Announcing the 19th Spring Meeting of the Anesthesia History Association - May 2-4, 2013, Hartford, Connecticut

Announcement and description of the program for the 19th Spring Meeting of the Anesthesia History Association, May 2-4, 2013, in Hartford, Connecticut

Medical History for Anesthesiologists: Continuation of a Primer

Editor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a primer on the history of medicine and anesthesia history. The goals of this primer are to educate and to help individuals target future study. Below is the second article in a continuing series

Primer on Medical History for Anesthesiologists: Introduction

Editor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a survey of medical history. The goals of this primer are 1) to educate, and 2) to help individuals target future study. Below is the first article in a continuing series

Alternative Methods to Teach History of Anesthesia

Background: History of Anesthesia [HOA] may be taught through lectures, small group discussions, or by one-on-one teaching. HOA competes for scarce time in a busy didactic schedule and for coverage in mainstream medical journals devoted to anesthesiology. These efforts are hampered by the fact that HOA does not have any direct impact on the delivery of modern anesthesia, and the fact that these topics do not appear in written or oral board examinations. We describe three additional modalities to teach HOA to anesthesia residents that have been successfully employed by the Department of Anesthesiology at the University of Massachusetts: 1) Tours; 2) Historical Narratives and Novels; and 3) Movies and Video Clips. Conclusions: It is difficult to impart information using lectures due to time constraints and a very busy didactic schedule in residency programs. HOA related material does not get adequate coverage in standard textbooks of anesthesiology. We describe successful use of three modalities of imparting interesting information in an informal setting. Such efforts provide a unique experience during residency training. From preliminary reports we are confident that details from such tours, novels and movies remain imprinted in their memory for many years, perhaps permanently. These individuals are likely to remain advocates of history, and may choose to devote a part of their academic career towards exploration of HOA

The Discovery of Modern Anaesthesia – Contributions of Davy, Clarke, Long, Wells and Morton

While many may argue as to who deserves the most credit for the discovery of modern anaesthesia, events in the late 18 th and early 19 th centuries led to the introduction and development of modern anaesthetic techniques. English physicist and chemist Humphry Davy [1778-1829] first became aware of the sedative and analgesic properties of nitrous oxide in 1795. Although he never experimented with the drug during a surgical procedure, he was the first to suggest that it would be beneficial in relieving pain during surgical procedures. The mind-altering properties of nitrous oxide and ether were often abused for recreational purposes, and the term \u27ether frolics\u27 was coined to describe such use. While physician William Crawford Williamson Long [1815-1878] first used ether during general surgery, medical student William Edward Clarke [1819-1898] was the first to use ether for dental extraction in 1842. Dr. Long neglected to publicize his findings until 1849, thereby denying himself much of the credit he deserved. Dentist Horace Wells [1815-1848] successfully used nitrous oxide for dental procedures, but a public demonstration which he held in January 1845 turned out to be a fiasco. Medical student William Thomas Green Morton [1819-1868] was the first to publicly demonstrate the effectiveness of ether for general surgery on October 16, 1846. This article seeks to give rightful credit to each of these individuals for their unique contributions to the discovery of modern anaesthesia

Horace Wells Memorials in the City of Hartford, Connecticut

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 coat of arms. (Fig. 2) After Wells’ tragic death in 1848, his friend and dental colleague, John Riggs, prepared a death mask. (Fig. 3). The original mask was used by T. H. Bartlett in 1874 to sculpt a bronze statue of Horace Wells that was erected in Bushnell Park1 (Fig. 4). Wells’ office was located on Main Street, Hartford, and a plaque has been inserted onto the modern structure that stands in its place currently (Fig. 5). Horace and Elizabeth Wells were buried initially at Hartford’s Old North Cemetery. However, in 1908, Charles T. Wells (Horace’s only son) disinterred his parents’ remains from Old North Cemetery and reinterred them at Cedar Hill Cemetery. He also commissioned sculptor Louis Potter to create a fitting memorial consisting of a large granite grave marker with a bronze plaque on the front surface, and two angel figures on either end depicting the glory of his father’s discovery.2 (Fig. 6) Charles’ efforts to recognize his father’s discovery also led him to order from Louis C. Tiffany, a stain glass window (Fig. 7) that adorns Center Congregational Church. The Chapel at Trinity College has a pew dedicated to Horace Wells (Fig. 8).3 American artist Charles Noel Flagg (1848-1916) painted a portrait of Horace Wells, and this is part of the collection at Wadsworth Atheneum Museum of Art (Fig. 9).3,4 Conclusions: The city of Hartford, Connecticut celebrates Horace Wells’ achievements with many historical monuments, gifts, books and paraphernalia; thereby remembering his role in the discovery of the anesthetic effects of nitrous oxide. His work was recognized not only in the United States, but also in Europe.

William James Morton (1845 – 1920): Like Father, Like Son?

William Thomas Green Morton, the man most commonly associated with the introduction of anesthesia in 1846, fathered William James Morton. William James Morton’s contributions to society were substantial. He conducted pioneering work in radiology, radiation oncology, and therapeutic electricity. He authored numerous textbooks and articles, and he was an editor of a journal on human behavior. His expertise on diamond mining led to an error in judgment that resulted in a felony conviction. We examine his career and contributions to society, and consider his career in light of his father, William Thomas Green Morton

A Chronology for the Identification and Disclosure of Adverse Effects of Succinylcholine

Background: New therapies are created to address specific problems and enjoy popularity as they enter widespread clinical use. Broader use can reveal unknown adverse effects and impact the life cycle significantly. Succinylcholine, a depolarizing neuromuscular blocker, was the product of decades of research surrounding the ancient compound, curare. It was introduced into practice in the 1940s by Burroughs Wellcome and Company (BW Co.) and was welcomed due to its rapidly acting muscle relaxation effects. Global clinical use revealed adverse effects, both minor and major, in particular, hyperkalemia and malignant hyperthermia. We investigated when practitioners and the manufacturer became aware of these adverse effects, how information about these side effects were disseminated, and whether the manufacturer met the regulatory requirements of the time, specifically regarding the timely reporting of adverse effects. Sources: Primary literature search using online and archived documents was conducted at the Wood Library-Museum of Anesthesiology, Schaumburg, Illinois. We consulted documents submitted by BW Co. to federal authorities, through the Freedom of Information Act (FOIA), Food and Drug Administration (FDA) reports, promotional advertisements, package inserts, published articles, and textbooks. Results: Initial clinical testing in humans in 1952 found no adverse effects on cardiovascular or respiratory systems. Fasciculations and myalgia were early side effects described in case reports in 1952. Large-scale clinical trials in 1953 found abnormally long recovery times among some patients; the discovery of abnormal pseudocholinesterase enzyme activity was not fully demonstrated until the early 1960s. Bradycardia was first reported in 1957 in children, and in 1959 in adults. In 1960, animal studies reported a transient increase in plasma potassium; further experiments in 1969 clearly demonstrated succinylcholine-induced hyperkalemia in burn patients. Malignant hyperthermia was first described in 1966. Similar cases of elevated temperatures and muscle rigidity were described globally but the underlying mechanism was not elucidated until the 1990s. Standard anesthesia textbooks did not report major side effects of succinylcholine until 1960 and included newly documented side effects with each edition. BW Co.\u27s packaging contained warnings as early as the 1950\u27s but were later updated in 1962 and beyond to reflect the newly discovered hyperkalemia and malignant hyperthermia. Conclusion: Particularly given the regulatory environment of the time, BW Co. appropriately reported the adverse effects of succinylcholine after market entry; it updated promotional and packaging material in a timely manner to reflect newly discovered adverse effects. The toxicity, though alarming and put clinicians on alert, did not seem to heavily impact succinylcholine\u27s use, given its various desirable properties. It is still a choice muscle relaxant used today, although there are efforts to develop superior agents to replace succinylcholine

A Comprehensive Curriculum of The History of Regional Anesthesia

The study of the past with regards to medical history has been an underemphasized component of the medical school curriculum for several reasons. These have included the lack of direct or immediate clinical impact, the emergence of new disciplines such as medical ethics, expansion of the existing knowledge base, as well as a lack of research grants and funding. The curriculum in graduate medical education struggles to cope with the explosion of new information related to basic and applied sciences. The elimination of questions related to history in certifying examinations could be considered a fatal blow. This study explored the teaching of history of regional anesthesia (HORA) and proposes a curriculum for such education. A formal curriculum has not been described in published literature, even the latest guidelines for fellowship training in regional anesthesiology and acute pain medicine published by ASRA in 2015 did not include a curriculum to teach HORA. We propose a curriculum related to a variety of topics that would provide useful information and enrich the educational experience of trainees. It is suggested that this briefly formatted review of HORA could be used as a starting point for teaching and research to place major events of this specialty in an historical context