made rather too
merriment than the latter felt to be appro­
priate. The town of Penzance began to com­
influenced Elliotson to adopt the technique.
Elliotson was a very prominent physician in
interested in mesmerism, did not ascribe to
England-being the first Professor of the
Newpnology 01' the Rationale ofNel'VOUS Sleep,
plain of the "devilish gas." A visitor to the
town, Dr. Giddy, later to become president of
Practice of Medicine at the new University
he described how the mesmeric phenomena
the Royal Society, heard of Davy and recom­
of London and senior physician at the Col­
could be due to suggestion and substituted
mended him to Beddoes at Bristol. Beddoes
lege Hospital. He was instrumental in intro­
the term "hypnotism."
invited Davy to become superintendent of his
the theory of animal magnetism. In his
ducing the stethoscope and was known for
Nevertheless, mesmerism was a wide­
Pneumatic Institute at Clifton in 1799. Dr.
his progressive attitude.Thus, when he pro­
Beddoes was one of the first to devote him­
moted this practice, much attention was paid
spread cult, pursued by many important and
far thinking individuals.Although a mislead­
to his opinions.His demonstrations, attended
ing development in that claims were made
by such notables as Charles Dickens and
that were only sporadically realized, the tech­
Thomas Moore, were, however, attacked as
nique did indicate that painless surgery could
be achieved-a belief that until the middle
of the 19th century was not realized.
"humbug." By the end of 1838, a resolution
was passed by the Council of University Col­
lege forbidding the further practice of mes­
merism.Elliotson, who continued to passion­
ately believe in the practice, resigned.In 1843,
he started a journal, the
Zoist: A Joul'Ilal of
Cerebral Physiology and Mesmerism and their
Application to Human ll1ellfare. The publica­
tion lasted for 12 years and covered such is­
Pneumatic Medicine
It is obvious today that anesthesia may be
self to making available for medical use the
gases discovered by Priestley. The Institute
was founded "for the treatment of disease by
inhalation." A lO-bed hospital and outpatient
department were attached. However, it was
noted that several patients who inhaled the
gases became bradycardic and giddy; many
did not get better; and some charges of im­
proprieties regarding young ladies were
achieved by the inhalation of gases or vapors.
raised. The Institute fell into dispute, but not
For centuries men have believed that ail­
before Davy's S80-page treatise,
ments may be cured and pain relieved by
breathing something. The question was
"what "? The pioneer who discovered carbonic
Re­
searches... concerningNitrolls Oxide, was writ­
ten (at that time he was 21) including draw­
of social problems. Many reports of numer­
acid, oxygen (1771) and nitrous oxide (1772)
ings of his gas machine. Although brilliant
and so much before his time in so many ar­
ous operations performed painlessly during
was Joseph Priestley-a dissenting Unitar­
eas, Davy made one large error.
a trance appeared in the
ian minister who was forced to leave England
for America in 1794 because of his sympa­
sues as mesmerism, phrenology and a host
Zoist. Elliotson's
"anesthetic " technique was very involved and
required that the subject rest in a dark room
thies for the French Revolution. He believed
for about an hour while he made passes over
that the inhalation of oxygen might be ben­
the body and breathed on the vertex of the
eficial for diseases of the lungs-a sugges­
tion that led members of the medical profes­
patient's head.
An ardent follower of Elliotson, James
sion and others to develop "pneumatic medi­
Esdaile, also from Edinburgh, was another
cine." This treatment fad promoted the in­
halation of not only oxygen but also hydro­
strong believer in mesmerism as a n
anesthetic.While i n charge o f the Native Hos­
pital at Hooghly, India, Esdaile reported 73
painless surgical operations in January, 1846,
with the aid of mesmerism. When the
gen and nitrogen as a cure for asthma, tuber­
culosis, paralysis, scurvy, hysteria and can­
cer, among other diseases. One American
Zoist
physician, Lantham Mitchell, used nitrous
reported on the successful use of ether 10
oxide in animals. As they all died, he assumed
it was a very poisonous gas and believed that
months later, Esdaile used the agent also in
Calcutta.He wrote, "By cautious and gradu­
ated doses and with a knowledge of the best
it was the contagion for the spread of epidem­
antidotes, I think it is extremely probable that
ics.As a prominent figure and doctor, his re­
ports were accepted without disagreement
this power will soon become a safe means of
and for years no one dared to inhale nitrous
procuring insensibility for the most formi­
oxide. However, in 179S Humphrey Davy,
dable surgical operations even.All mesmer­
then aged 17 and apprenticed to John
ists . . .will rejoice at having been the means
Bingham Bolase, a surgeon in Penzance, tried
Of respira ble gases . . .one only has
the power of uniformly support life;
atmospheric air. Some such as nitro­
gen and hydrogen, effect no positive
change in the venous blood.Animals
immersed in these gases die of a dis­
ease produced by privation of atmo­
spheric air.
Oxygen. . . finally destroys life.
Had he devised a means to supply impris­
oned animals with oxygen and remove car­
bon dioxide, his findings would have been
more extensive. Instead post mOltem find­
ings on all animals showed a pattern which
led Davy to the conclusion that the lungs of
animals destroyed by nitrous oxide are the
same as those destroyed by oxygen.Although
he had confirmed the findings of Lavoisier
that inspired air contained more oxygen and
less carbon dioxide than expired air, he did
not adapt this fact to his work and thus de-
BULLETIN OF ANESTHESIA HISTORY
layed the implementation of a critical part of
John Snow's text on chloroform published
indeed caused an almost instant on and off
the anesthetic puzzle for decades.
Another English physician, Henry Hill
in 1858 is devoted to the complications of its
administration.
Nitrous oxide, although considered inert,
anesthetic. However, the incidence of intra­
was the cause of many deaths. The dentist
with the agent were abandoned.
Colten had reestablished the popularity of
the gas for dental extractions in the 1860s.
Acupuncture Anesthesia
Hickman, was very concerned about the pain
of surgery. Born near Ludlow in 1800, he
trained in medicine in Edinburgh before re­
turning to practice in his home town.In 1824,
he went to Shifnal, the birthplace of Beddoes,
where he may have learned of the pneumatic
researches of the latter. Hickman conducted
operative ventricular tachycardia and fibril­
lation was extremely high, and further trials
His method consisted of breathing the gas
After the establishment of the People's
until unconsciousness supervened and then
RepUblic of China in 1949, traditional Chi­
nese medicine, which had fallen into disre­
ferent gases to animals confined under glass
removing the mouth piece and quickly ex­
tracting the teeth. When others tried to ex­
tend the inhalation and push for longer peri­
domes. When they become unconscious (pre­
ods of unconsciousness, sudden death was not
the first half of the 20th centUlY, received new
sumably from asphyxia) he operated on them
in what was apparently a pain-free state.
uncommon-especially in healthy individu­
attention.
als. In 1868, Edmond Andrews, the Chicago
surgeon, advised the use of oxygen with ni­
whether acupuncture, long used to treat pain,
many experiments on administration of dif­
Hickman tried repeatedly to get permission
pute by the second half of the nineteenth cen­
tury and which was officially banned during
Some Chinese physicians considered
to try his experiments on humans, but nei­
ther Davy nor his assistant Faraday, would
bring up the matter to a committee of the
trous oxide, but little attention was paid to
could prevent pain.A technique of "acupunc­
his suggestion. By 1924 Gwathmey advised
ture anesthesia" was developed.The first re­
against the use of nitrous oxide altogether and
Royal Society. Hickman later petitioned
in 1939 Dr.C.B. Courville published an en­
tire book related to the untoward effects of
ported use of acupuncture instead of anesthe­
sia took place in China in 1958.The opera­
Charles X of France to bring his proposals to
the Royal Academy of Medicine.
At a meeting of the Academy on Decem­
ber 28, 1828, the leaders of French medicine
declared that "Operate under laughing
nitrous oxide-mainly those of anoxia.
Paul Bert tried to solve the problem of
nitrous oxide anesthesia (i.e., to allow the gas
to induce anesthesia in something other than
a hypoxic mixture). During the 1880s he con­
tion was a dental extraction. The technique
was used sporadically from 1958 to 1968.
Then with the Cultural Revolution and suc­
cession of Chairman Mao in 1966, reports
indicated successful use of acupuncture
gas. . . it would be nothing but a crime to
expose a human being to such needless per­
structed a special tank, large enough to in­
spite this impressive figure, Dr.John Bonica
ils." Only Baron Dominque Larrey, army sur­
clude the operating table with patient and
estimated the total number of cases per­
geon to Napoleon, voted against the others,
staff, in which he could increase the atmo­
spheric pressure.The idea sounded feasible but
formed under acupuncture anesthesia to be
noting that he "would be willing for Mr.
Hickman to administer laughing gas to me
did not work. Apart from being cumbersome
and see what would happen."
29.Thus the early 19th centUlY medical au­
and very expensive, those inside were subject to
the "bends" on decompression.
By the middle of the 20th century, ether
and cycloproprane were widely used. How­
generated a great deal of interest and specu­
thorities of both the United Kingdom and
ever, they were both explosive. The electro­
lation in the West.Several studies were un­
France may be held liable for delaying dis­
cautery had been introduced to coagulate
vessels. The danger to patients and practi­
state-more reliably induced than by hypno­
tioners was not inconsiderable.
sis-was appealing to many patients and
Defeated Hickman returned to Shifnal.
He died prematurely on April 5, 1830, age
covery of surgical anesthesia and advancing
surgery for some 20 years.
anesthesia in over a half-million patients.De­
less than 1%.
In 197 1, New
York Times reporters James
Reston and Seymor and Audrey ToppinlS vis­
ited China and witnessed surgelY performed
under acupuncture anesthesia. Their stories
dertaken as the idea of a drug-free anesthetic
Rather, other techniques to relieve opera­
Woodbridge in the United States gave an
tive pain were described. In 1846, Dr. J.F.
Malgaigne of the Faculte de Medicine in
explosion rate of 2-4 per 100,000 anesthetics.
failed attempts, it was apparent that acupunc­
Pinson, in 1930, stated that about 100 cases
of burns due to ether fires or explosions oc­
ture was ineffective for surgical purposes,
Paris, wrote a Manual of Operative SurgelY. A
chapter on means to diminish pain includes
the use of narcotics, mesmerism, cutting the
physicians. By the early 1980s, after many
certainly in Western Countries.
curred annually in Great Britain. However,
Anesthesia continues to develop in fits and
the incidence was undoubtedly much higher
as, unless a patient or staff were killed or
starts. Alleviation of pain and hence the abil­
ity to perform more and increasingly com­
badly burned, a report was probably not
made. (Similar to under reporting.) Before
plex surgical procedures has not taken a
straight path. However, the safety of our drugs
the use of conductive rubber materials, static
electricity was considered most dangerous, es­
today, the reliability of our delivery and moni­
and render the incised area anesthetic.
Inhalation Anesthesia after 1846
pecially during cyclopropane anesthesia.
Ether at 4% concentration required a 45 times
nerve supply to the area or excessive venesec­
tion.Malgaigne also relied on James Moore's
experiments using a Dupuyten compressor
to exert sufficient pressure to damage a nerve
The introduction of inhalation anesthe­
sia in 1846 did not automatically make sur­
greater spark of energy to ignite than did cy­
clopropane.
gery safe and reliable. Indeed the number of
To provide a "non-explosive" ether, espe­
surgical deaths rose sharply in the 19th cen­
cially during neurosurgical procedures when
tury for several reasons. Procedures were at­
surgeons demanded that spontaneous respi­
ratory patterns be monitored, Van Poznak and
tempted on patients who would have other­
wise died; potent agents were given without
any ability to control dosages; hypoxic mix­
tures were the rule; training in anesthetics
was almost nonexistent; muscles were often
cut hampering recovery, and the germ theory
was not widely accepted. Over one-third of
Artusio developed methoxyflurane.However,
this inhalation agent was metabolized up to
50%, caused renal damage and was extremely
long acting.These two anesthesiologists then
introduced teflurane-a non-explosive cyclo­
propane (i.e., very rapid action). Teflurane
toring systems, the level of our training gives
credence to the statement: "If the patient can
withstand the surgical procedure, he can do
so more safely under anesthesia."
Further Reading
1. The Edwin Smith Papyrus. in Breated GH
(trans ed.): University of C hicago Institute Pub.,
Chicago, University of Chicago Press, 1930.
2. Paul of Aegina. The Seven Books of Paulos
Aeginata (3 volumes). Adam F (trans.): London,
Sydenham Society, 1844.
3. Raper HR. Man against Pain. New York,
Pren tice Hall, 1945.
4. Erichsen E. Science and Art of Surgery.
Philadelphia, Henry C. Lea, 1869.
Continued 011 Page 8
6
BULLETIN OF ANESTHESIA HISTORY
Henry Knowles Beecher and The Redefinition of Death
by Vincent J. Kopp, MD
Assistant Professor of Anesthesiology and Pediatrics, Adjunct Assistant P rofessor of Social Medicine
Department of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, N C
Presented a t the Anesthesia HistOlY Association 5th Annual Spring Meeting
Williamsburg, Virginia-April 3, 1997
Research for this paper 'Was supported in part by a 1995 Paul M. Wood Fello'Wship A'Ward
On September 29, 1967, Henry Knowles
Beecher, M.D., Dorr Professor of Research
Unconscious Patient, " delivered at Mount
in Anaesthesia, Harvard, sent a series of iden­
ture undoubtedly under preparation at the
time he called his standing committee to­
tical letters.I quote:
This letter will confirm my secretaty's
telephone call to say that I am calling a
meeting of the Standing Committee on
Human Studies, to take place at 3:00 P.M.
on Thursday, October 19, 1967, in the
Ware Room of Countway Library (5th
floor).
Sinai Hospital on December 6, 1967-a lec­
gether-Beecher stated his case, quoting Brit­
ETHICAL PROBLEMS CREATED
BY THE HOPELESSLY UNCON­
SCIOUS INDIVIDUAL.
With this letter Dr.Beecher set in motion
the events that would culminate in the re­
definition of death, thus altering the course
of medical progress, and forever changing the
way we view ourselves as human beings.
Beecher's stOlY is well known. It will not
be reviewed here. It is fair to ask, however:
What motivated him?
Those who knew Dr. Beecher character­
ize him as a complex man with an undying
faith in science (Raymond D.Adams), a semi­
nal thinker (Leroy D.Vandam), with an in­
nate sense of ethics (Richard Wolfe), and a
man who relished a good fight (Elliot V.
Miller).
In His Januaty 9, 1948, Lowell Lecture
titled "On the Relief of Suffering Within the
Hospital, " Beecher enunciated what could be
considered his life-long professional creed:
. . .within the hospital we have one
world and its riches belong to man­
kind: There is no such thing as Chi­
nese opium or American anesthesia
or British penicillin. Since Adam,
suffering is universal, universal too,
are measures for its relief.
Beecher, January 9, 1948
Beecher's commitment to the relief of suf­
fering and the logical extension of his con­
cern for the rights of patients motivated him
to advocate a redefinition of death. In the
Fifth Bernard Eliasberg Memorial Lecture
titled "The Right to Be Let Alone; The Right
to Die: Problems Created by the Hopelessly
desirable for a group at Harvard
ish poet Arthur Hugh Clough's "The Latest
University to come to some subtle
conclusion as to a new definition of
Decalogue " ( a line I suspect Beecher mis­
took in its irony):
body and I think we have an oppor­
"Thou shalt not kill; but need's not
strive
Officiously to keep alive."
The subject for discussion will be
tion.
I cannot tell you how strongly I
agree with you that it would be most
Before calling his meeting, Dr. Beecher
death.This must be done by some­
tunity here for true leadership of a
most constructive sort. . .
On October 27, 1967, in reply to Beecher
and copied to Ebert, Dr. Murray wrote:
sought permission from then Dean of Har­
vard Medical School, Robert H. Ebert, M.D.
Thank you for your letter of Oc­
tober 20, 1967, about the recent meet­
Quoting Dr.Beecher's letter to Dr. Ebert,
ing of the Committee on Human
dated September 6, 1967:
Studies. The subject has been thor­
oughly worked over in the past sev­
As I am sure you are aware, the de­
velopments in resuscitative and sup­
portive therapy have led to many
desperate efforts to save the dying
patient. Sometimes all that is rescued
is a decerebrated individual. These
individuals are increasing in num­
ber over the land and there are a
number of problems which should be
faced up to. I am sure that my pre­
sentation will evoke a good deal of
discussion which should be fruitful
and useful for the School staff. . .
In his reply granting Beecher permission,
Dr. Ebert stated that he found the proposed
topic "intriguing " and would make every ef­
fort to attend the meeting himself.The meet­
ing was held as scheduled. Although the
record is not entirely clear, approximately 30
people attended, among them members of the
Harvard Human Studies Committee, repre­
sentatives from affiliated institutions and
departments from outside the medical school.
Following the meeting, Beecher wrote one
of the attendees, Dr.Joseph Murray, a sur­
geon from Peter Bent Brigham Hospital, on
October 20, 1967:
I write this little note to say how
much I appreciated your coming to
the meeting yesterday. I thought one
of the few really positive products of
the meeting was y o u r c o n t r i b u -
eral years, and by now two areas for
action are crystallized into two catego­
ries.First is the dying patient, and sec­
ond, distinct and unrelated, is the need
for organs for transplantation.
The first problem requires merely
a definition of death. No longer is
cessation of heart beat or respiration
applicable, as you pointed out.Brain
death is the essential requirement,
and the faculty of the Harvard Medi­
cal School is in a suitable position to
make a statement about this medi­
cal definition of death.This will re­
quire the opinions of the neurolo­
gists, neuro' s urgeons, anesthetists,
general surgeons and physicians who
deal with terminal patients. W hen to
declare death is a problem to be
solved whether or not organ trans­
plantation follows.
The second question regarding
organs for donation is really simple.
Once the patient is dead, the legal
mechanism then applies, Professor
William Curran has obtained the
necessary legal help in Massachu­
setts, and all that is now required is
proper permission from either the
patient or next of kin. . .
In his letter dated October 30, 1967, re­
porting the meeting's results to Ebert,
BULLETIN OF ANESTHESIA H ISTORY
Beecher regretted Ebert's absence and stated:
I reported the basic material on
ETHICAL PROBLEMS CREATED
BY THE HOPELESSLY UNCON­
SCIOUS MAN in as neutral a way as
possible, not because I felt neutral; on the
copied to Beecher and is found in Beecher's
personal papers, Ebert wrote:
D r. B e e ch e r ' s p r e s e n t a t i o n
re-emphasized to m e t h e necessity o f
giving further consideration to the
contrary, I have very strong feelings about
definition of brain death. As you are
well aware, many of the ethical prob­
the issues raised.
lems associated with transplantation
Beecher continued, revealing some of
these strong feelings, saying:
You have a copy of the letter from Dr.
and other developing areas of medi­
cine hinge on appropriate definition.
W ith its pioneering interest in
organ transplantation, I believe the
Joseph Murray which summarizes
f a c u l ty of the H a r v a r d M e d i c a l
the issues I presented nicely. Both
Dr.Murray and I think the time has
come for further consideration of the
date this area than any other single
definition of brain death.The ethi­
cal problems hinge on such defini­
tion. Failure to act could be more
radical than action in this area. Ev­
ery major h o s pi t a l h a s p a t i e n t s
stacked up waiting f o r suitable do­
nor kidneys. If any group is compe­
tent to make a statement concerning
brain death as death indeed, I believe
the faculty of the Harvard Medical
School is better equipped to do this
than any other single group.
After receiving Beecher's letter, Ebert
wrote to him on November 3, 1967:
After reading your letter and that of
Dr. Joseph Murray, I would agree
that the time has come for better defi­
nition of brain death.I would think that
a subcommittee of the Standing Com­
mittee on Human Studies might put to­
gether an appropriate statement.
Ebert went on to suggest inclusion of Dr.
William Curran, Visiting Professor of Health
Law, and representatives from a number of
fields, including "someone from the Divin­
ity School."
On November 13, 1967, Beecher thanked
Dean Ebert for requesting "a Subcommittee
of the Standing Committee on Human Stud­
ies . . . to get together in order to make an
'appropriate statement' defining brain death."
In this letter Beecher submitted a list of names­
including Ebert's-of individuals with whom
Beecher had discussed the exploration of the
issue in a committee format.
In the letters that followed, the list of par­
ticipants was lengthened to allow broader
representation from outside of Massachusetts
General Hospital.
By January 4, 1968, Ebert informed
Beecher that he had sent letters to selected
committee members, but declined to be a
member himself. He appointed Beecher
chairman of the committee. In his letter to
Dr. Joseph Murray, which was presumably
School i s better equipped t o eluci­
group. To this end I ask you to ac­
cept appointment to an ad hoc com­
mittee . . .
The letter went on to list the suggested
committee members, all of whom appear as
authors of the published report with the ad­
dition of Drs. Potter and Schwab.
On January 9, 1968, Beecher thanked
Ebert for "making official the Committee to
deal with the problem of brain death." Both­
ered by what to call the committee, Beecher
wrote:
ing separate telephone interviews on Febru­
ary 11, 1997, with Dr.Raymond Adams and
Dr. Joseph Murray, two of the velY few living
members of the ad hoc committee, the com­
mittee either "never met" but existed in the
form of Beecher serving as a go-between
among members (Adams' recollection); or it
met three or four times with Beecher keep­
ing minutes and providing follow-up to com­
mittee members after meetings (Murray's
recollection). A preliminary review of
Beecher's papers indicates no clear contra­
dictory or corroborative evidence of either
committee member's recollections.
Clearly, much attention was focused on
the committee's work. Unspecified outside
influences were being exerted on the com­
mittee to shape its direction and timetable.
In a letter to Dean Ebert on March 28, 1968,
Beecher wrote:
I am being pressed on several sides
to speed along the action of the ad
hoc Committee on Brain Death.
These pressures are helpful, and I
have taken all into consideration, but
I think it would be nothing short of
disastrous for us to rush consider­
ations simply because other groups
I am not sure what the title of the
may be plowing the same field. The
group should be. I suggest the fol­
lowing: the ad hoc Committee to
delicate and could be so easily mis­
Study the Problems of the Hopelessly
Unconscious Patient. I am reluctant
to use a more flamboyant title . . .
In the same letter Beecher expressed re­
gret that "no theologian appears on the Com­
mittee. You had once spoken of the need for
this and I heartily agreed." Dean Ebert took
Beecher's concern to heart.On February 2,1968,
Ebert wrote to Dr.Curran stating that the:
. . .ad hoc committee on brain death
seems to have become quite popular.
In the past several weeks I have had
many direct, and indirect, requests
from faculty members who would
like to join the committee.I think to
avoid a real stampede we had best
not add any more faculty to it. . .
He stated, however, that Beecher's sugges­
tion about adding someone from the Divin­
ity School was "a good idea". Ebert invited
Professor Ralph Potter of the Divinity School
to join the ad hoc committee in a separate let­
ter also dated February 2, 1968. The text and
list of members in Ebert's letter to Potter was
otherwise identical to the letters sent to other
committee members. The ij.ame of Robert
Schwab, however, was handwritten into the
list on the copy of the letter found in Dr.
Beecher's personal papers.
According to information provided dur-
matters under consideration are so
understood, I think we shall have to
move like the Supreme Court, with
all deliberate speed-but not faster!
By April 26, 1968, an early draft of the
committee's recommendations was circulated
to members. Extensive revisions were made.
Drafts located among Dr. Beecher's papers
at The Countway LibralY are dated April 26,
1968; June 3, 1968, and June 13, 1968. In his
cover letter dated June 13, 1968, to "the Mem­
bers of the ad hoc Committee to Examine the
Definition of Brain Death", Beecher referred to
this draft, entitled ''A Definition of Irreversible
Coma," as "the fifth draft of our report."
Beecher's tone is resolute:
Here is the fifth draft of our report.
Everybody has had several opportu­
nities to see the materials as it has
developed. It seems to me that no
future changes can be accepted un­
less some major oversight is present.
Dr.Adams' copy of the June 13 draft is
among Beecher's papers.A handwritten note
to Dr. Beecher at the bottom of the cover let­
ter which accompanied Dr. Adams' correc­
tions reads:
Dear Henry
This s e e m s a l r i g h t as it n o w
Continued o n Next Page
BULLETIN OF ANESTHESIA HISTORY
Beecher.
dure. Nevertheless, the total impact
definition. Beecher actively advocated for its
stands. I object to using the need of
of the whole statement has been
weakened. Would it not be better to
use on a number of legal and social fronts as
well.Tracking events after the report's pub­
lication is a subject for another time.
. . COlltillued from Page 7
donor organs as a valid argument for
state the problem, and indicate that
redefining cerebral death. This is
obsolete criteria for the definition of
It is important to note, howevel; that the
another problem though one which
death can lead to controversy in ob­
issue of brain death is not settled in everyone's
taining organs for transplantation?
mind. Robert D.Truog's recent article in the
Hastings Center Report, January-February,
1997 ( Hastings Center Report 27: 1, 29-37,
is influenced by our definition. I have
tried to present unreceptivity and
unresponsivity as the leading clinical cri­
terion-with respir arrest & areflxia.
On June 25, 1968 Beecher submitted the
committee's report to Dean Ebert, calling it
the "sixth draft. "
Addressing the issue of promulgating the
report, Beecher wrote:
From our corridor conversation last
week I assume that I may send this
on for publication. I have discussed
the matter with John Talbott and he
has seen a earlier draft of the mate­
rial. He says that he would like to
have it and publish it in three weeks
in the "Journal of the American
Medical Association. "
Dean Ebert responded to Beecher on July
1,1968.He thanked the ad hoc committee and
commended it saying:
It is an excellent report and may well
be an historic document for the pre­
cise definition of death. By all means,
have it published.
Ebert went on, however, to raise one spe­
cific issue-th e linkage between the
committee's definition and a statement about
the need for donor organs for transplanta­
tion.Quoting Ebert's letter:
I have only one issue to raise, but I
think it of some importance.I would
urge the re-wording of the item 2 on
page 1. At present it reads as follows:
'An issue of secondary but by no
means minor importance is that with
increased experience and knowledge
and development in transplantation,
there is grea t need for the tissues and
organs of, among others, the patient
whose cerebrum has been hopelessly
destroyed in order to restore those
who are salvageable.' The connota­
tion of this statement is unfortunate,
for it suggests that you wish to rede­
fine death in order to make viable
organs more readily available to per­
sons requiring transplants. Immedi­
ately the reader thinks how this prin­
ciple might be abused.Later, on page
8, this suspicion is allayed by the
suggestion that the physician pro­
nouncing death should not be in­
volved in the transplantation proce-
Dean Ebert concluded his letter granting
Beecher permission to re-word this statement
as he saw fit, but to expand it so as to prevent
misinterpretation. Aware of the import of
Beecher's work, he wrote, "Since this docu­
ment is likely to be widely quoted in the future,
I should like to send a copy to President Pusey.
As soon as I have heard from you about item 2,
I will send him a copy of the document. "
On July 3, 1968, Beecher wrote Ebert ac­
knowledging the requested changes, sending
along two copies of the seventh and final
draft, one for Dean Ebert and one for Presi­
dent Pusey.On July 15, 1968 Ebert, acknowl­
edged receipt of the report and his satisfac­
tion with Beecher's changes.Ebert stated that
he had sent one copy to Mr.Pusey " . . . for
his information."
On August 5, 1968, ''A Definition of Irre­
versible Coma: Report of the Ad Hoc Com­
mittee of the Harvard Medical School to Ex­
amine the Definition of Brain Death," was
published as a Special Communication in
JAMA, Vol.205, No.6. It had no lead author.
The title page footnote reads:
1997) is an example. He asks the question in
his title: "Is It Time to Abandon Brain
Death? " In brief, he answers the question,
"Yes." Truog and others are troubled by in­
consistencies in how brain death is diagnosed
and clinically applied. ln arguing for its aban­
donment he advocates that its discontinua­
tion be coupled with the creation of new forms
of legalized medical killing. Predicated on the
principle of nonmaleficence toward the brain
dead patient and on the principle of respect
for freely given consent by the potential or­
gan donor patient, Truog makes a case that
would abandon brain death in favor of car­
diorespiratory death. In doing so, any ques­
tions about what true death is are avoided. It
then becomes the new category of legalized
medical killing that will challenge the ethics of
present and future generations of physicians.
If only Beecher were around to give us his
thoughts on the subject, I'm sure he would
have a few words to say and I'm sure they
would be provocative.
The Ad Hoc Committee includes
Henry K. Beecher, MD, chairman;
R a y mo n d D. A d a m s , M D ; A.
Clifford Barger, M D ; W illiam J.
Curran, LLM, SMHyg;
Derek
D e nn y - B r o w n , M D ; D a n a L .
Farnsworth, M D ; Jordi Fo lch-Pi,
MD; Everett I.Mendelsohn, PhD; John
P. Merrill, MD; Joseph Murray, MD;
Ralph Potter, ThD; Robert Schwab,MD;
and William Sweet, MD.
Reprint requests to Massachu­
setts General Hospital, Boston 02114
(Dr.Henry K. Beecher).
The content of this report is well known
and will not be reviewed here. Perhaps the
most curious characteristic of the report is
its single reference: Pius XII: The Prolonga­
tion of Life, TIle Pope Speaks 4:393-398 ( No.
4), 1958. The article references the papal
statement,concluding that "It is the church's
view that a time comes when resuscitative
efforts should stop and death be unopposed."
No other comment of a religious or social
nature was made.
After the report was published, there was
debate about brain death as death indeed
became robust and widespread. Within the
year the American Heart Association's ad hoc
Committee on Ethics accepted the Harvard
Missed
Opportunities.
. . Contilluedfrom Page 5
5. C artwright FF. The English Pioneers of
Ane sthesia (Beddoes, D avy, Hickm an) . J o hn
Wright and Sons, Bristol, 1 952.
6. D avy H. Researches, Chemical and Philo­
sophical chi efly concerning Nitrous Oxide or
dephlogisticated nitrous air and its respiration.
London, printed for J Johnson by Biggs and Cottle,
Brstol, 1 800. Printed in Great Britain in Facsimile
by Butterworth & Co., 1972.
7. Snow J. On chloroform and other Anesthet­
ics. John Churchill, London, 1 858.
8 . Robinson V. Victory over Pain. Henry
Schuman, New York, 1 946.
9 . Ful o p - M i l l e r R . Triumph over Pain.
Bobbs-Merrill Co., Indianapolis, 1938.
1 0. Keys TE. The History of Surgical Anesthe­
sia. Henry Schuman, New York, 1945.
1 1 . Bert P. Sur la possibilite d'obtenir, a l'aide
du protexyde d'azole, une mis-ensibilite de long
duree et sur l'innocuite de cet anesthesique. Compt.
Rend. Acad. d. sc. 87:728-730, 1 8 7 8 .
12. Courville CB. Untoward Effects of Nitrous
Oxide Anesthesia. Pacific Press Pub. Assoc., Moun­
tain View, California, 1 939.
13. Keating V. Anesthetic Accidents. The Year
Book Publishers, One. Chicago, 1956.
1 4. Robbins EH. Cyclopropane Anesthesia.
The Williams & Wilkins Co., Baltimore, 1940.
1 5. Acupuncture Anesthesia Monograph, pre­
sented by Roerig from the fil m "Acupuncture
Anesthesia, " produced by the Shanghai Film Stu­
dio, The People's Republic of China.
16. Frost E, Hsu CY, Sadowsky D . Acupunc­
ture therapy, comparative values in acute and
chronic pain. NY State J Med 76(5):695-7, 1976.
BULLETIN OF ANESTHESIA HISTORY
9
Anesthetic Lessons from Gettysburg and the Civil War
by Gmy E. Shanks, J.D., M.D., Penn State University, Department of Anesthesiology
The Milton S. Hershey Medical Centel; Hershey, Pennsylvania
EntlY for Anesthesia HistOlY Association Residents' Essay Contest, 1996
The Battle of Gettysburg in Southern Penn­
engagements. Participating in the war was an
sylvania is remembered as one of the bloodiest
battles in history. Immediate deaths from the
estimated 2,800,000 Union troops and 750,000
battle and subsequent casualties from battle
self occurred from July 1-3, 1863, although the
injuries tested the medical knowledge of treat­
treatment of casualties continued for months
ment consisted of ether or chloroform, opium,
morphine, Dover's powdet; quinine, syrups,
ing physicians in the pre-antibiotic era.The use
of anesthetics was in its infancy at the time of
after the battle.
William Thomas Green Morton, a pioneer
proven so valuable in the medical and surgical
the Civil Wm; with the first administration of
militaty physician and anesthetist, had previ­
an ether anesthetic having occurred only 15
ously shown the value of anesthesia in the treat­
years earlier at the Massachusetts General Hos­
ment of wounded at the Battle of Fredericksburg
pital (October 16, 1846).Throughout the wm; a
great deal of knowledge and experience on the
use of anesthetics and their role in promoting
Confederate troops.The battle of Gettysburg it­
on December 13, 1862.3 While there is no evi­
dence that Morton was involved at Gettysburg,
it is likely that lessons he previously learned were
the surgical care of the wounded was acquired.
passed on and employed at the .battle.Morton's
This experience likely hastened the civilian
use of anesthetics for surgical procedures in the
most intimate involvement as a militaty physi­
postwar years.Considering the limited knowl­
at the Battle of the Wilderness in May, 1864. In
his work during the Battle of the Wilderness, it
edge of anesthetics and the lackof patient moni­
toring other than observation and pulse, the
cian was best documented during his presence
is estimated that he delivered in the range of
safety record of the Civil War surgeon and anes­
2,000 ether anesthetics to wounded soldiers. It
thetist is even more impressive. Experience
was also noteworthy that Dr.Morton wrote that
gained by the administration of anesthetics in
he "prepared patients for the knife, producing
the Civil War may have helped hasten the ac­
perfect anesthesia in an average time of 3 min­
ceptance of anesthetics as an essential part of
utes."3
quality surgical care.
The nature of the fighting and the weapons
used, with the resultant injuries, made challeng­
As we celebrate the sesquicentennial year of
anesthesia, we recall how the Civil War provided
ing work for the physicians.Early battles in the
an early opportunity to test anesthesia in the
war exposed glaring deficiencies in the Union's
treatment of a variety of war wounds. Prior to
medical preparedness.Shortages of ambulances,
the Civil Wat; there was limited knowledge of
supplies and trained physicians became appar­
anesthetics in the treatment of the wounded.
ent early in the war during the Peninsular Cam­
Ether had been used for surgical procedures
since 1846 and chloroform since 1947, but sig­
paign in Virginia. By the time the Armies en­
nificant experience with either agent was lim­
medical director of the Army of the Potomac,
ited to a few physicians.I•2 The Army had used
had refined the triage, field hospital and ambu­
ether in Vera Cruz in 1847, but discontinued
the use as too dangerous.2 The British Army had
lance system.At Gettysburg,Dr.Letterman com­
gaged at Gettysburg, Dr. Jonathan Letterman,
manded 650 medical officers, 1000 ambulances
favorable results with chloroform during the
Crimean wm; however the British Surgeon Gen­
eral believed it to be dangerous in serious cases.2
and approximately 3,000 ambulance drivers and
Despite this military knowledge on the use and
had been battle tested and had assumed a stan­
benefit of anesthetics, routine use of anesthet­
dard plan for the care and treatment of the
ics in this countly was still met with controversy
among surgeons at the initiation of the Civil
responsibility only for wounds to soldiers in their
War, as some believed anesthetics would worsen
shock, increase hemorrhage, and delay wound
healing.2
stretchermen.2
By Gettysburg, the Union medical system
wounded.The idea of a regimental surgeon with
regiment had been abandoned, and medical care
was provided by a divisional field hospital sys­
tem.4 A normal infantry division's hospital staff
This paper focuses on the experience gained
with anesthetic use in the Civil Wm; with em­
phasis on the Battle of Gettysburg and the Union
included
the
surgeon
in
charge,
one
assistant-surgeon designated as recorder and one
assistant-surgeon to provide food and shelter.
forces.The focus on the Union Army is prima­
Three medical officers were assigned to perform
rily due to more readily available information,
as many Confederate records have perished.The
and other ancillaty staff.I,4-5 Dr. Letterman had
relevant period is from April 12, 186l, through
May 26,1865. In this period, there were approxi­
"operating surgeons" only those he considered
mately 10,000 battles, skirmishes and smaller
as capable. To each operating surgeon, he as-
surgical operations, besides stewards and nurses
improved the system greatly by designating as
signed two assistants and an anesthetist.2 Be­
sides operating instruments, standard equip­
wine and whiskeys. This arrangement had
care of the wounded that, in September of l 864,
the Medical Director of the Army of the Potomac
set out written duties of the medical team.6 Spe­
cific duties included recording the names of the
wounded, the type of injUly and cause, the treat­
ment of injuries and possible surgical care.If
surgery was required, the operating surgeon was
to judge the "practicability of administering an­
esthetics, and if their use is found necessary
should superintend the administration."6 At
least initially, many of the anesthetics were ad­
ministered by hospital stewards, with much of
the initial learning via trial-and-error.1
The battle at Gettysburg was, in some ways,
a chance meeting. General Lee had been ad­
vancing his Army of Northern Virginia into
Pennsylvania.Major General George G.Meade
had only been given command of the Army of
the Potomac on June 28, 1863, three days be­
fore the minor skirmishes of the battle started.
At this time, the Army of Northern Virginia had
already taken Carlisle, Pennsylvania, and Gen­
eral Ewell's corps was preparing to attack Har­
risburg when he was summoned back to
Gettysburg on June 29. Speculation persisted
that General Lee wished to conquer Harrisburg,
Pennsylvania, as it provided a potential source
of military supplies, would allow for interrup­
tion of the crucial East-West rail supply lines,
and provide a psychological edge for the Con­
federate forces.This marked the Northernmost
penetration of the Confederate forces.The fear
was that, if the Confederate forces continued,
they could then move Southeast toward Phila­
delphia, Baltimore and perhaps Washington,
D.C.
The Battle at Gettysburg involved approxi­
mately 85-88,000 Union forces and 70-75,000
Confederate forces.During the battle it is esti­
mated that there were 3,155 Union deaths and
3,903 Confederate deaths. Adding in the sig­
nificant additional losses from mortal wounds
and missing soldiers gives one total losses of
23,049 Union soldiers and 28,063 Confederate
soldiers from this one battle.To place the casu­
alties in perspective, total casualties in the Civil
War were estimated at 94,000 Confederate and
110,070 Union soldiers killed or mortally
Continued 011 Next Page
10
BULLETIN O F ANESTHESIA HISTORY
Gettysburg.
.
. Continued /rom Page 9
wounded in battle. An additional 249,458 Union
and 150,000 Confederate soldiers were felt to
have died of subsequent disease following inju­
ries.
At least one significant Union leader under­
junction with surgely. Of this number, 6,784
noted adverse events, but were less common with
(76.2%) involved chloroform. Ether was the
chloroform than with an ether anesthetic. The
primary agent in 1 ,305 (14.7%) and a mixture
of ether and chloroform was used in 8 1 1 cases
(9.1 %). Despite lack of monitoring as we know
it, only 43 deaths of the 8,900 cases were re­
records also show that anesthetic overdoses
where treated via the "Marshall Hall Ever Ready
Method of Artificial Breathing. " This consisted
of placing the apneic patient in the prone posi­
tion and rolling him side to side 1 6 times per
General Daniel E. Sicldes, Commander of the
ported. In deaths per thousand, the rate was 5.4
for chloroform vs. 3.0 for ether, yet chloroform
was the preferred agent, especially by surgeons
U.S. Third Corps at Gettysburg, was wounded
in the field hospitals. In cases of combined ether/
in the leg during battle onJuly 2nd. Several wit­
chloroform anesthetics, a death rate of2.4 deaths
Ether was associated with unique risks, one
of which was its use for evening surgery in the
nesses have given accounts of his surgery.Most
per thousand was noted.
went surgery with an anesthetic at Gettysburg.
accounts show that he received chloroform for
According to records reviewed in
minute, applying pressure to the back with each
pass through the prone position.1
presence of candles, lanterns and torches. Ether
was also a vasodilator, perhaps with a greater
this surgery, but the exact location of the opera­
The Medi­
cal al/d Surgical HistOlY of the Rebellion, chloro­
tion remains in some dispute.5 At least one ac­
form was valued by field surgeons for its rapid­
induction was notably slower with ether due to
count by Joseph H. Hopkins, Chaplain of the
7lst New York Infantry, indicated that he ad­
ity and speed of onset, qualities that made it
its higher volubility in fat, it remained the pre­
ferred agent by some for its greater safety mar­
ministered the chloroform anesthetic to Gen­
eral Sicldes.5 If correct, this would confirm a
belief of many, namely, that administration of
anesthetics is part of a higher calling.
The weapons used in the Civil War provided
ample opportunity for surgeons to ply their
trade. The minie ball, a soft .58 caliber bullet
uniquely suited for mass surgelY following a
battle. The average time to insensibility was
chance for worsening hemorrhage.2 Although
gin when time and location permitted.Thus its
listed as nine minutes vs. sixteen minutes for
an ether anesthetic.Its use was common by sur­
geons of both armies, but adequate supplies of
use was primarily in the general, rather than
field hospitals. It was favored for the ability to
the agent were more difficult to obtain in the
South. Faced with scarce quantity of the valu­
a greater degree of muscle relaxation than seen
maintain a lighter plane of anesthetic depth and
with chloroform.2
Specific case records concerning presumed
fired from a rifled musket, would deform and
able agent, Southern surgeon J,J. Chisolm de­
veloped a chloroform inhaler for use in the field.
tumble on impact. For the period, the minie ball
This consisted of a metal cylinder with a wire to
had a high velocity of 950 feet per second, and
elevate a cloth or a sponge and two tubes to place
in the patient's nostrils.A few drops of chloro­
An illustrative case concerning death from chlo­
produced a shattering and splintering effect on
long bones? Bullets such as the minie ball caused
form could be placed on a folded cotton cloth or
the largest percentage of injuries; of the 144,000
sponge and the mixture inhaled through the
patient's nostrils.l.6
sidering the circumstances during which the
death must have occurred.
cases where the type of missile could be ascer­
The means of administration of chloroform
anesthetic complications and possible causes
were reproduced in the HistOlY of the Rebellion.
roform shows surprising attention to detail con­
CASE 1 236 involved Private G. Budlinger,
76th Ohio, age 30, admitted into the hospital of
tained, the minie ball caused 108,000 wounds.
Cannon balls, conversely, only caused 359 rec­
were varied. Most references suggest that ad­
the 1st division, Fifteenth Corps with a shot
ognized wounds.2
ministration was by dripping the agent onto a
hand.The case report continues as follows:
The injuries were extremely varied, but in­
juries to extremities allowed the practice of
amputations to become relatively commonplace.
Anesthesia was routinely supplied, and was
likely the rule, not the exception, in these cases.
A wounded soldier undergoing surgely with­
cone-shaped cloth held over the patient's nose
and mouth. Other methods included the use of
a cow's horn stuffed with cotton.5 As previously
mentioned, some Confederate physicians used
the "Chisolm inhaler " to minimize waste.1 The
risk of the former methods was that it allowed
out some form of anesthesia was most often due
the chloroform to directly contact the patient's
to exhaustion of supplies.Beyond intraopera­
often provided by opium administration, either
skin, which was associated with tissue burns. It
was recognized by some that the chief danger in
the use ofchloroform may have been from ad­
by dusting into the wound or by pill form.To­
ministration of a hypoxic mixture.Another pos­
ward the end of the war, administration of mor­
phine by hypodermic injection was being prac­
sible complication of chloroform was that it is
unstable in light, forming phosgene which was
ticed by some.
later used as a poison gas in World War I. It is
The Civil War did provide some early ex­
amples of surgical record keeping, includingthe
possible that some of the mortality with chloro­
form may have been due to inadvertent admin­
administration of different anesthetics.For the
istration of phosgene. 1 It is now well known that
record of the Union army, these histories were
any administration of chloroform may cause
liver damage. Delayed liver failure may have
tive anesthesia, postoperative pain control was
summarized in the multi-volume work,
The
Medical al/d Surgical HistOlY ofthe Wur ofthe Re­
bellion.6 Accurate records of the medical activi­
ties of the Confederacy were not well preserved,
so the best example of the practice during the
war comes from Union records, but it is safe to
assume that the practice of medicine was simi­
lar for the Confederate forces.
The exact number of anesthetics adminis­
tered is estimated to be in the vicinity of 80,000.
Of this number, more in-depth records exist for
8,900 cases of anesthetic administration in con-
been another unrecognized complication of
chloroform administration.Besides using chlo­
roform as an anesthetic, it appears that some
surgeons used the drug as a reversal agent,
splashing it on the scrotum to help speed awak­
He was placed upon operation table
and about a drachm of chloroform
sprinkled upon four folds of patent lint
applied to face, space being given for
the free admission of air. After breath­
ing it for a few moments quietly with­
out any apparent effect, more chloro­
form was added and reapplied by a
nurse in attendance (the surgeon hav­
ing stepped aside for a moment), when,
after six or seven respirations, the pa­
tient drew up his legs and arms con­
vulsively, and heavy stertorous breath­
ing came on. Chloroform removed
immediately, and a few moments given
him to resume his regular breathing,
but the difficulty increased; frothy exu­
dation from mouth not caused by ex­
cess of saliva; respiration became more
and more incomplete, pulse small and
imperceptible, veins of neck and face
prominently distended; heart action
ceased before respiration had entirely
stopped. Friction to extremities, cold
ening.s
The most common adverse event from chlo­
water dashed in face, jugular vein
roform administration was noted to be "pros­
tration, " which occurred in 13.3% of the cases,
relief.The surgeons of the hospital re­
slightly greater than that noted with ether
( 1 1 .1 %). Vomiting and excitement were also
opened, artificial respiration, without
ported, as the result of an autopsy, that
'being unable to discover any other
BULLETIN OF ANESTHESIA H ISTORY
abnormal condition, and in the ab­
sence of further evidence, it may be
proper to conclude that this is a case
of apoplexy induced by chloroform.'6
While most records indiCate that the administration of some form of anesthesia was the
norm for surgelY, it is also known that it was not
uncommon for a soldier to refuse anesthesia and
consciously endure the pain of amputation.The
case of Private Richard Phillips of the 44th New
York illustrates a case where refusal of anesthetic
was beneficial.The soldier was wounded at Little
Round Top and was being prepared for the am­
putation of his arm.When asked if he wished to
receive chloroform, he answered "not till I knew
how bad it was." The surgeon took the knife
and cut the ball, which was just under the skin,
I I
Letter to the Editor
Editor:
Two more important factors remain to be
Dr.Bias should be congratulated for his
pointed out in the historical perspective of
efforts to write an essay on the early history
of epidural anesthesia,! a kind of romantic
1943 wrote of his experiences with an inflat­
"Extradural Anesthesia'" E. de Souzal2 in
era full of amazing achievements by adven­
turous pioneers.At the risk that his collec­
able balloon attached to the hub of the epi­
tion of data may be turned into factual his­
tory, I would like to point out some other
before McIntoshll described a similar device.
events that were either omitted or mistakenly
De Souza. Last, but by no means least, we
dural needle; this was reported seven years
Nevertheless, little credit has been given to
quoted.In reviewing the chronology, it seems
need to clarify the first introduction of a flex­
that these events are mostly limited to publi­
cations in the English language. Such a re­
ible catheter into the lumbar epidural space.
view of historical events of any technique used
Though Adam, Lundy and Seldon!4 inserted
a ureteral catheter into the caudal hiatus, it
widely throughout the world needs to include
was in fact Miguel Martinez-Curbelo in La
a more global perusal of the literature.I can
only add events occurring in Latin America
Habana, Cuba, who first inserted it into the
There is a similar case of a confederate soldier
refusing chloroform for a limb amputation stat­
and Europe with which I am familiar, and do
invited by Lundy to the Mayo Clinic, where
ing, "Cut off the leg Doc, but leave off the chlo­
not pretend that this is by any means the last
he demonstrated the technique resulting in
word.
Although Sicard and Forestier2 should be
considered the pioneers in demonstrating the
his paper published inAllesthesia and Analge­
sia in 1949,15
This addendum is presented with the
radiographic access to the extradural space
purpose of complementing Dr.BIas' review;
using lipiodol as a contrast media, it was re­
ally Janzen3 from Germany in 1926 who first
described and measured the negative pres­
cism.May this work serve as stimuli for oth­
and decided that no amputation was necessaly.
roform; if you can stand it, I can."s
The lessons regarding the use of anesthet­
ics for such brutal surgely likely helped speed
the general acceptance of the role of anesthe­
sia for surgelY as the wartime surgeons re­
turned home.By war's end, it was generally
acknowledged that ether was the safer agent,
and the dangers of anesthetic administration
in the face of shock or "prostration" were rec­
ognized.Additionally, the importance of ob­
servation of the patient, with particular at­
tention to pulse, respiration and color was
recognized as part of the safe practice of an­
esthetic administration.! By the war's comple­
tion, many surgeons had come to believe that
the use of anesthetics had decreased the
patient's potential anguish and hence, con­
tributed to a lower than expected mortality
rate.2 While some would contend that the
growth of the speciality of anesthesia was
slowed due to the lack of skilled medical per­
sonnel administering anesthetics, the lessons
and experience were invaluable in showing
the safety and necessity of anesthetics for fu­
sure in the lumbar epidural space.Two years
later Heldt and MaloneyJ discovered Janzen's
work, proposing that the vacuum effect was
due to the difference in growth development
of the dural sac and the vertebral column.In
1932, Dogliotti'sS first report on the technique
of "loss of resistance " was in the Italian lan­
guage.After 25 years of a successful career as
Professor of Surgery, having written over 300
articles and 2 books, Alberto Gutierrez6 be­
came i ntrigued with the techniques of
metameric anesthesia as described by Pages: 7
Being concerned that Dogliotti's method had
some hazards, he devised a method that de­
pended on the negative pressure in the epi­
dural space, the "hanging drop " method, as
published in 1932.6 Later, he proceeded to
measure the negative pressure by attempting
ture surgical care.
a reversible withdrawal approach, first find­
ing the subarachnoid space, then withdraw­
Bibliography
ing it to the peridural space, found when CSF
1 . Margreiter JL, Jr. Anesthesia in the Civil War.
ClflTI 6 (May 1967), pp 22-25.
2. Adams GW Doctors ill Blue-17ze Medical HistDlY
of the Union Army in the Civil Ifi/r. Dayton, OH:
hlorningside House, Inc., 1985.
3. Albin MS. William Thomas Green Morton as a
military anesthetist during the Civil War. Bulletin of
Anesthesia HistolY 14(1) Ganuary 1996).
4. Jones G\V, Wartime surgery. ClflTI 2 (May 1963),
pp 7-9 and 22-25.
5. Coco GA.A Strange and Blighted Land. Gettysblllg:
17ze Ajie17llath ofa Battle. Thomas PubliCations, 1995.
6. United States. TIle Medical and Surgical HistolY of
the Wilr of the Rebellion, 1861-1865. Part III, Volume II,
Surgical History.
7. Kuz JE, Bengtson BP. Orthopaedic Injuries of the
Civil l%r. Kennesaw lvlountain Press, 1996.
8. Cole TE. Civil War reenactors revere, learn from
the past. JAMA 275(15):1 146-1148.
ceased to flow.s Moreovel; he measured the
distance from skin to the epidural space in
2000 patients, having found a range from 3
to 10 cm, but in 80% of them it was shorter
than 5.8 cm.9 He also founded the Revista
Argentina de Anestesiay Analgesia in 1939, serv­
ing as its first editor for five years.
W hile BonniotlO in 1934 confirmed the
presence of negative pi'essure in the lumbar
epidural space, he also described a "clik "
("sifflement") occurring at the perforation of
the ligament flavum. In 1936 Zorraquinll
proposed the combination of fluid and air in
the syringe to better "feel " the changes in tis­
sue consistency as the needle advanced.
lumbar spine in 1946.Two years later, he was
in no way should it be interpreted as a criti­
ers to find important events on the earlier
period of epidural anesthesia; after all his­
tory is always in the making.
J. A ntonio Aldrete, MD, MS
iVledical Directol; TIle Neuro and Spine
Institute at Walton Regional Hospital
DeFuniak Springs, Florida
References
1 . Bias ML: The early history of epidural an­
esthesia. Bull Allesth Hist 1 5 (3) :5-6, 1997.
2. Sicard JA, Forestier J: Radiographic method
for exploration of the extradural space. Rev Neural,
28 : 1 264, 1921 .
3 . J anzen E: D er nega tive vors h l a g b e i
lumbalpunktion. Deutsch Z Nel'VenileiI 94:280, 1926.
4. Heldt, Maloney JC: Negative pressure in the
epidural space. 1 75:37 1-372, 1 928.
5. D o g l i o t t i AM: Un nuovo m e todo do
anestesia tronculare la rachianestesia peridurale
segmentaria. Arch Ital ChiI' 38:797-800, 1932.
6. Gutierrez A: Anestesia metamerica peridu­
ral. Rev Cir de Buenos Aires 12: 1-3, 1932.
7. Pages F: Anestesia metamerica. Rev de San
Militar 1 1 :35 1-358, 1921 .
8. Gutierrez A: Valor de la aspiracion liquid a
en el espacio peridural en la anestesia peridural.
Rev Cirugia 12:225-230, 1 933.
9. Gutierrez A: Anestesia extradural. Rev Cir
de Buenos Aires 19:52-58, 1 939.
1 0. Bonniot A: Note sur l a presion epidurale
negative. Bull Soc Nat ChiI' 60: 1 24, 1934.
1 1 . Zorraquin C : Ane s thesia meta merique
peridural. Presse Med 44:783, 1936.
12. De Souza E: Puncao extradural. Tecnica de
un novo sinal. Rev Bras Circ 12: 120, 1943.
1 3 . McIntosh RR: Extradural space indicator.
Anaesthesia 5:98, 1 950.
14. Adams RC, Lundy IS, Seldon TH: Continu­
ous c a u d a l anesthesia or analg e s i a . JAMA
122: 1 52-1 58, 1943.
15. Martinez-Curbelo M: Continous peridural
segmental anesthesia by means of a ureteral cath­
eter. Allestit Allalg 28:1-4, 1 949.
12
BULLETIN O F ANESTHESIA HISTORY
The Evolution of the Anesthesia Machine
by Carlos M. Nunez, M.D.
Jackson Memorial Hospital, Department of Anesthesiology,
Central Building, Room 301, 1611 N. W. 12th Avenue, Miami, FL 33136
Entry for Anesthesia Hist01Y Association Residents' Essay Contest, 1 996
On October 16, 1846, medical science,
and the world, learned that the pain caused
by surgical operations had been conquered.
Mankind now possessed a potion so pow­
erful, that a soul entranced by its fumes
paid no mind to the horror that was sur­
gery in that age. That first demonstration
taught another, more subtle lesson to those
who would pursue this newly created medi­
cal art: to harness the properties of this
potent liquor, to deliberately poison a
person's breath and to alter the conscious­
ness of that living being would require a
clever instrument of some precision. From
that day forward, anesthetists have em­
ployed a variety of devices to deliver the
gases and vapors of anesthesia to their pa­
tients. The modern anesthesia machine is
a collection of components whose inven­
tion and refinement parallel the history of
anesthesia practice and whose lineage can
be traced back to that October morning in
Boston one hundred and fifty years ago.
The demonstration was set to begin this
morning, bu t William Thomas Green
Morton was in danger of being late. He was
working feverishly on an instrument with
which to administer the secret compound,
so that he could claim as his own the break­
through that had eluded medicine for cen­
turies. He remembered vividly the failed
attempt by his one-time partnel� Horace
Wells, to make public a similar discovery,
and vowed not to suffer the same humilia­
tion. As the time grew near, he continued
to assemble what was to become the first
working anesthesia inhaler in history. The
appointed hour had come and passed, and
now IS minutes late, Dr. Morton arrived
in the operating theater j ust in time to stop
the surgeon from cutting skin. It was the
last-minute work on the inhaler that made
him late, but it was that same inhaler that
helped him announce to the world that a
new era of medical practice had begun.
Morton's ether inhaler was a two-necked
glass globe that was stuffed with a few small
sponges soaked with ether. It was a simple
draw-over vaporizer, with a short non­
rebreathing mouthpiece, and an inlet for
fresh atmospheric gas flow. This basic de­
sign was widely copied and modified, as
the a cc ounts of his amazing discovery
spread across the globe. William Morton
not only introduced the concept of surgi-
cal anesthesia, but also created the prede­
cessor of all anesthesia "machines" to fol­
low. The j ourney from this modest begin­
ning to the state-of-the-art computerized
anesthesia workstations of today was com­
pleted in three stages, the first of which was
the era of inhalers.
Anesthesia Devices
from 1842-1876:
The Simple Inhalers
Within two months of Morton's demon­
stration, ether anesthesia was being used
in Great Britain and various inhalers had
been devised to administer the drug. The
first operation was a tooth extraction on
December 1 9, 1846, followed by a leg am­
putation two days later. Although the anes­
thesia was given by two different anesthe­
tists, using different inhalers, the devices
had similarities to each other as well as to
Morton's invention. Both the "Hooper" in­
haler used in the tooth extraction and the
modified "Nooth's" apparatus used for the
amputation were glass draw-over vaporiz­
ers, employing sponges as wicks for the
ether.
Before ether anesthesia was even one
year old, chloroform was introduced as an­
other inhalational anesthetic, and an even
simpler type of inhaler was now being used.
Some anesthetists worked to minimize the
equipment requirements of anesthesia, us­
ing lint, cotton, sponges and handkerchiefs
onto which ether or chloroform liquid was
poured, to deliver anesthetic vapors. In
1862, the first wire frame mask was intro­
duced by Thomas Skinner, a Liverpool ob­
stetrician, to keep the cold cloth away from
the patient's face. This "open drop" method
of anesthesia was popular well into this cen­
tury, but did not detract from the continu­
ing pursuit of more advanced, safe and pre­
cise inhalers.
John Snow, the first British physician to
devote his practice exclusively to anesthe­
sia, developed one of the most advanced
early inhalers. His ether apparatus of 1847
incorporated features, such as temperature
compensation and a wide bore breathing
circuit, that are still in use today. Another
anesthesia pioneer from England, Joseph
Thomas Clover, devised several noteworthy
inhalers for b o th chloroform a nd ether.
Clover's chloroform inhaler was the first to
allow an accurately measured amount of
anesthetic to be delivered. This clever in­
haler was actually two separate devices; a
warmed vaporizer and bellows was used to
create a four percent mixture of chloroform
in air, which was then passed into a large
bladder with a connected breathing hose
for administration to the patient.
Countless other anesthesia inhalers,
masks, insufflators and contraptions were
developed during this period, and they all
shared several important and defining
qualities. They were designed to be used
with a single anesthetic agent mixed in at­
mospheric air. The concentration of the
anesthetic delivered was determined by the
physical characteristics of the device, and
could not be altered with reliability or pre­
cision. Finally, these early tools required
very little user input for operation, need­
ing only to be filled and held. It was truly
an era of simple inhalers, one that would
only span 30 or so years in the life of this
new and growing specialty.
Anesthesia Devices
from 1876-1911:
The Complex Inhalers
Eventually the clinical realities of an­
esthesia practice became the driving force
behind inhaler design. Anesthetists needed
more flexibility in their newer instruments,
such as the ability to adjust the inspired
concentrations of anesthetic, or the capac­
ity to deliver more than one agent. The
inhaler was now more than a curious gad­
get used to get fumes into someone's lungs;
it was evolving into a complex scientific
instrument reflecting the forefront of bio­
medical engineering at the turn of the cen­
tury.
This new period in anesthesia equip­
ment design was ushered in by many of the
same tinkerers responsible for creating
some of the earliest inhalers. An example
of this evolution can be found in Joseph
Clover's nitrous oxide/air/ether apparatus,
constructed in 1 876. Clover, now less en­
thusiastic about the use of chloroform as
an anesthetic agent, described a method for
sequential induction using nitrous oxide
and ethel� and built a machine to facilitate
this technique. For the first time the anes­
thetist could switch between two different
anesthetic agents, or bypass them alto-
BULLETIN OF ANESTHESIA H ISTORY
gether, and therefore have 1ll0re control
over induction, maintenance and emer­
gence from anesthesia. This elaborate in­
haler incorporated valves, a reservoir bag,
and a portable source of nitrous oxide­
features more in common with today's an­
esthesia machines than with Morton's glass
globe.
One year later, in 1877, Joseph Clover
again introduced another breakthrough in
inhaler design; his portable regulating
ether inhaler. This ingenious device was the
first to allow control over the amount of
anesthetic inspired by the patient. It was
not accurate enough to deliver specific con­
centrations of ether, but its four settings
made it easier to vary the anesthetic depth
by diverting more or less of the patient's
respiration through the vaporizing cham­
ber. This inhaler was very popular, and as
such was widely used, copied and modified
for use in anesthesia practice.
One of the more common modifications
of Clover's portable regulating ether in­
haler was to add a selector valve and a res­
ervoir bag that could be filled with nitrous
oxide. The resulting device was the most
versatile anesthetic apparatus to date, with
the capacity to deliver nitrous oxide, ether,
or room air, and the ability to control the
relative amount of ether in the inhaled
mixture. In 1901 a modification of this in­
haler was introduced by FW. Hewitt to
overcome some of the problems associated
with Clover's original design. The most
important change was an increase in the
diameter of the central breathing tube, to
lessen breathing resistance, with the hopes
of decreasing the incidence of cyanosis.
Hewitt also fitted this inhaler with a stop­
cock of his own design, that allowed the
anesthetist to switch between nitrous ox­
ide and ether.
Although chloroform was falling out of
favor as the twentieth century was begin­
ning, some die-hard "chloroformists" were
still looking for ways to make its adminis­
tration safer. Probably the last device cre­
ated solely for the administration of chlo­
roform was the Vernon-Harcourt chloro­
form inhaler. First described in 1903 by
A.G. Vernon-Harcourt, this apparatus was
constructed with many advanced features,
such as temperature compensation and an
air bypass, and would limit inspired chlo­
roform concentration to less than two per­
cent. This inhaler was an excellent example
of the evolving complexity of anesthesia
apparatus, and like the other complex in­
halers of this era, was designed to give the
operator more control over the administra­
tion of anesthesia.
Anesthesia Devices
from 1912-Present:
The Gas Machines
After the turn of the century, anesthe­
sia equipment evolution advanced quickly,
as the knowledge base of anesthesiology,
surgery, physiology and engineering ex­
panded under the influence of industrial­
ization and two world wars. The next phase
in the evolution of the anesthesia machine
was inspired by experiments on respiratory
physiology. FJ. Cotton, a Boston surgeon,
and an anesthetist, W.M . Boothby, also
from Boston, developed a gas-oxygen ap­
paratus in 1912, based on similar instru­
ments used in animal studies of gas ex­
change. Their device allowed oxygen and/
or nitrous oxide to pass through an ether
vaporizer, acting as a carrier for the agent,
then flow through a small rubber reservoir
bag and proceed to the patient. Although not
immediately apparent, the differences be­
tween this instrument and some of the com­
plex inhalers previously described, define
this last stage in the evolution of anesthesia
equipment-this was a true "gas machine".
What made this device different was
that the flow of a carrier gas, not the respi­
ratory flow of the patient, created the an­
esthetic mixture to be delivered. The ether
vaporizer was no more sophisticated than
Morton's first inhaler, the valves and tub­
ing for the gases were nothing new or revo­
lutionary, and the use of a reservoir bag was
definitely an old idea, but the way the ma­
chine operated made this device a model
for a new generation of anesthetic appara­
tus. In fact, it was this very device that in­
spired Gwathmey to design his nitrous ox­
ide and oxygen apparatus, which in turn
inspired Boyle to create his own instru­
ment. In November of1917, the basic struc­
ture of the modern anesthesia machine had
been assembled, and was commonly known
as "Boyle's machine".
B oy l e ' s m a chine was e s s e n t i a lly a
Gwathmey apparatus fitted for B ritish
standard oxygen and nitrous oxide cylin­
ders. The earliest versions had water-sight
or bubblethrough flowmeters and simple
drawover vaporizers for ether and/or chlo­
roform. The fresh gas flow from the cylin­
ders would pass through the vaporizers on
the way to a reservoir bag, and then exit to
the breathing circuit. The flow of gas and
the relative concentration of volatile agent
could be controlled with various valves and
levers, giving a great deal of control over
a nesthetic delivery. Although modified
countless times, usually to accommodate
more advanced components, Boyle's amaz­
ing machine still lives in the heart of most
anesthesia machines made today.
13
Between 1917 and the present day, what
has changed the most in anesthesia equip­
ment is the complexity and safety features
of the various components that make up a
"gas machine". The flowmeters are still
there, between the gas source and the va­
porizers, however they are now more so­
p h i s t i c a ted and a c c u r a t e than a ny
water-sight or dry bobbin relative of the
past. Vaporizers still accept fresh gas flow
to c arry vola tile agent molecules to a
patient's lungs, but they too have under­
gone so many changes. What used to be
nothing more than a glass bottle is now an
extremely accurate, temperature compen­
sating instrument with a proud ancestry of
Oxfords and copper kettles. The reservoir
bag is still there, now an integral part of a
breathing circuit that includes mechanical
ventilators and carbon dioxide absorption.
Probably the only thing that Boyle or
Gwathmey might find strange is the stunning
array of computerized monitoring that is now
packaged with every new anesthesia machine.
Each day that anesthetists step into the
operating room to deliver a general anes­
thetic, they are aided by one of the most
sophisticated medical machines ever de­
vised. This silent partner speaks volumes
of history, and is a physical link to the glo­
rious past of this great medical specialty.
Every component of this device represents
the vision of someone who worked to make
anesthesia safe and practical-every part of
this machine tells a story that goes back in
time one and one-half centuries. William
Morton probably did not understand how
important those extra 15 minutes were, but
as you look over your shoulder at the great
gas machine that helps you keep your pa­
tient alive and free from suffering, maybe
you will understand. . .
The Bulletin ofAnesthesia HistOlY is pub­
lished four times a year as a joint effort of
the Anesthesia History Association and
the Wood-Library Museum of Anesthesi­
ology.
C.R. Stephen, M.D., Editor
Doris K. Cope, M.D.,
Associate Editor
Donald Caton, M.D.,
Associate Editol'
Debra Lipscomb, Editorial Staff
Editorial, Reprint, and Circulation mat­
ters should be addressed to the Editor,
1 5 8 0 1 Harris Ridge Court, Chesterfield,
MO 630 1 7 U.S.A.
Manuscripts may be submitted un disk
using Word for Windows or other text pro­
gram. Please save files in RICH TEXT
FORMAT (.rtf) and submit a printout in
addition to the disk. All illustrations/pho­
tos must be submitted as hard copy, not
electronically.
14
B U LLETIN OF ANESTHESIA H ISTORY
Fifth Annual Spring
Meeting, 1 997
Anesthesia
History Association
Held in Colonial Williamsburg, VA, under the joint Chair­
manship of Dr. Douglas Bacon and A.I. Wright, MLS, the Fifth
Annual Spring Meeting of the AHA was judged by the attend­
ees as a distinct success. There follow a number of photographs
which depict scenes from the Reception held at that time. The
photographs are courtesy of Rebecca and Jason Wright.
BULLETIN OF ANESTHESIA H ISTORY
Lundy. .
15
. Continued /rom Page 2
lokalen Anaesthesia fur Arzte und Studierende
Published: Berlin: Urban & Schwarzenberg,
1903
Language in German
Author: Flagg, John Foster Brewster, 18041 872
Title: Ether and chloroform; their employ­
ment in surgery, dentistry, midwifelY, therapeu­
tics, etc.
Published: Philadelphia: Lindsay and
Blankiston, 1851
Author: Flagg, Paluel Joseph
Title: The art of anaesthesia
Published: Philadelphia: J.E. Lippincott Co.,
1928
Edition: 4th ed.
Author: Goldman, Victor
Title: Aids to anaesthesia
Published: London: Bailliere, Tindall & Cox,
1941
Notes: Card within the book (separated from
the book) is signed by the author
Author: Guedel, Arthur E.
Title: Inhalation anesthesia: a fundamental
guide
Published: New York: Macmillan, 1937
Notes: The book is signed by the author to
JS Lundy, 1937
Author: Gwathmey, James Tayloe
Title: Anesthesia
Published: New York: Macmillan, 1924
Edition: 2nd ed.
Notes: Book signed by the author to JS
Lundy 6-26-24
Author: Hadfield, Charles F.
Title: Practical anaesthetics for the student
and general practitioner
Published: New York: William Wood, 1931
Edition: 2nd ed.
Author: Hellman, Alfred M.
Title: Amnesia and analgesia in parturition
(twilight sleep)
Published: New York: P.B. Hoeber, 1915
Author: Hertzler, Arthur Emanuel, 1 8701946
Title: Surgical operations with local anesthe­
sia
Published: New York: Surgery Publishing,
1912
Author: Hertzlel; Arthur Emanuel, 1 8701 946
Title: The technic oflocal anesthesia
Continued on Page 23
16
BULLETIN OF ANESTHESIA H ISTORY
Humphtz1Y Davy's Small Circle of Bristol Friends : Part 3
by A.J, Wright*
(Middle EastJ Anesth 13(3):233-2 78, 1 995)
In 1799 the Edgeworth family returned to
Bristol. Maria Edgeworth, author of such nov­
els as Castle Rackrellt alld Belinda, visited her
sister Anna and brother-in-law Beddoes and left
the following impression of the experiments:
A young man, a Mr. Davy, at Dl: Bed­
does', who has applied himself much to
chemistry, has made some discoveries of
importance, and enthusiastically expects
wonders will be performed by the use of
certain gases, which inebriate in the most
delightful mannel; having the oblivious
effects ofLethe, and at the same time giv­
ing the rapturous sensations of the Nec­
tar of the Gods! Pleasure even to mad­
ness is the consequence of this draught.
But faith, great faith, is I believe neces­
saryto produce any effect upon the drink­
ers, and I have seen some of the adven­
turous philosophers who sought in vain
for satisfaction in the bag ofGaseoliS Oxyd,
and found nothing but a sick stomach
and a giddy head.145
Despite Maria Edgeworth's views on the ni­
trous oxide experiments, she remained friends
with Davy until the end of his life. In 1 808 she
told one of her correspondents about a strange
fish her father had acquired: "I wish Henry
would talk to Davy about it."146 Davy's passion
for angling was well known. In 1 826 she wrote a
long letter about Davy, "who has been with us
since Thursday, and his visit has been delight­
ful; he has always been kind and constant in his
friendship to us." The letter includes a descrip­
tion ofMaria's request to him that she be given
manuscript copies of his annual speeches as
President of the Royal Society. "Sir HumphlY
was so velY kind to have a copy made for me of
all his Discourses. I have found them fully equal
to my expectations. . . "146 Many years later
Southey reminisced about Maria Edgeworth in
an 1 838 letter: ". . . I very well remember see­
ing her more than once at Clifton in 1 800, at
which time her father said to me, 'Take my word
for it, sil; your genius is for comedy.' "147
Coleridge left Bristol in the fall of 1798 on a
trip to Germany with Wordsworth, his sister
Dorothy and another companion, thus missing
a meeting of Davy then. Coleridge, after sepa­
rating from the Wordsworths, did not return to
England until July, 1 799. About that time Bristol
publisher and printer Joseph Cattle, according
to his own claim, introduced Coleridge and
*MLS, Department of Anesthesiology Library,
School of Medicine, University of Alabama at Bir­
mingham, 6 1 9 South 1 9th Street, Birmingham,
Alabama 35233-6810, U.S.A.
Davy.148 Cottle and his partner, N. Biggs, in ad­
dition to printing some of Beddoes' titles and
the first edition ofColeridge and Wordsworth's
Lyrical Ballads in 1798, had issued other works
by the nitrous oxide group. These publications
included a small 1 797 collection of poems by
Coleridge, Lamb and Lloyd; Southey's joint
poetry collection with Richard Lovell (1794) and
hisJoan ofArc (1795); and twoAnnllalAnthology
poetlY collections edited by Southey that in­
cluded a total of six poems by Davy.
Davy had been writing poetlY and planning
various romantic and epic tales from an early
age and continued to do so after moving to
Bristol,149-15o Lefebure describes Davy's poetic
output as "prolific;"15! in her examination of
Davy's literary work, Weisenthal identified 90
extant poems and guessed that even more re­
mained in Davy's manuscripts.152 Lefebure fur­
ther notes that "The notebooks, throughout his
life, contain accounts of his visions and vision­
alY experiences and though a few of these carry
a strong whiff ofdrug inspira tion, most of them
indicate that Davy was one of those rare beings,
like Blake: visionary by nature."153 That vision­
atY inclination never deserted him; Davy's fi­
nal work was Consolations ill n'GVel,. or the Last
Days of a Philosopher, a series of philosophical
dialogues among three men, one of them repre­
senting Davy,154-155 Davy himself felt the work
contained "several truths which cannot be re­
covered if they are lost, and which I am con­
vinced will be extremely useful botlt to tlte moral
and intellectual world."156
Sharrock and Weisenthal have noted the
influence D avy apparently had over
Wordsworth's revisions to the preface ofthe tltird
edition of LYlical Ballads. 157-1 SS Weisenthal also
describes a kind of eventual closure in
Coleridge's and Davy's relationship-the simi­
larities between one part of Davy's final work,
Consolations ill nycvel, and Coleridge's posthu­
mously published essay, Hints Towards the
Formation of a More Comprehensive TheOlY
of Life.159
Beddoes hoped for great benefits from the
nitrous oxide experiments. " . . . [\X1e] should
now have at our disposal an infinite series of
powers," he wrote. "Man may sometime come
to rule over the causes of pain and pleasure
with. . . absolute dominion." But in his mem­
oir ofColeridge and Southey written years latel;
Bristol publisher and printer Joseph Cottle has
left a different description of the Pneumatic
Institution events. He says he warned Davy
"against his imminent perils" from the "haz­
ardous" experiments. Davy often breathed ni­
trous oxide and other gases to the point of hy-
poxia. "He occasionally so excited my fears, that
I half despaired of seeing him alive the next
morning." Apparently for these reasons, Cottle
declinedwhen Beddoes "presented me hisgreen
bag. . . The Pneumatic Institution, at this time,
from the laughable and diversified effects pro­
.
duced by this new gas on different individuals,
quite exorcised philosophical gravity, and
convested the laboratOlY into the region of hi­
larity and relaxation."161 Cottle is not consid­
ered a reliable witness by literaty scholars, but
his attitude expressed here was shared by oth­
ers. The Pneumatic Institution and several spe­
cific individuals, including Beddoes, were sati­
rized in a contemporalY poem, "The Pneumatic
Revellers-An Ecologue." Southey's fictional
speech closeswith "Ingulph the dephlogisticated
floods oflife, and riot in immortal gas!"162
Also present at the Pneumatic Institution
trials was Peter Mark Roget. After receiving his
medical degree from the University of
Edinburgh in June 1 798, nineteen-year-old
Roget undertook a tour to introduce himself to
various individuals who might aid his career­
Erasmus Darwin,James Keir and Thomas Bed­
does. According to his biographer, Roget re­
mained in Bristol until the end of the summer
of 1799, working as a chemist and physiologist
in Beddoes' Institution. Shortly after leaving
Clifton, Roget responded with a lengthy letter
to Jeremy Bentham, who through family con­
nections had inquired of Roget about the ni­
trous oxide experiments. In his Januaty 9, 1 800,
letter, Roget not only described "his own expe­
riences in inhaling nitrous oxide but describing
other experiments he had made, showing the
effect (lethal) of the gas on mice and other small
animals. Roget also gave Bentham explicit di­
rections on how to prepare the stuff, and some
practical advice in the handling ofthe gas. . ."163
In 1 802 Roget made a trip to France, managing
to escape the fate of Lovell Edgeworth and sev­
eral other Englishmen who were arrested and
spent eleven years in a French prison at
Verdun.lM Roget went on to a distinguished ca­
reer as a physician and prolific author. In 1 852,
at the close of his life, he published his famous
thesaurus. His publications include one on a
principle later used in motion pictures and a
respectful entty on Beddoes for the Encyclope­
dia Bl'itannica.165-166
Trials of the gas were being attempted out­
side Clifton as well. In an exchange ofletters in
early Novembel; 1 799, James Watt and Joseph
Black discussed the ongoing nitrous oxide ex­
periments. Black informed Watt that he had
received Beddoes' pamphlet about the experi­
ments, which noted Watt's participation. "I beg
BULLETIN OF ANESTHESIA H ISTORY
to be informed particularly how you prepared it
and in what dose you took it etc. etc." Black
wrote, "I am impatient to tly it on a Friend of
mine who is in a deplorable state of
Hypochondriacism. . ."167 In a letter three days
later, Watt responds, "I wrote to you a few days
ago mentioning some, general facts about the
gaseous oxide and today received your kind let­
ter which I immediately answer-I never pre­
pared any of that gas, but took a trial of it at the
Pneumatic Institution at Clifton." Watt then
gives details on preparation of the gas, the
method ofbreathingwith his apparatus and his
own trial of the gas at Clifton.168 Finally, on
November 22, Watt informs Black that prepa­
ration and a trial of the gas has been conducted
in Birmingham. "Yesterday I was present at the
preparation and trial of some of this new air, at
Dr. Catwichael's. . ."Watt describes the breath­
ing of the gas by two unnamed men; "more per­
sons were willing to try but the air holder was
exhausted."169
Coleridge finally breathed the gas at Clifton
after his return from Germany inJuly, 1799. His
account of four inspirations appears in Davy's
book. Coleridge notes after his first attempt that
"the only motion which I felt inclined to make,
was that of laughing at those who were looking
at me." After the third time and "the mouth­
piece was removed, I remained for a few sec­
onds motionless, in great extacy [sic] ." The fi­
nal attempt produced "more unmingled plea­
sure than I had ever before experienced."170
As Hoover has pointed out, Coleridge is cu­
riously silent on these experiences except for this
account.l7l He makes veiled references to them
in his letters and notebooks, but never anything
explicit. Coleridge sometimes joked using im­
agelY of the nitrous oxide trials. "God love you,
my dear Friend!" Coleridge wrote Davy in early
May, 1 801, "From Tobin's account I fear that I
must give up evelY sweet vision-that ofseeing
you this summer. The summer after my ghost
perhaps may be a Gas-."172 He claimed about
his infant son Hartley that "the air. . . is to my
Babe a perpetual Nitrous Oxyde. Never was
more joyous creature born. . . "173 Coleridge in­
formed Davy July 15, 1 800, that "I see your Re­
searches on the nitrous oxyde regularly adver­
tised-Be so kind as to order one to be left for
me at Longman's. . ."174
Some other identified participants at the
Clifton trials are less well-known than those al­
ready discussed, but nonetheless an impressive
group. James Mackintosh "several times
breathed nitrous oxide" and had "generally plea­
surable feelings."175 Mackintosh was a Scottish
writer, politician, lawyer and early French revo­
lution supporter, who by 1799 had turned Tory.
A recent biographer has labelled him the "Whig
Cicero."176 Coleridge never forgave him. In the
fall of 1 801, Mackintosh visited the poet. "Mack­
intosh, (who is a large tall man) spent two days
with me at Keswick," he reported to Tom Poole,
"and was velY entertaining and pleasant. He is
evelY inch the being, I had conceived him to be
a t C ote House [Wedgwood residence in
Bristol] . . . When I asked him concerning
Davy-he answeredOhf-little Davy-Dr. Bed­
does' Eleve, you mean?-This was an exquisite
trait of character. "177 Yet in May, 1 800, Coleridge
had referred in a letter to "the great Dung-fly
Mackintosh. . ."178 and continued to express his
dislike in later years.I79
Another participant was Beddoes' wife. Anna
Beddoes suffered some kind ofpulmonaty com­
plaint and wished to tty the gas. "This gazeous
oxide was not given her as a remedy, but on the
contraty she was by her husband forbid [sic] to
take it. She however chose to have a will of her
own and tool< it at the institution unknown to
him, and aftelwards continued it for the same
reason other Ladies take brandy viz, the plea­
sure it gave her."Iso
George Burnett was a poet, friend of Cole­
ridge and one ofthe original Pantisocracy group.
Reverend Charles Coates and Henry Wansey
were English antiquarians; Wansey had also
published an account of his 1794 visit to the
United States.I81-182 Stephen Love Hammick and
Robert Kinglake were physicians who later wrote
major texts.l83-I S4 William Russell Notcutt was a
local chemist. John Cave, Jc, has not been iden­
tified, but the Cave surname was prominent in
Bristol from at least the 1770s and well into the
nineteenth centmy.I85 Several women also par­
ticipated; Anna Beddoes has already been men­
tioned. Others included writer Anna Barbauld,
James Watt's wife, a Miss Ryland and a Miss
Morgan. Joseph Priestley's son, Watt's son Gre­
gOly and Coleridge's friends Thomas Poole and
Tom Wedgwood also enjoyed the gas.
Another self-experimenter at Clifton was
James Webe Tobin, Jr., whose account is one of
the longest in Davy's book and gives evidence
of gas breathing as ardent if not quite as fre­
quent as Davy's own.I86 Tobin was the brother
of playwright John Tobin, who seems to have
had some influence on the early work of
Wordsworth.ls7 John Tobin wrote at least four­
teen plays, mostly light comedies, including77ze
HOlley iHoon. Davy wrote a poetic prologue for
this play "in a few hours the day before the play
opened" in 1 805, the year after the author's
death.I8s Coleridge continued to see and corre­
spond with many of these people well into the
nineteenth centmy. His collected letters include
numerous items to and/or mentions of
Wedgwood, Tobin, Bedford, Rickman, Poole,
Mackintosh, Southey and of course Davy.
What Davy and many of his fellow experi­
menters described as a result of nitrous oxide
inhalation was a mental state unlike anything
previously noted in Western literature, except
perhaps by the Christian mystics. "I felt as if
composed of finely vibrating strings," Beddoes
proclaimed.I89 Tobin felt his "mind was elevated
to a most sublime height."I90 On one occasion
17
Davy himself"lost all connection with external
things; trains of vivid visible images rapidly
passed through my mind and were connected
with words. . . I existed in a world ofnewly con­
nected and newly modified ideas. I theorized; I
imagined that I made discoveries. When I was
awakened from this semi-delirious trance. . . I
exclaimed to Dr. Kinglake, 'Nothing exists but
thoughts!-the universe is composed' ofimpres­
sions, ideas, pleasures and pains!"191
By the end of May, 1 800, the nitrous oxide
trials had ceased. Davy and Beddoes probably
concluded nothing more could be gained; be­
sides, "Beddoes' hospital was rendered ridicu­
lous" by the notoriety.192 In March, 1801, Davy
left Clifton for London and a post as chemistty
lecturer at the infant Royal Institution. He
briefly continued nitrous oxide demonstrations
there during his increasingly popular lectures;
Grosvenor Bedford and lawyer and journalist
John Stoddart participated on June 20.193
Gillray's caricature, including a satanic portrait
of Davy, dates from this period.60
The news of the nitrous oxide experiments
soon reached America. What may be the first
published account of the Pneumatic Institution
work to appear in the United States was a letter
Priestleywrote from Northumberland, Pennsyl­
vania, to Samuel Latham Mitchill, editor of the
Medical RepositOlY, on JanualY 30, 1800. "Dear '
Sil;" Priestley said, "I send you an extract from
a letter just received from my son in England. . .
'Mr. Watt desired me to tell my fathel; that he
has completely got the better of his asthma, by
breathing dephlogisticated air, and he is in much
better health in evelY respect. They are admin­
istering dephlogisticated nitIVus ail' to two para­
lytic patients, one of whom is nearly cured. It
excites the nervous system in a wonderful man­
ner. Some that take it are thrown into fits of
laughtel; others into most antic gestures, affect­
ing them much in the same way as if they were
intoxicated, and in some it produces a state of
insensibility'."194
In Novembel; 1794, the trustees of the Uni­
versity of Pennsylvania voted to offer a chemis­
tty professorship to Priestley, who considered
the post seriously but turned it down. James
Woodhouse, a 1792 medical graduate of the
university, was 'Offered and accepted the posi­
tion in July, 1795. In early 1802, Woodhouse left
for England, where he stayed until late in the
year. Immediately upon his return, "I prepared
a large quantity of the nitrous oxide or
dephlogisticated air. . . the air was examined
and found to be extremely impure ."195
Woodhouse gave up that day, but one of his
chemistty students preselved an account of the
extensive nitrous oxide trials that took place
throughout 1807. In a dissertation written for
his medical degree, William Barton discusses
and replicates Davy's research and agrees with
Contilllled all Next Page
IS
BULLETIN OF ANESTHESIA HISTORY
Davy. .
.
COlllilllled }i'om Page 1 7
his conclusions.196 Barton noted that nitrous
oxide trials had also been conducted by Ben­
jamin Silliman at Yale, J. Griscom in New York
and even by .M.P. Dispan and the Society of
Amateurs at Toulouse, France.!97 "This inde­
scribable extacy,must be whatangels feel," Barton
concluded.198 Intermittent experimentation
would continue in the United States and Eu­
rope until Horace Wells' failed Boston demon­
stration of 1 844.199
Davy's great work on nitrous oxide appeared
in the summer of 1 800 under the imprint of
London publisherJohnson, one ofthe 425 medi­
cal or scientific works he brought to press dur­
ing his lengthy career. Probably 750 copies were
printed. "One technique Johnson used with
some frequency was to undertake to publish a
work-that is, to underwrite its expenses but
have it printed in the provincial city of its au­
thOl; presumably saving considerable expense
and making the work more promptly available
in the area where it would be of greatest inter­
est."12 Thus, Biggs and Cottle were engaged to
actually print the book in Bristol. Davy was in
good company. "Virtually evelY giant ofthe sec­
ond half of the eighteenth century in medicine,
science, religion, philosophy, political thought,
education, and poetly published at least one
work with Johnson."12 Although Johnson him­
self died in 1 809, his firm issued Davy's Ele­
ments ofChemistry three years later (Table 4).
In addition to working on Researches, Davy
had another task during the summer of 1 800.
William Wordsworth wrote to Davy, whom he
Table 4.
had not met, on July 28, 1 800, asking the young
man to proofread the manuscript for the sec­
ond edition oflJwicalBallads. "Youwould greatly
oblige me by looking over the enclosed poems,
and correcting anything you find amiss in the
punctuation, a business at which I am ashamed
to say I am not adept. . . In future I mean to
send the MS. to Biggs and Cottle, with a request
that along with the proof-sheets they may be
sent to you." Wordsworth followed this appeal
with detailed instructions about getting the cor­
rected poems "into Mr. Bigg's hands as soon as
you have looked them over." Wordsworth also
asked Davy to "Remember me most affection­
ately to Tobin," meaning James Tobin, with
whom Wordsworth and Coleridge both corre­
sponded.2OO Coleridge had already asked Davy
to take up this task. On the same day her
brother's letter was written, Dorothy
Wordsworth recorded in her journal, "Received
a letter from Coleridge enclosing one from Mr.
Davy about the Lyrical Ballads. Intensely hot. I
made pies in the morning. We went into the
wood and altered his poems."202
What then are we to make of these people,
their relationships and their experiments? Stan­
dard histories of anesthesia cite these events as
the beginning of man's search for surgical pain
relief.199,203.205 Certainly they came tantalizingly
close to that goal; Priestley, Beddoes and others
had hopes that something useful would emerge
from the inhalation of gases. Davy, in the clos­
ing pages of Researches, makes an explicit con­
nection between nitrous oxide, pain relief and
surgely.206 Yet such reliefwas never their goal,207
The research effort at Beddoes' Pneumatic In-
stitution also confirmed the earlier work of
Priestley on gas inhalation by humans, and the
elaborate apparatus designed for Beddoes and
Davy would not be equalled until anesthesia
machines appeared almost a century later. Bed­
does also foresaw the usefulness of both oxygen
and nitrous oxide: "Between the two, we should
now have at our disposal an infinite series of
powers. . . "208
In an August, 1 799, letter to John May,
Southey left a telling evaluation of Beddoes'
work:
Of Beddoes you seem to entertain an er­
roneous opinion. Beddoes is an experi­
mentalist in cases where the ordinary
remedies are notoriously and fatally in­
efficacious. If you will read his late book
on consumption, you will see his opin­
ion upon this subject; and the book is
calculated to interest unscientific read­
ers and to be of use to them. The faculty
dislike Beddoes, because he is more able,
and more successful, and more celebrated
than themselves, and because he labors
to reconcile the art of healing with com­
mon sense, instead of all the parade of
mystery with which it is usually envel­
oped. Beddoes is a candid man, trusting
more to facts than reason. I understand
him when he talks to me, and, in case of
illness, should rather trust myself to his
experiments than be killed off secundem
artem, and in the ordinary course of prac­
tice. . .209
Southey's confidence in Beddoes echoes
Sample of Books Published by the Firm of Joseph Johnson
Aikin, John A. A Manual of Materia Medica
Aikin, John A. Poems
Aikin, John. View of the Character and Public Services of the Late John Howard
B arbauld, Anna Letitia. Poems
Barbauld, Anna Letitia. An Adress to the Opposers of the Repeal of the Corporation and Test Acts. 2nd ed.
Beddoes, Observations on the Nature of Demonstrative Evidence
Beddoes, Letter to the Right Hon. William Pitt
Beddoes, Collection of Testimonies Respecting the Treatment of the Venereal Disease'
B eddoes, Considerations on the Medicinal Use, and on the Production of Factitious Airs
Brown, Elements of Medicine (Translated by Beddoes)
D arwin, A plan for the conduct of Female Education in Boarding Schools
D arwin, The Botanic Garden-Part 1. Economy of Vegetation
Darwin, The Botanic Garden-Part 2. Loves of Plants
Darwin, Phytologia; 01', the Philosophy of Agriculture and Gardening
Darwin, The Temple of Nature, 01' The Origin of Society
Darwin, Zoonomia; or, the Laws of Organic Live
Davy, Elements of Chemical Philosophy
Davy, Researches
Edgeworth, Maria. Castle Rackrent; an Hibernian Tale
Edgeworth, Richard Lovell and Maria. Practical Education
Priestley, History and Present State of Electricity
Priestley, Familiar Introduction to the Study of Electricity
Priestley, Familial' Introduction to the Theory and Practice of Perspective
Priestley, Directions for impregnating Water with Fixed Air
Priestley, History and Present State of Discoveries Relating to Vision, Light and Colours
Priestley, Experiments and Observations on Different Kinds of Air, Vols. 1-3
Priestley, Free Discussion of the Doctrines of Materialism and Philosophical Necessity
Priestley, Experiments and Observations Relating to Various Branches of Natural Philosophy
Priestley, Experiments on the Generation of Air from Water
Seward, Memoirs of the Life of D r. Darwin
1785
1791
1 792
1 773
1 790
1 793
1 796
1 799, 1 800
1 795
1 795
1 797
1791
1 7 89
1 800
1 803
1 794-96
1812
1 800
1 80 1
1 798
1767, 1 769, 1 775, 1 794
1 768, 1 769
1 770, 1 780
1 772
1 772
1 773, 1 775, 1 776, 1 777,
1 7 8 1 , 1 784, 1 790
1778
1 78 1 , 1 786
1 793
1 8 04
BUllETIN OF ANESTHESIA HISTORY
from an essay appended to Davy's Researches.
Written by Beddoes and titled "Proposal for the
Preservation of Accidental Observations in
Medicine," it forms the final pages of the book.
With the nitrous oxide trials sputtering to a halt
in a cloud ofridicule and inconclusiveness, Bed­
does makes a plea for recording clinical phe­
nomenon-accidents-in the hope that one day
some will prove important. He wrote that such
observations would " . . . if they could be
brought togethel; compose a body of fact, so in­
structive to the philosophel; and useful to the
physician, that he despairs of finding a term
worthy to characterize it."zJOThus, the common­
sense Beddoes tried to justify what had become
a public embarrassment to all involved.
Yet there is another context here. Davy's labo­
ratory; animal and clinical works on nitrous ox­
ide, as accurate as they were and as important
as they appear in retrospect, was imbedded in a
wider matrix. Papper argues that the attention
to individual pain and suffering, as exemplified
by Beddoes in medicine and by Coleridge and
Shelley among the Romantic poets, "made pos­
sible a radical improvement in the lot of ordi­
naty people and placed, for the first time, a val­
ued premium on the avoidance of pain, which
in turn made anesthesia and surgical therapy a
reality for human betterment."211
Coleridge was certainly a student of pain,
especially his own. In a letter to Davy in early
Decembel; 1800, referring to surgeon Anthony
Carlisle, Coleridge asked, "Did Carlisle ever
communicate to you, or has he in anyway pub­
lished, his facts concerningPain, which he men­
tioned when we were with him? It is a subject
which exceeding(y interests me-I want to read
something by somebody expressly on Pain, if
only to give anarrangemellt to my own thoughts,
though if it were well treated, I have little doubt
itwould revolutionize them."zlZBy mid-centmy
the revolution of surgical anesthesia would oc­
cur.
Beddoes' vision went far beyond pneumatic
medicine, which he saw as a tool of the moment
to attack one of rapidly-industrializing
England's worst health problems--consump­
tion. Beddoes' critique also went beyond the
political system; he was truly a "doctor of soci­
ety" (as Porter labels him). Beddoes, wrote Por­
tel; "believed that, as then constituted, medi­
cine was a disgrace, reduced to quackelY, as the
political establishment had been reduced to cor­
ruption. Doctors had prostituted their art for
gain. Clearly, medicine must cease to be a racket.
Above all, it had to cease to be a trade. It had to
escape from the market, for medicine had a
higher mission."213Beddoes' attack on the ills of
his time seems surprisingly modern. His vision
of change embraced politics, education, public
health and medical practice-he targeted ad­
dictions, quackelY and oppression everywhere.
His nearly decade-long project to organize a
pneumatic clinic and laboratOlY for testing
Priestley's gases attracted in some fashion many
of the finest intellects ofhis age-the names are
staggering: Watt, D arwin, Black, Kier,
Wedgwood, Coleridge, D avy, Edgeworth,
Southey, Roget, Mackintosh, Rickman. Beddoes
also attracted subscribers to the Pneumatic In­
stitution from a large number of individuals. A
list published in 1796 included 1 89 individuals
and institutions; among them were 44 physi­
cians, 19 surgeons, 14 clergymen and at least 5
members of royalty and ParliamentF14
"Beddoes's project was rooted in an Enlighten­
ment model of public science, a model that was
articulated by Priestley in conjunction with his
dissemination of his own chemical discoveries.
Beddoes. . . also developed his program in con­
junction with overt calls for social reform and
for reform of the medical profession. He at­
tempted to place himself at the head of a net­
work of progressive medical practitioners who
were continuing the project ofpneumatic medi­
cine initiated by Priestley."z15 Beddoes distrib­
uted Watt's apparatus to physicians and patients
in hopes that it "would soon come to be ranked
among the ordinalY articles of household furni­
ture," thus allowing patients "to take control of
their own medical treatment."216 Watt and
Boulton sold the devices as well. Beddoes' "style
of writing, his cultivation of connections with
progressive medical practitioners and among
provincial elites, and his diffusion ofinstruments
to render experiments widely replicable all re­
capitulated Priestley's methods of advancing
science in his society."21 7And Beddoes' work ran
aground in the political currents ofhis day, just
like Priestley's.
His recent biographer, Gill, has described
Wordsworth's preparations to attend a Queen's
Ball on April 25, 1 845: "Wordsworth hastened
to Samuel Rogers for a lesson in etiquette.
Apparelle in Rogers's court dress and S ir
Table 5.
HumphlY Davy's sword, Wordsworth presented
himself to his sovereign so becomingly that the
wife of the American Minister to London had
to dab her eyes."ZlS Here, surely, is a striking
image: the elderly poet, fresh from his lesson,
wearing borrowed clothes, bearing the sword of
his long-dead friend, and kneeling before his
queen. The metaphorical sword wielded by Bed­
does, Davy and their associates in the nitrous
oxide trials remains with us today in operating
rooms around the world, and in the way that
science and the public have interacted over the
past two centuries. The publications of Priest­
ley, Beddoes, Davy and Watt and their willing­
ness to share knowledge, techniques and equip­
ment with numerous other individuals all con­
tributed to what Golinski calls "science as pub­
lic culture" in the late eighteenth and early nine­
teenth centuries. Davy's circle ofBristol friends
turned out to be velY wide indeed.
References
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2. IVlitchill SL: Remarks on the Gasious Oxyd of
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3. lvlitchill SL: The doctrine of Septon. Medical Re­
posit01Y 1:183-1 86, 1797.
4. Davy H: Researches, Chemical and Philosophi­
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don: J. Johnson, 1800.
5. Cartwright FF: HumplllY Davy's researches on
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9 . Schofield RE : The Lunar Society o f Birming­
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Nicholson'sJ Natl Phil Chem Arts 3:93,
'
Continued on Next Page
Pneumatic Medicine Connections
Black
19
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t
Wells
20
Davy.
BULLETIN OF ANESTHESIA HISTORY
•
COlltillued from Page 1 9
10. Ritchie-Calder P: The Lunar Society ofBirming­
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12. Chard LF: Bookseller to Publisher: Joseph
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13. Chard LF: Joseph Johnson, Father of the Book
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19. Ibid, p. 291.
20. Priestley, op. cit., Vol. 1:228.
21. Cavallo T: A Treatise on the Nature and Proper­
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22. Cavallo T: An Essay on the Medicinal Proper­
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23. Pearson R: A Short Account of the Nature and
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the Pneumatic Method of Treating Diseases. . . Lon­
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24. Brown C: A treatise on Scrophulous Diseases,
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25. Wood L: Observations on a New and Easy
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the Use of Drugs. London, 1780.
26. Ewart J: The History of Two Cases of Ulcerated
Cancer of the Mamma; One of Which has Been Cured,
the Other Much Relieved, by a New Method of Apply­
ing Carbonic Acid Air. Bath: R. Crattwell, 1794.
27. Barzun J: Thomas Beddoes or medicine and
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28. Stansfield DA: Thomas Beddoes M.D.
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30. Stock JE: Memoirs of the Life of Thomas Bed­
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31. Stansfield, op. cit., p. 239.
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Reform. London: Routledge, 1991, p. 41.
33. Stansfield, op. cit., p. 5.
34. Ibid., p. 76.
35. Ibid., pp. 78-79.
36. Beddoes T: A Word of Defence of the Bill of
Rights against Gagging Bills. Bristol: N. Biggs, 1794.
37. Beddoes T: Where Sould Be the Harm of a
Speedy Peace? Bristol: N. Biggs, 1795.
38. Beddoes T: An Essay on the Public Merits of
Mr. Pitt. London: J. Johnson, 1796.
39. Beddoes T: A Letter to the Right Hon William
Pitt, on the Means ofRelieving the Present Scarcity, and
Preventing the Diseases that Arise from Meagre Food.
London: J. Johnson, 1796.
40. Beddoes T: Alternatives Compared; or, What
Shall the Rich Do to be Safe? London: J. Debrett, 1797.
. 41. Levere TH: Dr. Thomas Beddoes at Oxford, radi­
cal politics 1788-93 and the fate of the Regius Chair in
Chemistry. Amblx 28:61-69, 1981.
42. Stansfield, op. cit., p. 283.
43. Holt A: A Life ofJoseph Priestley. London: Ox-
ford University Press, 1931, p. 28.
44. Stansfield, op. cit., p. 83.
45. Stansfield, op. cit., p. 88.
46. Sschofield RE: The industrial orientation of sci­
ence in the Lunar Society ofBirmingham.Isis48:408-415,
December 1957.
47. Stansfield, op. cit., p. 39.
48. Rolt LTC: The Aeronauts: a History of Ballooning 1683-1903. New York: Walker, 1966, pp. 26-40.
49. Ibid., p. 185.
50. Ibid., pp. 79-81.
51. Sadler J. and Clayfield W: Balloon: The Only
True and Authentic Account of the Voyage from Bristol,
on Monday, September 24, 1810. Bristol: Mercury and
Mirror, 1810.
52. Beaufoy HBH: Journal Kept by H.B.H.B. dur­
ing an Aerial Voyage with Mr. James Sadler, sen., from
Hackney, Middlesex, to East Thorpe, Essex, Five Miles
from Colchester, August 29, 1811. London: G. Woodfall,
1811.
53. Marion F: Wonderful Balloon Ascents: or, The
Conquest of the Skies. New York: Scribne1; 1870, p. 187.
54. Stansfield, op. cit., p. 39-40.
55. Beddoes T: Observations on the Nature and Cure
of Calculus, Sea Scurvy, Consumption, Catarrh, and
Fever; Together with Conjectures Upon Several Other
Subjects of Physiology and Pathology. London: J. Murray,
1793.
56. Beddoes T: A Letter to Dr. Darwin, on a New
Method of Treating Pulmonary Consumption and Some
other Diseases Hitherto Found Incurable. . . Bristol:
Bulgin and Rosser, 1793.
57. Anon: The Golden Age, a Poetical Epistle from
Erasmus D--N, M.D., to Thomas Beddoes, M.D.
London: Ri\�ngton and Cooke, 1794.
58. Levere TH: Dr. Thomas Beddoes (1750-1808):
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59. Kinsley J, Boulton JT, Eds: English Satiric Po­
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60. Gillray J: The Works of]ames Gillray: 582 Plates
and a Supplement Containing the 45 So-Called "Sup­
pressed plates." 1851. Rep. Bronx: Benjamin Blom, 1968,
plate 520.
61. Burgess R: Humphry Davy or Friedrich Accum:
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1972.
62. Stansfield, op. cit., pp. 60-61, 79:148-149.
63. Stansfield, op. cit., pp. 104, 254-260.
64. Nott J: Of the Hotwell Waters, near Bristol. 3rd
ed. Bristol: EmelY and Adams, 1803.
65. Keir J: Account of the Life and Writings ofTho­
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66. Day T: The History of Sandford and Merton.
New York: C.S. Francis, 1800.
67. Stansfield, op. cit., pp. 62-65.
68. Ibid., p. 103.
69. Ibid., p. 122, 270-271.
70. Smith EF: Priestley in AmeriCa 1794-1804. Phila­
delphia: P. Blakiston, 1920.
71. McClelland CW: The Chemical Experiments
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72. Lefebure M: Humphry Davy: philosophic alche­
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nection. New York: St. Martin's Press, 1990, p. 87.
73. Ibid., pp. 88-89.
74. Wylie I: Coleridge and the Lunaticks. In: The
Coleridge Connection. New York, St. Martin's Press,
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75. Stansfield, op. cit., p. 129.
76. Ibid., pp. 120-144.
77. Griggs EL, Ed. Collected Letters of Samuel Tay­
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79. Stansfield, op. cit., p. 153.
80. Rolt, op. cit., p. 80.
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Bristol Pneumatic Institute. Med Hist 30:276-302, 1986.
82. Cartwright FF: The association ofThomas Bed-
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Soc Lolldon 222:131-143, 1967.
83. Beddoes T, Watt J: Considerations on the Me­
dicinal use of Factitious Airs and on the Manner ofOb­
taining Them in Large Quantities. London: Joseph
Johnson, 1794.
84. WattJ: Supplement to the Description of a Pneu­
matic Apparatus, for Preparing Factitious Airs; Contain­
ing a Description of a Simplified Apparatus, and of a
Portable Apparatus. Birmingham: T. Pearson, 1796.
85. Robinson E, McKie D, Eds: Partners in Science:
Letters ofJames Watt and Joseph Black London: Con­
stable, 1970, pp. 224, 228.
86. BeddoesT: Suggestions Towards Setting on Foot
the Projected Establishment for Pneumatic Medicine.
Bristol: Biggs and Cottle, 1797.
87. Stansfield, op. cit., p. 158.
88. \'\Iylie: op. cit., p. 35.
89. Ibid.
90. Ibid., p. 36.
91. Fullmer JZ: Davy's biographers: notes on sci­
entific biography. Science ISS: 285-291, 1967.
92. Hartley H: Humphry Davy. London: Thomas
Nelson, 1966.
93. Lrgr utr, op. cit.
94. Knight D, Humphry Davy: Science and Power.
Oxford: Blackwell, 1992.
95. Neve M: The Young Humphry Davy: or John
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96. Thorpe TE: Humphry Davy: Poet and Philoso­
pher. London: Cassell, 1896, pp. 24-25.
97. Ibid., pp. 26-27.
98. Beddoes T: Contributions to Medical and Physi­
cal knowledge from the West of England. Bristol: Biggs
& Cottle, 1799.
99. Emblen DL: Peter Mark Roget: The Word and
the Man. New York: Crowell, 1970, p. 39.
100. Mitchill SL: Remarks on the gaseous oxyd of
azote or of nitrogen. In: Beddoes T, Watt J, eds. Consid­
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Bristol: Bulgin and Russer, 1796, pp. 41-69.
101. DAVY H: op. cit., pp. 451-576, 485.
102. Ibid., pp. 573-576.
103. Smith WDA: William Clayfield's mercurial
airholder. History of Anaesthesia Society, Great Britain.
Proceedings 4:33-36, 1988.
104. Thorpe: op. cit., p. 41.
lOS. Southey CC, Ed: Life and correspondence of
Robert Southey. New York: Harper, 1851, p. 120.
106. Ibid., p. 112.
107. Ibid., p. 113.
108. Ibid., p. m.
109. Davy H: op. cit., pp. 528-529.
110. Ibid., p. 120.
111. Ibid., p. 118.
112. Williams 0: Life and Letters ofJohn Rickman.
Boston: Houghton Mifflin, 1912.
113. Wrigley AK: Checking Rickman. Local Popu­
lation Studies (Great Britain) 17:9-15, 1976.
114. Edwards WJ: National marriage data: a
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Populatioll Studies (Great Britain) 17: 25-41, 1977.
l iS. Davy H: op. cit., p. 526.
116. Marrs EJ, Ed: Letters of Charles and Mary
Lamb. 3 vols. Ithaca, NY: Cornell University Press,
1975-1978, 1:244.
117. Southey, op. cit., p. 243.
118. Ibid., p. 489.
119. Ibid., p. 147.
120. Litchfield RB: Tom Wedgwood: The First Pho­
tographer. 1903. Rep. New York: Arno Press, 1973.
121. Wedgewood T: Experiments and observations
on the production of light from different bodies by heat
and attrition. Phil TimlS Royal Soc 1792, pp. 28-47.
122. Gernsheim H: The Origins of Photography.
London: Thames and Hudson, 1982, p. 24.
123. Priestley J: History and Present State of Dis­
coveries Relating to Vision, Light, and Colours. Lon­
don, 1772.
124. Gernsheim, op. cit., p. 25.
125. Ibid.
BULLETIN OF ANESTHESIA H ISTORY
Ibid., p. 27.
Davy H: An account of a method of copying
paintings upon glass, and of making profiles, by the
agency of light upon nitrate of silver. Invented by T.
Wedgwood, Esq.] Royal IlIst 1 : 170-174, 1 802.
128. Lefebure M: Samuel Taylor Coleridge: A Bondage of Opium. New York: Stein and Day, 1974, p. 61.
129. Davy H, Researches. . ., op. cit., p. 478.
130. Lefebure, Humphry Davy. . ., op. cit., p. 95.
13 1 . Griggs, op. cit., 2:933-934.
132. Porter, Doctor of Society, op. cit., p. 1l0.
133. Porter, Patient's Progress, op. cit., p. 150.
134. Courteney WF: Young Charles Lamb
1775-1802. New York: New York University Press, 1982,
p. 1 3 0 .
135. Griggs, op. cit., 1:257.
126.
127.
136. Ibid., 2:670-71.
137. Ibid., 2:725.
138. Coleridge ST: Notebooks. New York: Pantheon
Books, 1957, 1:1098.
139. Davy J, Ed: Collected Works of Sir Humphry
Davy. London: Smith, Elder, 1 839-40, 9 vols., 1 : 1 52-153.
140. Griggs, op. cit., 2:397.
141. Ibid., 2:1028.
142. Fruman N: Coleridge, the Damaged Archan­
gel. New York: George Braziller, 1971, pp. 422-444.
143. Guest-Gornall R: Samuel Taylor Coleridge and
the doctors. Med Hist 17:327-342, 1973.
144. Ibid.
145. Hare AJC, Ed: Letters of Maria Edgeworth.
London: E. Arnold, 1894, 1:65-66.
146. Barry FV: Maria Edgeworth: Chosen Letters.
Boston: Houghton Ivlifflin, 1931, pp. 152, 360-364.
147. Southey: op. cit., p. 555.
148. Cottle J: Reminiscences of Samuel Taylor Cole­
ridge and Robert Southey. New York: Wiley and Putnam,
1847, p. 243.
149. Pritchard A, Ed: The Poetry ofHumphlY Davy.
Penzance: Penwith D.C., 1978.
150. Treneer A: The Mercurial Chemist: A Life of
Sir HumphlY Davy. London: Methuen, 1963.
151. Lefebure: op. cit., p. 95.
152. Weisenthal FE: The Literary Production of Sir
HumphlY DaV)� Ph.D. Dissertation, Wayne State Uni­
versity, 1975, pp. 157-158, 178-179, 252.
153. Lefebure, op. cit., p. 95.
1 54. Weisenthal, op. cit., pp. 1 15-138.
155. Knight DM: Scientist as sage. Stud Romanti­
cism 6(2):65-88, 1967.
156. Davy J: op. cit., 1:441.
157. Sharrock R: The chemist and the poet: Sir
Humphry Davy and the preface to Lyrical Ballads.Notes
ofthe Royal Society ofLolldoI1 17:57-76, 1962.
158. Weisenthal, op. cit., pp. 53-55.
159. Ibid., pp. 139-155.
160. Beddoes T: Notice of some Observations Made
at the Medical Pneumatic Institution. Bristol: Longman
and Rees, 1799, pp. 26-27.
161. Cottle, op. cit., pp. 199, 201.
162. Polwele R: Biographical Sketches in Cornwall.
Truro: Nichols, Longmans, 1831, pp. 22-31.
163. Emblen, op. cit., p. 44-45.
164. Ibid., pp. 66-88.
165. Roget PM: Explanation of an optical decep­
tion in the appearance of the spokes of a wheel seen
through vertical apertures. Phil TrailS Roy Soc
115 : 131-140, 1825.
. 166. RogetPM: Beddoes. Supplement to the Fourth,
FIfth, and Sixth Editions of the Encyclopedia Britannica,
Edinburgh. 2:206-21 0, 1824.
167. Robinson, op. cit., p. 306.
168. Ibid., pp. 309-310.
169. Ibid., pp. 31 1-312.
1 70. Davy H: Researches. . ., op. cit., pp. 516-517.
171. Hoover SR: Coleridge, HumphlY Davy, and
SOme early experiences with a consiousness-altering
drug. Bull Res HI/manit 81:9-27, 1978.
172. Griggs, op. cit., 2:727.
1 73. Ibid., 1:612.
174. Ibid., 1:605.
175. Davy H, Researches . . ., op. cit., p. 534.
. 176. O'LeaIY P: Sir James Mackintosh: The Whig
Cicero. Aberdeen: Aberdeen University Press, 1989.
177. Griggs, op. cit., 2:770-771 .
1 7 8 . Ibid., 1:588.
179. Ibid., 2:931, 1016, 1041.
180. Robinson and McKie, op. cit., pp. 310, 315.
181. Coates C: The HistOlY and Antiquities ofRead­
ing. London: J. Nichols, 1802.
182. Wansey H: The Journal of an Excursion to the
United States of North America, in the summer of 1794.
Salisbury: J. Easton, 1796.
183. Hammick SL: Practical Remarks on Amputa­
tions, Fractures, and Strictures of the Urethra. London:
Longman, 1830.
1 84. Kinglake R: A Dissertation on Gout. London:
J. Murray, 1804.
185. Smith GM: A History of the British Royal In­
firmary. Bristol: J. \v, Arrowsmith, 1917, pp. 125, 276-277.
186. Davy H, Researches. . ., op. cit., pp. 497-502.
187. Mantell DLB: The Dramatic Poetry and The­
atrical Interests of William Wordsworth, 1795-1805.
Ph.D. dissertation, Emory University, 1980.
188. Fullmer JZ: Sir Humphry Davy's Published
Works. Cambridge, Massachusetts: Harvard University
Press, 1969, p. 47.
189. Davy H: Researches. . ., op. cit., p. 544.
190. Ibid., p. 501.
191. Ibid., pp. 488-489.
192. Stansfield DA, Stansfield RG: Thomas Bed­
does. . ., op. cit., p. 279.
193. Jones HB: The Royal Institution: Its Founder
and Its First Professors. London: Longham, 1871, p. 323.
194. Priestley J: Singular effects ofgaseous and oxyd
of Septon (dephlogisticated nitrous air). MedicalReposi­
to/y 3:305, 1 800.
195. Smith EF: James Woodhouse: a Pioneer in
Chemislly, 1770-1809. Philadelphia: Winston, 1918, pp.
200-201.
196. Barton WPC: A Dissertation on the Chymical
Properties and Exhilarating Effects of Nitrous Oxide
Gas; and its application to Pneuma tick Medicine. Phila­
delphia: Printed for the author at the Lorenzo Press, 1808.
197. Ibid., pp. 3, 5 1 .
198. Ibid., p. 57.
199. Smith WDA: Under the Influence: A HistOlY
of Nitrous Oxide and Oxygen Anaesthesia. Park Ridge,
Ill: Wood Library-Museum of Anesthesiology, 1982, pp.
29-41 .
200.
Knight \'\1, Ed: Letters of the Wordsworth Fam­
ily from 1787 to 1855. 3 vols. New York: Haskell House,
1969, 1 : 1 l4-116, 123-124.
201. Griggs, op. cit., 1 :606.
202. Moorman M, Ed:
Journals of Dorothy
Wordsworth. London: Oxford University Press, 1971, p.
32.
203. Keys TE: The HistOlY of Surgical Anesthesia.
1945. Rep: Huntington, New York: Kriegel; 1978, pp.
14-17.
204. Duncan BM: The Development of Inhalation
Anaesthesia. London: Oxford Unviersity Press, 1947, pp.
51-76.
205. Cartwright FF: The English Pioneers of Ana­
esthesia (Beddoes, Davy, and Hickman). Bristol, John
Wright, 1952, pp. 49-240.
206. Davy H, Researches . . ., op. cit., p. 556.
207. Bergman NA: Humphry Davy's contribution
to the introduction of anesthesia: a New Perspective.
Perspect Biol iVIed 34: 534-541, 1991.
208. Beddoes T, Notice. . ., op. cit., p. 26.
209. Southey CC: op. cit., p. 1 13.
210. Davy H, Researches. . ., op. cit., p. 577.
2 1 1 . Papper EM: Pain, Suffering and Anesthesia in
the Romantic Period. PhD. dissertation, University of
Miami, 1990, pp. i-ii.
212. Griggs, op. cit., 1 :648.
213. Porter, Doctor of Society, op. cit., p. 189.
214. Beddoes T and \'{Tatt J, Considerations..., op.
cit., pt. 3, pp. 177-178.
215. Golinski J: Science as Public Culture: Chem­
istry and Enlightenment in Britain, 1760-1820. Cam­
bridge: Cambridge University Press, 1992, p. 158.
216. Ibid., p. 10.
217. Ibid., p. 166.
218. Gill S: William Wordsworth; A Life. Oxford:
Clarendon Press, 1989, p. 412.
21
Etymology Corner
by Massimo Ferrigno, M.D.
This corner is dedicated to the etymology
(origin) of medical terms, and it is also an ex­
cuse to talk about mythological and historical
figures. In this issue we will talk about "opio­
ids".
The word "opium" derives from the ancient
Greek 01tOS (opos, which means juice) and in
fact opium (also called tears, or lacrimae of
poppy) is a sap obtained from the Papaver
sOlllnijiml1ll (which in Latin means "poppywhich
induces sleep"). Substances obtained from
poppy plants have been used to relieve pain since
ancient times in various cultures, including the
Assyrian (the Bronze Age kingdom in a region
that now belongs to Iraq), the Egyptian and the
Greek civilizations. According to Prof. Gualtiero
Bellucci,1 the technique to obtain juice by cut­
ting the unripe seedpod of the poppy plant was
first described in the Greek world by Diagoras
of Melos. Howevel; Diagoras, who lived in the
5th centmy BC and was active as a lyric poet in
Athens, became famous for another reason: his
atheism, even ifno trace ofatheism can be found
in his surviving poems. The Greek poet Homer,
in book 4, 221 of the Odyssey (probably written
in the second half of the 8th centmy BC), talks
of a medication called Vll1t£vt}llS (nepenthes)
which means against pain and which, dissolved
in wine and drunk by a sick person, could alle­
viate all sorts of pains. It is thought by many
scholars that nepenthes was actually a substance
derived from the poppy plant. In the same epic,
the witch Circe (who transformed a grOlip of
Odysseus' men into pigs, and who was prob­
ably the first feminist in history) used a potion
containing wine, acid milk, white flom; honey
and "a juice" (which may have been opium) to
make Odysseus forget his beloved countly. Fi­
nally, opium may have also been used by Helen
(the daughter of Zeus whose abduction caused
the Trojan War) to prepare a potion "which
quenches pain and strife and bring forgetful­
ness of every ilL"
In his other epic, the Iliad, Homer used two
other words which have relevance to "opioids".
The first one is the verb V<XPK<Xo) (narkao, book
8, 328) which means to become torpid. The sec­
ondword is Kco&l<X O<odeia, book 14, 499) which
means head or capsule of the poppy, and which
must have inspired the French physician
Pierre-Jean Robiquet (1780-1840) who isolated
codeine in 1 832. A year earlier, in 1 831, the Ger­
man pharmacist Friederich Wilheim Serturner
(1783-1821) had won the Monthyon Award from
the Academy of Sciences ofParis for having iso­
lated morphine.
The word morphine derives fromMorpheus,
found in book II, 633-8 of the Metamorphoses
Continued 011 Page
23
22
BUllETIN O F ANESTHESIA H ISTORY
Edwin Sterling Munson - 1 933- 1 997
Edwin Munson was born on December 29,
1933, in Akron, Ohio.
After attending Memphis State Univer­
sity he went on to medical school at the Uni­
versity ofTennessee, Memphis branch, receiv­
ing his M.D. in 1957.
After an internship at the University of
Iowa Hospital, he became a resident in the
Department of Anesthesia in 195 8-59. He
then entered military service, serving as a
Lieutenant, Medical Corps, at the U.S. Na­
val Hospital in Newport, Rhode Island, from
1960-1962.
In 1964 he was an NIH trainee in the
Department of Anesthesia at the University
of California, San Francisco, following which
he was a Clinical Instructor and then an As­
sistant Professor until 1967 . In 1967 he moved
to the University of California, Davis, where
he was an Assistant and then Associate Pro­
fessor of Anesthesia until 1971.
He then moved to Florida where he was
Professor of Anesthesiology and Director of
Research Training at the University of Florida
College of Medicine from 1 971-84.
Ed continued his teaching and academic
career by becoming Professor and Chairman
of the Department of Anesthesiology at the
University of Kentucky from 1984-86. In 1986
he moved to Ohio where is was Professor and
Vice-Chairman in the Medical College of
Ohio in Toledo, where he served for one year.
In 1988 he was appointed a Staff Anes­
thesiologist at the Jewish Hospital of Cincin­
nati and in 1992 became a Volunteer Profes­
sor of Clinical Anesthesiology at the Univer­
sity of Cincinnati College of Medicine. In
1 994, Ed and his wife, Priscilla, retired to
Cochiti Lake in New Mexico.
Extracurricular medical activities kept
Munson busy. For a number of years he
served in numerous Committees of the A.S.A.
and for several years was an Associate Exam­
iner of the American Board of Anesthesiol­
ogy. He was elected to the Board of Trustees
of the International Anesthesia Research
Society from 1 972-78.
Among other appointments, he served on
the Editorial Board of the journal Anesthesia
and Analgesia from 1972-78 and of the jour-
nal Anesthesiology from 1980-86, and was a
consultant to the World Book Encyclopedia
from 1983-90.
Throughout his academic career, to which
he remained true to the precepts of teaching
and research, Ed authored or co-authored
over 92 papers which were published in peer­
reviewed journals.
Despite his active and varied professional
career, Ed found time to indulge in hobbies.
As a musician, playing both trombone and
piano, he was a member of numerous jazz
bands throughout his life and composed over
70 songs. While living in Florida, he hosted
a radio program which played "Jazz on the
Quiet Side."
Ed was also an accomplished bridge
player, and in his later years, a major interest
of Ed's was his extended family organization,
the Thomas Munson Foundation, in which
he served as President and Scholarship Chair­
man.
D r. Munson is survived by his wife
Priscilla, four daughters and two sons.
Intravenous Ether Anesthesia.
Personal Experiences
by Edwin S. Munson, M.D.
I read with interest the fascinating report of
Drs. Goerig and Schulte am Eschl concerning
the development of intravenous [diethyl] ether
anesthesia. The authors concluded their remarks
by saying, "During the 1930s, enthusiasm for
the intravenous ether infusion technique
waned." This was due, in part, to the introduc­
tion of the ultrashort-acting barbiturates into
clinical practice. In addition, it also was the time
of the rapid development of other anesthetic
techniques and drugs such as cyclopropane, the
muscle relaxants and later the more potent flu­
orinated inhalation agents.
During my research training at the Univer­
sity of California, San Francisco, in the early
1960s, I was involved in numerous laboratOlY
and clinical studies of anesthetic solubility, up­
take and distribution, and potency and became
aware of the potential clinical use of IV ether: I
would like to point out an additional and more
recent reference by Eger et al.2 regarding the
uptake and distribution of intravenous ether.
This work reported the rate of administration
of intravenous ether in 13 healthy young adult
patients required to maintain a constant EEG
level ofanesthesia (level 4) that had been shown
by Courtin et aU and Faulconetl to represent
an arterial concentration ofroughly 100 mg. per
cent ethel; or a 2.3 per cent alveolar ether con­
centration.
In the mid-1960s I had the opportunity at
the University ofVirginia to administer IV ether
to a dozen or so healthy adult patients who were
scheduled for direct lalyngoscopy. The Chair­
man of the Department of ENT, the late Dr.
Slaughter Fitzhugh, had made a definite deci­
sion to perform this procedure under general
anesthesia without the use of an endotracheal
tube. Since neither external ventilators nor jet
ventilator systems were available, I suggested
the use of IV ether.
The technique consisted of preparing 3 li­
ters of a 5 per cent diethyl ether solution, using
refrigerated Ringer's Lactate solution so as to
increase the solubility of the ether. (This point
is contrary to the suggestion in the historical
reportl that aqueous solutions should be
warmed.) Patients were premedicated with at­
ropine, morphine and pentobarbital. Following
. induction of anesthesia with thiamylal, the IV
ether solution was administered at a rapid rate
and then was slowed as an adequate depth of
anesthesia was obtained. The usual volume of
ether solution used was between 1500 and 2500
ml. The rate ofIV ether administration has long
since been forgotten. Howevel; I recall that the
use of a 16 g. IV needle, an assistant to manage
the fluid administration and the positioning of
the IV bottle(s) at the highest point in the room
were necessary factors to assure a rapid and
smooth induction of ether anesthesia.
The anesthetic technique also used a stan­
dard circle absorption system with equal parts
of nitrous oxide and oxygen set at relatively low
flows in order to facilitate a high degree of
rebreathing. The gases were administered via a
face mask. When the signs of anesthesia showed
that an adequate level of anesthesia had been
obtained, the face mask was removed and the
surgeon inserted the laryngoscope, examined the
larynx and performed the necessalY biopsy. In
order to avoid eye irritation from the strong con­
centration of exhaled ether vapor, the surgeon
wore plastic eye covers. During the procedure,
the IV ether solution was continued at a rate
necessary to maintain an adequate level of an­
esthesia. When the procedure was completed,
the anesthetic solution was discontinued and
the patient allowed to recover breathing rooUl �
.
Comillued all Next Page
=
BULLETIN OF ANESTHESIA HISTORY
Lundy. .
. Cominlledji'olll Page 15
Published: St Louis: Mosby, 1933
Edition: 5th ed.
Author: Hewitt,Frederic William
Title: Anaesthetics and their administration:
A text-book
published: New York: Macmillan, 1912
Edition: 4th ed.
Author: Jackson, Charles T.
Title: A manual of etherization
Published: Boston: I-E. Mansfield,1861
Notes: Book signed by the publisher JB
Mansfield and JS Lundy 1942
Author: Kahle, Paul
Title: Anasthaesis in the Arabic medicine
Author: Labat, Gaston
Published: London: HK Lewis, 1944
Mayo
Author: Nosworthy, M.D.
Published: Philadelphia: WB. Saunders,
1923
Notes: One copy signed by Frank Hammond
sia
Knusen to JS Lundy 1-46 and another book
1935
Title: The theOlY and practice of anaesthe­
Published: London: Hutchinson scientific,
signed by RG Spurling 8-7-25
Added Entries: Mayo, William INote: Collection contains 4 vol.(1923) of the
book
Author: Patton, Joseph McIntyre,1860Title: Anaesthesia and anaesthetics, general
and local,for practitioners and students of medi­
cine and dentistty
Author: Lyman, Hemy M.
Title: Artificial anaesthesia and anaesthetics
Published: Chicago: Cleveland Press, 1911
Edition: 3rd ed.
Published: New York: William Wood,1881
Notes: Book signed by CT Gale of New
Author: Poe, James G.
Brighton, PA on July 6,1882
Title: Modern general anesthesia: a practi­
cal handbook
Author: Marks, Jan
Description: 19 p. 2 letters
Notes: Bound histOlY of anesthesia in Ara­
Title: Doctor PurgatOlY
PaulA.Kahle,of Baroda House Kensington Pal­
Title: Regional analgesia
Title: Regional anesthesia: its technic and
clinical application / foreword by William I­
Published: London: 1951
bic medicine prepared by Chester A. Beatty and
Published: Philadelphia: Davis, 1926
Published: New York: Citadel, 1959
Notes: Book signed by JS Lundy on 5-19-61.
Pre-1959 donation
Author: Probyn-Williams, Robert James
Title: A practical guide to the administra­
tion of anaesthetics
ace Gardens, London, England, for John S.
Lundy in 1941.Also included are two letters
between JS Lundy and CA Beatty addressing
possible U.S. participation in World War II.
Added Entries: Lundy, John S., 1894-1973;
Beatty, Chester A.
23
Published: New York: Longmans, Green,
Author: Maurel; David W
Title: Narcotics and narcotic addition
David WMaurer and Victor H.Vogel
1909
Edition: 2nd ed.
/
Published: Springfield, IL: Thomas, 1954
Author: Rapel; Howard Riley
Added Entries: Vogel, Victor H.
Title: Man against pain: the epic of anesthe­
Note: Pre-1959 donation
sia
Author: Kidd, Charles
Title: On aether chloroform
Author: Mead, Sterling Vernon
1947
Published: London: Renshaw,1858
Edition: 2nd ed.
Published: St.Louis: Mosby, 1935
Published: New York: Prentice Hall Press,
Title: Anesthesia in dental surgely
Notes: Book signed by the author to JS
Lundy on 12-22-48
Notes: Book signed by JS Lundy, 1940
Author: Molesworth, H.WL.
Personal.
Continued Oil Next Page
Etymology. .
. . Continlled /1'0111 Page 22
. Continlled ji'01ll Page 21
ail; supplemented with a few liters per minute
of oxygen.
the use of IV ether in any other clinical circum­
(an epic written by the Latin poet Ovid, 43
stances.I am pleased to have had this experi­
BC-AD 17).Morpheus was one of the sons of
None of the patients experienced any adverse
ence and to make this small contribution to the
histOlY of IV ether anesthesia.
effects related to the administration of ether and
the surgeon was satisfied with the technique.
The potential problems with IV ether anesthe­
sia are those related to the rapid administration
of large volumes of cold intravenous fluids,
namely, pulmonaty edema, central core hypo­
thermia and cardiac depression.Of course,elec­
trocautelY had to be avoided and the surgeon
and operating personnel accepted the added
time necessalY for induction and recovery from
anesthesia.
Acceptance of this technique was short-lived
due to the inexperience of others to produce
adequate surgical working 'conditions without
having some of the complications listed above.
In addi tion, the introduction of jet ventilation
and apneic oxygenation techniques gradually
replaced the use of IV ether.I am not aware of
References
1. Goerig 1"1, Schulte am Esch J. Historical remarks
regarding intravenous ether anesthesia. Bull Anesthesia
HistOlY 14:1, 1996.
2.
Eger El, Johnson EA, Larson Cp, Severinghaus
J\'v. The uptake and distribution of intravenous ether.
Anestliesiology 23:647, 1962.
3. Courtin RF, Bickford RG, Faulconer A. Classifi­
cation and significance of electro-encephalographic pat­
terns produced by nitrous oxide-ether anesthesia dur­
ing surgical operations. Proc Mayo Clin 25:197, 1950.
4. Faulconer A. Correlation of concentrations of
ether in arterial blood with electro-encephalographic
patterns occurring during ether-o),'j'gen and during ni­
trous oxide, o),'j'gen and ether anesthesia of human sur­
gical patients. Anestliesi% gy 13:361, 1952.
the God of Sleep in the Greek mythology named
Y nvo� (hypnos, from which the terms hypnotic
and hypnosis are derived). The winged
Morpheus spent his time flying around the
world and inducing sleep by touching the mor­
tals with a poppy flower. He also induced
dreams, during which he appeared as a human
being. The poet Ovid also talked about the
"Lethe", the infernal river where the souls of
the dead people went to drink in order to forget
their past.Virgil, an earlier Latin Poet (70-19
BC),had described the "Lethaea papavera ",that
is, the poppies of the river Lethe and this led to
the adjective "Lethaeus " to describe the effects
of opium. The term "Leatheon" was also used
by William Morton when he was Hying to keep
the true nature of his discovery a secret.
I. Bellucci G. Storia della Allestesi% gia (in Italian).
Published by Piccin Editore, Padova, Italy, 1982; pp
21-26.
24
BULLETIN OF ANESTHESIA HISTORY
Lundy.
.
. COIllilluedfi'olll Page 23
Author: Rice, Nathan P.
Title: lhals ofpublic benefactor, as illustrated
in the discovery of etherization
Published: New York: Pudney & Russell,
1858
Notes: Book signed by John l May January,
1 898
Author: Sansom, Arthur Ernest, 1839-1907
Title: Chloroform; its action and adminis­
tration
Published: Philadelphia: Lindsay &
Blakiston, 1 866
Author: Schleich, Karl Ludwig, 1859-1922
Title: Schmerlose Operationen; oertliche
Betaubung mit indifferenten Flussinkeiten
Psychopysik des naturlichen und kunstlichen
Schlafes
Published: Berlin: Springer, 1894
Language is German
Author: Schmidt, Jacob Edward
Title: Narcotics: lingo and lore
Published: Springfield, IL: Thomas, 1959
Note: Pre-1959 donation
Author: Sherwood-Dunn, B.
Title: Regional Anesthesia
Published: Philadelphia: RA. Davis, 1920
Author: Smith, Arthur E.
Title: Block anesthesia and allied subjects
Published: St Louis: Mosby, 1920
Notes: Book signed by Sigel Roush, MD,
DDS, May 20, 1922
Author: Smith, Truman, 1781-1884
Title: An examination ofthe question ofana­
esthesia, arising on the memorial of Charles
Thomas Wells, presented to the United States
Senate, second session, Thirty-second Congress,
and referred to a Select committee, ofwhich the
Hon. Isaac P. Walker is chairman
Published: New York: Gray, 1 859
Notes: Book signed by LL Paddock
Added Entries: Wells, Horace, 1815-1848
Author: Smith, Truman, 1781-1884
Title: An inquity into the origin of modern
anaesthesia
Published: New York Hartford, Brown &
Gross, 1 867
Notes: Book signed: with respect GQ Colton.
Originally published in part in the Medical and
Surgical Reporter, Philadelphia, under the title:
A lover of truth and justice
Author: Snow, John, 1813-1858
Title: On chloroform and other anesthetics,
their action and administration / John Snow;
edited with a memoir ofthe author by Benjamin
W Richardson
Published: Chicago: Wood-Libraty Museum
of Anesthesiology, 1950
Notes: Signed by JS Lundy 5-19-51 . Reprint
by the Wood Library-Museum of Anesthesiol­
ogy
Author: Snow, John, 1813-1858
Title: On the inhalation of the vapour of
ether: containing a statement of the result of
nearly eighty operations in which ether has been
employed in St George's and University Col­
lege hospitals
Published: Boston: Boston Medical Library,
1946
Notes: Reprint of the 1847 original by the
Boston Medical Library in 1947. Book is signed
by JS Lundy and annotated as being used in
Portugal in an exhibit at the century celebra­
tion of ether.
Author: Taylor, Frances Long
Title: Crawford W Long & the discovery of
ether anesthesia / Frances Long Taylor; fore­
word by Francis R. Packard
Published: New York Hoeber, 1928
Added Entries: Packard, Francis R.
Author: Walton, Robert Petrie
Title: Marihuana: America's new drug prob­
lem: A sociologic question with its basic expla­
nation dependent on biologic and medical. . .
Published: Philadelphia: Lippincott, 1938
Note: Pre-1959 donation
Author: Willard, De Forest
Title: Artificial anaesthesia and anaesthetics
Published: Detroit: G.S. Davis. 1 891
Bulletin of Anesthesia History
C . Ronald Stephen, M.D., C.M., Newsletter Editor
1 5 8 0 1 Harris Ridge C ourt
"
Chesterfield, MO 630 1 7 U.S .A.
American Society of Anesthesiologists
520 N. Northwest Hig hway
Park Ridge IL 60068-2573
RECEIVED
OCT
-8
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1997