"The Warmth of His Continuing Interest": Henry K. Beecher, the Bioethics Revolution, and Pharmaceutical Industry Funding of Academic Medical Science in Cold War America.

This paper examines anesthesiologist Henry K. Beecher's funding relationship with pharmaceutical manufacturer Edward Mallinckrodt, Jr. Beecher is a familiar figure to both medical ethicists and historians of medicine for his role in the bioethics revolution of the 1960s and 1970s. In particular, his 1966 article "Ethics and Clinical Research" is widely considered a turning point in the post-World War II debate about informed consent. We argue that Beecher's scientific interests should be understood in the context of his funding relationship with Mallinckrodt and that this relationship shaped the direction of his work in important ways. We also argue that Beecher's views on research ethics reflected his assumption that collaboration with industry was a normal part of how academic science is conducted. In the conclusion of the paper we suggest that Beecher's failure to consider his relationship with Mallinckrodt as worthy of ethical deliberation has important lessons for academic researchers who collaborate with industry today.

The Death of Sodium Pentothal: The Rise and Fall of an Anesthetic Turned Lethal.

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 punishment.

Swan, Ganz, and Their Catheter: Its Evolution Over the Past Half Century.

Jeremy Swan and William Ganz developed their eponymous pulmonary artery (PA) catheter in the 1970s and, in the process, revolutionized measurement of cardiac output, pressures within the left side of the heart, and resistance in systemic and pulmonary circulations. Their invention enabled diagnostic measurements at the bedside and contributed to the birth of critical care medicine; technologic advances preceding the PA catheter generally could not be used at the bedside and required patients to be stable enough to be taken to the catheterization laboratory. Swan and Ganz worked in the same department but had quite dissimilar backgrounds and personalities. This article describes their lives and careers, the state of intensive care before and after their catheter was introduced, and the natural life cycle the PA catheter faced as new, less invasive technology arrived to replace it.

The Anesthesia Records of Harvey Cushing and Ernest Codman.

Hundreds of thousands of anesthesia records are created each day. The earliest records were prepared by 2 medical students in late 19th-century Boston. Ernest Codman and Harvey Cushing went on to become prominent surgeons and contributed much to the safety of the surgical patient. Cushing's career is celebrated due to his associations with William Stewart Halsted, Peter Bent Brigham Hospital, Yale University, in New Haven, Connecticut, and his biography of Sir William Osler. Codman is remembered for introducing the morbidity and mortality conference as well as his drive to improve outcomes and patient safety. We analyze every anesthetic record created by Codman and Cushing and provide both a historical context and perspective on many ways in which their doggedness, brilliance, and insight anticipated many advances that enhanced safety for patients undergoing surgical procedures.

History of anaesthesia: Nurse anaesthesia practice in the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America).

: 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.

Dr. Polio: Revisiting FDR's Medical Legacy.

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.

Sites Related to Crawford Williamson Long in Georgia.

BACKGROUND: Crawford Williamson Long (1815 to 1878) was the first to use ether as an inhaled anesthetic for surgical operations. By not publishing his discovery for 7 yr, his pioneering work was largely overshadowed by that of Horace Wells (1815 to 1848), Charles Thomas Jackson (1805 to 1880), and William Thomas Green Morton (1819 to 1868). As a result, sites commemorating Long's discovery are not offered the same recognition as those affiliated with Wells or Morton. METHODS: We highlight sites in Athens, Danielsville, and Jefferson, Georgia, that honor the first man to regularly use ether as an anesthetic agent. Extensive site visits, examination of museum artifacts, and genealogical research were used to obtain information being presented. RESULTS: Historic Oconee Hill Cemetery in Athens is where Long and members of his family are buried. Established in 1856, it is closely linked to the history of Athens and the University of Georgia (Athens, Georgia). The main site we describe is the Crawford W. Long Museum, located in Jefferson, Georgia, which opened to the public in 1957. It has undergone extensive renovations and holds an expansive collection of Long's family heirlooms and personal artifacts. In addition, it displays an impressive art collection, depicting Long, surgical procedures, members of Long's family, and homes associated with him. Visitors to the museum may also enjoy a walking audio tour that highlights the life of Long and his contribution to medicine. CONCLUSIONS: We provide information on sites and artifacts that honor Georgia's most celebrated physician. Much of this has not been published before, and it is our hope that Crawford Williamson Long's legacy receives the attention it richly deserves.

Medical and ethical challenges during the first successful human kidney transplantation in 1954 at Peter Bent Brigham Hospital, Boston.

BACKGROUND: The first successful major organ transplantation, a kidney transplant, took place on December 23, 1954, at Peter Bent Brigham Hospital, Boston, Massachusetts. This was the beginning of major organ transplants commonly performed today, heralding one of the most significant achievements of medicine. A half-century later, heart, liver, limb, and even face transplants have become standard practice. In this report, we explore details of the preparations, the ethical dilemmas and the unknowns, and how these issues were addressed and overcome. METHODS: Published works, hospital records, personal notes, and conversations with the individuals who participated in this event allowed us a unique opportunity to collect, analyze, and interpret the events. RESULTS: Several factors converged at Peter Bent Brigham Hospital to enable success. The department chair in medicine was committed to studying renal hypertension who then recruited others to work in this area. The department chair in surgery was committed to research, including making research results clinically useful. The chair of the anesthesia division was a technically skilled clinician, able to manage a previously unknown procedure. Finally, a suitable candidate for kidney transplant happened to have an identical twin brother, eliminating the issue of possible rejection. These factors aligned at the right time and place to transplant the first human kidney. CONCLUSIONS: Medical and ethical challenges dominated the scene of the first successful major organ transplant, which began the remarkable advance in transplant medicine, an advance that occurred very rapidly between 1947 and 1951.

Discovery of Modern Anesthesia: A Counterfactual Narrative about Crawford W. Long, Horace Wells, Charles T. Jackson, and William T. G. Morton.

The discovery of anesthesia occurred during a narrow time span in the mid-19th century, but there is no agreement about who deserves credit for this important American contribution to medicine. Based mostly on an examination of primary sources, we explore how formal and informal interactions between the principals affected their careers, lives, and attribution of credit for the discovery of anesthesia. There should be no controversy as to which individual deserves credit for the discovery of anesthesia if credit is ascribed for specific contributions. We suggest that credit for the discovery of anesthesia be divided among 4 individuals who played specific roles. Crawford W. Long first used ether as an anesthetic during surgery, Horace Wells introduced nitrous oxide for pain relief during dental surgery, and William T. G. Morton gave the first public demonstration of ether anesthesia and spread the word about its efficacy. Charles T. Jackson suggested the use of ether as an anesthetic agent to Morton. We also assert that had these individuals not known one another, the discovery of anesthesia would have proceeded in approximately the same timeframe, but Wells, Morton, and Jackson would have enjoyed more productive careers as well as longer, more peaceful lives.

Alternate methods to teach history of anesthesia.

Residency programs in anesthesiology in the United States struggle to balance the conflicting needs of formal didactic sessions, clinical teaching, and clinical service obligations. As a consequence of the explosion in knowledge about basic and applied sciences related to our specialty, residents and fellows are expected to make substantial efforts to supplement formal lectures with self-study. There is strong evidence to suggest that members of the younger generation use nontraditional methods to acquire information. Although training programs are not required to include topics related to history of anesthesia (HOA) in the didactic curriculum, and despite the fact that such knowledge does not directly impact clinical care, many programs include such lectures and discussions. We describe and discuss our experience with 3 alternate modalities of teaching HOA.First, we provide brief descriptions of HOA-related historical narratives and novels within the domain of popular literature, rather than those that might be considered textbooks. Second, we analyze content in movies and videodiscs dealing with HOA and determine their utility as educational resources. Third, we describe HOA tours to sites in close proximity to our institutions, as well as those in locations elsewhere in the United States and abroad.We suggest that informal HOA teaching can be implemented by every residency program without much effort and without taking away from the traditional curriculum. Participating in this unique and enriching experience may be a means of academic advancement. It is our hope and expectation that graduates from programs that incorporate such exposure to HOA become advocates of history and may choose to devote a part of their academic career toward exploration of HOA.

Sites and artifacts related to Horace Wells in Hartford, Connecticut.

Horace Wells, a contender for recognition as the discoverer of anesthesia, is celebrated in the town where he conducted most of his work, Hartford, CT. His only descendant was his son, Charles Thomas Wells (1839-1909), an influential and successful business executive at Aetna Insurance Company. He was a man of considerable influence, and he worked tirelessly with city officials and the Connecticut Dental Association in celebrating the 50th anniversary of his father's contribution to medicine. This discovery is unique because events and individuals in 1 country, the United States, contributed entirely to the birth of a medical specialty. Sites in Jefferson, GA; Hartford, CT; and Boston, MA and their environs celebrate this most precious contribution to modern medicine, especially since the introduction of safe anesthesia permitted the development of surgical specialties and obstetrics. We trace the history and relationship between Horace Wells and several sites and artifacts in Hartford, CT. These sites span the most important, distinctive, and attractive parts of the city: Bushnell Park, Trinity College, Cedar Hill Cemetery, the Athenaeum, and the Connecticut Historical Society.

Publication trends for articles related to the history of anesthesia: a 10-year analysis from six journals.

INTRODUCTION: Anesthesia historians believe they have difficulty in getting their work published in peer reviewed journals devoted to anesthesiology. To test the hypothesis of whether such publication bias exists, we conducted a review of all articles published in six journals. METHODS: We examined all articles published between January 2001 and December 2010. In order to enable comparison among journals, articles were categorized as major or minor. We also examined whether there were trends in publication over this period. RESULTS: During this 10-year period, 30,600 articles were published in these journals (range, 2573 to 8563 articles). Of all articles published, only 382 (1.25%, range, 0.41% to 2.87%) were related to the history of anesthesia. The proportion of all articles related to history showed a significant difference with time (P<.001), primarily from differences in minor articles (P<.001). Analysis of the number of history-related articles published shows no obvious difference over the 10-year period (P=.25), but a significant difference among journals (P=.005). For major articles, there was a significant effect with time (P=.046) and journal (P<.001). Minor articles revealed no significant effect with time (P=.15), but significant differences among journals (P=.02). CONCLUSIONS: Our analysis of 30,600 articles published in six mainstream journals devoted to anesthesiology found that considerable differences exist in the proportion and number of articles that were related to history of anesthesia.

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.

Ebenezer Hopkins Frost (1824-1866): William T.G. Morton's first identified patient and why he was invited to the Ether demonstration of October 16, 1846.

Although he was not the first to use ether as an anesthetic, it was not until William Thomas Green Morton's demonstration of the efficacy of ether anesthesia that its use spread rapidly throughout the world. Full identities of the first anesthetized patients of William Edward Clarke and Horace Wells are not known, but we are quite certain that Crawford Williamson Long correctly identified James Venable as his first patient to receive anesthesia. Using municipal records, historical accounts, and recent analyses of Morton's unsavory side, we undertook this study to explore three questions. First, we examine how Morton refined the technique of administering anesthesia based on Wells' failed attempt. Second, we describe the circumstances under which Morton encountered his first patient to receive anesthesia. Third, we offer an explanation as to why Morton insisted on bringing along this patient to attend the grand event we celebrate as Ether Day. This is an essay about William Thomas Green Morton and Ebenezer Hopkins Frost.

An appraisal of William Thomas Green Morton's life as a narcissistic personality.

The troubled life and death of William Thomas Green Morton has been described in several texts. His first public demonstration of ether anesthesia was the highpoint of a life that was less than successful in many of his endeavors. Close examination of this life reveals a pattern of behavior that progresses from narcissistic traits to narcissistic personality pathology. This retrospective psychiatric analysis of Morton's life was undertaken to theorize as to why Morton, after having successfully demonstrated ether anesthesia, did not continue to develop anesthesia as a clinical specialty. Biographies about Morton were used to explore details of his life. The Diagnostic and Statistical Manual of Mental Disorders classification of narcissistic personality disorder was used to analyze his life. We conclude that Morton progressed from displaying narcissistic personality trait to disorder over his lifetime.

History of anesthesia for ambulatory surgery.

PURPOSE OF REVIEW: Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. RECENT FINDINGS: The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. SUMMARY: Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.

The making of an anesthesia historian: lessons from a worldwide biographical survey.

BACKGROUND: There are few, if any, training opportunities for individuals wishing to pursue a career as an anesthesia historian. We surveyed anesthesia historians to learn about their training and experience, with an emphasis on mentoring, obstacles faced, and opportunities for improvement. METHODS: Questionnaires were sent to 34 anesthesia historians in North America, Europe, Asia, and Australia seeking information about demographics, medical training, training related to history, mentoring, research funding, obstacles faced, and suggestions for improvement. RESULTS: The response rate exceeded 90%. The average age of respondents was 70 years, and 85% of the respondents were male. The majority of respondents resided in North America (68%). The rest were from Europe (21%), Australia (9%), and Asia (3%). Graduate training in history was reported by 6%. Thirty-eight percent considered themselves to be self-trained. Thirty-eight percent were recipients of fellowships from the Wood Library-Museum of Anesthesiology. Research guidance was obtained by 74% of respondents. Guidance came from a department chairman (24%), a member of the Wood Library-Museum staff (33%), or another source (43%). The 3 most common obstacles described were difficulty in obtaining funding for research activities (33%), academic recognition (20%), and availability of training and mentoring (18%). Areas identified as needing improvement were research funding (17%), exposure to anesthesia history during residency training (23%), academic recognition (26%), mentoring (17%), and promotion of anesthesia history (17%). CONCLUSIONS: A study of history does not necessarily produce changes in clinical practice, which may limit the perceived value of historical study. The suggestions by these historians should help preserve the history and heritage of anesthesiology.

Gertrude Mary Gerrard, Chief Anesthetist, Peter Bent Brigham Hospital.

Gertrude Gerrard is a relatively unknown but important early nurse anesthetist in the United Sates in the early part of the 20th century. She was in the first class to graduate from the Peter Bent Brigham Hospital (PBBH) School of Nursing in Boston, Massachusetts. After graduating from nursing school, she participated in anesthesia training with Walter Boothby and became the first nurse anesthetist at the PBBH. In 1917 she was included in a group of medical professionals from the Harvard hospital system to serve in the medical corps in France during World War I. While there she worked with surgeon Harvey Cushing and this professional relationship continued back in Boston. She also was the first nurse anesthetist at Strong Memorial Hospital in Rochester, New York from 1925-1927. She returned to Boston in 1928 and continued as the chief anesthetist at PBBH until leaving in 1946 during a departmental staffing transition after WWII.

Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report.

BACKGROUND: Regional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-à-vis physician anesthesiologists and surgeons. SOURCES: Hospital records and interviews with individuals familiar with the case. FINDINGS: An otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. CONCLUSION: Spinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.