"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.

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.

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.

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.

Literature and new innovations leading to the rise and fall of the Swan-Ganz catheter.

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.

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.

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.

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.

The Chemical History of Morphine: An 8000-year Journey, from Resin to de-novo Synthesis.

Evidence of human use of opium dates back as far as the sixth millennium BCE. Ancient societies through the Renaissance period created a variety of opium products, proliferating its common use and subsequent addiction. Because the active moiety was not known at this time, the potency of these opium concoctions could neither be predicted nor controlled. The first step in identifying opium's active ingredient, morphine, was its chemical isolation in the early 1800s by Wilhelm Sertürner. The subsequent elucidation of morphine's chemical formula and Sir Robert Robinson's derivation of morphine's structural formula, which won him the 1947 Nobel Prize in Chemistry, round out 150 years of the incremental advances in our chemical understanding of morphine. Nevertheless, our attempts to synthesize morphine, despite our advanced knowledge in synthetic chemistry, are still no match for the plant-based extraction of morphine from the poppy plant. The status quo remains problematic socially, economically, and politically; the relationships between the countries laboriously growing poppy plants to extract morphine and those countries importing these painkillers are unstable at best. In this study, we contrast the cumulative scientific discoveries that have led to our current chemical knowledge of morphine with the centuries-old natural method of morphine production that still dominates the opioid market today.

The History and Evolution of Anesthetic Care in Rwanda.

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.

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.

The history of the nurse anesthesia profession.

Despite the fact that anesthesia was discovered in the United States, we believe that both physicians and nurses are largely unaware of many aspects of the development of the nurse anesthetist profession. A shortage of suitable anesthetists and the reluctance of physicians to provide anesthetics in the second half of the 19th century encouraged nurses to take on this role. We trace the origins of the nurse anesthetist profession and provide biographical information about its pioneers, including Catherine Lawrence, Sister Mary Bernard Sheridan, Alice Magaw, Agatha Cobourg Hodgins, and Helen Lamb. We comment on the role of the nuns and the effect of the support and encouragement of senior surgeons on the development of the specialty. We note the major effect of World Wars I and II on the training and recruitment of nurse anesthetists. We provide information on difficulties faced by nurse anesthetists and how these were overcome. Next, we examine how members of the profession organized, developed training programs, and formalized credentialing and licensing procedures. We conclude by examining the current state of nurse anesthesia practice in the United States.

Three Portraits, 2 Artists, and 1 Harvard Department of Anaesthesia: the Brigham Chairs and the Artists Who Rendered Them.

BACKGROUND: Many forms of art accurately depict physical attributes of their subjects. But how precisely do portraits capture personal, emotional, and behavioral aspects of individuals holding leadership positions in academic departments of anesthesiology? METHODS: We examined formal portraits of the first three academic chairmen of anesthesiology in our department - Leroy D. Vandam, Benjamin G. Covino, and Simon Gelman and obtained information about the artists (George Augusta and Marc Klionsky) regarding how they conducted research on their subjects, and the methods they used to depict significant character traits into their art. We then correlated the artistic depiction with known biographical and behavioral qualities of these leaders. RESULTS: We found that the artists were remarkably astute in their observations and that they successfully captured both physical and emotional aspects of these chairmen in their portraits. Moreover, in one instance, significant early life experiences were added to the composition with subtlety. Individuals familiar with these chairmen and aware of their management style can easily appreciate the techniques employed by the artists. SUMMARY: We conclude that art successfully depicted personal and executive attributes of these three academic anesthesia chairmen.

Publishing Trends in Two American Journals in Anesthesiology-Results of an 80-Year Geographical Survey.

BACKGROUND: We examined publication trends in two major American journals devoted to anesthesia to understand the geographical distribution of authorship and attempt to decipher the factors that influence this distribution. METHODS: In addition to bibliometric information for all articles published in Anesthesiology between 1941 and 2010 and Anesthesia & Analgesia between 1931 and 2010, we also collected information about the country, continent, and medical school or institution from which the articles were submitted. RESULTS: The top five countries that published research in these journals were the United States, Japan, Germany, Canada, and France. More than 50% of the published articles were submitted from the United States. However, US publications have steadily and significantly declined over the decades. Contributions from Europe and Asia (especially China) have shown marked increases. US spending on research, especially biomedical research, has remained essentially unchanged and declined in some areas, whereas it has increased steadily in some of the other countries we discuss. CONCLUSIONS: There is a significantly increased prominence in publishing from countries other than the United States. The reasons for this include the convenience of Web-based submission, an increased desire by researchers from around the world to publish in journals considered prestigious, English becoming the preferred language of communication amongst academicians in science, the advent of globalization, and a decrease in public research funding in the United States relative to other countries.

An Examination of Horace Wells' Life as a Manifestation of Major Depressive and Seasonal Affective Disorders.

Horace Wells was a Hartford, Connecticut, dentist whose practice flourished because of his clinical skills. He had an imaginative mind that propelled him to the forefront in several aspects of dentistry. Unfortunately, he suffered a recurrent "illness" that began in the winter and resolved in the spring. These symptoms were compatible with both major depressive disorder and seasonal affective disorder as a qualifier. Wells' introduction of nitrous oxide as an anesthetic was also associated with self-inhalation. This led to periods of hypomania, followed by depression. With the progression to ether, then chloroform, there was an episode of mania in January 1848, followed by depression and suicide.

Imagining in Time.

Lieutenant Adeline Simonson, a young nurse from McGregor, Minnesota, was one of more than 2,000 nurse anesthetists who served in WWII. Like the 59,000 other nurses who joined the Army Nurse Corps (ANC) between 1941 and 1945, they worked in physically exhausting and often hazardous conditions. Until recently, their vital contribution to the Allied war effort has attracted little scholarly or popular interest. Neither the Veteran's Administration nor historical societies kept any records, and the nurses rarely spoke about their service. A handful of recent studies has finally begun to shed light on the history of the ANC, yet their discussion of nurse anesthetists is surprisingly scant. This article aims to fill a gap in our knowledge by throwing light on the ordeal of one nurse anesthetist attached to the 95thEvacuation Hospital. Drawing on unpublished correspondence and diaries, we recreate the story of Adeline Simonson and examine its lessons for combat nursing. The frontline setting fostered an unprecedented level of collaboration between nurse anesthetists and physician anesthetists. Under the guidance of Captain Marshall Bauer, the 95th Evac's sole anesthesiologist, Simonson not only acquired new techniques such as the administration of spinal anesthesia, but also helped train other nurses. Most important, while under fire the medical officers learned to overcome varying levels of ability and experience and to work together as a unit.

A report on the consequences of the first implanted device for long-term analgesia in refractory cancer pain.

BACKGROUND: During the early 1970s, satisfactory long-term treatment of the severe pain associated with metastatic cancer was not available. Spinal cord stimulation introduced a few years earlier in 1967 had not proven to be effective in treating nociceptive pain. We describe our pioneering experience using an implanted device to infuse local anesthetics into the epidural space and provide pain relief to the patient. METHODS: Increasing doses of systemic opioids were unsuccessful in treating the intractable pain of spinal metastases in our patient. We devised an analgesic delivery system by modifying equipment usually used for ventriculoperitoneal shunts. A lumbar epidural catheter was inserted in the patient's spine, then tunneled subcutaneously across the flank to the anterior abdominal wall, and subsequently connected to a modified Ommaya reservoir with ventriculoperitoneal shunt tubing. This was filled with local anesthetic and injected into the patient's epidural space by manual compression. RESULTS: The system was used for several months with intermittent addition of local anesthetic to the reservoir with satisfactory control of the patient's pain. CONCLUSIONS: We describe the first use of an implanted epidural catheter system for long-term relief of pain due to terminal cancer that occurred at Peter Bent Brigham Hospital in Boston. We contend that this event played an important role in the cascade of devices that followed and connect it to the changes in the attitude of health care providers toward treatment of cancer pain.