Journal of the History of Medicine and Allied Sciences
For nearly a century, sodium pentothal was the undisputed king of anesthetics. Anesthesiologists ... more For nearly a century, sodium pentothal was the undisputed king of anesthetics. Anesthesiologists were not, however, the sole consumers of pentothal, as psychiatrists used it to treat acute anxiety during psychoanalysis. The associated drug-induced inhibitions were attractive not only to psychotherapists, but also to a new generation of policing and Cold War espionage searching for the elusive truth serum. Cameo appearances of pentothal in media, film, and popular culture propagated the anesthetic’s negative public image. While legal challenges to the admissibility of pentothal-induced confessions and congressional investigations of clandestine truth serum programs may have tainted the popular anesthetic, it was pentothal’s widespread adaptation as part of the lethal injection cocktail that finally killed the king of anesthetics as pharmaceutical companies around the world refused to manufacture what had been transformed into a largely unprofitable drug, associated with capital punis...
Introduction: Hartford, capital city of Connecticut was where Horace Wells conducted most of his ... more Introduction: Hartford, capital city of Connecticut was where Horace Wells conducted most of his work on the only anesthetic gas still used in clinical practice since the 19th century – nitrous oxide. Wells was born and raised in Hartford, Vermont, studied dentistry in Boston and established his practice in Hartford, Connecticut. Various icons celebrating Wells' unique contributions in discovering the analgesic properties of nitrous oxide are located throughout this city. Materials and Methods: We consulted staff at Connecticut Historical Society (CHS) and at Hartford Medical Society to help identify sites and artifacts in Hartford that honor Horace Wells. Thereafter, we visited and studied each of these sites. Results: In 1847, Wells wrote a pamphlet titled 'History of the Discovery of the Application of Nitrous Oxide Gas, Ether and Other Vapors to Surgical Operations.' (Fig. 1). In 1907, the Spanish Dental Society honored Wells by awarding the city of Hartford a silver...
We report another technique of transcranial magnetic stimulation (TMS) for exciting the originati... more We report another technique of transcranial magnetic stimulation (TMS) for exciting the originating cells of the descending corticospinal tract. Acap shaped TMS coil has been described for simultaneously exciting muscles in all four extremities. This TMS coil is useful for monitoring the functional integrity of the descending motor paths during spinal cord surgery, because information regarding the integrity of both the left and right sides of the spinal cord motor paths can be obtained concurrently. Despite the improved design of the cap coil, careful placement is required for achieving bilateral spinal cord motor responses. Cortical mapping was used to identify the optimum scalp foci for the muscles studied. The cap coil must overlap these foci to simultaneously elicit compound muscle action potentials (CMAPs) in all four extremities. Increasing TMS stimulation intensitywill increasethemagnitudeoftheacquired CMAPs responses without significantly changing latency.
The effects of lidocaine (25,50 and 100 μg/ml) and bupivacaine (5,10, and 20 μg/ml) on amplitude,... more The effects of lidocaine (25,50 and 100 μg/ml) and bupivacaine (5,10, and 20 μg/ml) on amplitude, velocity, and contraction frequency were studied in monolayer cultures of spontaneously beating chick embryo ventricular cells. The physiologic parameters of contraction frequency, amplitude, and velocity of shortening were measured with an optical-video system. Studies were also carried out in the presence of 1μM tetrodotoxin (TTX) to isolate effects caused by TTX-sensitive ion channel blockade from other possible mechanisms of action of local anesthetics. Lidocaine and bupivacaine produced concentration-dependent, reversible decrements in contraction frequency, amplitude, and velocity of contraction. Bupivacaine demonstrated a 5-fold higher potency for depression of contractile properties than lidocaine. At a high concentration, bupivacaine (20 μg/ml) produced significantly more depression in all three measured parameters than did lidocaine (100 μg/ml). In the presence of predominantl...
BACKGROUND In 1970, Harold James Charles Swan and William Ganz published their work on the pulmon... more BACKGROUND In 1970, Harold James Charles Swan and William Ganz published their work on the pulmonary artery catheter (PAC or Swan-Ganz catheter). They described the successful bedside use of a flow-directed catheter to continuously evaluate the heart, and it was used extensively in the years following to care for critically ill patients. In recent decades, clinicians have reevaluated the risks and benefits of the PAC. AIM We acknowledge the contributions of Swan and Ganz and discuss literature, including randomized controlled trials, and new technology surrounding the rise and fall in use of the PAC. METHODS We performed a literature search of retrospective and prospective studies, including randomized controlled trials, and editorials to understand the history and clinical outcomes of the PAC. RESULTS In the 1980s, clinicians began to question the benefits of the PAC. In 1996 and 2003, a large observational study and randomized controlled trial, respectively, showed no clear benefits in outcome. Thereafter, use of PACs began to drop precipitously. New less and noninvasive technology can estimate cardiac output and blood pressure continuously. CONCLUSIONS Swan and Ganz contributed to the bedside understanding of the pathophysiology of the heart. The history of the rise and fall in use of the PAC parallels the literature and invention of less-invasive technology. Although the PAC has not been shown to improve clinical outcomes in large randomized controlled trials, it may still be useful in select patients. New less-invasive and noninvasive technology may ultimately replace it if literature supports it.
Journal of Education in Perioperative Medicine, 2014
History of medicine does not receive the coverage it deserves in medical school curricula, or dur... more History of medicine does not receive the coverage it deserves in medical school curricula, or during graduate medical training, in part, because of its lack of impact on direct clinical care. This is particularly disturbing for the specialty of anesthesiology not only due to its colorful history, but also because ours is the only major medical discipline to have developed entirely in the United States. We examine four commonly cited reasons for the study of history in general, and comment on whether these lessons are applicable to medicine and anesthesiology. We provide compelling reasons why studying history is important to clinicians. Background: Humans are the only species to be aware of their past. Our future is largely unknown, and the present is fleeting. Thus, almost everything that is known with certainty falls within the realm of history. Thus one would expect society at large, and physicians and anesthesiologists in particular, to be history enthusiasts. As the facts suggest otherwise, one wonders whether history is regarded much like art, music, and fine cuisine-more adornment than an essential and integral part of education in any discipline, especially medicine.
We identified nearly 180 Black women who earned medical degrees prior to the start of the Second ... more We identified nearly 180 Black women who earned medical degrees prior to the start of the Second World War and found information regarding their family and social connections, premedical and medical educations, and internship experience or lack thereof for many of these women. Through their collective history, we observed large-scale trends, especially regarding the importance of “separatist” medical education and declining medical school attendance among African American women in the 1910s as medicine became an increasingly exclusionary profession. While our research uncovered trends specific to Black women physicians, the implications of our research can be applied far more widely to other historically marginalized scientific practitioners. This research reminds us of the longstanding and shifting presence of Black women in science and medicine, despite the enduring popular belief that white men represent who participates in science, both historically and today.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
To determine the anesthetic techniques used and who provided the anesthetic care. To see what les... more To determine the anesthetic techniques used and who provided the anesthetic care. To see what lessons were learned during this 3 month period and what changes were made when the unit returned in 1917. Resources: The journals of Elliott Cutler and Harvey Cushing provide details of daily life. A photo album by Virginia Martin documented scenes of the unit while deployed. The records of 441 patients treated by the unit.
From the advent of the use of anaesthesia during surgery through the Second World War, confusion ... more From the advent of the use of anaesthesia during surgery through the Second World War, confusion and competition over who should administer the technology – doctors or nurses – dominated gendered discussions of professional boundaries. Using information about practice in the United States, the United Kingdom, and France in this period, we find vastly different outcomes for nurse-administered anaesthesia. Differences in perceptions regarding the gendered nature of this technology and its related level of prestige largely determined who could practice it. When administering anaesthesia carried low prestige and was viewed as non-technical, it fell under the purview of women’s work in medicine, that is, nursing. When the same technology gained prestige and became perceived as a technical, medical skill, doctors associated it with their masculine professional identity and worked to exclude nurses from administering anaesthesia.
I n America, the task of giving the patient a "whiff" of ether or chloroform during surgical proc... more I n America, the task of giving the patient a "whiff" of ether or chloroform during surgical procedures was often left to junior house officers, nurses, medical students, orderlies, or individuals with no medical training. Harvard medical students Harvey Cushing (1869-1939) and Ernest Amory Codman (1869-1940) were required to do their share of "anesthesia duty" in the mid-1890s. Death under anesthesia was not uncommon, and in some instances, the surgical procedure would be continued despite the patient's death to maximize the learning opportunity. 1 During one fateful operation, Cushing's patient died during anesthesia, an event that greatly affected him and even led him to question his career choice. 2,3 However, instead of succumbing to despair, he and fellow medical student Codman began keeping accurate records during anesthesia. Their motivation for this action is not known, although Cushing writes that he was instructed to do so by the chief of surgery. In the process, these 2 medical students made a lasting contribution to a medical specialty that had not yet been born. They kept anesthesia records for more than 100 surgical procedures, which are now the property of Massachusetts General Hospital (MGH) and are preserved at the Francis A. Countway Library. 4 Every anesthesia record in this collection was examined for this study, and never before have they been subjected to the detailed analysis we offer: their notes, comments, drugs administered, and vital signs recorded. There is no indication that other students or house officers continued to maintain anesthesia records after Cushing and Codman. Later in their distinguished careers, these physicians continued to make major contributions to the safety and improved outcomes of surgical procedures.
Treatment guided by data from pulmonary artery (PA) catheters was intended to help optimize cardi... more Treatment guided by data from pulmonary artery (PA) catheters was intended to help optimize cardiac performance and improve outcomes; however, not every medical advance meets initial expectations. Regardless of their ultimate impact and clinical utility, PA catheters helped define the field of modern critical care medicine. They enabled diagnostic differentiation of the various causes of shock states and often were used in conjunction with arterial lines and potent vasoactive drugscontributing to the creation of specialized intensive care units (ICUs). This article reviews the history of PA catheterscolloquially known as SwanGanz cathetersand how they helped shape modern critical care medicine. Cardiac Critical Care Before the PA Catheter The battlefield experience of World War I led to great interest in understanding the physiology of traumatic shock, whereas the concept of the postoperative recovery room was developed during World War II (1). Later, specialized surgical units were created for patients recovering from open-heart surgery (1). The coronary care unit concept, as it currently is conceived, was proposed in 1961 by Morris Wilburne, and the first such unit was established at Bethany Hospital in Kansas City in 1962 (2). Several earlier developments offered promising improvements in treating cardiovascular conditions but necessitated specialized units to allow close monitoring (2). In 1948, Raymond Ahlquist clarified and reported the mechanism of action of adrenergic agents, prompting their widespread use in the 1950s and 1960s (3). In 1956, Paul Zoll reported on the use of 2 closed-chest technologiesthe external defibrillator and pacemakerto treat cardiac arrest (2). In 1960, William Kouwenhoven and a team at Johns Hopkins University reported an early version of modern, closed-chest CPR (2). With these new technologies, monitoring and treating cardiac conditions, such as congestive heart failure and acute myocardial infarction, changed dramatically, requiring units in which treatments could be administered with continuous monitoring and close observation. Catheterization Before Swan and Ganz In 1870, Adolph Fick (18291901) suggested a principle for measuring cardiac outputaiming to quantify heart failure beyond clinical symptomologythat came to bear his name (4). His simple and elegant technique for directly measuring arterial (PA) and venous (pulmonary vein) oxygen content remains the gold standard for calculating cardiac output. Although arterial and central vein cannulations had been used previously, cardiac performance had been assessed only on the basis of clinical history and radiographic examination at the time (5). Although Fick did not measure cardiac output in animals or humans, his concept was explored during the next 7 decades. In 1929, Werner Forssmann introduced the idea of cardiac catheterization by threading a flexible ureteral catheter through his own basilic vein into his right atrium (6). He had convinced an operating room nurse, Gerda Ditzen, to allow him to do the experiment on her but surreptitiously cannulated his own vein while she was on the operating table (7). Another nurse, who is known only as Eva, captured fluoroscopic images (7, 8). Forssmann's report on these findings in Klinische Wochenschrift drew significant criticism from the media, because he had not received permission to carry out the experiment, and ultimately led to his dismissal from Auguste-Victoria-Heim hospital in Eberswalde, Germany. Although considerable skepticism surrounded his nontraditional methology, his results captured the attention of the cardiology community (1, 7). The 1940s saw substantial progress in the spread of cardiac catheterization. In 1941, Andre Cournand and Hilmert Ranges reproduced Forssmann's method at Columbia University (9), and a year later, Cournand and Dickinson Richards estimated cardiac output by using the oxygen content of mixed venous and arterial blood samples (10). For these contributions, Forssmann, Cournand, and Richards were awarded the Nobel Prize in Medicine or Physiology in 1956. In 1944, Alfred Blalock (18991964), a surgeon at Johns Hopkins, was the first to diagnose tetralogy of Fallot using catheterization (9). This breakthrough led to developments in pressure transducers, instruments to measure oxygen saturation in blood, and dye injection techniques to study intracardiac shunts (9). The Mayo Clinic Board of Governors established the nation's first cardiac catheterization laboratory in 1947 (1). Early reports described the technique's utility in diagnosing atrial and ventricular septal defects, patent ductus arteriosus, and pulmonary stenosis; moreover, it made it possible to determine oxygen saturation and pressures in major vessels and cardiac chambers (1). In 1947, Lewis Dexter developed a technique to wedge the tip of a cardiac catheter into the small branches of the PA (11, 12). Earl H. Wood used this method to prove that pressures in the PA were…
One of the most famous (or infamous) narratives in the Old Testament is that of Adam and Eve. The... more One of the most famous (or infamous) narratives in the Old Testament is that of Adam and Eve. The ancient scriptural account in Genesis of the disobedience of humankind's first parents has been central to Western society's explanations of the introduction of sin into the world. Of particular concern has been the punishment for sin (here, eating forbidden fruit) that God gave to Eve (who sinned first in the Garden of Eden), namely, the experience of pain in childbirth: "In pain you shall bring forth children" (Genesis: 3:16). This narrative has been dissected many times throughout the centuries, finding its way into religious, artistic, and medical works. For instance, in the sixteenth century, Protestant reformer Martin Luther (1483-1546) extolled the plight of women in childbirth: "If Eve had not sinned, she would not only have given birth without pain. .. This punishment, too, springs from original sin."[1-3] Elsewhere the reformer described such pain as "a happy and joyful punishment" which serves women as a means to combat evil.[1] Centuries later, Scottish physician James Young Simpson (1811-1870) echoed the discussion of Eve's curse, this time to negate its validity: "But does the word sorrow ('in sorrow thou shalt bring forth children') really mean physical and bodily pain, as is taken for granted by those who maintain the improper and irreligious character of any means used to assuage and annul the sufferings of childbirth?"[4] The account of Eve and the comments that have surrounded it convey much about Western society's portrayals and views not only of the female sex (as inferior to men) and women's reproductive roles. They also exemplify some of the ways people have defined and explained pain itself. In this article, we discuss a critical topic in religious and medical history, namely, Western European women and childbirth pain during three formative periods-the high and late Middle Ages (c. 1200 to 1500), the early modern era (1500-1800), and the nineteenth century, when anesthesia was introduced into delivery rooms. Employing analysis of religious and
: Many factors determine whether nurses, physicians or both administer anaesthesia in any country... more : Many factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of Seven (G7) countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America) and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other G7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II.
1. Plasma amino acid kinetics were determined in hospitalized patients receiving one of three int... more 1. Plasma amino acid kinetics were determined in hospitalized patients receiving one of three intravenous solutions: isotonic amino acids, isotonic sodium chloride, or total parenteral nutrition. 2. Whole body amino acid appearance, oxidation and incorporation into protein were estimated with two different isotopically labelled amino acids: l-[1-14C]leucine and l-[U-14C]tyrosine. 3. A positive correlation was obtained between whole body amino acid appearance, oxidation and incorporation into protein with the two isotopically labelled amino acids. 4. Derivation of whole body protein kinetics with l-[U-14C]tyrosine consistently gave higher values than those obtained from l-[1-14C]leucine, presumably due in part to the contribution of phenylalanine hydroxylation to plasma tyrosine appearance. However, the percentages of amino acid appearance oxidized and used for protein synthesis were similar. 5. It can be concluded that estimates of whole body protein kinetics are qualitatively simil...
In October 2010, history enthusiasts from Boston area teaching hospitals formed the Boston Anesth... more In October 2010, history enthusiasts from Boston area teaching hospitals formed the Boston Anesthesia History Group. The primary reason for joining forces and working together was the recognition that collective action was necessary to promote the study of history. Our group is not affiliated with any particular Department, Hospital, Medical School, University, or Professional Organization. Members do not pay dues and the group does not maintain a bank account or undertake financial dealings. Founding members were selected on the basis of an interest in history, and they represent anesthesia departments from each of the four medical schools in Massachusetts. We seek to promote history by supporting and undertaking the following activities:
The National Foundation for Infantile Paralysis (NFIP), the March of Dimes, and the Georgia Warm ... more The National Foundation for Infantile Paralysis (NFIP), the March of Dimes, and the Georgia Warm Springs Resort were reflections of Franklin D. Roosevelt's (FDR) complicated and personal relationship with polio. Between 1934 and 1957, significant advances were made in the care of polio survivors, and new and innovative medical fields gained both public attention and funding. The plight of disabled Americans and questions of accessibility also received widespread national attention. The NFIP helped establish a new prototype for grassroots philanthropy and personified FDR's vision for national health insurance. Drawing upon a variety of archival and primary sources, this article aims to revisit Roosevelt's contribution to the medical field. Rather than condone or defend FDR's public persona as a survivor of polio, this article argues that Roosevelt and his affiliated organizations played an important medical role during this period.
Although the development of anesthesia as a specialty and its practice in Rwanda have occurred po... more Although the development of anesthesia as a specialty and its practice in Rwanda have occurred postindependence, there are several contributing factors that have had an impact on the current state of the delivery of anesthetic care. European colonization of Africa, in general, and Belgium's control, in particular, are primary factors that have had a significant impact on education. The ripple effect has had a long-lasting impact on health care as well as other facets of present-day Rwandan society. Tertiary education did not start until the latter half of the 20th century and has left this country with the belated development of an educated population in sufficient numbers to handle health care problems and provide sufficient care to its population. This article will examine the history of Rwanda and delineate factors that have led to the current state of anesthetic practice.
Journal of the History of Medicine and Allied Sciences
For nearly a century, sodium pentothal was the undisputed king of anesthetics. Anesthesiologists ... more For nearly a century, sodium pentothal was the undisputed king of anesthetics. Anesthesiologists were not, however, the sole consumers of pentothal, as psychiatrists used it to treat acute anxiety during psychoanalysis. The associated drug-induced inhibitions were attractive not only to psychotherapists, but also to a new generation of policing and Cold War espionage searching for the elusive truth serum. Cameo appearances of pentothal in media, film, and popular culture propagated the anesthetic’s negative public image. While legal challenges to the admissibility of pentothal-induced confessions and congressional investigations of clandestine truth serum programs may have tainted the popular anesthetic, it was pentothal’s widespread adaptation as part of the lethal injection cocktail that finally killed the king of anesthetics as pharmaceutical companies around the world refused to manufacture what had been transformed into a largely unprofitable drug, associated with capital punis...
Introduction: Hartford, capital city of Connecticut was where Horace Wells conducted most of his ... more Introduction: Hartford, capital city of Connecticut was where Horace Wells conducted most of his work on the only anesthetic gas still used in clinical practice since the 19th century – nitrous oxide. Wells was born and raised in Hartford, Vermont, studied dentistry in Boston and established his practice in Hartford, Connecticut. Various icons celebrating Wells' unique contributions in discovering the analgesic properties of nitrous oxide are located throughout this city. Materials and Methods: We consulted staff at Connecticut Historical Society (CHS) and at Hartford Medical Society to help identify sites and artifacts in Hartford that honor Horace Wells. Thereafter, we visited and studied each of these sites. Results: In 1847, Wells wrote a pamphlet titled 'History of the Discovery of the Application of Nitrous Oxide Gas, Ether and Other Vapors to Surgical Operations.' (Fig. 1). In 1907, the Spanish Dental Society honored Wells by awarding the city of Hartford a silver...
We report another technique of transcranial magnetic stimulation (TMS) for exciting the originati... more We report another technique of transcranial magnetic stimulation (TMS) for exciting the originating cells of the descending corticospinal tract. Acap shaped TMS coil has been described for simultaneously exciting muscles in all four extremities. This TMS coil is useful for monitoring the functional integrity of the descending motor paths during spinal cord surgery, because information regarding the integrity of both the left and right sides of the spinal cord motor paths can be obtained concurrently. Despite the improved design of the cap coil, careful placement is required for achieving bilateral spinal cord motor responses. Cortical mapping was used to identify the optimum scalp foci for the muscles studied. The cap coil must overlap these foci to simultaneously elicit compound muscle action potentials (CMAPs) in all four extremities. Increasing TMS stimulation intensitywill increasethemagnitudeoftheacquired CMAPs responses without significantly changing latency.
The effects of lidocaine (25,50 and 100 μg/ml) and bupivacaine (5,10, and 20 μg/ml) on amplitude,... more The effects of lidocaine (25,50 and 100 μg/ml) and bupivacaine (5,10, and 20 μg/ml) on amplitude, velocity, and contraction frequency were studied in monolayer cultures of spontaneously beating chick embryo ventricular cells. The physiologic parameters of contraction frequency, amplitude, and velocity of shortening were measured with an optical-video system. Studies were also carried out in the presence of 1μM tetrodotoxin (TTX) to isolate effects caused by TTX-sensitive ion channel blockade from other possible mechanisms of action of local anesthetics. Lidocaine and bupivacaine produced concentration-dependent, reversible decrements in contraction frequency, amplitude, and velocity of contraction. Bupivacaine demonstrated a 5-fold higher potency for depression of contractile properties than lidocaine. At a high concentration, bupivacaine (20 μg/ml) produced significantly more depression in all three measured parameters than did lidocaine (100 μg/ml). In the presence of predominantl...
BACKGROUND In 1970, Harold James Charles Swan and William Ganz published their work on the pulmon... more BACKGROUND In 1970, Harold James Charles Swan and William Ganz published their work on the pulmonary artery catheter (PAC or Swan-Ganz catheter). They described the successful bedside use of a flow-directed catheter to continuously evaluate the heart, and it was used extensively in the years following to care for critically ill patients. In recent decades, clinicians have reevaluated the risks and benefits of the PAC. AIM We acknowledge the contributions of Swan and Ganz and discuss literature, including randomized controlled trials, and new technology surrounding the rise and fall in use of the PAC. METHODS We performed a literature search of retrospective and prospective studies, including randomized controlled trials, and editorials to understand the history and clinical outcomes of the PAC. RESULTS In the 1980s, clinicians began to question the benefits of the PAC. In 1996 and 2003, a large observational study and randomized controlled trial, respectively, showed no clear benefits in outcome. Thereafter, use of PACs began to drop precipitously. New less and noninvasive technology can estimate cardiac output and blood pressure continuously. CONCLUSIONS Swan and Ganz contributed to the bedside understanding of the pathophysiology of the heart. The history of the rise and fall in use of the PAC parallels the literature and invention of less-invasive technology. Although the PAC has not been shown to improve clinical outcomes in large randomized controlled trials, it may still be useful in select patients. New less-invasive and noninvasive technology may ultimately replace it if literature supports it.
Journal of Education in Perioperative Medicine, 2014
History of medicine does not receive the coverage it deserves in medical school curricula, or dur... more History of medicine does not receive the coverage it deserves in medical school curricula, or during graduate medical training, in part, because of its lack of impact on direct clinical care. This is particularly disturbing for the specialty of anesthesiology not only due to its colorful history, but also because ours is the only major medical discipline to have developed entirely in the United States. We examine four commonly cited reasons for the study of history in general, and comment on whether these lessons are applicable to medicine and anesthesiology. We provide compelling reasons why studying history is important to clinicians. Background: Humans are the only species to be aware of their past. Our future is largely unknown, and the present is fleeting. Thus, almost everything that is known with certainty falls within the realm of history. Thus one would expect society at large, and physicians and anesthesiologists in particular, to be history enthusiasts. As the facts suggest otherwise, one wonders whether history is regarded much like art, music, and fine cuisine-more adornment than an essential and integral part of education in any discipline, especially medicine.
We identified nearly 180 Black women who earned medical degrees prior to the start of the Second ... more We identified nearly 180 Black women who earned medical degrees prior to the start of the Second World War and found information regarding their family and social connections, premedical and medical educations, and internship experience or lack thereof for many of these women. Through their collective history, we observed large-scale trends, especially regarding the importance of “separatist” medical education and declining medical school attendance among African American women in the 1910s as medicine became an increasingly exclusionary profession. While our research uncovered trends specific to Black women physicians, the implications of our research can be applied far more widely to other historically marginalized scientific practitioners. This research reminds us of the longstanding and shifting presence of Black women in science and medicine, despite the enduring popular belief that white men represent who participates in science, both historically and today.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
To determine the anesthetic techniques used and who provided the anesthetic care. To see what les... more To determine the anesthetic techniques used and who provided the anesthetic care. To see what lessons were learned during this 3 month period and what changes were made when the unit returned in 1917. Resources: The journals of Elliott Cutler and Harvey Cushing provide details of daily life. A photo album by Virginia Martin documented scenes of the unit while deployed. The records of 441 patients treated by the unit.
From the advent of the use of anaesthesia during surgery through the Second World War, confusion ... more From the advent of the use of anaesthesia during surgery through the Second World War, confusion and competition over who should administer the technology – doctors or nurses – dominated gendered discussions of professional boundaries. Using information about practice in the United States, the United Kingdom, and France in this period, we find vastly different outcomes for nurse-administered anaesthesia. Differences in perceptions regarding the gendered nature of this technology and its related level of prestige largely determined who could practice it. When administering anaesthesia carried low prestige and was viewed as non-technical, it fell under the purview of women’s work in medicine, that is, nursing. When the same technology gained prestige and became perceived as a technical, medical skill, doctors associated it with their masculine professional identity and worked to exclude nurses from administering anaesthesia.
I n America, the task of giving the patient a "whiff" of ether or chloroform during surgical proc... more I n America, the task of giving the patient a "whiff" of ether or chloroform during surgical procedures was often left to junior house officers, nurses, medical students, orderlies, or individuals with no medical training. Harvard medical students Harvey Cushing (1869-1939) and Ernest Amory Codman (1869-1940) were required to do their share of "anesthesia duty" in the mid-1890s. Death under anesthesia was not uncommon, and in some instances, the surgical procedure would be continued despite the patient's death to maximize the learning opportunity. 1 During one fateful operation, Cushing's patient died during anesthesia, an event that greatly affected him and even led him to question his career choice. 2,3 However, instead of succumbing to despair, he and fellow medical student Codman began keeping accurate records during anesthesia. Their motivation for this action is not known, although Cushing writes that he was instructed to do so by the chief of surgery. In the process, these 2 medical students made a lasting contribution to a medical specialty that had not yet been born. They kept anesthesia records for more than 100 surgical procedures, which are now the property of Massachusetts General Hospital (MGH) and are preserved at the Francis A. Countway Library. 4 Every anesthesia record in this collection was examined for this study, and never before have they been subjected to the detailed analysis we offer: their notes, comments, drugs administered, and vital signs recorded. There is no indication that other students or house officers continued to maintain anesthesia records after Cushing and Codman. Later in their distinguished careers, these physicians continued to make major contributions to the safety and improved outcomes of surgical procedures.
Treatment guided by data from pulmonary artery (PA) catheters was intended to help optimize cardi... more Treatment guided by data from pulmonary artery (PA) catheters was intended to help optimize cardiac performance and improve outcomes; however, not every medical advance meets initial expectations. Regardless of their ultimate impact and clinical utility, PA catheters helped define the field of modern critical care medicine. They enabled diagnostic differentiation of the various causes of shock states and often were used in conjunction with arterial lines and potent vasoactive drugscontributing to the creation of specialized intensive care units (ICUs). This article reviews the history of PA catheterscolloquially known as SwanGanz cathetersand how they helped shape modern critical care medicine. Cardiac Critical Care Before the PA Catheter The battlefield experience of World War I led to great interest in understanding the physiology of traumatic shock, whereas the concept of the postoperative recovery room was developed during World War II (1). Later, specialized surgical units were created for patients recovering from open-heart surgery (1). The coronary care unit concept, as it currently is conceived, was proposed in 1961 by Morris Wilburne, and the first such unit was established at Bethany Hospital in Kansas City in 1962 (2). Several earlier developments offered promising improvements in treating cardiovascular conditions but necessitated specialized units to allow close monitoring (2). In 1948, Raymond Ahlquist clarified and reported the mechanism of action of adrenergic agents, prompting their widespread use in the 1950s and 1960s (3). In 1956, Paul Zoll reported on the use of 2 closed-chest technologiesthe external defibrillator and pacemakerto treat cardiac arrest (2). In 1960, William Kouwenhoven and a team at Johns Hopkins University reported an early version of modern, closed-chest CPR (2). With these new technologies, monitoring and treating cardiac conditions, such as congestive heart failure and acute myocardial infarction, changed dramatically, requiring units in which treatments could be administered with continuous monitoring and close observation. Catheterization Before Swan and Ganz In 1870, Adolph Fick (18291901) suggested a principle for measuring cardiac outputaiming to quantify heart failure beyond clinical symptomologythat came to bear his name (4). His simple and elegant technique for directly measuring arterial (PA) and venous (pulmonary vein) oxygen content remains the gold standard for calculating cardiac output. Although arterial and central vein cannulations had been used previously, cardiac performance had been assessed only on the basis of clinical history and radiographic examination at the time (5). Although Fick did not measure cardiac output in animals or humans, his concept was explored during the next 7 decades. In 1929, Werner Forssmann introduced the idea of cardiac catheterization by threading a flexible ureteral catheter through his own basilic vein into his right atrium (6). He had convinced an operating room nurse, Gerda Ditzen, to allow him to do the experiment on her but surreptitiously cannulated his own vein while she was on the operating table (7). Another nurse, who is known only as Eva, captured fluoroscopic images (7, 8). Forssmann's report on these findings in Klinische Wochenschrift drew significant criticism from the media, because he had not received permission to carry out the experiment, and ultimately led to his dismissal from Auguste-Victoria-Heim hospital in Eberswalde, Germany. Although considerable skepticism surrounded his nontraditional methology, his results captured the attention of the cardiology community (1, 7). The 1940s saw substantial progress in the spread of cardiac catheterization. In 1941, Andre Cournand and Hilmert Ranges reproduced Forssmann's method at Columbia University (9), and a year later, Cournand and Dickinson Richards estimated cardiac output by using the oxygen content of mixed venous and arterial blood samples (10). For these contributions, Forssmann, Cournand, and Richards were awarded the Nobel Prize in Medicine or Physiology in 1956. In 1944, Alfred Blalock (18991964), a surgeon at Johns Hopkins, was the first to diagnose tetralogy of Fallot using catheterization (9). This breakthrough led to developments in pressure transducers, instruments to measure oxygen saturation in blood, and dye injection techniques to study intracardiac shunts (9). The Mayo Clinic Board of Governors established the nation's first cardiac catheterization laboratory in 1947 (1). Early reports described the technique's utility in diagnosing atrial and ventricular septal defects, patent ductus arteriosus, and pulmonary stenosis; moreover, it made it possible to determine oxygen saturation and pressures in major vessels and cardiac chambers (1). In 1947, Lewis Dexter developed a technique to wedge the tip of a cardiac catheter into the small branches of the PA (11, 12). Earl H. Wood used this method to prove that pressures in the PA were…
One of the most famous (or infamous) narratives in the Old Testament is that of Adam and Eve. The... more One of the most famous (or infamous) narratives in the Old Testament is that of Adam and Eve. The ancient scriptural account in Genesis of the disobedience of humankind's first parents has been central to Western society's explanations of the introduction of sin into the world. Of particular concern has been the punishment for sin (here, eating forbidden fruit) that God gave to Eve (who sinned first in the Garden of Eden), namely, the experience of pain in childbirth: "In pain you shall bring forth children" (Genesis: 3:16). This narrative has been dissected many times throughout the centuries, finding its way into religious, artistic, and medical works. For instance, in the sixteenth century, Protestant reformer Martin Luther (1483-1546) extolled the plight of women in childbirth: "If Eve had not sinned, she would not only have given birth without pain. .. This punishment, too, springs from original sin."[1-3] Elsewhere the reformer described such pain as "a happy and joyful punishment" which serves women as a means to combat evil.[1] Centuries later, Scottish physician James Young Simpson (1811-1870) echoed the discussion of Eve's curse, this time to negate its validity: "But does the word sorrow ('in sorrow thou shalt bring forth children') really mean physical and bodily pain, as is taken for granted by those who maintain the improper and irreligious character of any means used to assuage and annul the sufferings of childbirth?"[4] The account of Eve and the comments that have surrounded it convey much about Western society's portrayals and views not only of the female sex (as inferior to men) and women's reproductive roles. They also exemplify some of the ways people have defined and explained pain itself. In this article, we discuss a critical topic in religious and medical history, namely, Western European women and childbirth pain during three formative periods-the high and late Middle Ages (c. 1200 to 1500), the early modern era (1500-1800), and the nineteenth century, when anesthesia was introduced into delivery rooms. Employing analysis of religious and
: Many factors determine whether nurses, physicians or both administer anaesthesia in any country... more : Many factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of Seven (G7) countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America) and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other G7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II.
1. Plasma amino acid kinetics were determined in hospitalized patients receiving one of three int... more 1. Plasma amino acid kinetics were determined in hospitalized patients receiving one of three intravenous solutions: isotonic amino acids, isotonic sodium chloride, or total parenteral nutrition. 2. Whole body amino acid appearance, oxidation and incorporation into protein were estimated with two different isotopically labelled amino acids: l-[1-14C]leucine and l-[U-14C]tyrosine. 3. A positive correlation was obtained between whole body amino acid appearance, oxidation and incorporation into protein with the two isotopically labelled amino acids. 4. Derivation of whole body protein kinetics with l-[U-14C]tyrosine consistently gave higher values than those obtained from l-[1-14C]leucine, presumably due in part to the contribution of phenylalanine hydroxylation to plasma tyrosine appearance. However, the percentages of amino acid appearance oxidized and used for protein synthesis were similar. 5. It can be concluded that estimates of whole body protein kinetics are qualitatively simil...
In October 2010, history enthusiasts from Boston area teaching hospitals formed the Boston Anesth... more In October 2010, history enthusiasts from Boston area teaching hospitals formed the Boston Anesthesia History Group. The primary reason for joining forces and working together was the recognition that collective action was necessary to promote the study of history. Our group is not affiliated with any particular Department, Hospital, Medical School, University, or Professional Organization. Members do not pay dues and the group does not maintain a bank account or undertake financial dealings. Founding members were selected on the basis of an interest in history, and they represent anesthesia departments from each of the four medical schools in Massachusetts. We seek to promote history by supporting and undertaking the following activities:
The National Foundation for Infantile Paralysis (NFIP), the March of Dimes, and the Georgia Warm ... more The National Foundation for Infantile Paralysis (NFIP), the March of Dimes, and the Georgia Warm Springs Resort were reflections of Franklin D. Roosevelt's (FDR) complicated and personal relationship with polio. Between 1934 and 1957, significant advances were made in the care of polio survivors, and new and innovative medical fields gained both public attention and funding. The plight of disabled Americans and questions of accessibility also received widespread national attention. The NFIP helped establish a new prototype for grassroots philanthropy and personified FDR's vision for national health insurance. Drawing upon a variety of archival and primary sources, this article aims to revisit Roosevelt's contribution to the medical field. Rather than condone or defend FDR's public persona as a survivor of polio, this article argues that Roosevelt and his affiliated organizations played an important medical role during this period.
Although the development of anesthesia as a specialty and its practice in Rwanda have occurred po... more Although the development of anesthesia as a specialty and its practice in Rwanda have occurred postindependence, there are several contributing factors that have had an impact on the current state of the delivery of anesthetic care. European colonization of Africa, in general, and Belgium's control, in particular, are primary factors that have had a significant impact on education. The ripple effect has had a long-lasting impact on health care as well as other facets of present-day Rwandan society. Tertiary education did not start until the latter half of the 20th century and has left this country with the belated development of an educated population in sufficient numbers to handle health care problems and provide sufficient care to its population. This article will examine the history of Rwanda and delineate factors that have led to the current state of anesthetic practice.
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