Newsletter July, 1988

Anesthesia History Association Newsletter Volume 6, Number 3

July, 1988

Festschrift

StuartC. Cullen, M.D.

1909-1979

TO do credit to the role of Stuart C. Cullen as a developer of the specialty, I have asked three people whose rather intimate contacts cover "The Chiefs" careerfrom residency toretirement and added afew summary comments ofmyown. Dr.JohnAdriani shared the residetlCY trainingdays; Dr.Jack Moyers was amedicalstudent, resident,jarulty member and close colleague at the University of Iowa where Dr. Cullen spent his first20years; Dr.JohnSeveringhaus, who moved west with Dr. Cullen, chronicles his tranifer and building of the Department at UCSF. - William K Hamilton, M.D. THE BEGINNING YEARS Dr. Stuart Cullen was well into his first year oftraining when I began my residency in Anesthesia at Bellevue in October 1936. Of the nine positions that Rovenstine had filled at the time, he was two ahead of me. Cullen was number seven, Fred Haugen eight and I nine. It is noteworthy that the nine of us eventually scattered nationwide and entered academic medicine. We became Chairmen and organized anesthesia departments in medical schools, the majority of which had none or bad "on paper" departments. Most of the nine kept in touch with each other after leaving Bellevue and served together on various national committees or engaged in other endeavors in the years that followed. Interestingly, none of the score or more of residents who enrolled after us became interested in academic anesthesia. The nine ofus were a closely knit group because we had a number of things in common. First, we were more or less shunned by the remainder ofthe housestaff. We were new and strange to them. Anesthesia was looked down upon in those days. The administration ofanesthetics was considered to be a simple and menial task and something anyone could do. They could not understand why any physician with any ability would specialize in anesthesia. They believed that anyone who did was renouncing medicine. Second, we had entered a specialty whose future was uncertain and which was being accepted with reluctance. We had no certifying board or representation in the AMA. The ASA was just being organized and had not begun to function. We had no peer review journal and the accumulated knowledge pertaining to the specialty was scant. This uncertainty created a degree of insecurity that bonded us together. Third, the 1929 depression was still with us. We all had little money and had to watch our pennies. We could not afford the usual New York entertainment. Therefore, we socialized by ourselves, had parties at each other's apartments, and went out to dinner together at inexpensive restaurants, usually Chinese or Italian. Most ofus became

lifetime friends. This camaraderie gradually disappeared from the department as each ofus left and was replaced by a new resident, and the specialty began to achieve recognition and acceptance. Stuart Cullen, or Stu as we called him, was a quiet and unassuming individual .. He was well informed, deliberate, methodical, and efficient. He was an excellent clinician, a good organizer, and a good administrator. He never appeared to be rushed or hurried; yet he accomplished much without wasted time or effort. He was not talkative. When he did speak he was brief, logical and to the point. Many times when he answered yes or no to something, his response sounded more like a grunt, be it of approval or disapproval. He was a good listener. He was even tempered and slow to anger and not easily ruffled. He had a good sense of humor. He had good working relationships with all with whom he worked, including some surgeons who were difficult. When he completed his training in October 1938, he left for the University of Iowa. I stayed on with Rovenstine for three more years and became his first full-time assistant.Thus my relationship with Stu at Bellevue extended over approximately 18 months. Stu was married and had two children. He, Milton Peterson, the senior resident, and Fred Haugen lived in Sunset, a suburb of New York.. The three commuted every day by subway. Those of us who were married remained in the hospital only on the nights we were on call. Two residents who were not married lived in the doctors' quarters which were dreary and lonely. There were two episodes in which we were both involved that I will always remember. The first was a complication that I had with an epidural block. It was the custom in those days for the older residents to teach and supervise the newcomers. I was assigned to give an anesthetic for a hernioplasty for which I proposed using a spinal anesthetic. The patient had experienced difficulty with a general anesthetic for a previous operation. Rovenstine was partial to inhalation anesthesia and averse to the use ofspinal blocks. He suggested that I have Cullen show Continued 01/ Page 3

LETTER FROM THE PRESIDENT Many thanks to all of you who stopped to lend a hand or simply say "hello" at our exhibits during the "9th World Congress of Anesthesiologists" in Washington in May. Our displays were well received. Dr. Colon Morales and Dr. Ron Stephen joined forces to produce a most interesting panel display of the History of Anesthesia in stamps. Included in it was a section dedicated to the development of blood transfusion. Almost next door, our second presentation was a combined effort with the Anesthesia Foundation to introduce and describe both our organizations, in matching panels. Dr. Stephen had collected and enlarged the front page of all the newsletrers and they flanked a large map. Visitors were invited to pinpoint their home towns. Thanks to Anaquest, who resolved the mechanical and financial considerations, continuous showing of the two historical films which we have assembled over the past year, was possible. At each exhibit postcards depicting historical events and updated copies of the booklet of the Anesthesia Foundation - An American Heritage Anesthesiology were distributed. Equally successful and also well attended were the two sessions dedicated to the history of anesthesia. In all, 33 papers were presented by anesthesiologists from 13 countries. And now, news ofour annual. meeting. We are planning to return to the Five-Star Award Four Seasons Clift Hotel again. We will convene in the Sequoia room for cocktails at 7 p.m. on Sunday, October 9th. Dr. Jonathan Daitch, now a captain in the United States Air Force, will

again provide a violin accompaniment. Dinner will be served in the Yosemite room at 8 p.m. After our usual business meeting, our speaker this year will be Dr. Norman Bergman, Professor ofAnesthesia at the Oregon Health Science University. Dr. Bergman is the first recipient of the David Little award which is presented to an anesthetic historian in recognition ofoutstanding work in that field. The award was made in his absence last year as Dr. Bergman was on sabbatical leave. This year he willjoin us and share with us some ofhis thoughts on research which he carried out last year. I look formard to seeing you all again in October in San Francisco. -Elizabeth A.M. Frost, M.D.

Historical Exhibit Planned for Art Display The Committee on Art Exhibits has again set aside space for a historical exhibit at the 1988 Annual Meeting in San Francisco. As in the past, private collectors will have an opportunity to show their books, documents, photographs and antique pieces ofanesthesia equipment in a locked glass display cabinet. Larger items may be displayed on the walls or adjacent floor space. Anyone who wishes to participate in the Historical Exhibit is invited to request an application from Rod Calverley, M.D., UCSD Medical Center H-770, San Diego, CA 92103.

Lewis Wright Memorial Lecture John Severinghaus, M.D., F.F.A.R.C.S. will deliver the 1988 Lewis Wright Memorial Lecture on October 11 during the A.S.A. Annual Meeting. He will speak on "Monitors, the Patent Medicine of Anesthesia." Dr. Severinghaus is highly recognized internationally for numerous important research contributions. He was the recipient of the 1986 First Annual A.S.A. Award for Excellence in Research. For the past 30 years he has been a staff member of the Cardiovascular Research Institute and a faculty member of the University of California in San Francisco. Previously he has earned the B.S. degree at Haverford College and the M.D. degree at Columbia University. He has also received an honorary doctorate from the University of Copenhagen. Dr. Severinghaus is probably best known as the developer ofblood gaselectrodes. Other work on devices includes: a calcium electrode; an electrophrenic respirator; an end-tidal gas sampler; a blood gas slide rule; a transcutaneous Pcos electrode and a combined Paz and Pcoz electrode. He has made important research contributions in chemical regulation of respiration; acclimatization to high altitude; hypoxic pulmonary hypertension and high altitude pulmonary edema; uptake ofanesthetic gases; pH-regulation role ofthe blood-brain barrier; and Oz dissociation curves. Much of Dr. Severinghaus' research work has been done at high altitude locations in North and South America. He has had a life-long love affair with mountains and has spent a great deal of leisure time there also. Dr. Severinghaus is an internationally famous lecturer who has spoken around the world and will take us on a special tour in the world of monitors. - E. V. Miller, M.D.

A Request for a Ventimeter Dr. Selma Calmes has received a request from New Zealand for an old ventimeter to be used for teaching purposes. Ifany reader has such an instrument available, would he or she kindly contact Dr. David Dawoojee, Chief Technologist in Anaesthesia, Napier Hospital, Napier, New Zealand.

Anesthesia History Association Newsletter Printed and Distributed Courtesy of DESERET MEDICAL, INC. Manufacturers of a Complete Line of LV. Catheters

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me how to do an epidural block. Stu was interested in epidural blocks because Charles B. adorn, a surgeon at the Charity Hospital in New Orleans, had just published a paper in the American Journal ofSurgery on the subject (1936). adorn had gone to South America on his honeymoon. While there he visited a number ofhospitals where he saw the method being used for surgery and obstetrics. He introduced the technique at Charity Hospital. Epidural was not used in the United States until adorn called attention to it with this article. Labat's Regional Anesthesia, the Bible at the time, made no mention of epidural block. Cullen gave me a blue Amytal capsule to give the patient for premedication. The patient was superstitious and said blue pills were "bad luck." Cullen insisted that he have it because, in those days, we were taught that barbiturates protected against reactions to local anesthetics. He swallowed it with reluctance. We used the single injection technique. Continuous methods had not as yet been developed. I introduced the needle, injected the test dose and waited five minutes, during which time the patient became uncooperative and restless and moved about on the stretcher. I was concerned that the movements would cause the needle to shift its position. i tested him for anesthesia and paralysis. None was present and I injected the remainder of the solution in increments, aspirating each time with no return of spinal fluid. The recommended dose at that time was 1,000 mg ofprocaine combined with 20 mg of tetracaine in 20 rnl of saline. We returned the patient to the supine position, wheeled him into the operating room, and asked him to move over to the operating table. He attempted to lift his left arm and leg but they both fell limply back on the stretcher and he became unresponsive. At the moment Cullen thought it was hysteria. I vividly recall saying, "hysteria my eye, we have a total spinal," and reached for the laryngoscope and intubated him. I completed the intubation just as the diaphragmatic movements were coming to a halt. One hour later the diaphragm began to show signs of activity and 30 minutes later the intercostals were contracting and consciousness returned. Three hours later he still had some areas of anesthesia and hypalgesia in the lower extremities. Rovenstine coauthored a case report of this complication with Cullen which was published in Anesthesia and Analgesia. The article did not indicate who had attempted the block. Those who read it assumed that it was Cullen. From time to time over the years Stu would remind me that he had been credited for my total spinal. I will always remember my first epidural. We were both only peripherally involved in the second misadventure which I will never forget. In those days we did not hesitate to use closed system ether or cyclopropane with cuffed endotracheal tubes in the presence of cauteries. We were unaware of the lethal potential of flammable anesthetics in a closed system. A junior resident was giving an anesthetic for a craniotomy. Cyclopropane and a cautery were being used. I was in the anesthesia office across the hall from the operating room tabulating some research data. The resident supervising him asked me to "keep an eye" on him for a few minutes and left. I heard a pop that sounded like a balloon bursting and immediately went into the operating room to investigate. The surgeons were excited and said as I walked in, "We just had an explosion." I saw nothing wrong with the patient, the anesthetic machine, bag, mask or canister. There was no visible evidence of an explosion. The craniotomy was almost completed. They quickly finished and closed the wound. I extubated the patient and noted that the end ofthe endotracheal tube was bloody and that there was a tear in the cuff. I concluded that the cuffhad ruptured and traumatized the trachea and explained this to the surgeons. They appeared to accept my explanation and said nothing more. About five minutes later a telephone call was relayed to me by a nurse from the "front" (superintendent's) office inquiring about "the explosion." The

operating room supervisor had notified them without first investigating. I relayed word back that there had been no explosion and that a cuff had ruptured which was nothing of consequence. At no time did we hear anything more from the "front office." Rovenstine was in Europe at the time. I sent for Stu, who by then had become senior (chief) resident and had been left in charge of the department. Departments, in those days, were "one-man" affairs composed of "the chief' and his residents. Stu came sauntering in and I explained to him that the cuffon the endotracheal tube had ruptured and traumatized the trachea. He examined the cuff, patient and the machine, and agreed that we were dealing with a ruptured cuffand left. After he left the patient's condition began to deteriorate. The blood pressure fell to 80/60. I realized then that we were dealing with more than a ruptured cuff and that we, indeed, had had an explosion. Later that day, in discussing the patient's condition with Stu, I referred to the episode as "an explosion." Stu said, "What explosion? That was no explosion; that was a ruptured cuff." The patient remained in shock and coma despite treatment. He developed subcutaneous emphysema from head to foot. Respirations became labored and he coughed up bloody sputum. He died the next day. Stu saw the patient only that one time. Had he followed the patient, as I did, I am sure he would have thought otherwise, too. When Rovenstine returned from Europe, Cullen briefed him about the patient. He, too, was convinced that we had bee'n dealing with a ruptured cuff. He reasoned that, ifit had been an explosion, the breathing bag would have burst or the canister would have ruptured. We were using the to-and-fro system, which consisted of a mask, canister and breathing bag. Furthermore, he reasoned that there would have been signs oftrauma to the face and in the pharynx; there were none. Postmortem examination revealed numerous hemorrhages and ruptured alveoli in both lungs and ecchymotic spots scattered in the tracheal mucosa. I maintained that such extensive trauma could not have been caused by rupture of a cuffcontaining 5 or 6 rnl of air. Rovenstine coauthored a case report with the resident who gave the anesthetic that was published in Anesthesia and Analgesia as a fatality due to rupture of an endotracheal cuff. That case report was cited in publications for a number ofyears by various authors. Dr. Henry Beecher at the Harvard Medical School, who had an aversion to cuffed tubes, repeatedly referred to the article in a crusade against cuffs. The press was giving anesthetic explosions sensational front page publicity nationwise. This one luckily received no publicity, not even in the hospital itself. Unlike most hospitals, Bellevue lacked an effective "grapevine." After that I no longer administered flammable anesthetics when cauteries were being used. Our paths crossed many times after we left Bellevue. We regularly attended meetings of the AMA Section on Anesthesia, ASA, AUA and other societies. We both appeared as guest speakers or participated in panel discussions at State and other society meetings. We served together as members ofthe National Research Council Advisory Committee on Anesthesia, the Editorial Board of Anesthesiology, and Directors of the American Board of Anesthesiology. Stu was selected from a list ofnames that I had been asked to submit to serve on the Advisory Panel to the Food and Drug Administration on Anesthetic and Respiratory Drugs, of which I was appointed Chairman. The agency was implementing the 1962 Amendments to the Food and Drug Laws. We reviewed package inserts, and advised the agency on problems pertaining to anesthetics, analeptics, and inhaled adjunctive products (oxygen, helium, etc.). The halothane associated hepatitis, which was receiving worldwide attention at the time, was one of the many topics brought before us for discussion and recomrnenContinued all Page 4

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dations. Most ofthe recommendations and suggestions we made during our tenure that did not require legislativeaction were adopted. We served from 1966 to 1970 and were replaced by other appointees. Some time during 1955 Stu wrote me advising that I would be receiving a letter from the AMA asking me to serve on the Residency Review Committee for Anesthesiology, which wasjust being organized. The American Board ofAnesthesiology was the last ofthe major boards to accept the cop.cept of a Residency Review Committee. The letter came and I accepted the appointment. I served with him on the committee for five years, after which I was elected a Director on the American Board. Three of us represented the AMA and three the Board. Stu, who represented the American Board, was Chairman. Stu served well on this and other committees. Unlike some committee members with whom I have served at various times, Stu was not one who liked to pontificate, thereby prolonging a meeting. He spoke when he had something to contribute. It was a pleasure to work with him on committees. The most difficult thing that we both were called upon to do while on the Residency Review Committee was to vote disapproval of the residency at Bellevue Hospital. The days ofresidents teaching residents were over. Rovenstine had insufficient staff to supervise his complement ofresidents. Once one ofthe most outstanding in the country, the program had deteriorated badly over the years. No American graduates were enrolled in the program; all were foreign. The Board frowned upon a program that had more than 40 percent foreign graduates. As the demand for residents increased, American applicants were in short supply. Continuation of the doctors' draft after World War II compounded the problem. Many hospitals, particularly the public, taxsupported institutions, could attract only foreign graduates. We both knew the problems that Rovenstine faced, budgetary and otherwise. His department was always underfunded by the City ofNew York. The program had been on probation for three years. He had been warned repeatedly to make the recommended changes and improvements, but failed to do so. We had no choice but to vote disapproval. Stu quickly grew into his position as Chairman ofthe Department at Iowa and later into the larger department at the University of California in San Francisco. He quickly became a recognized leader in the specialty nationally and internationally. While he was at Bellevue he did not appear to be interested in research. However, there was neither time nor opportunity for him to demonstrate this talent. It was not until he became established at Iowa that his capabilities as an investigator became apparent. He arranged liaisons with basic science departments in the medical school and performed research jointly with them. In due time, he, as did others ofus, established his own independent research program funded with private grants. Obtaining grants for research in those days, before anesthesiology received recognition as a scientific specialty and before the federal government began to fund research, was most difficult. Medical school budgets did not provide for research. We relied principally on grants from pharmaceutical firms. The products ofthe research that Stu directed over the years became subjects of many scientific papers offundamental scope and importance. They are too numerous to mention here. Stu was not imbued with the "publish or perish" concept. He wrote only when he had something to say. He added to the medical literature; he did not help to dilute it. Rovenstine imbued us, as Ralph Waters had imbued him, with the concept that our missionwas to promote the specialty, recruit physicians into it, and train teachers and researchers as well as clinicians. Not all nine of us did all these things, but Stu did. His department was recognized as one of the most outstanding in the United States. He trained many excellent residents who scattered throughout the nation

and became outstanding clinicians, educators and researchers. Robert Virtue, Virgil Stoelting, William Hamilton, to name a few, became departmental chairmen in medical schools. I was invited as a visiting professor to both Iowa and San Francisco at various times and saw these splendid departments: I recall receiving a letter from Stu, while recuperating from surgery accompanied by multiple complications, advising me to stop being a crusader. It was a question ofthe pot calling the kettle black. IfI was a crusader, he was too, perhaps in a different way, using different tactics. We had to crusade to advance the specialty and render quality patient care. I recall writing to Stu when he became Dean at the University of California School ofMedicine in San Francisco and telling him he was "out ofhis mind." He wrote back and said he loved the job. Four years later, after he had resigned and after he had a spell ofillness, I wrote him wishing him well. In answer to my letter, he said that he had resigned soon enough and that he had never spent four more miserable years in his life than while he was Dean. He obviously had not as yet experienced the frustrations of being a Dean when he had written previously. Stu was an academician through and through. He did not dabble in the politics of anesthesiology locally or at the national level. He remained a clinician, an educator, and an investigatorfrom the moment he left Bellevue until he retired as Chairman ofthe'Departmenr at the University of California. - John Adriani, M.D. THE IOWA YEARS Dr. Stuart Chester Cullen reported for duty as ChiefofAnesthesia, University ofIowa Hospitals, in the fall of 1938. He did not have any money, only the promise ofa $3,000 per year job. His personal finances were appropriate for hisnew location. The University was certainly not overly funded by the Legislature or endowed by others, and the Hospital's 800 beds were mostly occupied by indigent people, only about 10 percent of beds being used (or needed!) for private patients. He inherited a hospital Department that since 1912 had been directed by an anesthesiologist. Moreover, since that date all senior medical students had been given clinical instruction in the administration of ether or chloroform. A small but relatively well designed two year anesthesia residency program had been operational since 1922. The various general and specialty surgical departments had a wealth of "clinical material," and the quality ofpatient care and teaching throughout the hospital was extremely high. So, the "Chief' had a number of good things going for him. War years kept efforts to develop the residency program from being very effective. I know from personal experience, however, that student lectures and operating room instruction during those years were exemplary. As a result of such teaching there was unusual interest in the specialty among senior medical students. We found in Dr. Cullen a teacher who behaved as he taught and who insisted that we identify and solve problems in anesthesia by using all we had learned in the basic sciences and on other clinical services. Is it any wonder that, during his 20 years in Iowa City, over 6 percent of medical students graduating from Iowa elected Anesthesiology as a professional way oflife? At the time that figure was over twice the national average. By the late forties the residency program was flourishing. It featured hard work, a broad range ofclinical experiences, and a thorough corn-s mitment to patients asindividual persons, not"cases." There was insistence that we behave as physicians practicing a specialty, not specialists who had detached themselves from medicine's mainstream. We were

taught that inquiry and asking questions were as much a part ofour study as was the learning ofanswers. Assigned reading, so called spoonfeeding, and the like were considered inappropriate exercises for graduate education, so the Chiefwould have no part ofthem. Rarely was a problem solved by the addition ofequipment, simply because the latter was not a likelihood! As a substitute, the application of concepts and basic principles wwas used to prevent or confront clinical troubles. I don't ever remember being told that there was a certain way to do things. I don't recall being taught the dose of any drug that was to be given intravenously or by inhalation. I did learn, however, that the appearance ofa certain expected action ofan anesthetic agent would be to a significant extent dependent upon how I administered the drug and how closely I observed the patient's response. And, perhaps most ofall, I can't think of a time when anyone thought there was a substitute for moment to moment stewardship of the patient and prompt recording ofwhat was seen and measured. Postoperative care was considered to be the proper practice ofanesthesiology because it was what a physician deemed necessary and desirable, not what a hospital rule said was obligatory. While at Iowa Dr. Cullen developed a clinical service that featured the best in medical teaching. He stimulated residents to adopt an academic life, so that during those years over 25 percent of his pupils left the program for a teaching position. Although his research background was modest and our facilities were regrettably inadequate, he nevertheless fostered a spirit ofinquiry that resulted in significant basic and clinical research, more remembered for its quality than its abundance. More than anything else the Chief, by his own behavior, convinced students and residents, both on other services as well as on ours, that anesthesiology was an enjoyable way to practice medicine. Many of his pupils assumed leadership roles in well recognized academic departments. Their achievements were a source ofpride and comfort for him because he knew he had been a successful teacher: he had improved the breed. In 1947 the College ofMedicine had adopted a private practice plan that favored faculty development in terms of numbers and quality. It was considered by some Department Heads (and some hoping to become Head someday) to be a threat to their incomes and authority. Dr. Cullen was a strong leadership proponent ofthe plan. It is my personal notion, perhaps not widely held or easily proven, that Dr. Cullen's goals for the Division ofAnesthesiology, Department ofSurgery, were to a great extent disallowed because ofhis role in the plan's adoption. Departmental autonomy was never given to him and was only begrudgingly granted to his successor, Dr. William Hamilton. Confrontations were not the Chiefs nature, though as much as anyone he was a man of principle. More opportunities to advance the specialty appeared to lie elsewhere, so he left Iowa in 1958 to develop the fine Department in San Francisco.The move wassensible to him, so he made it. He was not a man to act in an impetuous style or as a response to irrational emotion. For each of us there came a time, either during residency days or later, when the naive image ofDr. Cullen as a knight on a white horse wearing shining armor needed to be questioned. We found that he hadn't changed a bit, but that our idolatry had perhaps been undeserved. Our respect and affection were not as objective as even he would have found acceptable. And yet, when I look at the present problems in medical practice; the deterioration of doctor-patient relationships; the threats to student-teacher kinship occasioned by the regimentation oftoday' s undergraduate and residency curricula; and the regrettably prevalent notion that a computer energized by oxygen and glucose is an out-dated resource in the management ofan anesthetized

patient, I admire Stuart Cullen more and more. His horse seems whiter and the armor shines brighter than ever before.

- Jack Moyers, M.D. THE MOVE WEST In the mid-1950's, Stu Cullen was a member of the National Research Council Subcommittee on Anesthesia,advisory to the military medical service. I was on the committee representing the NIH, although I had completed only a year ofresidency with Bob Dripps (and a year of research with Julius Comroe) when the draft caught up with me. As my indentured time drew to a close, I arranged with Dr. Cullen for a second year ofresidency, which ended inJune, 1957. The fall meeting ofthe American Physiologic Society broughtJulius Comroe to Iowa in late August of 1957. He had just moved to San Francisco, was full of enthusiasm for UCSF, and asked me to consider joining him. The problem was that Leon Goldman, chiefofsurgery, had consistently refused to relinquish control ofanesthesia, a section ofsurgery. When Comroe asked me who, in my opinion, would be a great chief of anesthesia, I said "Bob or Stu," to which he replied, "Stu who?" I only suggested he talk to Stu Cullen about the possibilities. Incredibly, within the next hour, Comroe not only persuaded Cullen to leave Iowa, after 20 years, but by phone persuaded Goldman, after some long silent periods, interrupted by audible sighs, gulps and swallowing.jto agree to an independent department ofanesthesia. The first I heard about it was a call from Stu saying, "How'd you like to come to California with me.;>" Dr. Cullen strongly supported research, not only with time assignments but with funds. He suggested that we establish an Anesthesia Research Foundation, into which excess income generated by the four faculty members would flow. The Foundation still functions, but its income has seldom been overflowing, being mostly from industrial support and faculty contributions of honoraria, royalties and consultantships. Dr. Cullen's warm personal relationships with everyone created a friendly family feeling in the new department. For the first halfdozen years, we held annual Christmas parties, June farewells, andJuly hellos, to which everyone associated with the department was invited. When that number passed 200 in the mid-1960's, the researchers split off an independent Christmas party, and we gradually stopped inviting all the community clinical faculty who came to help about once a month. But the conviviality remained, and was remarked upon as a contrast to other departments, especially since it appeared to attract residents to change course to anesthesia after other specialty training. Neri Guadagni once said to me, "Dr. Cullen carries democracy too far. He should make some tough decisions without consulting all of us." This style and his openness, warmth and integrity, led him into committee work at higher and higher levels, until he was tapped to be the Dean. The only complaints about his administration from the Dean's Office were that he bent over too far backward to avoid criticism of helping Anesthesia obtain research and office space criticism from us, his best friends and admirers. Although Stu had been the Iowa athletic physician, he wasn't much of a physical exertion devotee. One fall we had a party for the faculty and residents, and invited them to help cut up an old oak and take home the resulting firewood. Stu wasn't much interested in one end ofa twoman saw, but was grateful for a Yule log it produced. Everyone in the operating room wore standard blue pajamas except Stu. He had a fresh, pressed, white cotton shirt and pants every day, in which he stood out in the corridor about every two hours to restore his Continued Oil Page 6

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nicotine level until cardiovascular disease persuaded him to quit. Mter eight years as department chairman, Dr. Cullen's faculty evidenced recognition of his commitment and integrity and selected him their Dean. This position was long sought by Stu, but it never really suited him. His dissatisfaction and increasing health problems led to his return to faculty status in 1970. Mter three years ofactive teaching, he "retired" only to become Mayor ofBelvedere, a suburb of San Francisco. Again he had demonstrated the role of leadership and service which won him the true accolades of his peers. - John w: Severinghaus, M.D.

FINALE These three stories reveal much about Dr. Cullen. He started with a group of colleagues who were indeed developers of the specialty. He played major roles in development of the journal Anesthesiology, the American Board of Anesthesiology, the ResidencyReview Committee, and the National Research Council Committee in Anesthesia. He developed two departments, a large number ofoutstanding individual teachers and practitioners, and gave the specialty an uncommon level of respect. The words of Dr. Moyers indicate the respect, and in fact affection, common in Dr. Cullen's students. All these together convey the real person who was this outstanding man. I am proud ofmy privilege to have served with the Chiefas student, resident, faculty under his chairmanship, faculty under his deanship, and then as his department chairman. I was thus allowed to know a lot about him as a doctor, a teacher, an administrator, a husband and father, a citizen and a person. I cannot tell my story ofhim any better than to provide a transcript of remarks I made at a memorial service after his sudden death in August of 1979.

Memorial Service for Stuart C. Culleu 1909-1979 It's been my privilege and easy task many times in my life to say nice things about Dr. Cullen. Most of these times I've spoken at points of advancement in his career. I have spoken at honors for many groupslocal, national and international. They've been the gatherings ofmany clans at which these nice things have been said. But today is a bit different. For the first time, he's done something that I'm sure I can do! Secondly, the Chief is not visibly present today. In the past, I have tried to recount the things in some detail ofhis p.ofessional accomplishments. I've pointed out to groups such as you that he was a pioneer in a newly developing specialty; that he was a researcher, far ahead ofhis time; that he was an educator who created two fine academic departments; and that he was an administrator of whom others can speak. Today it is my intent to speak briefly ofDr. Cullen as a person, and as a representative of his students, colleagues and friends. Those ofyou who knew Dr. Cullen for many years knew that he was a person who had many hobbies. He had them kind offor a short time, so maybe they could be called fads rather than hobbies. One of the earliest that we remember - he got interested in general semantics. He would say that I have, as a semanticist, created an artificial dichotomy; that one cannot separate the personal from the professional. As usual, he'd be right. It was his personal qualities that made his success. In all honesty, I think, if we divided the components ofwhat makes a good academician, what makes a good teacher, a good dean, there are many

who would exceed Dr. Cullen. But putting them together and adding to them the personal characteristics he had, no one would match him. I'd like to review a few ofthese qualities in no particular order in a few moments here this afternoon. Firstly, the boss was straightforward. He was honest and he was direct. I've said that he might not have been an outstanding speaker, but his direct approach made him a master ofcommunications. I would like to relate to you an example of the directness of his communication. Again, I get back to his hobbies. Those of you who have only known him in California might not be aware that, for many years before he moved here, he was a licensed pilot; had his own small airplane. One day I went for a ride with him from Iowa City to Des Moines, where he was consultant at the VAHospital. It was a winter day, which we had in great abundance there. It was a cold winter day and a windy winter day. He and another group ofphysicians had a small aercoupe, which ifyou know is a small plane and was capable of being buffeted about in the winds quite a bit. I wasn't quite as comfortable in this airplane as he was, but we finally tossed around and landed. Just as the wheels touched the runway and I began to breathe a little bit easier, we hit a patch ofice. We slid down that runway, which seemed to me to be a long distance. I certainly hadn't let go ofanything, I was hanging on for dear life, and I looked at the boss - he had sort of an almost impish smile - it was asymmetric - and he said, "Slick, hmm!" I can recall one of the residents finishing training with him one day - atthe end of a twoyear period with him - who said, "I wish, before I leave, you would tell me what 'hmm' means." He was a direct and effective teacher. He taught basics without dogma. I'd like to quote a little bit, not really from what would ordinarily be called scriptures, but from something many ofus revered like we would scriptures. This is the Preface to the 5th edition of Dr. Cullen's book. Remember that I said that when he spoke, he taught with directness and refused dogma. I'll read a half of this paragraph. He says: "The years spent teaching, and practicing and participating in research in the field of anesthesia have consistently impressed the author with the number and extent ofthe defects in our knowledge. Perhaps no other discipline in medicine has advanced so rapidly and concepts been so often subjected to change. Those entering or caught in this fluid state, this relatively unchartered wilderness, are strongly tempted to grasp at dogma, to construct convenient signposts or seize floating bits of information in efforts to establish stability. The authoritarian can exploit these defects in knowledge and satisfy those who are bewildered and seeking refuge by establishing routines for the practice. Although a strenuous effort has been made in preparing previous editions of this book to avoid dogmatism, born of incomplete information and understanding of the complex processes attendant upon the state of anesthesia, the effort has been unsuccessful in some parts. (I thinknext is the most important sentence.) The changes that have been made in this edition have been based on an increasing realization by the author that in a field so challenging, progress will be enhanced only if the mind is uncluttered - by fixed notions." It was this direct approach, this refusal to accept things as they were, that made him an effective teacher. He persisted in direct patient observation in the face of rapidly developing and attractive technology. At the moment, and always, I can hear him with alarming and almost frightened clarity say, "You Continued all Page 12

RESERVATION FORM

Annual Meeting Anesthesia History Association SUNDAY, OCTOBER 9, 1988 FOUR SEASONS-CLIFT HOTEL Geary at Taylor San Francisco, California 94102 415-775-4700

Cocktails

7 p.m.

Sequoia Room

Musical accompaniment -

Dinner -

8 p.m.

Yosemite Room

Captain Jonathan Daitch, U.S.A.F

Business Meeting - 9 p.m. LECTURER: DR. NORMAN BERGMAN Professor of Anesthesiology Oregon Health Science University Topic -

Thomas Beddoes, Humphry Davy at the Pneumatic Institute

Name Address Number of Reservations Names of Guests

_

Amount Enclosed (Cost: S50.00/p1'TsolI)

_

Make your check payable

to

the Anesthesia History Association and mail to:

Ms. Carolyn Burke Department of Anesthesiology Montefiore Medical Center Bronx, New York 10467 212-920-4316 Reservations and checks are due by September 30

A Few Episodes Associated with Surface Cooling of Patients by Robert W. Virtue, M.D. In September, 1952, a group of physicians from the University of Colorado Medical School attended a surgical meeting in Estes Park, Colorado. One of the speakers was Dr. c.P. Bailey of Philadelphia, who told ofcooling a patient to make efficient use ofhis blood oxygen while stopping circulation to perform an open heart operation. This story stimulated several of us, particularly Dr. Henry Swan, cardiac surgeon, to do some investigation to find a way to render this method safe. Dr. W.G. Bigelow (1950)had previously done similar work with dogs, finding that shivering actually increased oxygen demand. Talbot (1941) and Dill (1941), using hypothermia for different purposes, had observed that temperatures below 30° C were frequently associated with arrhythmias. Kenneth K. Keown (anesthesiologist) and Bailey (cardiac surgeon) had used a blanket, through which tubes ofcold fluid circulated, wrapped around the patient to lower the temperature. Mter being stimulated by Dr. Bailey's talk, our group measured the oxygen uptake and carbon dioxide output of dogs atlowered ternperatures, and found that oxygen was used more slowly asthe temperature dropped. We found that a practical method of measuring the temperature was to use a refrigerator thermometer. This had a probe on the end ofa 4-foot wire, so that one could be at a little distance from the subject while reading the value as measured in the rectum. Immersion in ice-water produced cooling much more rapidly than wrapping in cooling blankets. We alsolearned that cutting off the dog's hair greatly increased the rate of cooling. The meeting of the American Society of Anesthesiologistsin 1952 was held in Philadelphia. Through the courtesy of Drs. Keown and Bailey at Hahnemann Hospital, a few visiting anesthesiologists were able to observe two open-heart operations using hypothermia and cessation ofcirculation. An unusual feature ofthis event was the presence of professional photographers who were accustomed to having control of the movements of their subjects. On this occasion the photographers were relegated to places where no one else was busy, and as a result they showed quite a bit of irritation. Another unusual situation arose when an undiagnosed cardiac anomaly was discovered when the heart was opened. Dr. Keown suggested that the chest be closed and further surgery on that patient be done after reexamination. Dr. Bailey said the work should be done at that time, and called the husband of the patient to the operating room door. He then asked: "There's a hole in your wife's heart. Do you want us to fix it?" So he thereby obtained "informed consent," and operated. This pioneer group at Hahnemann was most gracious and hospitable to those of us who visited that day. In our laboratory we continued to look for methods ofavoiding ventricular fibrillation, which had plagued both Bigelow and Keown and Bailey when the cold heart wasincised.We tried KCl, papaverine, pronestyl, and other methods of 'avoiding sympathetic speeding of the heart, and had little success until Dr. Arthur Prevedel, a surgical resident training with Dr. Swan, found that acetylcholine, injected at the base ofthe aorta so it would perfuse the coronary vessels,prevented the fibrillation. Practically, it turned out better to use prostigrnine, which was easier to obtain and which lasted longer. This was a great advance in the safe use of hypothermic manipulation. When the safety of this method became known, visitors from many places came to observe its application. They tame from many states, from Europe, Africa, Asia,Australia, Central and South America. One ofthe visitors, who had been a resident in training at the same time and place as myself, said, "I wasn't impressed until the patient woke upJt!

While cooling one of the earlier heart patients, I experienced considerable pain at the level of my diaphragm. I stuck with the patient until he was removed from the ice-water, after which the anesthesiologist needed to give only oxygen, and lay down in the lounge. Our cardiologist thought "heart attack" and gave me some intravenous morphine. I knew it would make me vomit, but the pain was such that I was happy to have it. The cause ofthe pain turned out to be movement of a renal calculus. Invitations came from various places to demonstrate the use of hypothermia. One occurred at the American Society ofAnesthesiology meeting in KansasCity ("Out to the Sticksin Fifty Six"). Those present agreed that our type of surface cooling saved much time compared to blanket cooling. At the First World Congress of Anaesthesiologists in Holland in 1955, I approached a group of Dutch and German anesthesiologists who were conversing. When I arrived the Dutch "cut" the Germans and turned to me. I was surprised for I did not know the Dutch physicians.On inquiring, it became evident that the Dutch still remembered that Germany had bombed Rotterdam after the armistice had gone into effect. While the greatest use of hypothermic anesthesia-was for cardiac surgery, several caseswere done because cutting offblood flow during surgicalmanipulation rendered the surgicalfield easier to see, aswell as avoiding great blood loss, e.g., aneurysmal or tumor surgery, especiaIly cerebral. When visiting Santiago, Chile, and testing anesthetic machines the day prior to surgery, I found that with no machine on the floor could I maintain a full breathing bag with lessthan 1500 ml per minute flow of gas. While asking for equipment to possibly improve the situation, a nurse told me there was a machine in the corner that had not been taken from its crate because, "No one wanted to do it." On looking into the crate, I found a brand new Drager! As I was anesthetizing a patient a few days later in Sao Paulo, I requested three buckets of ice. I was greatly dismayed to see those child's toy buckets, with the comment that the operating room had only this much ice. Fortunately, the patient was rather smail, but the situation kept me on edge, for the subject became barely cold enough to stop circulation for the surgery. When in Buenos Aires, I was surprised to be asked to give a hypothermic anesthetic for a cardiac operation to be done by Dr. Lillihei, who was visiting from Minnesota. The local anesthesiologist knew I would be in Buenos Aires at the time, and so "volunteered" my services. Surgery went satisfactorily,but the patient did not.waken as I expected. I left the hospital that evening for a medical dinner meeting feeling apprehensive and a bit depressed. Later, the patient did well, and I found that, while the patient was still sleeping, the surgeon had given some pentobarbital without my knowledge. Mter a few years ofusing this method ofcooling patients for cardiac surgery, an Englishman came to Minnesota.and suggested that blood pumps be lined with plastic to prevent clotting ofblood on the metal parts. With this advance, pumps for continuing circulation ofblood to the brain and vital organs became safe, and surface cooling gave way to direct cooling of blood.

REFERENCES Bigelow W.G.: Am] Physiol160:125 (1950). Dill: Am] Physiol132:685 (1941). Talbot: New EnglJ Med 224:281 (1941).

Four Win Wood Library-Museum Fellowships The Trustees of the Wood Library-Museum (WLM) have awarded four fellowships for investigative studies to be performed in the extensive WLM archival collection at ASA Headquarters in Park Ridge, Illinois. Mter the Fellowship program was announced in September, the Trustees were pleased by the number ofresponses received before the deadline ofJanuary 31, 1988. As each ofthe applications was ofhigh quality, the selection committee faced difficult decisions in determining which candidates would receive financial support for their investigations. The Trustees are confident that each ofthe four 1988 Fellows will have a productive experience which will be expressed in publications of interest to all ASA members. In alphabetical order the 1988 WLM Fellows are: 1. David L. Brown, an attending anesthesiologist at the VIrginia Mason Clinic in Seattle, Washington, will undertake an historical review of anesthetic risk, a subject upon which he has already worked extensively. In this phase of his work he will concentrate on the development ofprofessional and public attitudes toward general anesthesia during the nineteenth century. Within a few,months of the first public use ofinhaled agents, deaths occurred which were attributed to the action of anesthetics. These events, and the discussions which followed in newspapers and medical journals, caused some clinicians to call for an examination ofwhat modern readers would recognize as the risk/benefit ratio of anesthesia. Dr. Brown will begin his historical study of anesthetic risk from 1846 until modem times by surveying 19th century American and European medical literature. He will use this information to determine how public and professional perceptions of risk have influenced the evolution of anesthesia. 2. Dr. Eugene H. Conner of Louisville, Kentucky, a retired anesthesiologist who is already a respected historian, will examine the remarkable role played by the United States Congress from 1847 to 1863 in its evaluation of the contending claims for priority in the discovery ofanesthesia. In an action then almost without precedent, members of Congress repeatedly considered the granting ofan award for a scientific discovery. A prize ofS100,000.00 was proposed for the discoverer ofanesthesia. The contenders for the award and their supporters expended great energy in influencing members of Congress but, while a confusing array of reports were published, the issue was never resolved. No decision was announced and the prize so long contemplated was not awarded. Dr. Conner will assemble each of the Congressional Reports, examine the circumstances surrounding their preparation, prepare a definitive bibliography of the documents, and then undertake the first detailed assessment ofthis unique chapter in the history ofanesthesiology. As Dr. Conner is a talented writer, his readers shall benefit from his insights into this early example ofthe lobbying practices still evident today. In delving into Congressional responsiveness to special interest groups, Dr. Conner may develop a message relevant to political scientists and other students of government, as well as anesthesiologists. 3. B. Raymond Fink, Professor Emeritus of Anesthesiology of the University of Washington and 1987 Winner of the American Society ofAnesthesiologists' Excellence in Research Award, will investigate the origins of Claude Bernard's exceptional interest in anesthesia. Bernard was already the pre-eminent physiologist ofhis time when he presented a course oflectures in 1870, "Lecons sur les anesthesiques et sur l'asphyxie," which he published as a book five years later. At that time such a degree of attention to anesthesia by a scientist of renown was an event without parallel. The significance ofBernard's contribu-

tion has not been adequately appreciated in this country as his lectures were available only in French before Professor Fink completed an English translation in 1987. While studying the original text, Professor Fink realized that the factors which had excited Bernard's singular interest in anesthesia were never explained, and that this question had not been addressed by any of the great scientist's biographers. Why, at a time near the end ofhis exceptionally distinguished career, did Claude Bernard set out to learn how anesthetic drugs affected laboratory animals which he had been studying for other purposes over more than three decades? Once developed, his interest was not transient, as he maintained an attention on this subject and even revised a second publication touching on anesthesia while on his deathbed. As a result ofProfessor Fink's study, we will gain a new measurement of the qualities of Claude Bernard through an appreciation ofthe development and scope ofhis commitment to research in anesthesia. 4. Mr. Amos J. Wright, ill, Librarian of the Department of Anesthesiology, University of Alabama at Birmingham will prepare a comprehensive review of self-experimentation in anesthesia. Almost every early pioneer of the specialty either attempted to administer an anesthetic to himselfor was the subject ofan experimental anesthetic. While some episodes such as Davy's use of nitrous oxide, Simpson's inhalation of chloroform, and Bier's cocaine spinal-are regularly recounted, other examples have not been examined. Two of the first public anesthetics in Britain and France were conducted by individuals who a short time before had first inhaled ether themselves. The evening before William Squire anesthetized Frederick Churchill for Sir Robert Liston, he had allowed his father, Peter Squire, to anesthetize him as a test of the elder Squire's inhaler. At almost the same time a Bostonian living in Paris, Willis Fisher, is reported to have self-tested an inhaler sent to him by his friend William Morton before demonstrating its action before J.F. Malgaigne. Self-experimentation with anesthetics continued into the middle of this century. Professor Max Sadove received the first fluroxene anesthetic administered to a human just a few hours before he initiated the first clinical use of the drug. In this way was the first fluorinated anesthetic passed through preliminary Phase II and Phase III trials in a single afternoon. While an expanded chronology ofthese events willbe an important addition to the literature, Mr. Wright's report will also examine other facets of self-experimentation. As part of a review ofthe evolution of research methods, he will study the evolution ofprofessional attitudes toward results gathered when the investigator was his own subject. His analysisofthe factors motivating self-experimentation willdemonstrate new dimensions of the debt we owe to those pioneers who advanced our understanding of the action of anesthetic drugs by courageously their own experiments. becoming the subjects

0:

The Trustees of the 'Wood Library-Museum wish to thank all those who submitted an application for the first WLM Fellowships. They anticipate receiving a second series ofexcellent submissions before the next deadline ofJanuary 31, 1989. The Trustees wish to encourage anyone with a developed interest in library studies to request an application packet from the Librarian, Wood Library-Museum, ASA Headquarters, 515 Busse Highway, Park Ridge, IL 60068.

- RodCalverley, M.D. Chainnan,. WIM Fellowship Committee •

From the Literature

Submitted by AJ. Wright, M.LS. Department oj Anesthesiology University oj Alabama at Birmingham

Benedetti C. Intraspinal analgesia: An historical review. Acta Anaesthesiol Scand supp 85:17-24, 1987. Primarily covers late twentieth century developments. One hundred and three references.

Ershler 1. Willem Einthoven - The Man: The stringgalvanometer electrocardiograph. Arch ItztMed 148:453-455, 1988. Briefly describes the life and work of the little-known Nobel Laureate. Nine references.

Bevan DR, Bevan JC, Donati F. The Arrival ofCurare in Montreal. In Bevan DR, et al., Muscle Relaxants in Clinical Anesthesia. Year Book, 1988, pp 1-12. Describes the nineteenth and early twentieth century discovery ofcurare and attempts to use the drug clinically, as well as Griffith's work in Montreal. Disjointed presentation, with few details. The book's frontispiece is the 1942 anesthesia record for curare administration by Griffith in a twenty-year-old patient. Twenty-five references.

Fink BR. History ofneural blockade. In CousinsJM, et al., eds. Neural Blockade in Clinical Anesthesia andManagement oJPain. 2nded, lippincott, 1988, pp 3-21.

Brown DL. Anesthesia risk: A historical perspective. IriBrown DL, ed. Risk and Outcome in Anesthesia. Lippincott, 1988, pp 1-29. This excellent chapter covers primarily mortality and includes sections on "The First Deaths", "The Ether-Chloroform Debate", "The Chloroform Commissions", "Regional Anesthesia" and "Contemporary Anesthesia Risk". Especially useful is a detailed table, "Fatal Cases ofInhalation of Chloroform", that gives fifty cases analyzed by John Snow. Three illustrations, fourteen tables, 131 references. Cartwright PD, Fyhr P. The manufacture and storage oflocal anesthetics. RegAnesth 13:1-12, 1988. Includes information on "the chronological development in the manufacture of commonly used local anesthetics." Eighteen illustrations, thirty-seven references. Clark, Jr. LC, Clark EW. A personalized history of the Clark oxygen electrode. Int Anesthesiol Clin 25(3):1-29, 1987. Gives"some ofthe details ofexperiments ... that led eventually to the 'Clark electrode'." Eight illustrations (including portrait of Eleanor Clark), twenty-nine references. Cooperman LH. Development of thoracic surgery and anesthesia. In Marshall BE, Longnecker DE, Fairley HB, eds. Anesthesia for Thoracic Procedures. Blackwell, 1988, pp 157-167. Surveys the past century ofanesthesia for thoracic surgery. Four illustrations, thirty-six references. Critchley M. Discarded theories in the past 50 years. In Blau JN, ed. Migraine: Clinical andResearch Aspects. Johns Hopkins University Press, 1987, pp 241-246. Covers ophthalmological and endocrine aspects, Spitzer's hypothesis, etc. Twenty references. Dolev E. The management of trauma: Historic perspective. Prob Crit Care 1:527-537, 1987. Concentrates on twentieth century developments in organization, systems approach, etc., with some discussion of earlier periods. Eighty-five references. Dopson L. No laughing matter. Nursino Times 83(25):20-21, 1987. Brief discussion of two London exhibitions on anesthesia history, one at the Wellcome Institute for the History ofMedici.ne and the other at the headquarters of th e Association ofAnaesthetists. Three illustrations.

GelftndC. Diphtheria: Dr.Joseph O'Dwyerandhisintubation tubes. Caduceus 3(2):1034, 1987. This lengthy article details O'Dwyer's efforts to develop tracheal intubation as a substitute for tracheotomy in the treatment of diphtheria. Fourteen illustrations (including full-page portrait of O'Dwyer), twenty-eight footnotes, bibliography. Graham JR. Discarded therapies during the past 50 years. In Blau IN, ed. Migraine: Clinical andResearch Aspects. Johns Hopkins University Press, 1987, pp 155-164. Sections include diet, hormones, drugs and surgery. Three illustrations, thirty-seven references. ,,' Howland WS, Rooney SM, Goldiner PL. Evolution of anesthetic techniques for cancer surgery. In Howland WS, et al. Manual of Anesthesia in Cancer Care. Churchill Livingstone, 1986, pp 247-257. Covers developments of four decades at Memorial SloanKettering Cancer Center. Thirty-three references. Isler H. Retrospect: The history of thought about migraine from Aretaeus to 1920. InBlau IN, ed. Migraine: Clinical andResearch Aspects. Johns Hopkins University Press, 1987, pp 659-674. Covers migraine history from ancient times to the early 20th century. Two illustrations, thirty-six references. Isler H. Independent historical development ofthe concepts ofcluster headache and trigeminal neuralgia. Funct Nel/roI2:141-148, 1987. Primarily pre-1900 descriptions. Thirty-three references. Jantzen j-P AH, Stanton-Hicks MDA. Bronchoscopy through the mask? A renaissance! Anesthesiology 68:650, 1988. This letter gives brief biographical information on Wilhelm Bmnings and also describes the German physician's method of "bronchoscopy, performed during simultaneous administration of a volatile anesthetic agent through a mask." Bmnings published his method in 1910. One illustration, eight references. Kanterman CB. Who really discovered anesthesia? TIC 46(7):8-11, 1987. Contends that both Wells and Morton deserve the honor. Three illustrations. Kyle RA, Shampo MA. William S. Halsted: Early American surgeon. Mayo Clin Proc 62:1107, 1987. Briefbiography illustrated with postage stamp issued by Transkei in 1985. Why Halstead would be considered an "early" American surgeon is not explained. Lassner J. L'Histoire de la pratique de l'anesthesie en France. Cah AtzesthesioI35:341-344, 1987. French-language article gives cursory overview. Continued Oil Page 10

From the Literature . .. Cmcilllledfn'l/l

Page 9

Leavitt JW. Brought to Bed: Childbearing ill America, 1750to 1950. Oxford University Press, 1986. Chapter 5, "The Greatest Blessing of This Age" (pp 116-141), covers pain reliefin obstetrics. This excellent book has extensive documentation, a glossary and index. Maltby JR. Sherlock Holmes and anaesthesia. Can J Anaesth 35:5862,1988. The appearance ofanesthesia in various popular culture formats (fiction, film, television, cartoons, etc.) is an almost totallyunexplored aspect ofthe specialty's history. Dr. Maltby rectifies this shortcoming with regard to the world's best known fictional detective. Covers general anesthetics, opium, morphine, curare and Holmes' own drug use. Twenty-four references. Maltby JR Second International Symposium on the history of anaesthesia. Can J Anaesth 35:174-177, 1988. Overview ofthe symposium held July 20-23, 1987, in London. Six illustrations, four references. Mapleson WW. This week's Citation Classic. Current Contents: Clinical Medicine 16(6):20, 1988. Dr. Mapleson comments on his article, "The elimination of rebreathing in various semi-closed anaesthetic systems" (Br J Anesth 26:323-332, 1954), which has been cited in over 170 publications since 1955. Four references. Marx GF. Die historische entwicklung der geburtschililichen anaesthesia. Anaesthesist 36:537-540, 1987. This German-language article briefly reviews use ofchloroform, ether and nitrous oxide in childbirth pain relief, as well as more recent developments, such as twilight sleep and continuous lumbar extradural analgesia. English abstract, thirty references.

Patterson RW. Advance prediction ofrequired inspired anesthetic concentration: Development of rationale and early application. Circular 5:4-9, 1988. Describes nineteenth and early twentieth century efforts to understand uptake and distribution ofanesthetic agents. Includes work of Zuntz, Boothby, Connell and others. Six illustrations, sixteen references. Petrikas AZ. History ofthe development and outlook oflocal injection anesthesia of the teeth. Stomatologiia (Mosk) 66(4):82-85, 1987. This Russian-language article has nt been examined. Ravitch MM. Halsted's "deathbed statement." Surgery 103:132, 1988. Discusses the confusion over the date ofcomposition ofHalsted's final piece ofwriting, a two and one-halfpage note on inguinal hernia. Four references.

RothbergML, Stanislav GV. Milestones in the first century ofmedicine in Nebraska. Nebraska MedJ 72:339-340, 1987. Includes brief mention of "Dr. George Shidler ofYork ... one of the first surgeons west ofthe Mississippi and a pioneer in the use of local anesthesia." Three references. Rutkow 1M,Hempel K. An experiment in surgical education - The first international exchange of residents. Arch Surg 123:115-121, 1988. Explores this topic via correspondence among Halsted, Heuer and Landois. The exchange began in late 1913 and ended in August 1914 with the beginning ofWorld War 1. Numerous letter translations. Five illustrations, thirteen references. Saddler JM, Horsey PJ. The new generation gelatins: A review oftheir history, manufacture and properties. Anaesthesia 42:998-1004, 1987. Historical portion describes gelatin solutions for intravenous infusions since World War 1. Two illustrations, four tables, thirty-one references.

Masson AHB. The appointment of an anaesthetist: Edinburgh Royal Infirmary 1900-12. Anaesthesia 43:146-149, 1988. Describes the problems surrounding anesthesia training and practice at the Infirmary during the early years of this century. The story is another example ofsurgeon resistance to anesthesia specialists and to the education ofmedical students in anesthesia. One reference.

Severinghaus JW. Theory and history of oximetry. Acta Anaesthesiol Scand Suppl 86:81, 1987. This abstract was presented at the 19th Congress of the Scandinavian Society of Anaesthesiologists in Linkoping, Sweden, June 29-July 3, 1987.

MatsukiA. History ofspinal anesthesia inJapan. Masui:JpnJ Anesthesiol 36:1462-1465, 1987. ThisJapanese-language article has not been examined.

Simard-Savois S. Histoire de l'anesthesie locale. J Dent Que 23:295, 1986. . Brief French-language article covering cocaine, procaine and lidocaine "epochs."

McGrath PJ, Unruh AM. The history ofpain in childhood. In McGrath PJ, Unruh AM, Pain ill Children andAdolescents. Elsevier, 1987, pp 146. Covers three. broad areas, each by time period and world geographical location: concepts ofpain and disease, symptomatology and treatment, and childrearing beliefs and practices. Good overview of largely ignored topic. Over two pages of references. Murphy LJT. Sir Douglas Shields (1876-1952): A forgotten Australian surgeon. Aus N Z J Surg 57:565-577, 1987. Covers the life and work of Shields, whose "remarkable and colourful career ... is unparalleled among Australian surgeons of his generation." Includes information on and photograph of the chloroform mask designed by Shields. Six illustrations, seventeen references.

Sykora O. Dr. L.E. Van Buskirk: Pioneer maritime dentist was first to use anaesthetic in surgical operation in Canada. J Canad Dent Assac 53:907-909, 1987. Describes career ofVan Buskirk (1799-1867), "the first permanent dental practitioner ofrepute in Atlantic Canada." In 1847, Van Buskirk administered ether, using an inhaler of his own design, for amputation of a limb. The operation took place in Halifax, Nova Scotia. Three illustrations (including portrait of Van Buskirk), twelve footnotes. Tanner JR. St. Anthony's Fire, then and now: A case report and historical review. Can J Surg 30:291-293, 1987. Includes discussion of past and present ergot use in migraine management. Five illustrations, tables and figures; nineteen references. Continued 011 Page 11

Wood Library-Museum Prepares for the Next Century by Edward A. Emst, M.D. Chairman, WIM Long-Tenn Planning Committee What will the Wood Library-Museum (WLM) look like in 2100? How will it function to best serve the historical, educational, and archival needs ofthe ASAmembership? The science ofinformation retrieval, processing, and transmission is changing very rapidly. An entire encyclopedia now fits on one 4.72 inch compact disc, and that information can be sent electronically to an unlimited number of distant locations. What is the possibility that future libraries will have few, or no, books? During the past year, the WLM Board ofTrustees addressed a series ofquestions concerning the future ofthe library-museum. Before planning long-term strategy necessary to position the WLM for the challenges of the next century, they needed to consider several basic questions. Should the WLM continue to aspire to be both a library and museum? To date, most of the activities in the WLM have been limited to the library. However, material for an outstanding museum has been collected and a museum curator appointed. The stage is set for the development ofone ofthe best anesthesiology historical museums in the world. A quality museum will complement the library and viceversa. Museum pieces can be attractively dispersed throughout the library. For example, an historical "teaser" exhibit on curare could be placed near related literature, lead viewers to other display areas and encourage potential students to study permanent exhibits in detail. Theme exhibits, strategically located throughout the library, would periodically change. The Trustees unanimously reendorse the librarymuseum commitment. The sole purpose of the WLM is to serve the membership ofthe ASA. The strongest administrative, economic, and educational ties are most mutually rewarding and will be retained. How will the WLM position itselfto accept the challenges of the 21st century? With the support of the ASA membership, the basic resources ofspace and money seem assured. The WLM building, containing some 5,000 square feet of usable space, was built 25 years ago. It will probably be adequate for the foreseeable future, especially if information is stored electronically. Funding is assured from a modest endowment that continues to grow and an annual budget from the ASA. An increase in personnel is anticipated. The Librarian, Patrick Sim, has been excellent in managing the library over the past two decades. He will need much help. An assistant librarian is being recruited and a Medical Curator, Dr. George Bause, has been named. In addition to space, money, and personnel, many functional resources have been planned and acquired. The library already uses personal computers to process information and has on-line access to Medline facilities. The dominant electronic library network today is On-line Computer Library Center (OCLC). With an OCLC link the WLM will have immediate access to other important national libraries for the exchange and acquisition of information. An even newer and more exciting technology is the development of Compact Disc-Read Only Memory (CD-ROM). Where OCLC transmits text, CD-ROM can transmit images, making it possible to display anything that can be photographed, including museum pieces and other items, to distant sites. One of the most valued treasures of the library is the Rare Book Collection. An annotated catalog of the Rare Book Collection is currently being composed. It will eventually be published and made available. However, the possibility ofbeing able to put the entire Rare

Book Collection on one CD-ROM is exciting. The Trustees know that the WLM must be ready to use such emerging technologies at an appropriate time. What expectations should anesthesiologists have of the WLM? The WLM must be the ultimate information source for everything related to the specialty ofanesthesiology. And the information must be conveniently and immediately available. The WLM is the repository for all archival information ofthe specialty and the ultimate resource for historians and scholars. There is no reason why the WLM cannot house the premier museum ofthe specialty, rivaling well known museums in London, Melbourne, and elsewhere. Within the next few years an annotated catalog ofthe museum willbe published. The Trustees envision the Wood Library-Museum becoming one ofthe greater national library-museums of medicine. They are committed to that goal and willuse every resource available to assure its attainment. The ASAmembership is encouraged to be part ofthe process and to use the WLM for professional and personal enjoyment of the specialty.

From the Literature. ..

COlllillllt'dfr",dAlgC 10

Watkins PJ. Self experimentation in medicine. Br MedJ 295:1351, 1987. This letter describes the 40 or 50 anaesthetic self-administraitons by the author's great grandfather, which he described in his 1865 graduation thesis. Wilson G. Benjamin Arthur Kent: A South Australian pioneer. Anaesth Intens Care 15:451-458, 1987. Review of the career of Kent. who administered the first anesthetic in South Australia in September, 1847, for a breast amputation. Five illustrations (including a portrait of Kent), fourteen references. Wright AJ, Aldrete JA. Patient memories of anesthesia: Historical perspective. Middle East] AnesthesioI9:233-254, 1987. Covers historical aspects ofthree types ofmemories: awareness, dreams and hallucinations and transcendental experiences. Both research and anecdotal accounts from nineteenth and twentieth centuries are included. One hundred thirty-six references. Wright AJ. Regional and local anesthesia in Alabama before World War!. Ala] Med Sci 25:204-209, 1988. Second ofa planned series (seeAIAJ MedSci23:333-335,1986) on history ofanesthesia in the state. Covers physician reaction to and use of regional and local techniques in the early decades after Koller's 1884 report. Three illustrations, twenty-eight references. Wukitsch MW. Pulse oximetry: Historical review and Ohmeda functional analysis. IntJ Cli,l Monit Comput 4:161-166, 1987. Historical portion reviews oximetry developments since the 1930s.Especiallyuseful is the "Oximetry development timeline," a table covering events from 1760 to 1986. Eleven illustrations, one table, one reference. Zabludovskii PE. Assessment of the natural science views of N.!. Pirogov. Sou Zdravookhr 9:71-74, 1987. This Russian-language article has not been examined.

Festschrift . . . Continuedlron: A\~~

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gotta watch the patient." He had a very direct relationship with his residents. This could sometimes be uncomfortable. He could sense trouble from afar and appear suddenly when we were swamped. Again, I can recite a personal episode ofmany years ago that I remember quite clearly. I was into my residency training some months, I don't know how long, but long enough to know that I was very good. And I knew that the principles and the basics that Dr. Cullen had espoused were meant for some ofthose less gifted than I in the training program. This particular evening I was faced with a late evening emergency which I approached with my own plan and ignored some ofthe very basic principles that had been laid down for me. As I say, this was a late evening emergency and the boss should have been home, but he suddenly appeared in the side door ofthe operating room and saw that I had converted a serious and straightforward emergency into a situation ofcomplete and utter chaos; from which retreat was impossible and success less than likely. His simple comment to me at that time, and I think, as I remember, itis the only time that he ever spoke curtly to me, was "you want to learn the hard way, don't you?" Again, this was a direct, close personal observation. ' The boss had a real sense ofhumor and his talks to medical students and other professional audiences alike were laced with James Thurber and Charlie Schultz' Peanuts. He has on the wall ofhis study now a personally autographed copy of a Peanuts cartoon. The boss was progressive and liberal. And those of you who have only known him as a politician in Belvedere, if that is an apt phrase, would not recognize the liberal attitude, perhaps, that he had in his earlier days or in his approach to education and his approach to medical school. He had a great willingness to explore, and to change, and a refusal to accept tradition without equating it with progress. .The boss was a vain person. I think maybe many people did not recognize this, but he had a great pride in many things. He had pride in the schools, he had pride in his department; he had pride in his performance; and he had pride in his appearance. Those ofyou who saw him in the operating room would know that, while most of us wore scrub clothes in the operating room that were designed for anything except attractiveness (I guess they're economical and they're serviceable), the boss had his own made and he wore his own that were tailored. He laundered them himselfand he didn't look like the rest of us. He was proud ofhis family and he could be asquick asanybody with the photograph of a grandchild or the story of some of their achievements. He would be very proud ofthose who travelled so far to be here today. I believe pride is an essential component of success.

Anesthesia History Association C. Ronald Stephen, M.D., C.M., Newsletter Editor 15801 Harris Ridge Court Chesterfield, MO 63017

He was a humble man. He had true humility. He had the kind of humility that would be exemplified, and was, by this internationally known physician who had senior faculty rank, turning to an obviously bewildered, frightened student nurse on her first day in the operating room, and saying to her, "Can I give you a hand?," as he helped the young lady secure a patient on the operating room table. This same nurse, who is now more mature than bewildered, cherishes very warmly this first meeting. This same humility allowed the boss to return to the department from the Dean's Office. The Dean's Office has a great deal ofrespect and honor. He had a lot ofresponsibility, which I'm sure was gratifying. He had a spacious office. He came back to the department where he had no office and few facilities - even before Jerry Brown's day we were crippled with shortage of facilities - without asking any favors he served as a very diligent teacher in the department - put some of the rest of us to shame, and resisted the temptations which must have been very great to tell me how to run the department. He's a family man. You can look at the progeny here - two generations, now, oftalented people. His son and daughter are teachers. They have succeeded as teachers. They have continued in the spirit of community service which the boss did so well. And Mimi, in spite ofall the awards and the accomplishments he has had and which have been referred to today, and to which reference will bemade in the future, you're the greatest evidence that he was a perceptive and discerning man. The boss was forever youthful. He had lots of hobbies as I mentioned, and up until recent days he was active in ham radio. He had a great breadth of interest. Some of you won't know that the boss was active on the Athletic Board while at the University ofIowa, that he travelled throughout the country, and recruited Mr. Forest Evashesky back at the University ofIowa. Since he left there, the Big Ten hasn't done well, as you know. If you combine all of these things, and many more which must remain unsaid, the reasons for his success must be known and the reverence with which we regard him. Joseph Conrad said, "A man's real life is that accorded to him in the thoughts ofother men by reason of respect or natural love. " To these other men, these thoughts are of the greatest and they'll continue in our memory, and more importantly, in effect, and therefore, his real life will continue. - William K Hamilton, M.D.