Newsletter July, 1994

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s Volume 12, Number 3

July, 1994

Horatio Robinson Storer: Sir James Young Simpson's Boston Connection by Patrick Sim, Librarian, WoodLibrary-Museum ofAnesthesiology

Horatio Robinson Storer, 1830-1922, was born toa prominent Boston family. After graduating from Harvard Medical School in 1853, he traveled abroad to Europe and spent his time in Paris, London and Edinburgh. While in Edinburgh, he served as the private assistant ofSir James Young Simpson. Upon his return to America, he was credited for introducing the use of chloroform in obstetrics to Walter Channing, and to his father, David Humphreys Storer," As a close friend and disciple of SirJames, he was theAmerican editorof the latter's ObstetricalMemoirs which was published in 1855-56. Storer was further recognized for his effort to establish gynecology as a special branch of medicine, and for founding the first journal dedicated to the diseases of women. 1 In the twilight of Sir James Young Simpson's life, he was bitterly in disputewithjacob Bigelow regardingtheclaim ofcredit to the discovery of anesthesia. Friedlander has chronicled and documented this conflict admirably with a speculation that strong personality traits between the adversaries played a large pan in the dispute," In total, there were only five exchanges between the rivals,which were all published in medical journals. The dispute began in November, 1,869, and ended in April, 1870, just one month before the death ofSirJames Simpson. The tone ofthe dispute was bitter, sarcastic, and emotionallycharged. During the course of these exchanges, SirJames relied upon his two close friends in America to serve as his conduit to publish and circulate his two letters. They were New York physician George T. Elliot, and Boston obstetrician Horatio Robinson Storer.' Storer was especially close to Sir James, and his role in this trans-Atlantic debate might be more important than just a messenger. The Simpson-Bigelow dispute was instigated by the publication of a lavish praise of Simpson's contribution to the discovery of chloroform anesthesia by the Lord Provost of Edinburgh in October, 1869, on the occasion of a recognition ceremony in honor of Simpson by the city of Edinburgh. The praise on Simpson's discovery of chloroform, and Simpson's acquiescence to the praise, offended Jacob Bigelow. The total silence on Boston's role in the discovery of ether anesthesia infuriated Bigelow, and he expressed his displeasure in an open letter "Hisrorian and Horatio Storer biographer Frederick N. Dyer has reservations about this statement. In a communication with th'e Author, Dr. Dyer pointed out that Horatio was an admiring student of Channing's who had previously visited Simpson prior to Horatio's apprenticeship with the master. Channing should have known about chloroform as an anesthetic for obstetrics as early as 1852. Dyer further speculates that the senior Storer, who was Professor of Obstetrics and Dean of Harvard Medical School from 1855 to 1864, might not have been an advocate of chloroform anesthesia.

Horatio Robinson Storer, 1830-1922. Courtesy of Richard J. Woge, GarlandLibrarianoftheFrancisA. Countway Medica! Library. published in November, 1869, in the Boston Mediall &SurgicalJournal. Simpson responded in January, 1870, in his own defense, and had his letter published in his native Englandand in America in three different medical journals within a period ofthree months," Bigelow returned the favor in two letters, dated January 29 and February 27, 1870, and

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A Day of History Tuesday; October 18, 1994 In association with the Annual Meeting of the American Society of Anesthesiologists in San Francisco, Tuesday, October 18, promises to be a special day for history buffs. On Tuesday morning a special ASA session will be devoted to topics of historical interest. At 1:00 p.m., the Wood Library-Museum of Anesthesiology is presenting the annual Lewis H. Wright Memorial Lecture. The Distinguished Lecturer this year is Dr. James E. Eckenhoff, who will discuss TheGrowth of Ancsthesiology as Viewed by Artists

and Photographers. At 2:00 p.m., a panel will be moderated by Dr. Maurice Albin, at which several anesthesiologists will outline the careers of Unsung Heroes and Heroines ofAnesthesia. At 6:00 p.m., buses will go from the Hilton Hotel, ASA co-

headquarters, to a reception sponsored by the Guedel Memorial Center which is located at 2395 Sacramento St. There one can recall the many contributions to anesthesia ofArthur E. Guedel and review the events of the day with friends. Finally, the buses will leave in time to attend the business meeting and buffet dinner of the Anesthesia History Association scheduled for 7:15 p.m. at the California Culinary Academy, at 615 Polk Sr., corner ofTurk. Following the/dinner, the guest speaker will be Professor Frederick J. Spielman, M.D., as outlined on the accompanying notice of the annual meeting. Following, the dinner and speaker, buses will return to the Hilton Hotel. We are most indebted to Dr. John Severinghaus and to Dr. Rod Calverley for coordinating these events.

Wanted: Twenty-Four Papers The next annual Spring Meeting of the Anesthesia History Association will be held May 11, 1995, at the Holiday Inn at University Center in Pittsburgh, Pennsylvania. As in past years, it will be held the day before the annual meeting of the American Association for the History of Medicine. Each paperwill be allotted 20 minutes for presentation, with an additional 10 minutes for questions from the floor. The luncheon plenary session speaker will be Dr. Sherwin B. Nuland, surgeon and historian at Yale University, and author of The Origins of AI/csthcsia in the Classics of Medicine Library, and the widely acclaimed Doctors: The Biography ofMedicine. You are invited to submit abstracts on any subject related to the

history ofAnesthesiology byJanuary 31, 1995,on 8.5x 11inch paper with the author's name and address. Abstracts and meeting information requests should be sent to: Douglas R. Bacon, M.D. Department of Anesthesiology, Pain and Critical Care Medicine Roswell Park Cancer Institute Elm & Carlton Streets Buffalo, N.Y. 14263-0001 Phone: (716) 845-3240 Fax: (716) 845-8518

Letterto the Editor APostal Stampfor Horace Wils After I moved to Connecticut, the late Dr. Leonard Menczer invited me to help him in his effort to have a postal stamp issued for Horace Wells. I obtained close to 200 signatures from colleagues and neighborsand finally wrote an emphatic letter to the Postmaster General in Washington, D.C. A reply arrived promptly informing me that a. stamp had already been issued for the "discoverer" of Anesthesia, Crawford W. Long. I cannot argue with the Postmaster's opinion; Long did administer the first general anesthetic. I sincerely believe that a stamp honoring Horace Wells will not be forthcoming unless the logo is changed. How about the "first public advocate of anesthesia," or the "protagonist of anesthesia," or the "inventorof dental anesthesia," or the "inventor of nonflammable anesthesia"? Further proposals are welcome!

Gertie F. Marx,M.D.

The Anesthesia History Association is in the process ofchecking and updating its mailing list. Would you please take a moment to check the mailing label onyour copy of this Newsletter, and verify that your name and mailing address are correct. If there areany changes, please inform theNewsletter Editor, whose address appears on theback of this Newsletter. The Anesthesia History Association and theU.S. Postal Service thank you for your help!

52 Queen St. Edinburgh 28 Febry, 1870 My Dear Dr. I have taken the liberty of sending you a parcelofthe printed letters.Youwillobligeme much if you willgive copies to Mr. Eddy - or any other people interested in the matter. Whiletherearestillwimesseslivingshould notsomeonecollectamongyouand publishall the evidence that remains - with the view of settling the claims of Dr. Jackson and Dr. Morton,

I scribble in haste. Yours very ttuly j.Y.Simpson Dr. H. Storer

Figure 2. J.Y. Simpson's letter toDr. Storer, Febmary 28,1870. (From theWoodLibrary-Museum Rare BookCollection.)

Horatio Storer. . . Continuedfrom Page 1 published in the March 10, 1870, issue of the Boston Medical & Surgical.Iournal.' Simpson responded in early April, about a month before his death, and entrusted his confidant Horatio Storer to the publication and distribution in America of his last response to Bigelow's criticism." In preparing his last response to Bigelow, the original Ether Controversy involving W.T.G. Morton, Charles T. Jackson and Horace Wells was very much in Simpson's mind. In his letter to Storer on April 9, 1870, he espoused the notion that the largest credit to a discovery should be given to the individual who best perfected the discovery on grounds of its practicality. In this case, he contended that chloroform anesthesia was by far superior to ether anesthesia. The credit to a discovery should not simply be determined on the grounds of chronological priority. With this he invoked the dispute between Morton and Wells, with acomparison of the use of ether and nitrous oxide in surgery. He implied that even nitrous oxide was superior to ether. Therefore, Horace Wells' contribution in the discovery had unfairly been relegated in Boston," Thus, Simpson himself should be assigned the largest credit in the discovery. This argument may appear somewhat self-serving. Nevertheless, to arrive at this conclusion, Simpson must have reassessed the roles of the individuals involved in the original controversy in 1846. The evidence of the following letter (Figure 2), which he wrote to Storer, shows that during his dispute with Jacob Bigelow he had collected a fairamount of material relative to the original controversy in 1846. In this prized possession of the Wood Library-Museum, Sir James Simpson wrote to Storer three months before his death with obsession on the original controversy. The names ofMr. Eddy, Dr. Jackson and Dr. Morton in this letterare most revealing. C.R. Eddy was the son ofJackson's neighbor, Caleb Eddy. The junior Eddy was a patent solicitor whom Morton had approached for a patent application soon after the ether discovery. Being a neighbor to

Jackson, and knowing Jackson's involvement in the discovery, attorney Eddy persuaded Morton to includeJackson in his application as a joint-patent holder. Morton acquiesced, but Jackson initially declined, fearing that in doing so he would violate the ethical standard imposed by the Massachusetts Medical Society upon its membership. Jackson was later assured by Augustus A. Gould that such action would not be unethical. With this assurance, Jackson agreed to the terms ofa joint-patent application, and stood to share royalties for the use of the discovery with Morton," Eddy reported this event in May, 1847.However, Jackson soon regretted his action, and he vehemently denounced this arrangement in a letter to Sir James in December of the same year.? SirJames Simpson's feud with the elder Bigelow was not profitoriented. It was an issue that involved regional, and perhaps national, partisanship and pride on the relative merits ofchloroform and ether anesthetics. The dispute was also about the assignment of credit to which individual a discovery was due. Its relevance to the original Ether Controversy seemed to be minimal at the time. Simpson's reference to the individuals in 1846 was merely historical.Yet, in this letter, which he wrote in the midst of his feud with Jacob Bigelow, he appeared to have arrived at a different interpretation of the proper assignment ofcredits to the original claimants to the discovery of anesthesia. On April 9, 1870, he wrote tQ Storer again. Among other pertinent things on his dispute with Bigelow, he informed Storer that he was beginning to reassess the role of Horace Wells and his contribution to the discovery, after having carefully read "the official -volume of evidence in the matter, published by Dr. Morton," and found that nitrous oxide was a surgical anesthetic, not just a gas for "toorh-pulling"." As mentioned earlier, Sir James Simpson was reevaluating Horace Wells' role in the original controversy to establish his contention that only the discoverer of thebert anesthetic deserved the acclaim that went with the discovery. He did not live long enough to present his

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Stamp to be Released Honoring Dr. Virginia Apgar by Selma Hamson Calmes, M.D. On Monday, October 24,1994, the United States Postal Service willrelease a 20-centstarnp in honor of anesthesiologist Dr. Virginia Apgar (l909-1974). This stamp will be part of the Great American Series, which has 52 honorees. Apgar will be only the second physician related to anesthesia to be honored with a stamp (the first was Dr. Crawford Long of Jefferson, Georgia, whose stamp was released in 1940),and she will be the firstwoman physician honored in the Great American Series. Dr. Apgar was born in Westfield, New Jersey, to an interesting, dynamic family. Her father was a dedicated scientist, although he made his living selling various things. His basement lab and homemade telescope probably served as stimuli for her lifelong interest in science. Music was also an important part of their family life and continued to be important to Apgar throughout her own life. By the time she graduated from high school, she was committed to entering medicine. This was an unusual choice at the time, since there were few women physicians then. I The family was not wealthy, and Apgar funded her college education at Mount Holyoke College with scholarships and work, which included catching cats forthezoology lab. She was able to be active in an amazing number of college activities, especially music and athletics, in spite of the need to work. The all-female environment of Mount Holyoke, and its long tradition of training women of excellence in science, allowed her to continue toward her goal of becoming a physician. She graduated in 1929 from Mount Holyoke and entered Columbia University's College of Physicians and Surgeons. (She had wanted to go to Harvard Medical School, but it did not accept women yet and did not until 19451) America's Great Depression began shortly after she entered medical school, and the family's financial situation deteriorated further. She was able to borrow money from a family friend whose assets had survived the Crash, and she graduated in 1933, fourth in her class, a member of the medical honorary academic society AOA, and $4,000 in debt. She then began a two-year internship in surgery at Columbia, and she performed brilliantly. Butless thana year after starting, she was seeking anesthesia training. Probably this was because of the Department ofSurgery's need for better anesthesia, because of the difficulty women surgeons had in becoming established in practice, and because of better acceptance of women in anesthesia as opposed to women in surgery. After one year at Columbia learning from nurse anesthetists, she spent six months with Ralph Waters at the University ofWisconsin and six months with Emory Rovenstine at Bellevue. She returned to Columbia in 1938 as Director of the Division of Anesthesia, the first physician director of anesthesia at Columbia. Anesthesiology was just emerging as a specialty, and the problems were enormous. However, she did establish a residency program, began scientific research and wrote useful articles on anesthetic techniques. Eventually, the needs to establish a basic science effort in the division and to establish a separate department, outside the Surgery Department, led to Dr. Emmanual Papper's

appointment as chairman in 1949. Freed now from administrative responsibilities, Apgarmoved to obstetric anesthesia, in which she had always been greatly interested. This specialty area of anesthesia was greatly neglected at the time. This move led to the development of the Apgar Score. The Columbia anesthesia staff all ate breakfast together in the hospital cafeteria, and one day a medical student commented on the need to evaluate the newborn. Apgar had already noticed the great variability of newborn responses to birth and probablywas mentally prepared for a solution. She said, "That's easy, you'd do it like this. . ." and jotted down the five points of the Apgar Score on the nearestpiece of paper, a little folded card thatsaid, "Please bus your own trays." She then dashed off to the delivery room to try it out. 2 She first presented the Apgar Score at an IARS meeting in 1952 and it was published in their journal in 1953.3 She saw the Apgar Score, which she planned to be done one minute after birth, as a guide to which babies needed resuscitation. There was a need for this because the newborn was often neglected at that time. Eventually, with the help of physicians Duncan Holaday (an anesthesiologist-researcher who provided the needed laboratory support) and L. StanleyJames (a pediatricianwho provided the pediatricand invasive procedure support), a scientific basis for the Apgar Score was established. Hypoxia and acidosis were found nor to be normal at birth, in contrast to current thinking. Hypoxic, acidotic babies were shown to have low Apgar Scores and resuscitation should begin promptly, withoutwaiting for confirmatory lab studies. Also, different methods of newborn resuscitation could now be compared, and some strange resuscitation techniques then were no longerused. Others started measuring the Score at various intervals after first, to see how the baby was responding to resuscitation efforts. Later, the one- and five-minute Apgar Scores became standard. Every baby born in a modern hospital throughout the world now receives an Apgar Score. The rest ofApgar's careeris norwell known to anesthesiologists. In 1959 she went to Johns Hopkins to get an MPH, hoping to learn more about statistics to help with the newborn studies. While there, she was offered the position of Director of Research at the March of Dimes-National Foundation, which was just beginning its new mission of decreasing the incidence of birth defects," She took this position because she wanted to try something new," She later moved up to Vice-President for Medical Affairs,with the responsibility of fund-raising for research and management of the research direction. During her fifteen-year tenure, annual giving increased from $19,000,000 to $45,000,000. She was very successful in this position and became enormously popular with the public. Her energetic, humorous speaking style and her focus on the human aspects of birth defects endeared her to everyone she met. It was on one of these typically whirlwind national trips that the idea for the Apgar stamp was born. In 1962, she arrived in Denver on a March of Dimes-Naeional Foundation visit. Dr. Apgar met

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Virginia Apgar. . . Continuedfrom Preoious Page Dr. L. Joseph Butterfield of Denver Children's Hospital. (Dr. Butterfield introduced the concept of regional perinatal care and developed the first such system in the nation in the Rocky Mountain area. He received the Dr. Virginia Apgar Award from the American Academy of Pediatrics in 1992 for his contributions to perinatal medicine.) Dr. Butterfield had a child with a birth defect, and also had developed and published an acronym for the Apgar Score." They became friends, and Apgar visited the Butterfield home several times when she was in Colorado. In 1984, ten years after Apgar's death, Butterfield had the idea for an Apgar stamp. After an informal surveyata SocietyforPediatric Research meeting demonstrated support, the Perinatal Section of the American Academy of Pediatrics (AAP)adopted a resolution requesting that the AAP Executive Board approve nomination of Dr. Apgar for a postage stamp. The AAP Executive Board agreed. Then the difficulties began; getting a stamp nomination approved is extremely difficult. Through connections in Washington, Butterfield found out that he had to contact the Citizens Stamp Advisory Committee (CSAC), which is an appointed group of 1416 citizens with wide interest representation who serve at the pleasure of the Postmaster General. They meet four times a year in Washington and deal with 30,000 letters per year nominating people, places and events for possible recognition with a stamp. Nearly all stamp subjects come from this committee, which focuses on interesting and educational topics. Recommendations from the committee are made to the Postmaster General. In addition to the extensive line of regular stamps, 2S to 30 commemorative stamps are issued each year. A steering committee for the stamp effort was appointed by the Executive Board of AAP. Dr. Butterfield was chairman; Dr. L. StanleyJames, Apgar's researchcolleague, was alsoa member. The AAP's Washington office gave staff support, and the March of Dimes loaned their Washington lobbyist. The steering committee held a planning meeting in Washington in 1986.This was attended by representatives ofgroups which might support the stamp effort, such as the American College of Obstetricians and Gynecologists (ACOG). The stamp process was explained, and a strategy of quiet lobbying by highly placed individuals (as opposed to a massive letter-writing campaign) was chosen. Written supporting material was presented. Next, letters to second the AAP nomination were sought. These came from Dr. L. Stanley James, former Surgeon General Dr. Julius Richmond, and opera star Miss Beverly Sills, who served as national chairwoman for the March of Dimes volunreers.?

The formal nomination was carried to the USPS office in February, 1987, and a long wait began. Other professional organizations also signed on to the nomination. Through connections at Mount Holyoke College, a lobbying campaign ofCSAC members also began. The search for people who knew CSAC members included a basketball coach at Notre Dame, a TV anchorwoman, a Denver golfer who grew up on a ranch in Texas which was next to the ranch ofa woman who later became chair of the committee, and a pioneer transplant surgeon. Additional support and publicity came from another similar mix of people: Representative Pat Schroeder (D-Colorado), Joan Beck (syndicated columnist for the

Chicago Tribune and coauthorofa book by Apgaron birth defects), Lawrence K.Altman, MD, science writerfor the New YorkTimes, the Colorado staff of the Associated Press, and the Apgar Family Association. In July, 1990, the group learned that a stamp had been recommended by the CSAC, but the year was undetermined. Finally, in late 1993 the AAP office received an inquiry from the USPS about the most desirable future event of the AAP where the Apgar stamp might be dedicated. The 1994 annual meeting in Dallas was chosen. On December 7, 1993, a USPS press conference presided over by Postmaster General Marvin Runyon at the new National Postal Museum introduced the Apgar stamp. It is a line-drawn portrait, with the simple designation of "Physician" on the side. After ten years, Dr. Butterfield's very hard work was successful! Apgar no doubt would have loved the varied mix of people who organized to work for her stamp. She would have also enjoyed the idea of a stamp since she was an avid stamp collector. The stamp release will take place October 24 during a plenary session at the annual meeting of the American Academy of'Pediatrics in Dallas. Before the ceremony, a string quartet will perform a selection of Dr. Apgar's favorite pieces. The group, which will include some Apgar friends, will playa cello and a viola which she made herself. AAP President Dr. Betty A. Lowe, Dr. L. Joseph Butterfield,Dr. L. StanleyJames and Mr. HenryApgaroftheApgar Family Association will participate in the release ceremony.

References and Notes 1. Women were 4.5% of the U.S. physician population when Apgar graduated from college. Apgar never met a woman physician until after she graduated from college. This was the wife of Dr. Cecil Drinker (of Drinker respirator), who hired VirginiaApgaras anoupoirforthe Drinkerchildren. The Drinkers were spending the summer at Woods' Hole. 2. Apgar often used these cards for making notes. One of my great treasures is one of these cards. Apgar scribbled the names and addresses of Scandinavian anesthesiologists whom she thought Dr. Richard Patterson should visit on an upcoming trip to Scandinavia. Dr. Patterson gave the card tome. 3. Apgar V. A proposal for a new method of evaluation of the newborn infant. Anes/h Ano(g32:230-267, 1953. 4. The National Foundation for Infantile Paralysis was founded in 1938. In the early 194Os, it became commonly known as the March of Dimes after its popular fund-raising program. Source: PauIJR.A History ofPoliomyelitis. Yale U Press, New Haven, 1971. pp 308-312. 5. Some wonder about the motivation of this move. A letter to Apgar's "Aunt Edith," April 22, 1959,states her reasoning; itwas clearly seen asa great opportunity. 6. Butterfield J, Covey MJ. Practical epigram of the Apgar score. lAMA 181:353, 1962. 7. Some readers might not know that Miss Sills has a child with a birth defect. 8. Further reading on Dr. Apgar: Calmes SH. Virginia Apgar: A woman physician's career in a developing specialty.JAMWA 39:93-97,1984. Calmes SH. Development of the Apgar Score. In J Rupreht, MH van Lieburg, JA Lee and W Erdman eds.Anest!Jesio:EssaysonItsHistory. (SpringerVerlag, Berlin), 1985, pp45-48. Calmes SH. Virginia Apgar. ASA News/ener 56:9-12, 1992.

Acknowledgement Theouthorexp=sesherthonksto Dr.JoeButterfieldofDet1verwho ledthestomp effortand whoshoredhisinformationon deoelopment ofthestompprocess with me.

Arthur E. Guedel (1883-1956) ThefOl/owit/grecol/ectioflS ofArthurE. Guedelwerepublishedif1 theBulletit/ oftlIeCalifomia Society ojAt/estlJeSiologists(CSA) 20ycorsago, and thetl resum:cted it/theil1ardJ-April, J994, issue oftheBulletit/. The author, CllOfl1Jcey D.Lenke, PhD.,wasa dose colleague ofGuedel. A ret/owt/ed'pharmacotogisz, LenkecametoCalifomiafromtheUt/iversity ojWiscoflSit/, wherehewasa dosefriet/dofRolphM. Waters, and became ChairoftlIeDepartmentofPhanJJacology at theUt/iversity ojCalifomia if1 Sat/Frandsco. We aremumit/debtedtotheEditorofthe Bulletit/ ojthe CSAfor'permission to reprint this vigtJette.

Recollections of Arthur E. Guedel -- 1883-1956 by Chaut/cey D. Leake, Ph.D. Like most places, the steep forested Santa Cruz mountains in California have known their quota ofjoy and sorrow. For me, however, memories centered there are filled with happiness. In 1933 we acquired a few acres of redwood circles along the San Lorenzo River about six miles above Boulder Creek. Elizabeth, my perceptive wife, says there were 85 steps down from the side road to the log bridge over the river and to the little cabin on the flat beyond. There was one redwood circle there with a barbecue pit and rustic benches, wherewecould feed the twenryorthirrypersons who would comedown from the laboratory on a Sunday for a seminar. Up the hill a bit was a larger circle, again with rustic benches, and a blackboard hung on the shaggy park ofa big redwood. There we would hold our seminar discussions, after a dip in the cold river where we had a dam, and after a refreshing lunch of ham ,cheeses, fruits,and wine. And there Art Guedel would hold forth on his favorite theme of metabolic detoxification rates of various depressing or stimulating drugs. It was always an exciting session."Often it resulted in renewed experimental vigor on the part ofthe young people in our laboratory who were looking toward a career in pharmacology. Art Guedel was a persistent catalyst for fruitful practical developments related roanesthesia, He had an infectious good humorand aclear down-to-earth way ofexplaining his point of view. He was an excellent teacher. Art Guedel was a sympathetic and calm clinician with a high sense of responsibility for his patients' welfare. He took the position that the anesthetist in a surgical team is the medical consultant to the surgeon and, as such, responsible for the physical condition and welfare of the patient on the operating table. Accordingly, itwas routine for Art Guedel to visit patients as soon as they arrived at the hospital and at once to win their confidence with his skillful physical examination. In supervising their restricted diet before the operation he would explain what he was trying to do and why. Similarly hewould tell what pre-anestheticmedication he was usingand why. Then he would discuss with the patients, theirattendants and the surgeonwhatanesthetic procedurehe would followand whatguided his choice. The resultwas thatall trusted him fully. Hiswiseand gentlecare of patients seta strong example to all who knew him, and greatly raised the standards of anesthetic procedure in everyarea in which he worked. During the operation Art Guedel was among the first, following the example setby the great neurosurgeon HarveyCushing(1869-1939), to carefully monitor the patient's physiological Status. He recorded blood pressure, respiration, muscle tone, wink reflex and pulse regularly, reporting as he went to the surgeon and advising regarding his opinion ofthe depth ofanesthesia. Always prepared to handle emergencies, he seldom had any. After operation, Art Guedel followed patients carefully, adjusting postoperative regimes to provide as much comfort as possible. He used

morphine freely to relieve pain and barbital to give sleep. He held that proper pre-anesthetic preparation and proper anesthetic procedure would keep postoperativenauseaand distress toarninimum. Longwere the discussions we held to assure this kind of practical success in anesthetic technique. Art Guedel came to his distinguished leadership in anesthesia as a result oflongyears ofstudyand ofpractical clinical experience. With us, in the Pharmacology Laboratory ofthe University ofCalifornia Health Center below the eucalyptus forest on Pamassus in San Francisco, he developed great experimental skill and taughtourstudents much of his wisdom. He came up from Pasadena, where he practiced, several times a year and stayed a week or so each time. In the summer, when amphetaminediscovererGordonAlles(1901-1963)wouldcomeupalso, and when Pete Knoefel,ProfessorofPharmacologyatLouisville,would be working with us, Art Guedel would often spend several weeks working long hours in the laboratory and relaxing only at the Sunday seminars at Pharmaglen in the Santa Cruz redwoods. Arthur Ernest Guedel was born june 13, 1883, in Cambridge City, Indiana. He received his medical degree from Indiana University Medical School in Indianapolis in 1908 and, after medical service in World War I, becameLecturerinAnesthesiaathisalmamaterandbegan his practical work as staff anesthetist at Indianapolis hospitals. While therehebecameaclosefriendofRalphMiltonWaters, whowashissame age and who had graduated with distinction from Western Reserve. Ralph Waters and Art Guedel were mutual stimulants to each other. Theygotalongfamouslyand often argued sharplyand vigorously in the development ofsome significant idea relating to anesthesia. Impressed by the work of Dennis Emerson Jackson, Professor of Pharmacology at the University ofCincinnati, on the relation between oxygen and carbon dioxide in anesthesia, theyfollowed his experimentalworkin developingaclosed-<:ircuitanesthesiasystemwith soda-lime for the removal of carbon dioxide and with a surplus of oxygen to preclude any possibility ofoxygen lack. AsJackson had shown, there is practically little metabolic loss ofan inhalation anesthetic agent during the ordinary time ofan operative procedure. Under these circumstances iris only necessary to remove carbon dioxide as formed bya patientand to keep up the oxygen supply, while the anesthetic concentration remains about the same. When I was in the pharmacology laboratory of the University of Wisconsin I publishedarticles indicatingthat the relativelygood postoperative condition ofpatients was due to the relatively higherconcentrations of oxygen which could be used in ethylene anesthesia. Later I showed that such inhalation anesthetic agents as ether and chloroform tend to produce an acidotic condition in patients, while nitrous oxide tends to cause an alkalosis. Ethylene lies between. This work attracted

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Arthur Guedel. . . Continuedfrom Preoious Page RalphWaters' interestand on the invitationofErwin&:hmidt, Professor ofSurgery, Ralph Waters was invited to the University ofWisconsin as ProfessorofAnesthesia.Thiswasin 1927,when thenew general hospital of the University ofWisconsin was first opened. Early in 1928 Ralph Waters and I began a study of carbon dioxide anesthesia and confirmedthe findings of Henry Hill Hickman (18001880), who had demonstrated carbon dioxide anesthesia a century before. About this rime Ralph Waters began training residents in anesthesia. His friend John Lundy (1894-1973), at the Mayo Clinic in Rochester, Minnesota, undertook residency training for anesthetists shorclythereafter. From RalphWaters I learnedofhis interestingstudies on the carbon dioxide absorption technique, which he had undertaken with Art GuedeI. Meanwhile Art Guedel had moved to Pasadena and become Clinical Professor ofAnesthesia at the University ofSouthern Califomiaand anesthetiston thestaffoftheCedars ofLebanonHospital in Los Angeles. I carne to San Francisco in 1928 to organize the pharmacology laboratory at the University ofCalifomia Health Center. We had a large open room on the top floor ofthe three-story, yellow-brick, ivy-covered medical school building under the eucalyptus trees ofMt. Sutro. In an effort to get work in the laboratory underway I invited Art Guedel to come up to the laboratory whenever he could to work with us. This he did, and his presence was stimulating to all ofus. I had theorized thatdivinyl etherwould beapotentanestheticagent, even though it was not yet in existence. Receiving samples ofunsaturated ethersfrom RandolphMajorinthechernistrylaboratoryatPrinceton, we started our experimental studies and demonstrated indeed that divinyl ethermightbea potentanestheticagent, When RandolphMajor became Director of Research for Merck Laboratory in Rahway, New Jersey, we received supplies ofdivinyl ether for studies on dogs. Arthur Guedel helped us greatly with this work. He and Ralph Waters had devised a tracheal tube with an inflatable tubbercuff, which could be used to seal off the trachea so that the full closed circuit anesthesia could be maintained, using the carbon dioxide absorption technique. Arthur Guedel helped us greatly with his practical skill. He demonstrated effective carbon dioxide-oxygen anesthesia to our students. When we had satisfied ourselves regarding the safety and effectiveness ofdivinyl ether anesthesia, we hoped to begin a clinical trial in the University of Califomia hospitals. Our stiffly conservative Professor of Neurosurgerywould have none of it. Accordingly, divinyl etherwas first used clinically and reported upon by Isadore S. Ravdin (1894-1972), Professor of Surgery at the University ofPennsylvania, Philadelphia. Arthur Guedel and I worked with Mary Botsford, who was an anesthetist associated with several of the San Francisco hospitals. She had been pioneering in anesthesia development in the San Francisco Bay Area and was highly respected. In our work on carbon dioxide anesthesia we considered that it might actually increase oxygen utilization in the brain. On this slim notion we thoughtitmight be worthwhile to try carbon dioxide and oxygen in schizophrenic patients. Thanks to Mary Botsford's contacts we were able to find patients for such a trial at Agnew State Hospital. This sort ofcerebral stimulation in such patients had been shown by Ralph Waters (lAMA 96:880,1929). Art Guedel, Mary Botsford, and I reported on five patients with catatonic dementia praecox. The results were astonishing to us. These patients were all robust males in a negative catatonic state. We used concentrations of carbon dioxide of30% with 70% oxygen. After a couple of inhalations, with rise in blood pressure and pulse rate and with deepening respira-

tion, the patients' facialexpressionswentfrom blankness to intelligence and they gave rational responses to our comments. This mental improvemenrwas short lasting; within a few minutes the patients' condition returned to the usual catatonic state (CaIMed31:20-24, July 1929). In our experiments with dogs, Art Guedel and I had noticed that carbon dioxide and oxygen anesthesia often was initiated with some degree of convulsive movements ofneckmuscles.There seemed to be no serious effect from carbon dioxide-oxygen anesthesia. On one occasion Art Guedel maintained a dog on carbon dioxide-oxygen anesthesia for nearly twelve hours in the laboratory. Art never seemed to tire! Oftenwe would talkaboutrateand mode ofmetabolism of different anesthetic agents and ofcentral depressant drugs. Art Guedel felt that drugs such as barbital might interferewith what little metabolism there might be of inhalation anesthetic agents. He felt that brain depressant drugs such as the barbitals would synergize with inhalation anesthetics. Healso pioneered in the use ofbarbitals beforelocalanesthesia, in order to reduce the potential toxicity oflocal anesthetics. Along in 1936 or so, we studied Pentothal as a possible intravenous anesthetic. We decided thatitwas certainly potent, but that it might be potentially dangerous, since once havinginjected it intravenously there would be no way to get rid ofa surplus if too much were inadvertently given. John Lundy, however, developed it successfully at the Mayo Clinic, and it was widely used in World War II. We had manydiscussions with Art Guedel on the physiological state of an anesthetized patient. Art Guedel clearly defmed four stages in surgical anesthesia. These were given in an Introdllaory Ollt/ine of Anesthesia, whichArtGuedei issued from his BeverlyHills homein 1935. The manuscriprforthis isin theAnesthesia Collectionofthe University ofCalifomia in San Francisco. We had manydiscussionswithArtGuedel on thevarious signs ofthe different stages of anesthesia. We decided the commonly used term "excitement" was notappropriate for that phase ofanesthesia immediately following induction. We felt that the term "delirium" is more appropriate to this state ofbrain depression. Theseideaswereincorporated by ArtGuedelin his excellentclinical text, Inholotion Anestherio, A FtmdamentalGlIide, MacMillan, New York, 1937, 186 pp. The success of this book was great enough to result in a second edition, which carne outin 1951. Art Guedel pushed himself hard. Often he found that he did not sleep as easily as he would hope to. He often took barbital for his insomnia. Sincethis isslowlyexcreted, ithasatendencyto resultinsome degree of brain sluggishness the nextday. Art Guedel used some ofthe shorter-acting barbitals also. However, he wanted to be fully alert early in the moming when he would begin his clinical practice. Gordon Alles, a distinguished chemist in Los Angeles, had developed amphetamine as a substitute for high-cosrephedrine, He carne to our laboratory to study its biological action. His meticulously pareful experimental work greatly impressed Art GuedeI. Presently, Guedel begantotakeamphetamineinthemomingtopephimselfup.Thenhe would find thathecouldn'tgettosleepatnight.Soonhewastakinglarger doses of barbitals in order to get some sleep, and then he found that he had to take larger doses ofamphetamine to getawake. Realizing that he was caught in a whip-saw vicious circle, he stopped both the use of barbitals and amphetamines. Art Guedel had great strength ofcharacter, as that episode showed. He was vigorously interested in promoting the best kind of anesthesia. A charter member and founder ofthe American Society ofAnesthesi-

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Recollections of Rotterdam, 1982

I

From May 2 to 5, 1982, a meeting was held at Erasmus University to discuss "The History of Modern Anaesthesia". It was organized by Professor Willhelm Erdmann and Dr. Josef Ruphreht and was attended by a large international audience. The interest and fervor in the history of anesthesia generated by this meeting led to what was called the Second International Symposium on the History of Anaesthesia, which was held in London in july, 1987.The Third such Symposium was held in Atlanta, Georgia, in 1992, and the Fourth Symposium is scheduled to be held in Hamburg. Also in Rotterdam, the enthusiasm engendered by the meeting by attendees from the United States, namely, Drs. Selma Calmes, Rod Calverley and Jacob Mainzer, led to the formation of the Anesthesia History Association, which is now an active organization. Recently, four photographs were made available from Thomas E. Keys, A.B., M.A., former Librarian of the Mayo Clinic and Emeritus Associate Professor of the History of Medicine at the Mayo Graduate School of Medicine in Rochester, Minnesota. The two-volume book, Foundationsof.Anesthesiology, written by Albert Faulconer,Jr., M.D., M.S., former Professor of Anesthesiology at the Mayo Graduate School of Medicine, and Thomas E. Keys, and published in 1965, has been reprinted recently by the Wood Library-Museum of Anesthesiology. We are much indebted to Tom Keys for making these photographs available. They were taken at the meeting in Rotterdam and show several of the luminaries at this meeting.

Figure I. At the podium is Dr. T.C. Gray, Professor Emeritus of Anaesthesia at the University of Liverpool. To his left is Sf. Robert Macintosh, former Professor of Anaesthetics, N uffield Department of Anaesthesia, University of Oxford. To the right, sitting, is Dr. J.W. van Kleef, University Hospital, Leiden, The Netherlands. Figure II is Dr. J. Alfred Lee, former Head of Anaesthesia at Southend Hospital, Southend-on-Sea, and author of the multi-edition book, A Synopsis ofAnaesthesia. II

Figure III is Dr. William W. Mushin, C.B.E., former Professor of Anaesthesia at the Welsh National School of Medicine, Cardiff, Wales. Figure IV is former Professor Dr. Med. Ole Secher, University of Copenhagen and Rigshos pi ta le t, Copenhagen, Denmark. His writings contributed much to the historyofanesthesia and he was a consummate teacher.

III

IV

K. Garth Huston, Sr., M.D. November 15, 1926 -- June 29, 1987 by Rod K. Co/verley, M.D. The operating rooms of the Adventist Hospital in Glendale, California, were closed at midday on July 2, 1987, as a mark of respect for the memory of K. Garth Huston, Senior, an anesthesiologist who had served the patients of the hospital for many years. That afternoon his colleagues joined his family and friends for a memorial service which celebrated the life of an exceptional man whose actions were guided by a strong Christian faith. Several friends shared their appreciation of his attributes as a dedicated anesthesiologist, bibliophile and historian. Each speaker echoed elements of his son's eulogy, "Garth Huston as a Father, Family Man, and Friend -- His Life Sketch." As the service proceeded, members of the congregation learned new facts of their friend's life and realized that the memory of this quiet gentleman was held in great respect by a large and diverse community of scholars in America and other countries. Among the personal qualities which attracted this broad circle of friends was Garth's ability to identify the needs of ochers.He always had a sincere interest in any person with whom he was in conversation. I know that my encounters with him were not unique but, as they are representative of the experiences of other friends that may remain unrecorded, I would like to share them. I first met Garth in his capacity as Chairman of the Board of Trustees of the Wood Library-Museum of the American Society of Anesthesiology. At the time I was a member of a small committee which had the goal of forming an Anesthesia History Association. I needed his direction and counsel. Garth welcomed this requestand agreed to a luncheon meeting. It was not until I had driven to Los Angeles that I learned that he had already declined cases for the afternoon so that we might proceed to Jake Zeitlin's "Red Bard" and other antiquarian bookstores that he felt I would enjoy. After we had set the affairs of the Anesthesia History Association behind us, we chatted through the evening while I explored his magnificent library. For some time I was perplexed that a bibliophile who had assembled one of the finest personalcollectionsin the history ofmedicinewouldshowastronginterest inthe limitednumberofbooks I was studying. This mystery was resolved as I prepared to leave forhe then presented me with a few well-chosen but out-of-printtexts which he feltI would need in order tostudy history.His Faulconer & Keysand other volumes remain the reference material I tum to first to answer a question. He knewwhatI would need even beforeI did and responded with great generosity. After we had grown to know each other, Garth encouraged my participation in the Wood Library-Museum and American Association for the History of Medicine. In both organizations I learned that, as a physician who had been a printer, he was uniquely endowed with an ability to appreciate notonlya book's content, but also its binding and presentation. Under his direction therare book collection of the Wood Library had been enlarged through a series of significantacquisitions. He also introduced an energetic program of conservation. He loved books and taught us to care for them appropriately. In 1985, I was Garth's guest at the Annual Meeting of the American OslerSociety. His presidential address was a fine review

of his warm and long-standing relationship with Sir Geoffrey Keynes, an English physician and lover of fine books, who had first encouraged Garth's interests when Garth had been a medical student and had written a letter to Sir Geoffrey. His carefully crafted account of Keynes ' career had a second unspoken message: the appreciation that every student has for his mentor. From the conversations that followed I learned that many members of his audience had responded to his common theme and had spontaneously recalled memories of their own instructors. For me it was a particularly rich moment for the lecturer, Garth Huston, was the man to whom I felt a personal debt as he had been a principal guide to a broader understanding of medical history. Late in 1986 Garth learned that he had an inoperable malignancy. In the months that followed many friends were able to call and to visit. Those who came to offer support found that they were themselves more comforted through their conversation with a man at peace with himself. He was happy to be able to be permitted additional hours to experience the close companionship of his wife, Pauline, their children and grandchildren. He continued to assist his son in the preparation ofan invited lecture which was completed two weeks before his death and was later delivered by Garth Jr. at the Second International Symposium on the History of Anaesthesia in London. Before his passing, Garth's contributions to the history of anesthesiology had already been considered by his fellow Trustees of the Wood Library-Museum. They had enthusiastically supported a motion to give his name to the rare book collection that he had fostered with such dedication. The decision was promptlycommunicated to Garth, who accepted our proposal. After his death we learned that this well-deserved recognition had given him happiness at a time when he was becoming separated from his friends. This information came to us at the time we were keenly aware of our loss. We were comforted by realizing that our small action had given pleasure to a fine man to whom we shall always owe a great debt for his leadership, friendship and counsel.

Arthur Guedel. . .

Continuedfrom Page 7

ologists, Art Guedel was popular with his colleagues at meetings and was a continual stimulus to them with his sharp but cheerful discussionof their reports. Generous in praise, he warmly encouraged many young anesthetists to hold to the highest professionalstandards. With hisharddriveand intense devotion tothewelfareofhispatients, it was inevitable that Art Guedel would overwork himself. He developed coronaryartery disease and, although he smoked rarely, he had some emphysema. Graduallyhe gaveup hispush and driveand enjoyed his home and family.He died on June 10, 1956. Art Guedel was really a great contributor to the establishment of anesthesiology as a high-level medical specialty in our country. His influencewasgreatand itremains lasting.TheArthurGuedei Memorial AnesthesiaCenter in San Franciscoisa worthy and fitting tribute to the high esteem in which Arthur Guedel was held by all who knew him.

From the Literature byAJ. Wright, Librarian Department ofAnesthesiology, University ofAlabama at Binningham Anonymous. The History of Anesthesia: ThirdInternational Symposium Proceeding>. Park Ridge, Illinois: Wood Library-MuseumofAnesthesiology; 1992.

Risk and Outcome in Anesthesia. 2nd ed. Philadelphia: J.B. Lippincott; 1992, pp 1-35. Slightlyrevisedfromthe firstedition.Bestoverviewofthistopic.5 iIIus., 11 tables,3 appendices,134refs.

Containsmorethan90papersfromthe Third International Symposiumon the HistoryofAnesrhesia heldinAtianta,GeorgiainMarch1992. Reviewed inEurJAI1CS1hesioll0:389, 1993;BrJAIJOWh71:465, 1993;Alroert1u:rio48:931932,1993; umJAnolS!h 40(10): 1007, 1993.

BrownDL, Winnie AP. Biographyof Louis Gaston Labat, M.D. Reg Anesth 17(5):249-262; 1992.

Alltree DH. Obituary: William Knox Peacock. Anaesth Intens Care 20(3):387; 1992.

Lengthy reviewof the lifeandcareerofthe giantof regionalanesthesia.18 iIIus. (includingportrait). Two appendicesincludebibliographyof Labat's publishedworkand sourcesforbiographical material.

Describesthe careerofAustralian Peacock(1898-1992).

Bacon DR, Lema MJ. To define a specialty: a brief history of the American Board of Anesthesiology's firstwritten exam. J C/in Anesth 4:489-497; 1992. Describes the fascinating backgroundto that firstexaminationgiven on March28,1939. Includes samplequestions.9 iIIus., 36 refs.

BaconDR, Lema MJ, Yearley CK. For allthe worldto see: anesthesia at the 1939New YorkWorld's Fair.JC/in Anesth 5:252-258; 1993. Describesthe exhibit,"an international showcase andanimportantopportuniryforpublicrecognition ofanesthesiology." 9 iIIus., 24 refs.

Bankert,Marianne.WatchfulCare:AHistoryofAmerico'sNurseAnesthetists. New York: Continuum; 1989. This definitive historyof nurse anesthetists between 1877and 1989was finally reviewedin Bull HistMed66:668-669, 1992.

BenedumJ.Historicaldevelopmentofbloodtransfusion.BeitrInjusionther 29:1-16; 1993.

Calverley RK, SchellerM. Anesthesiaas a specialty: past, present and future. In BarashPG, Cullen BF, Stoelting RK, eds. C/inicoIAnesthesia. 2nd ed. Philadelphia: J.B.Lippincott; 1992,pp 3-33. Slightlyrevisedfromthe firstedition.Stillone ofthe best overviewsof the topic.8 iIIus., 71 refs.

CarlsonKA,JahrJS.Ahistorical overviewand update onpulseoximetry. AnesthesiolRea 20(5):173-181; 1993. This articleisshorten historyandlongon update;abouta pageanda halfare devoted to historical background. 2 tables,69 refs.

Caton D. The Wood Library-Museumand the future.ASA Newsletter 57(9):12-14; 1993. Describescurrent programs and servicesof the WLM.

Cope DK. James Taylor Gwathmey: seeds of a developing specialty. At1esthAna(g-76:642-647; 1993. GoodoverviewofGwathmey'scareerandachievements.9i11us. (including portrait), 15refs.

This German-languagearticlehas not been examined.

Bernard,Claude. LecturesonAnestiteticsandAspIryxio. Park Ridge,illinois: Wood Library-MuseumofAnesthesiology; 1989. This classic, translated from the French by Dr. B. Raymond Fink., was reviewedinJCli11 MOI1it9(2):121, 1993.

BodmanR;GilliesD.Haro/dGriffitlz:TheEvolution ofModemAnaesthesio. Toronto: Hannah Institute and Dundum Press;1992. This volume is the eighth in a series on "Canadian Medical Lives" publishedby the Hannah Institute forthe HistoryofMedicine.Excellent biographybased on numeroussourcesand contributions froma varietyof individuals. Reviewed in Col1JA110esth 39(7):750-751, 1992; Al1esth Anolg 76:463, 1993; Al1estlJesiology 78:1000, 1993.

Boulton TB. Sir Geoffrey Marshall, shock, and nitrous oxide. Sum AnesthesioI36(1):4O-51; 1993. This entry in the "Classical File" seriesreprintsSirGeoffrey's1917article on"Theadminismltionofanaestheticsatthefront".Dr.Boulton'sinrroductionreviewsSirGeoffrey'scareerandworkonshock.,anoci-association and development of apparatusforcontinuousflow nitrousoxide, oxygenand ether anesthesia.Portrait,27 refs.

Dechene]p. Fernando Hudon (1907-1982). CanJAnaesth4O(12):1210; 1993. BriefFrench-language biographyof Dr. Hudon.

Dundee JW. Afterthiopentone:a reviewofrecent history. Bail/ere'sClin AnoesthesioI5(2):267-280; 1991. Reviewofinduction agents in post-World WarII period. 131refs.

FinkBR Putit there!AninvitationfromyourWood Library-Museum. ASANewsletter57(9):9-11; 1993. Describessome of the artifacts and collections of the WLM.

FrancoA,CortesJ,RabanalS,VidalMI.Unaaporracionalconocimiento de la anestesia inhalatoria de finales del siglo XIX Rea Esp Anestesiol Reanim4O(3):162-163; 1993. This articlehasnot been examined.

FrancoA, CortesJ, Vidal MI, Barreiro]L, RabanalS. Spanish doctoral theses on anesthesia. A new contribution to the knowledge on this subject. Rea Esp AnestesiolReanim 40(4):245; 1993. This Spanish-language letter has not been examined.

BrautigamKH. Fachanz-fur-Anaesthesie 40 years on developments between 1945and 1953.Anasthesio/Intensivmed34(9):259-268; 1993. This German-languagearticlehas not been examined.

BrownDL. Anesthesiarisk: a historical perspective. In BrownDL, ed.

Franco Grande A, Cortes Laino J, Vidal MI, Picatto P. An American dentist pioneered anesthesiain Spain.Anesthesiology 76(1):154; 1992. Continued on Next Page

From the Literature. . . Contit/tledfrom Precious Page This brief lerter describes the work ofOliver Machechan, who in January, 1847, was the first to successfully use ether anesthesia in Spain. 8 refs.

Friedlander WJ. The Bigelow-Simpson controversy: still another early

argumentoverthediscoveryofanesthesia.BtlI/HistMed66:613-625; 1992. Coversthe"acrimoniousdebateoverwhetherSimpson. . .rookforhirnself tOO much credit for the discovery ofanesthesia, or whether he gave the city of Boston inadequate credit for that discovery." Focus is content of the deb-ate, not personalities. Author contends this controversy has been ignored by historians of anesthesia. 42 refs,

Gardner RlvI. Omar Prakash, MD PhD, 1936-1993. Int J Clin .Monit Comptlt 10(2):87-89;1993. This obituary of Dr. Prakash has not been examined.

Goerig M, Schulte am Esch J. Arthur Lawen - a pioneer of modem anesthetic techniques. Anosthesiol Intensivmed Notfal/med Sdlmerzlher 29(5):315-325;1993.

J105:175-177; 1992. Survey of anesthesia beginning with the first general anesthetic administered in Wellington on September 26, 1847.23 refs,

Isler H. Episodic cluster headache from a textbook of 1745: van Swieten's classicdescription. Cephalalgia 13(3):172-174; 1993. This article has not been examined.

- - -. Historical background. In Olesen J, Tfelthansen P, Welch KMA, eds. Headaches. New Yark: Raven Press; 1993, pp 1-8. This chapter has not been examined.

Lake CL. History of cardiac anesthesia. In Lake CL, eds. Pediatric CardiacAnesthesia. 2nd ed. Norwalk, Connecticut: Appletonand Lange; 1993, pp 1-5. Brief but succinct, Includes table "Historical Milestones in Pediatric Cardiac Surgery." 65 refs.

Lassner J. Tracheal intubation. CohA1/est/Jel"ioI4l(3):293-297; 1993. This French-language article has not been examined.

This German-language article has not been examined..

Laxenaire Me. In memoriam. Jean-Marie Picard (1925-1992). Cah Graham SS. WLM Speakers Bureau: speaking out for anesthesiology.

ASANews/etter57(9):21; 1993. Briefdescription of the Wood Library-Museum ofAnesthesiology's historical speaker's bureau.

Gravitz MA. Early journals in hypnosis: an update. Am J Clin Hypn 36(1):12-14;1993. This article has not been examined.

- - -. Etienne Felix d'Henin de Cuvillers: a founder of hypnosis. AmJClin Hypn 36(1):7-11; 1993. This article has not been examined.

Greenblatt SH. The image ofthe "brain surgeon" in American culture: the influence of Harvey CushingJNetl1Vsmg75:808-811; 1991.

AnesthesioI4l(3):209-211; 1993. This French-language obituary has nor been examined.

-- -. Picard, Jean Marie (1925-1992). Ann Fran Anes Reanim 12(4):355-356;1993. This obituary has not been examined.

Lumley J. Arthur John Wells Beard. Anaest/Jel"ia 48:842-844; 1993. This obituary describes the personal and professional life of Beard (19081993). Beard developed a method of measuring central venous pressure in patients undergoing lung surgery or with mitral stenosis or both, and published the method in 1950. 1 ref', 1 portrait.

MacDonald AG.John HenryHill Lewellin: thefirstetheristinGlasgow.

BrJ A1/oesth 70:228-234; 1993.

Traces coverage ofCushing's career in the New YorkTimes and contemporary periodical literature. 1 ilIus., 25 refs.

LewelIin, who died in 1886, firstadministered ether in the Scottish city on January 4, 1847.45 refs,

Gunderman RB. Dr. Horace Wells and the conquest of surgical pain: a Promethean tale. Perspea BioIMed35(4):531-S48; 1992.

MadiganSR, Raj PP. Historyand currentstatus of pain management. In Raj PP, ed. Practical Management of Pain. 2nd ed. St. Louis: MosbyYearBook; 1992, pp 3-15.

ReviewolWells' careerand theirnportanceofhis nirrousoxidework.Zo refs.

Hamilton WK. The origins ofthe Association ofUniversiry Anesthesiologists. Anesth N/a(g-74:325-326; 1992. Editorial toaccornpany Dr.Papper'sarticleon this topic (Am:rthAlrnf.g-74:436453; 1992). 1 ret:

Harke H, Gagelmann H, Schuh F, Marquott H. On the 60th birthday ofWawersik, Jurgen. N/aesthesift42(8):499-500; 1993. This article has not been examined.

Harrison GG, Isaacs H. Malignant hyperthermia: an historicalvignette.

N/aesthesia47:S4-56; 1992. Describes previously unreported deathsofrwo membersofthesame family during general anesthesia in 1915 and 1919. 1 table,6 refs.

Hempel K Postoperative pain therapy - an interdisciplinary responsibiliry. Chinl1g64(7):suppll09-112. This German-language article has not been examined.

Hutchinson BR. A briefhistory ofanaesthesia in New Zealand. NZMed

Mosrofrhechapter isdevoted to historical aspects. Good overview. 15 illus., 29 refs.

MaltbyJR; Shephard DAE.Ha1VIdGriffith:HisLifeandUgacy. Montreal: Canadian Anaesthetists' Society; 1992. Issued as a supplement to the Society's journal. Several authors describe Griffith and his work and several ofhis rnostimportant papers are reprinted. Includes an annotated bibliography of his publications. Essential.

McCann B. Obituary: John Edmond O'Donnell. Anaesth In/ens Core 20:529-530;1992. Reviews the career of O'Donnell (1930-1992). 1 portrait.

Michenfelder JD. The past, present and future of research neuroanesthesia. J NeurosurgAnesthesiol5(1):22-30; 1993.

In

Dr. Michenfelder offers a personal history and prognostications.

Miller EV. Why visit the Wood Library-Museum of Anesthesiology?

Continued on NextPage

From the Literature. . . Continuedfrom Preoious Page ASANewsIetter57(9):5-7; 1993. Includesseveralphotographsof the newWLM facility.

Morris, David B.TheCultureofPain. Berkeley: Universiry ofCalifornia Press;1991. Englishprofessor Morrisexploresthe conceptof painthroughthe history ofWestemculrures.Fascinaringandwellwritten.ReviewedinN1efthA1104r 74:479, 1992; ClinJ POi119:142,1993;BullHistAfed66:691-692, 1992.

MustoDF. Cocaine'shistory, especiallythe American experience.Ciba FoundSymp 166:7-19; 1992. MustoistheexpertonthehistoryofU.S.druguseandabuse.Thisoverview ofcocaine's historyin the U.S.includesmentionof the workof Kollerand Halsted.27 refs.

Nunn DB. Dr. Halsted's secret operation on Dr. Maras. Ann Surg ,216(1):87-93; 1992. Theauthorconcludesthattheoperation, whichtookplaceinOctober,1903, wasa rightorchiestomyand lasted 1 hour 10 minutes.5 illus., 17refs.

Overton,CharlesErnest. StudiesinNarcosis. ParkRidge,Illinois: Wood Library-MuseumofAnesthesiology; 1991. Overton's classic has been translated from the German by Robert L. Lipnick,a toxicologist. ReviewedinNJOeflh ltllet1sCo~20:262, 1992; Bull HistAfed66:483-485,1992.

Papper EM. The influence of romantic literature on the medical understandingof pain and suffering- the stimulusto the discovery of anesthesia. Perspea BioIMed35(3 ):401-415; 1992. "Thomas Beddoes,Sr.,SamuelTaylorColeridgeandPercyByssheShelley areimportantfiguresin illustrating the changeinattitudestowardpainand suffering." (p 407) Dr. Papper has adapted this article from his doctoral dissertation on the topic.19refs. - - -. The originsof the Association of University Anesthesiologists, A11efthAno4r74:436453; 1992.

Detailed historyof this organization. 42 refs. Petty e. Evolution of the anesthesia machine. Intefaa» Society of TtdJnology inAnesthesia NtwfIetter3(2):18-19; 1992.

Cephalalgia 13(4):249-252; 1993. This articlehasnot been examined.

ReinholdH.ThecreationofmodemanesthesiainBelgium.AdoAnoesm Bef.g-42(3):171-176; 1991. Devoted primarily to developmentssinceWorldWar II. 2 illus, 6 refs.

- - -. Les premieres anesthesies en Belgique. Ado Bef.g- His!Med 6(2):81-92; 1993. This articlehasnot been examined.

Renton-PowerW.The firstanaesthetics in Ausrralia.MedJAust 159:68; 1993. Letter adding materialto WilsonG.The firstanaestheticsinAustralia: an historical update.AfedJA11St157:781-784; 1992.1ref.

RoseW,ScharffW.Qualityconrrol100yearsago."Narcosisstatistics" by Gurlt from 1893. Anosthesiol Intensivmed Notfallmed Schmerd!ter 28(4):254-257; 1993. This German-language articlehas norbeen examined.

RosnerF. Headache in the writings of Moses Mairnonidesand other Hebrew sages. Headache 33(6):315-319; 1993. This articlehasnorbeen examined.

Schurr,Peter H.Benjamin'sSon:BenjaminAn:f1erKent,MD. (1808-1864). London: Royal SocietyofMedicine Services; 1991. Biography of the man who, in September, 1847, administered the first anestheticinSouthAustralia; authorisKent'sgreatgrandson.Reviewedin A1JOefth Irltt7ISCo~20:125-126; 1992.

Sirn PP. From the WLM archives: Ansel M. Caine, M.D., pioneer anesthesiologist. ASANtwfletter 57(9):17-20; 1993. DescribesCaine's careerin New Orleansbetween 1909and mid-century and alsonotesmaterialrelated to Caine recentlyacquiredby the WLM. 2 illus. (includingportrait), 2 refs.

SkrabanekP. Pain reliefbywaterinjections. Lancet 341:905; 1993. This lenerresponds toanearlierarricle (BymC, etal, Subcutaneoussterile water injectionsfor chronic neck and shoulder pain following whiplash injuries.1.o11at341:449-452; 1993)with briefdiscussionoflate19th-cenrury experimentswith subcutaneouswaterand salineinjections. 6 refs.

Includesan interesting"machine genealogy"in the formofa tree. 2 illus.

Petry'TL. Does modern mechanicalventilation represent progress? Contemp InternalMed 4(2):37-48; 1992. Describes'tclinical historyofmechanical ventilation"andevaluatescurrent

technology: ", . .nomachinewilleveryreplaceclinicaljudgment."3illus., 19refs.

PirogoffN. Reseorr:hes: Practical and Plrysiological on Etherization. Park Ridge,Illinois: WoodLibrary-MuseumofAnesthesiology; 1992. This edition of the classicwork by Russian surgeon Pirogoffhas been translatedfromthe original Frenchby Dr. B.RaymondFink and includes a biographical essayon Pirogoffby Dr. Ole Secher, Reviewedin Anaeslh Inteus Care 20(4):547-548,1992; Br J NlOesth 69:333, 1992;Anesth A1104r 76:210-211, 1993; ColiJ A/lOesth 39(8):897-898, 1992; A1JOefthesia 47:10171018,1992; Allesl/1efiology 77(4):839-840, 1992.

Pirogov NI. Nikolai Ivanovidz Pirogov, QlJfS!ions ofLife: Diary ofon Old Plrysicion. Canton,Massachusetts: ScienceHistoryPublications; 1991. This bookwasreviewedinJAAfA268(18):2588-2589, 1992.

Ramadan NM. Migrainous infarction: the Charcot-Fere syndrome?

Snow, John. On Narcotism by the Inhalation ofVapours. London: Royal SocietyofMedicine Services; 1991. Facsimilereprintof 18articlesby Snowthat appeared firstin the London Medical Gazette from 1848 to 1851 and then in a series of now-rare pamphlets.Reviewed inCol1J.Anoesth39(3):306,1992;Anesthesiology76(4):665, 1992; Br J Anoesth 68(2):232, 1992; Anaesthesia 47:177-178,1992; Anaesth ltIIetISCo~20(2):262, 1992.

SpenceA,Younge. Dentistryandanaesthesia.BrDentJ175(4):135-138; 1993. Authorsnote rhar'trhecontriburion by dentalpractitioners to the discovery ofanaesthesiahasbeen central."IncludesportraitsofWells,Robinsonand others.10illus.

SzocikJF. Cost ofnew anestheticdrugs: are they worthit?A historical perspective.ASANtwfIetter57(10):13-16; 1993. Minimaldiscussion of actualCOSts. 5 refs.

Tinterow MM. Satanic agency and mesmerism reviewed - James ,

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From the Literature. . . Continuedfrom Previous Page

Horatio Storer. . . Continuedfrom Page 1

Braid. AmJ C/in Hypn 36(1):3-6; 1993.

revisionist view of the Ether Controversy in the light of his dispute with the elder Bigelow. Nor did his trusted disciple tell us more about Sir James' possible reassessment of the individuals in the original controversy. Undoubtedly, Horatio Storer was a loyal disciple and a great admirer of'james Simpson. However, other than dutifully carrying out his former teacher's wish to publish and distribute the two letters to Jacob Bigelow, Storer seemed reluctant to associate himselfin this latter controversy involving his beloved mentor and his native Boston. Almost two decades after the famous dispute, in . a paper on Benjamin Rush, he indirectly commented on this affair. Several matters of fact stood out. While attending the annual meeting of the American Medical Association in Washington, D.C. in May, 1870, Storer learned of Sir James Simpson's death by telegram. When it was announced at the meeting, the overwhelming sentiment of sympathy for the Scottish baron caused Storer to reflect on the emotionally charged controversy again. He considered the entire dispute improper, petty and frivolous. He was totally devoted to his former master, and had great respect for the Scottish tradition ofscholarship at the University ofEdinburgh. He considered the Edinburgh tradition significant and far-reaching in its contributions to medicine. As an obstetrician from the Edinburgh school, he literallycanonized Benjamin Rush for his vision in obstetric analgesia half a century ahead of his revered teachers, James Simpsonand WalterChanning, bothofwhom had beennuttured by the same Scottish tradition. He had total devotion to obstetric anesthesia. With such, he concluded that Boston indisputably deserved the honor for introducing surgical anesthesia. However, he felt that Bostonians were fortunate in bringing this priceless boon to humanity without any theologic objection. For the introduction of obstetric anesthesia, religious objection to it madetheworkofhis teachers more formidable, and thus their accomplishment more commendable. He felt that the harsh treatmentof Simpson by the elderBigelow,and his son HenryJacob six years later, unnecessary and petty. On the contrary, Walter Channing remained impartially silent on the whole affairdespite his professional association with the Bigelows at Harvard Medical School."

This article has not been examined.

Todd EM. Pain: historical perspectives. In Warfield CA, ed. Principles and Practice ofPain Management. New York: McGrawHill; 1992, pp 1-9. Brief overview of the subject from the ancient world to about 1800. Reprinted from Crue BLJr., ed. Chro1JicPai1J:FurtlierObservatio1JsfromCity ofHopeNatiollalAfedicolCmler.Jamaica, New York:Spectrum: 1978,pp3956. 24 refs.

Tremper KK. Noninvasive monitoring of oxygenation and ventilation: forty years in development. WeltJ Med156:662-663; 1992. Very brief review. 9 refs.

Vaca 1M, Herrero MA, Iglesias IL, Cabal VJ, Curto A, Gomez S. Morphine-scopolamine association in chloroforrnic anesthesia. RevEsp AnestesiolReanim 39:239-245; 1992. This Spanish-language article describes work done with this mixture in Spain in the first decade of the twentieth cenrury, including a dissertation on the topic completed by Blasco Rem in 1907.3 ilIus.,30 refs.

Vandam LD. Waters-Morton house. ASANewsletter 57(9):8;1993. Briefdescriprionofthe house in Charlron, Massachusetts.inwhichWilliam T.G. Morton lived between the ages of 8 and 16.This newsletter issue's cover fearures a painting by Dr. Vandam of the house.

VilloriaCM. The conceptof pain in Greekcultureand science. RevEsp

AtJestesiolReanim 38:327-333; 1992. ThiaSpanish-languagearticle reviewspainin rheconrexcof'Greekrnedical beliefs and culrure. Abstract by Cashman IN, Eur.J NlOl:l1JiefioI9:500-501, 1992.93 refs.

WesthorpeR deCaux'sendorracheal tube.AnaesthlntensCare20(3):271; 1992. Describes de Caux's 1930 single rube. De Caux was the firstto use curare in anesthesia in England, in 1928. 1 ilIus.,4 refs.

- - -. Magill's endobronchial tubes. Anaesth Intens Core 20(4):409; 1992. Describes the rubes Magill began developing in 1935. Also gives brief history of endobronchial incubation. 1 ilIus.,4 refs.

Wildsmith JAW. The history and development of local anaes thesia. In Wildsmith JAW, Armitage EN, eds. Principles and Practice of RegionalAnaesthesia. 2nd ed. Edinburgh: Churchill Livingstone; 1993, pp 1-7. Good overview beginningwith Simpson's topic-al experimentswith liquids and vapors in 1848. 7 ilIus., 19 refs.

Wilkinson DJ, The history of trauma anesthesia. In Grande CM, ed. Textbook ofTrauma Anesthesia andCriticolCore. St. Louis: Mosby; 1993, pp 1-34. Exhaustive, fascinating treatment of the topic. 41 iIlus., 174 refs.

Wright AJ, Diffusion of an innovation: the first public demonstrations ofgeneral anesthesia. MiddleEastJAnesthesio/11(2):93118; 1991. Applies sociological diffusion of innovation theory to events related to the public demonstration and spread of anesthesia use in 1846 and 1847. 110 refs.

Acknowledgment This paperwas written with valuable information received from Frederick N. Dyer, Ph.D., historian and biographer ofHoratio Robinson Srorer. Richard Wolfe of the Counrway Library graciously provided a copy of the rare portrait of Dr. Storer which was believed to have been taken from a medal struck by Storer's friend, R. Tait McKenzie, in 1913. For their assistance, the author expresses his gratitude.

References 1. Dictionary of American Biography, IX, 1963, pp 95-96. 2. Friedlander, WJ. The Bigelow-Simpson controversy: Still another early argument over the discovery of anesthesia. AHA Newsletter 11(4):10-15, 1993. 3. Friedlander, W]. ibid., p 14, Notes 10, 16. 4. Friedlander, WJ, ibid., p 14, Note 10. 5. Friedlander, WJ, ibid., p 11. 6. Duns, J. AfemoirofSirJames Y. Simpson, Ban, /873, pp 246-247. 7. Duns, J, ibid., pp 246-248. 8. U.S. COllgressiollal Repoft,30th Congress, 211dSession, House ofRepreseutatiues, ReportNo. II 4, Afi1Jority Report,Feb. 28, /849, Appendix 32, pp 86-91. 9. Duns, J, op. dt., pp. 232-233. 10. Duns, J, ibid., pp 246-248. 11. Storer, Horatio R. The Medals of Benjamin Rush, Obstetrician. Journal oftheAmerican AfedicolAssociation, 1889, pp 330-335.

Implications of the Personal Library of Horace Wells: Refocusing on the DiscoveryofAnesthesia byStephen D. Small, M.D.

Presentedat theAnnual Meeting oftheAmerican Society ofAnesthesiologists, October, 1993

Wells emerges from history -- to me -- as an enigmatic, mythical figure. This young dentist, educated before the availability of professional schools or curricula, not only conceived of a surgical plane ofanesthesia, but carried out the critical experiment on himselfand repeated the observation in over a dozen patients in the same month. He then traveled to Boston, probably to the Massachusetts General Hospital, to make his results known a few weeks later. In four years, he was dead by his own hand, the first suicide aided by inhalation anesthesia. This tragedy shadows that ofIcarus of Greek legend, or Henry jekyll-of Robert Louis Stevenson's great Gothic tale of tangled morals -- yet it is so thinly told. It asks us to look deeper, to want to know more, to believe that there is more to know, more than the vignette that begins: Horace Wells saw a drugstore clerk named Sam Cooley bang his leg on a bench and feel no pain because he was under the influence ofnitrous oxide offered at a public demonstration. There is no suitable explanation for Sir Humphry Davy's failure to pursue his observation that nitrous oxide might be used to relieve the pain of surgery in which no great effusion of blood takes place. There appears to be no connection between Davy's observation, published in England in approximately 1800, and Wells' self-experimentation half a century later. No one else, despite having more rigorous scientific and professional training, conceived of the idea, realized its importance and pursued it to its conclusion as a new experience in reality. Anesthesia rapidly developed after the introduction of the new paradigm. The famous surgeon John Warren, the most renowned dentist in Boston, Nathan Cooley Keep (later the first dean of Harvard's Dental School), and many other luminarieswrote of their anguish and empathy for their suffering patients, and were fully aware of the spread of nitrous oxide and ether frolics for decades before Wells' experiment. What was there so unique, so different about Wells that placed him at the center of this shift in thinking? For it was indeed a change in what people thought was possible-a stretching of the boundaries of reality to include another state of being that challenged then currently accepted cultural, religious and biological models. Wells was at the center of this shift in thinking. It is important to place him there ifwe are to believe we can look forand find credible evidence of the man, something tharwill stand up to the measure of his discovery. That is my hypothesis. While such symmetry does not always occur in the revealed structure of history, enough incongruities and unanswered questions exist that one is stimulated to think about it differently. I must mention that, in Wells 'time, Sir James Young Simpson placed him at the heart of the matter, and this helped insure that the AMA awarded to Wells the credit of being the discovererofanesthesia over a hundredyears ago. To anyone interested in the prelude to this paradigm shift, the establishment of the conditionsfordiscovery, the absence of data on Wells is as frustrating as his slippage into relative obscurity in this

century. To develop a more three-dimensional sense of WelIs, a trip was made to Hartford, Connecticut. WeIIs set up his dental practice there in the late 1830s, married, had a son, performed his experiments, and was returned in a coffin carried on a train from Manhattan. Through Dick Wolfe, the curator ofrare books and Garland Librarian at the Counrway Library in Boston, I met Leonard Menczer, a retired dental surgeon and the co-curator of the Medical and Dental Museum in Hartford. Dr. Menczer made me aware of the WeIIs CoIIection in the Hartford Public Library. He shared anyone's enthusiasm for the subject of WeIIs, as he had great empathy for the man and did his best to share whatever information he has unearthed. The WeIIs Collection was a startling find. Consisting of seventeen books believed to be the personal properry of'Horace Wells, the set became available in 1974 through the agent of a well-known New York rare book dealer. Attempts to obtain information from the rare book firm to determine the history of the collection, or tum up associations that might enlarge the holdings, have failed. The items are as follows: 1. Truman Smith: An Examination oftheQuestion ofAnesthesia 2. Mallory: KingArthur 3. James Hervey: Meditations 4. Harve: Character, Everythingto theYoung 5. TheVoyage oftheHMS Alceste 6. Blair: Grammar of Chemistry. Corrected & Revised by B. Tucker 7. Black: Lectures ontheElements ofChemistry 8. Boston: Human Naturein Its FourfoidState 9. John Clarke: The Christian Keepsake 10. Collot: French Reader 11. Eaton: BotanicalGrammar 12. Tytler: Elements of GeneralHistory 13. Sallust: De CatilinaeConjuratione Belloque (in Latin) 14. John Milton: Paradise Lost 15. Hooker: ThePoorDoubting Christian 16. AnnualReportoftheCommissionerofPatientsfortheYear1847 17. U.S. Patent Office: Original Specifications/Part of letters patent #4848 Wells died intestate, bankrupt. No books were auctioned off with the rest of his effects, from gold foilto furniture, as records from the Probate Court show. His wife and nine-year-old son were left penniless. Perhaps his books were kept by his family, a financial sacrifice. Perhaps they were sold to a family friend. The fact that they stayed together for a hundred and fifty years after his death, apparently unaltered and in good condition, is in itselfremarkable.

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Wells' Library. . .

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The devotional Christian works form the core of the collection, allcontaining marks ofemphasis or rareannotations in Wells' hand. They show by their selection evidence of his deeplytroubled soul, reflections of his spiritual life. Most interesting is a copy of Blair's GrammarofChemistry, corrected and revised by Benjamin Tucker. "Blair" was a pseudonym of Sir Richard Phillips, and Wells' copy was fourth edition -- part of the trans-Atlantic flow of English and continental knowledge to the New World in the post-Revolutionary period. The endpapers bear the signature, "Horace Wells, jr, his book 1831", accompanied by a small four-petaled flowerdoodle mark. This dates Wells' possession to his years in Academy at Amherst, Massachusetts, after the passing of his sixteenth year and the death of his father. Wells became caught up in the Second Great Awakening, a religious revival sweeping the country. In the chemistry volume, on page 107, paragraphs 369 and 370 discuss nitrous oxide as follows:"Nitrous oxide is procured by exposing nitrate ofammonia in a retort, to the heat ofa lamp, until red hot. The oxide then rises in the form of a gas," and "nitrous oxide supports combustion better than atmospheric air. When breathed into the lungs, it communicates a pleasurable or intoxicating sensation." Both of these paragraphs are bracketed in pencil. In the margin in thesame careful hand as the endpaper notation, Wells has written: Tosimp, asin Eternity. This very strong circumstantial evidence now dates Wells' concern with nitrous oxide at least thirteen years before his experiment, and a decade before the first known use of ether to . relieve the pain of surgery occurred (this latter breakthrough was without consequence due to a lack of vision, a lack of a sense of what really had occurred). It also couples Wells' obsession with the gas to a period in his life when concern for his soul began to preoccupy him. We know from two rarelyappreciated letterswritten byjohrrM. Riggs -- Wells' friend, possible student, and the fellow colleague who pulled Wells' molar during the first nitrous experiment -- we know that the two young men talked long into the night after witnessing Gardner Quincy Colton's demonstration of the effects of nitrous oxide in Union Hall, Hartford, Connecticut, in December of1844. Riggs has written, "Ouragreement, the night previous, was to push the administration to a point hitherto unknown. We knew notwhetherdeathorsuccessconfronted us.. . .no one but Wells and myselfknew to what point the inhalation was to be carried. The result was painfully problematical to us. . ." (author's emphases). Wells had insisted that he be the first patient, for he thought that their first subject might die. We may now begin to get a glimpse of Wells' developing psyche. The same year, 1831, that Wells studied chemistry, saw the birth of the rural cemetery movement. People began to be buried, not in crypts associated with church basements or urban lots adjoining churches, but out in romantically designed, bucolic surroundings. Children were taken out to these landscapes that we associate with pre-Impressionist painters in order to better meditate on their own mortality in a natural setting. New cultural traditions developed that today we might consider morbid. But these patterns must be seen in the context of a great religious revival sweeping the country, offering salvation for all, transforming the grimmer Calvinism of the founding fathers during the beginning of the Romantic period. These social traditions reflect the kinds of death and afterlives people began to expect, or hope

for. Ralph Waldo Emerson, the great American transcendentalist, dug up his wife's and son's bodies, after decay, to contemplate them. His aunt, meanwhile, had slept in a shroud, in a coffin-bed. There was an interest in mesmerism, spiritualism, and the linkages between life and eternity, life and death. One of Wells' favorite authors, referred to in Wells' letters, was James Hervey. He wrote not only the Meditations that Wells owned, but another work, Among theTombs. A close sense of being with the dead, peacefully, offered a deep experience ofone's own spirituality. More sources need to be developed to cover this important period of the 1830s. Wells has bracketed other material in the chemistry textconcerning nitrous oxide, including the observation that it suffocated animals. Humphry Davy is mentioned several times in the text. None of these references concerns volatile gases, nitrous oxide, or the relief of pain by any means. Another book in Wells' library, Black's Lectures OIl the Elements of Chemistry, similarly makes no mention of Davy in connection with nitrous oxide or the abolition of pain. Unpublished research I have conducted into the publication, dissemination and availability of Davy's writings on nitrous oxide has shown that the first English edition wasan exotic, not represented in extantlibrary catalogues of the period, either public, private or university collections, in Connecticut. The Boston Athenaeum -a private subscription library and roots of the Boston Medical Library -- had a copy later, but Wells was not on its member rolls. Davy's brother reprinted the Researches in Nitrous Oxide in 1839 as part of the Collected Works, and one copy of this edition surfaced in Hartford in 1839 or 1840 at the largest library in town. This library was owned and operated by the Young Men's Association, later to become the Hartford Athenaeum. It is highly unlikely that Wells owned or even saw a copy, and he denied familiarity with the book in his lifetime after the ether controversy heated up. That Wells did own other books not represented in the Hartford Collection is substantiated by letters of the Wells-Morton partnership published by Harry Beecher, in which Wells repeatedly requested return of dental texts he had loaned to Morton. In addition, Wells himselfpublished twO books, neither of which is represented in the Wells Collection. The first, An Essayon Teeth -- Comprising a Brief Description of Their Formation, Diseases, and Proper Treatment (1838), is a remarkable seventy-page manual, self-published and written in a hybrid style of both qualifying these as a marketing tool. It took its place among the very few dozen books on dentistry then published in the Federalist period, before any of the schools of dentistry were established. In it,Wells refers to the published works and philosophies of practice of eight dental and medical clinicians, includingJohn Hunter and several French authors. None of them is represented in the Wells Collection. One should consider the length, text, and manner of publication of the EssayonTeeth sixyears before the first nitrous oxide experiment. Wells was a complex, intense man, and his observation in Union Hall in 1844 was not serendipitous. The second book that Wells published -- and the only one that he used as a platform to advance his claim as the discoverer of anesthesia -- is also not present. As part of his defense, Wells adapted a populartheory ofdisease - stimulationand overstimulation -- to explain the anesthetic properties of nitrous oxide he had witnessed. This further expands our appreciation of the books and journals Wells must either have owned or studied. Although he had

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Wells'Library. . . Continuedfrom Previous Page never been in battle, Wells also observed in this book that men who are "over stimulated" by severe injuries in the excitement of war may not be in pain. It is unknown how he came by this observation, and it anticipates the writings of Harry Beecher a century later, reflecting his World War II experiences. Finally, I will mention some of the emphases Wel1s placed on passages in his devotional texts and religious poetry. These are books -- some of high culture -- of a book-loving man in an age when men had few books, and they were considered treasures. In his ParadiseLost, Wel1s has marked, "Fal1en Cherub! to be weak is to be miserable." This is Satan, speaking to one of his apostate angels as they lay in the lake of fire after being cast from Heaven. Other lines that spoke to him were, "Where all life dies, death lives, and nature breed Perverse, al1 monstrous, al1 prodigious things." It goes on to tell of gorgons, hydras, and chimeras, abominable, unutterable, and worse than fables have yet conceived. It might be too facile to speculate that Wel1s had troubling visions, either organic, or induced by brimstone sermons of the reawakened Calvinists. It is also possible that he underlined these passages after his experiments with chloroform or combinations of agents. He might have been terrified of death, or of his own death and afterlife, which he might have thought would consist of punishment for his weakness in this world. It is unclear how this relates to whatever notion he may have had about nitrous oxide and eternal sleep. The last mark appears by the verse, "Being as I am, why didst not thou, the head, command me absolutely not to go, Going into such danger as thou saidst?" This is Eve speaking; moved by Adam's recriminations, and reminding him she was once a lifeless rib, and he the head, -- she pleads her case -- "Hadst thou been firm. . . neither had I transgressed, nor thou with me." As with the other verses, Wel1s may have seen them in the context of his own deepest inner struggles -a drawn-out, lifelong anticipation of death, and an awareness of his seeming inability to control his own life-condition. In his reprint of that classic ofearly New England religious values, the

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

DoubtingChristian, Wel1sagain reveals to us his sensitivity to the paradoxes of life, life that must be lived and experienced, a mirror to his own life. Hookerwrites, "Oh, the word ofGod, how full of sweet flowers it is! There the sharpest terrors, and the most fearful plagues too." To review, I believe that a satisfying philosophical basis for understanding the roots of the discovery of anesthesia must incorporate: first, that Horace Wel1s had some ideas linking the use ofnitrous oxide to either an adolescent fantasy about suicide or the attainment of some undescribed state of consciousness; second, that Horace Wel1swas motivated by religious impulses to consider the ministry, undergo a conversion or born-again experience, study Milton's Paradise Lost and other religious metaphysis and literature; third, that there is no evidence at this time of the formative influence of other minds on Wells' initial work with nitrous oxide; and final1y, there is copious evidence chronological1y linking the work of Wells, its demonstration to Morton, and eventual widespread acceptance through Morton's clever variations on Wells' new paradigm. While others at this time grasped the possibility or desirability of using inhaled chemicals to alleviate the pains of healing interventions to the human body, none ofthem saw the tremendous ramifications of this idea, and none are organical1y a part of the earliest historical evolution of the concept as it relates to deep, reversible, painless sleep. I believe this was due to Wel1s' long-term preoccupation with a reality that transcended intoxication, a dangerous idea without scientific proof that the inhalation of nitrous oxide could be pushed to levels heretofore unknown, with great benefit. I submit that these books -- these cultural objects -- will help illuminate the moment when anesthesia crystallized as a discovery, partly the result of a man's spiritual longing and his leap of faith. 1 would like to acknotaledg«the late Leonard Afe1ll:zer, D.D.S., Co-Curator of the Hartford Afedical and Dental Afuseu1l1; Richard Wolfe, Garland Librarian at the Couf/tway Library of Afedicine, Boston; and the Wells Collection and stoff of the Hartford Public Library,forassistance i1J preparation ofthis manuscript.