October 1998, Vol 16 - Anesthesia History Association

BULLETIN OF
ANESTHESIA }(ISTORY
VOLUME 16,NUMBER4
OCTOBER, 1998
An Important and Unique Addition
to the Wood Library-Museum
of Anesthesiology
by Ray]. DeJalque, M.D.
Dr. Marguerite Zimmer, a dental sur­
geon in Strasbourg (France) and a pro­
lific writer on the early history of anes­
thesia in France, has recently presented
the Wood Library-Museum with a copy
of her thesis, "Des Premiers Brevets
d'Invcntion. . . Pour une histoire du De­
velopment de I.;Anesthesie" (First Pat­
ents . . . A Contribution to the History of
Anesthesia). This manuscript is a pro­
logue to a larger work that Dr. Zimmer
will submit for her Ph.D. degree in his­
tory at the Sorbonne.
Dr. Zimmer's thesis contains' much in­
formation and many references on the
early days of ether and N20 on the Con­
tinent and, more specially, in France,
with emphasis on anesthetic inhalers,
vaporizers and dosimeters of that period.
Those devices, many of them very inge­
nious, are described and illustrated in
detail. Much of this material was pub­
lished in French journals and is thus un­
k�own to most English-speaking anesthe­
siologists. This work should interest all
historians of anesthesia, especially those
fascinated by anesthetic equipment.
In her introduction Dr. Zimmer nar­
rates the discovery and medical uses of
the gases and vapors in the late 18th and
early 19th centuries; the controversy over
Stahl's theory of the phlogiston; Davy's
experiments with N20 anesthesia; Bed­
does' Pneumatic Institute in Clifton; and
Scheele's and Ingenhousz's discovery of
the metabolic role of oxygen in plants and
animals. The introduction ends with an
account of two micro-cauteries (hydrogen
flame) patented in Paris in 1847 and 1848
to destroy dental nerves and thus allow
oral surgery and the treatment of tooth­
aches.
The first chapter of Dr. Zimmer's book
concerns sulphuric ether, its early discov­
ery and chemistry, its use for pulmonary
diseases by Pearson in 1794 and at the
Pneumatic Institute in 1799, and its vari­
ous, occasionally strange, indications in
French and Continental medicine. The
discovery of ether anesthesia by C. Long
of Georgia in the Spring of 1842 and by
R.H. Collyer of Jersey in the Fall of the
same year, and the story ofW.G.T. Morton
and C.T. Jackson in Boston in 1846 and
their long and bitter controversy involv­
ing the French Academy, are minutely
recorded.
The introduction of ether anesthesia
in Paris on December 15, 1846, and in
London four days later and its rapid
spread throughout Europe during the
early months of 1847 are told in great
detail. The main part of this long chap.­
ter, however, is devoted to the numerous
inhalers and vaporizers tried in Paris
during the 1846-1847 winter, including
Morton's inhaler imported by F.W. Fisher,
the familiar devices of Charriere and of
Luer, and the lesser ·known implements
of Simoni, Cloquet, Brisbant-Gobert,
Merle, Defays, Maisiat, Raux and Gay.
Several of those devices had ingenious,
modern features, such as unidirectional
valves, thermoregulators and dosimeters.
The chapter on ether ends with a brief
mention of rectal ether and its methods
and apparatus of administration in Paris,
Madrid arid Brussels in February, 1847,
i.e., shortly before Pirogoff's publication.
The second chapter provides many
little known details on the early use of
N)O in anesthesia, including its produc­
tion by G.Q. Colton; F. Stanley's report
of its exhilarating effects in November,
1842; its successful use in New York by
H. Wells eight days before his suicide; its
popularity in New York for dental then
for general surgery from l863 on; the first
N20 death in New York, and the first N20
regulators of Sprague (Boston) a n d
Preterre (Paris) i n 1863 and 1866, respec­
tively.
Dr. Zimmer narrates the roles of G.Q.
Colton and the U.S. dentist, T.W. Evans,
in the introduction of N20 in France in
1863 and shortly later in Great Britain
for dental, then for general surgery. T.W.
Evans was the dentist of the French high
society and imperial family and drew to
Paris many Americans attracted by his
surgical skills and his N20 anesthesia. Dr.
Zimmer ends the chapter with an exten­
sive description of the methods and the
apparatus to produce, store, regulate and
titrate N20. This gas was successfully liq­
uefied and stored in metallic cylinders in
1868-9.
The last chapter briefly reviews the
methods of production of oxygen and its
early indications in medicine and anes­
thesia, including C.T. Jackson's recom­
mendation in 1847 to try it for ether as­
phyxia and its first use by Abraham o f
New York i n ] anuary, 1853, t o resuscitate
a patient who had_succumbed to chloro­
form "syncope."
Dr. Zimmer's book is a rich and
unique source of information on the early
days of anesthesia in France and, to a
lesser degree, on the Continent. Much of
her information and many of her numer­
ous references will be new to t h e
English-speaking anesthesiologist. Her
detailed review of the early French inhal­
ers is original and unique.
We hope to provide the Wood Library
with an English translation of Dr.
Zimmer's work in a few months.
:2
BULLETIN OF ANESTHESIA HISTORY
Anesthesia History Association
Council Meeting
At the Council Meeting of the AH.A, held
on May 6 just prior to the annual Spring
Meeting of the AH.A., the following Coun­
cil Members were present: AI. Wright and
Gerald Zeitlin, along with C.R. Stephen,
President; Te. Smith, Vice-President; Dou­
glas R. Bacon, Secretary-Treasurer, and
Lucien E. Morris, Past-President.
The present financial statement was pre­
sented, which showed the AH.A at present
to be in a healthy condition. There was dis­
cussion as to whether the present fee struc­
ture should remain as it is. It was noted that
a relatively large number of the A.H.A. mem­
bers were considered Emeritus and as such
were non-paying members. It was recom­
mended that these members in the future be
assessed a nominal amount of$10.00 per year,
with the proviso that such members be
granted the privilege of increasing this
amount if they so wished (the present dues
for regular members is $40.00 per annum).
There is at present considerable difficulty
in overseas members paying their dues in u.s.
funds. It was recommended that the AS.A.
be approached to determine whether arrange­
ments could be made to have overseas dues
paid by Visa or Mastercard credit cards, as is
the arrangement with the A.S.A.
The Committee appointments for theyear
1998-99 were published in the July issue of
the Bulletin ofAnesthesia History.
At the Annual Meeting of the A.H.A. this
year, the guest speaker will be Dr. Leroy D.
Vandam, who will speak on the topic, "Lmatomi­
cal Illustrations from its Beginnings to the An­
esthesia Era." The meetingwill be held onMon­
day evening, October 19, at the OmniRosen Ho-
tel, which is one of the headquar­
ters hotels of the A.S.A.
With respect to the future
Spring Meetings of the A.H.A.,
plans are being made to hold the
1999 meeting inBristol, England,
in Ivlay in conjunction with the
bicentennial celebrations of Sir
Humphrey Davy. See the follow­
ing article for more details.
In the year 2000 plans are being
made to hold the Spring meeting
in conjunction with the Annual
Meeting of the American Society of
Regional Analgesia (AS.R.A.). Fu­
ture announcements of this meet­
ing will soon be made.
Since the Editor of the Bulle­
tin ofAnesthesia Histmy will soon
be resigning, it was unanimously
recommended by Council that
Doris K. Cope, M.D., be the next
Editor, with A.J. Wright being
made an Associate Editor.
There was considerable dis­
cussion, led by Ted Smith, Vice-President, as
to whether the logo of the AH.A. should be
changed to that designed by the late Dr. Bill
Neff, as illustrated in the accompanying hne
drawing. This shield or logo would take the
place of the inhaler at present shown on the
Bulletin. It could also be adapted to become a
lapel pin or tie-pin of the AH.A. There will
be further discussion of this change at the
October meeting of the Council. In the mean­
time, opinions concerning this change will
be welcome from the A.H.A membership.
Lucien Morris suggested that increasing
efforts be made to have lectures of historical
interest presented at State Anesthesia Meet­
ings and that pharmaceutical companies be
approached to sponsor suitable speakers at
these meetings. Gerald Zeitlin volunteered
to pursue this subject.
Doug Bacon broached the subject of when
a new Directory of AH.A. members should
be published. He suggested that the year 2000
would be appropriate and it was so
reconmended by Council.
There being no further business, the meet­
ing was adjourned.
Call for Abstracts
AHA/HAS Joint Meeting: Bristol, England, May 1999
The Anesthesia History Association
(United States) and the History of Anaesthe­
sia Society (Great Britain) will hold their first
ever joint meeting 13-15 May, 1999, in Bristol,
England. A third sponsor for this meeting is
the Society of Anaesthetists of South West­
ern Region (Great Britain). This event will
be a celebration of the bicentennial of the
nitrous oxide experiments conducted by Dr.
Thomas Beddoes, Humphry Davy and oth­
ers at the Pneumatic Institute in Bristol in
1799 and 1800. The meeting will be held at
theWatershed Conference Center, next door
to the conference hotel, the Swallow Royal.
The Anesthesia History Association in­
vites the submission of abstracts for papers
on its portion of the program (probably 8-10
papers). Presentations should be 20 minutes
in length and relate in some way to the his­
tory of nitrous oxide anesthesia. Abstracts
should be no longer than what can fit on one
81h" xii" sheet of paper. If possible, abstracts
should indicate the research problem, sources
and methodological approach used and may
contain no more than 10 references. Abstracts
may be submitted by mail, fax or e-mail. Disc
submission inWord-compatible format is also
permitted. All accepted abstracts will be dis­
tributed in some form to all meeting regis­
trants. Individuals who wish to organized a
paper session around a theme should con­
tact us as soon as possible.
Abstracts should be submitted by Janu­
ary 31, 1999, to: George Bause, M.D.; P.O. Box
43100; Cleveland, OH 44143; (440) 446-0120
[voice]; gbause@pol.net [e-mail].
Submissions and correspondence by fax
can be directed to: A.I.Wright, M.L.S.; De­
partment of Anesthesiology Library; School
of Medicine; University of Alabama at Bir­
mingham; (205) 975-5963 [fax]; (205)
934-4696 [voice].
Conference Hotel: Swallow Royal Hotel;
College Green; Bristol BS 1 STA, England;
011-44-117-925-5200 [voice]; 011-44117-925-1515 [fax].
Registration materials for the meeting
will be mailed in February, 1999
BUlLETIN OF ANESTHESIA HISTORY
The Annual Meeting of the
History of Anaesthesia Society,
1998
by Gerald L. Zeitlin, M.D.
When we looked out of our hotel win­
dow in Southend-on-Sea, where our Brit­
ish colleagues held their Annuallvleeting
in late June, we could see right across the
Thames Estuary, at this point about five
miles wide. Across the water, on Canvey
Island, we could sec the outline of one of
England's largest gas-works. It was grey
and a gale was blowing, such as must have
disrupted the Normandy landings. The
Union Jack outside the hotel was hyperac­
tive. One might call it a romantic indus­
trial landscape.
But there was nothing violent or disrup­
tive about the meeting. Dick Patterson and
my wife and I were the only Yanks to at­
tend.We were received with great warmth,
friendship and humour. Just like
anaesthetists all over the world, British
anaesthetists are decidedly not reserved or
stand-offish.
The meeting ran as smoothly as (con­
trary to rumour) the British trains. It was
with the greatest subtlety that the organiz­
ers persuaded each speaker to proclaim for
precisely 17 minutes, thus allowing three
minutes for questions and plenty of time
for delicious tea-breaks, lunch and social­
izing. The Society has developed the tradi­
tion of a black-tie dinner the first evening.
This one was elegant and also unique. Ev­
ery 15 minutes the maitre d' grabbed the
The 1998 banner of the History ofAnaesthesia Society.
microphone and announced the latest
drama in England's World Cup match
against Tunisia.
If the Joint meeting of the A.H.A. and
the H.A.S. next May in Bristol equals (and
no doubt it will exceed the delights of) this
one, then a flight across the Atlantic will
be more than worthwhile. Among other
events there will likely be visits to the Pneu­
matic Institute, the Jenner Museum and
Berkeley Castle where Edward 2nd was
murdered.
Dr. Richard Atkinson, the recently re­
tired President of the H.A. S., reviewed the
life of Dr. J. Alfred Lee-his former chief
in Southend. Many readers will know Syn­
opsis ofAnaesthesia that Dr. Lee wrote and
edited through the first 10 editions. Synop­
sis of Anaesthesia was one of the few text­
books available in the '40s and '50s. Among
Dr. Lee's contributions were the
developement
of a
Preoperative
Out-Patient Clinic where he mostly treated
dental caries, obesity and anemia; and the
introduction of a postoperative observation
ward. He was also a preeminent advocate
of extradural block-this author was taught
The Lady Mayoress ofSouthend Applies the Medallion of Office to the new President ofH.A.S.
to Dr. Jean Horton. The retiring President, Dr. Dick Atkinson, looks thoughtful
by Dr. Lee -how to do one in 1959! This
meeting was held in South end to honour
Dr. Lee's memory.
Dr. Tony Adams revealed his finding
that there occurred an anaesthetic death
prior to the well known case of Hannah
Greener on 28 January 1848. A 55-year-old
man named Alexis Man tigny had died
while under ether anaesthesia in Auxerre,
France, the previous July. This paper was
beautifully researched, with primary
sources from the French literature and
newspapers. Dr. Howat (a former President
of the H.A.S.) discussed the most famous
French surgeon of the Napoleonic era,
Baron Larrey. He told us that Larrey was
first a humanitarian. Only one example will
be mentioned here-his great distress at the
pain he inflicted on Fanny Burney when
he performed a mastectomy in 1811. Dr.
Drury revealed how nitrous oxide came
into use in the English provinces quite soon
after its introduction by Evans (the Ameri­
can dentist) in Paris in 1858. Again, Dr.
Drury used unexpected sources-this time
the diaries of the former Curator of Here­
ford, a town deep in the rural centre of
England.
Dr. Patterson converted our one-dimen­
sional view of J. Leonard Corning as the
developer of spinal anesthesia to a full pic­
ture of an able, dedicated medical scientist
who devoted much of his life to the use of
"physical" means to cure illness. Amongst
other projects he invented a spinal needle
introducer well before Lincoln Sise; tested
the efficacy of anti-nausea drugs; and had
a 3-ton hyperbaric chamber built for his pa­
tients. In the same vein (I assume this trite
phrase comes from a vein in mines-not
those we stick needles into!), Dr. Barrie
Fischer discussed the first 50 years of spi­
nal anaesthesia. He reminded us of the
Woolley and Roe case in England when two
patients were made paraplegic on the same
day (the cause despite much investigation
remains uncertain) and the American neu­
rologist Foster Kennedy's report, "The
Continued on Page 23
4
BULLETIN OF ANESTHESIA HISTORY
The Influence of Feminists on the Early Development of
Obstetric Anesthesia
by Donald Caton, M.D., Professor of Anesthesiology and Obstetrics and Gynecology
University of Florida College of Medicine, Gainesville, Florida
The Lewis H. Wright Lecture, San Diego, 1997
Each year the Wood Library-Museum
sponsors this lecture to honor the memory
of Lewis H. Wright, an anesthesiologist
who made many important contributions
to the development of our specialty. A na­
tive of North Dakota, Dr. Wright worked
on the staff ofE.R. Squibb and Son for more
than 3 0 years before retiring as medical
director in 1962. He assisted Ralph Waters
with early tests of cyclopropane, but he is
best known for encouraging the use of
curare in clinical practice and for helping
to develop many anesthesia organizations.
It is appropriate that we honor the memory
of Dr. Wright. Without the foresight and
the work of such pioneers, the practice of
our specialty would have remained less
developed and less rewarding.
At this year's meeting ofthe American So­
ciety ofAnesthesiologists, we observe the l5 0th
anniversary of the first anesthetic for child­
birth. Obstetric anesthesia began on January
17, 1847, when the Edinburgh obstetrician,
J ames Young Simpson, administered diethyl
ether to facilitate the delivery of a woman
whose pelvis was badly deformed by rickets.
Not one to hide his accomplishments,
Simpson quickly described his experience in
a paper published in the Edinburgh Month6;
,Journal ofMedical Science.l Other physicians
soon followed Simpson's lead. In April of the
same year, anesthesia for childbirth formally
began in the United States when Harvard
dentist Nathan Cooley Keep administered
ether for the delivery of Fanny Longfellow,
wife of poet Henry Wadsworth Longfellow.2
Since then, many other physicians have made
important contributions to the treatment of
the pain of childbirth. It is appropriate that
we honor them too as their work helped make
women more comfortable and safe during
childbirth than ever they had been before.
However, it was not just physicians who
shaped the early development of obstetric an­
esthesia. Women themselves played an im­
portant role because physicians were slow to
accept anesthesia. They were skeptical of
Simpson's innovation, and thought it unnec­
essary, if not dangerous. Social pressure
forced them to reexamine this philosophy
Address for Correspondence: Donald Caton, MD,
Department of Anesthesiology, PO Box 100254,
Gainesville, FL 32610-0254
when anesthesia for childbirth became part
of the campaign of early feminists for social
and political emancipation. This ensuing
confrontation pitted medical science against
social values. To a large extent, current prac­
tice reflects the accommodation that emcrged
from these opposing forces.
In this paper I will review first the reac­
tions of physicians to obstetric anesthesia and
list the various reasons they opposed it. Next,
I will explain how relief of the pain of child­
birth became an important part o f the
woman's liberation movement of the 19th
century. Last, I will give two examples of the
process by which patients and physicians
found ways to reconcile their differences.
Through this story I hope to illustrate another
side of medical history. Physicians empha­
size the great events in medical science, but
tend to overlook the social context in which
they take place. The development of obstet­
ric anesthesia illustrates how social forces
may influence practice. I believe this history
offers several important lessons for us today
as we deal with economic and political pres­
sures that often appear more important than
clinical science. History can show us that
these problems arc not new. Moreover, his­
tory may teach us how others dealt with them
successfully.
Response of Physicians to
Obstetric Anesthesia
When Simpson published his paper de­
scribing the first obstetric anesthetic, he ex­
pected accolades, not criticism. To his Sl1r­
prise virtually every recognized authority in
Western medicine opposed this use of ether.
l\1.any historians suggest that the oppo­
sition to anesthesia came from conserva­
tive physicians and church officials, who
believed that all women were destined to
suffer during childbirth as punishment for
Eve's sin in the Garden of Eden. Accord­
ing to this story, Simpson dispersed his crit­
ics when he wrote a pamphlet titled, An­
swer to the Religious Objections to the use of
Anaesthesia/or Mid'WifelY and Surg61y.3 In his
article, Simpson systematically refuted ev­
ery conceivable religiol1s, moral and ethi­
cal objection. The paper was a tremendous
success and is still often cited as an example
of the obstacles confronting innovations to
medicine in the 19th century. Unfortunately,
the story appears to be more apocryphal than
true.4-6 Physicians did oppose Simpson and
he did write the pamphlet; however, Simpson
appears to have misrepresented the charac­
ter of the opposition as religious conserva­
tism had little to do with the issue.
Apparently, Simpson wrote his tract
during one weekend, while recovering from
a cold, in response to a rumor that a surgi­
cal colleague planned to give a lecture at­
tacking the use of anesthesia. When histo­
rian A.D. Farr looked for evidence of the
lecture, however, he found none. Moreover,
he learned that the surgeon in question said
that he had never planned to say the things
that Simpson had ascribed to him. Farr also
learned that church officials had no inter­
est in the problem. Asked about the theo­
logical implications of using anesthesia for
childbirth, one cleric called it a "trivial
problem," not one worth serious discussion.
Farr concluded that the resistance that
Simpson had perceived was chimerical.
Presumably, people believed and repeated
the story because it fit their preconceptions
of the religious and moral climate of the
timeJ In fact, the issues that separated
Simpson from his colleagues were medical.
Particularly important were differences in
the beliefs about pain.
Simpson thought pain was an unneces­
sary, if not a destructive, biologic phenom­
enon. Specifically, he believed that the pain
of childbirth was an important factor con­
tributing to the high rates of maternal mor­
bidity and mortality common at that time.
Simpson also believed that uterine contrac­
tions and uterine pain were distinct phe­
nomena; he recognized that contractions
caused pain, but he believed that the pain
could be abolished without diminishing the
strength or duration of the contractions. He
argued, therefore, that ether was an un­
qualified blessing, a drug that physicians
could use with impunity to abolish the pain
of childbirth.
Other medical experts disagreed with
Simpson on every point. They argued that
childbirth was a physiological process, one
that was better left to proceed to comple­
tion without meddling. They also believed
that the pain of childbirth was an inextri­
cable part of the physiology of childbirth.
Diminish pain, they said, and the quality
BULLETIN OF ANESTHESIA HISTORY
of uterine contractions will decrease in pro­
portion, and they cited clinical observations
t o supp ort their assertions. They ques­
tioned the safety of ether , and chloroform
and speculated about its ultimate effect on
the mother and child. For obstetrics, they
concluded, anesthesia should be used only
in the event of special problems.
Simpson and his colleagues had identi­
fied important issues, many 'of which still
concern us today: the significance ofpain; the
character of childbirth; the safety of anesthe­
sia; and the effects of anesthesia on labor and
on the child. Unfortunately, they did not have
the resources to resolve any of them. In the
middle ofthe 19th centurymedical sciencewas
in its infancy. Only a handful of physicians
had training in physiology or pharmacolog y,
much less experience in the interpretation
of scientific or clinical data. Lacking evi­
dence and the experience that they needed
to resolve these issues, they could only pos­
ture and debate.
Posture they did. 'The debate, often pub­
lic and rancorous, continued for several
years. Eventually conservatives prevailed.
The maj ority of experts concluded that the
risks of anesthesia outweighed its benefit
and they advised against using it for nor­
mal deliveries until they could evaluate its
safety. C onfirming evidence carne slowly.
Accordingly, as late as 1920 there had been
little change in the theory or practice of
obstetric anesthesia. Experts still urged
caution and few women received anesthe­
sia for childbirth.
Resolution of the medical issues, how­
ever, was only part of the problem. For most
women anesthesia simply was not available.
Several factors contributed to this situation.
One was the low status of obstetrics as a
medical specialty. In 1900 few medical
schools taught obstetrics well and some not
at all. Midwives, not physicians, attended
most deliveries and midwives were not au­
thorized to administer anesthesia. Accord­
ingly, most women continued to deliver as
they always had, at horne, attended by a
midwife, and in pain. Undoubtedly this
situation would have persisted if anesthe­
sia for childbirth had not become a cause
of early feminists.
Feminists and Obstetric Anesthesia
In the United States, obstetric anesthe­
sia and the feminist movement began al­
most simultaneously. In July, 1848, just 14
m onths after Nathan C o oley Keep had
anesthetized Fanny Longfellow, feminists
held their first national conference ever in
the small town of Seneca Falls, New York,
home of one of the organizers, Elizabeth
Cady Stanton.s
The main goal of 19 th-century feminists
..
was women's suffrage, something they
eventually achieved in the United States in
1920 when C ongress ratified the 19 th
amendment. In fact, however, feminists
sought far more than just the vote: they
wanted the right to participate in every as­
pect of the political, economic and social
life of the country.
To achieve their goals feminists orga­
nized a powerful and far-reaching cam­
paign. They lobbied to change legislation
that limited rights of ownership and inher­
itance; worked to abolish social inequali­
ties between the sexes and among races;
initiated social reform through organiza­
tions such as the League of Women Voters
and the Woman's Christian Temperance
Union; and they founded many women's
colleges, among them Wellesley, Smith,
Vassar, Sweet Briary and Randolph Macon.
Feminists also sought improvements in the
medical care of women and children.
Women, they said, could never be politi­
cally active and economically secure unless
they were healthy and strong. Thus, the
health of women became part of their po­
litical campaign. With this, they focused
their attention on childbirth.
With regard to childbirth, feminists had
good reason for concern. Despite many im­
provements in medicine during the 19 1h
century, the risks of childbearing had
hardly changed. As late as 1930 maternal
mortality rates in Great Britain and the
United States were almost as high as they
had been in 1853, the year that John Snow
anesthetized Queen Victoria for delivery of
her eighth child.9 Feminists attributed the
poor health of women to frequent pregnan­
cies that left them debilitated, to the care
oflarge families that exhausted them, and
to poor medical management of childbirth,
which increased the probability of other
medical problems later in life. Contribut­
ing factors, they said, were the paucity of
hospital beds available for childbirth, the
small number of physicians adequately
trained to conduct normal deliveries, and
the fact that few women had access to an­
esthesia for their deliveries.
The management of pain quickly be­
came a central issue in debates about the
quality of perinatal care. Feminists agreed
with Simpson; they thought pain unneces­
sary and destructive. They also argued that
modern women had become more sensitive
to pain through evolution and accultura­
tion, an idea widely held by physicians as
welL Throughout the 19t11 century physiolo­
gists taught that an individual's physical
sensitivity to pain increased with education
and a higher standard ofliving. "Primitive
women" feel less pain during childbirth,
they said, and therefore have less need for
anesthesia. This idea even surfaced III
Grimm's fairy tale of the princess and the
pea, her sensitivity to a pea through layers
of mattresses vetting her royalty. Suffrag­
ette Elizabeth Cady Stanton too subscribed
to this idea. Commenting on her own nearly
painless delivery, she once remarked, "Am
I not almost a savage?"lO
To remedy problems ofwoman's health,
feminists began an ambitious campaign.
For example, they founded new medical
schools dedicated t o the education of
women physicians. The first was the
Woman's Medical College of Philadelphia
in 1850, but by 1900 there were 18 more.
Women activists also founded and admin­
istered hospitals dedicated to the care of
women and children in Boston, New York,
Chicago and in other major cities. Femi­
nists even campaigned to improve the qual­
ity of obstetric training in medical schools.
They worked to shift obstetric care from
midwives to obstetricians and from homes
to hospitals. To recover from the stress of
childbirth, every woman needed two weeks
of recuperation in a hospital before return­
ing to her responsibilities in the home.
Feminists in the United States and Great
Britain also worked to increase the avail­
ability of anesthesia for childbirth.JJ-J6
Campaigns for the Increased
Availability of Obstetric Anesthesia in
the United States and Great Britain
In the United States the campaign for
better anesthesia crystallized with the for­
mation of an organization named the Na­
tional Twilight Sleep Association. A com�
parable movement in Great Britain culmi­
nated in the National Birthday Trust Fund.
The two organizations shared several char­
acteristics. For the most part, their
fou iIders were upper class women who were
politically sophisticated and already deeply
involved in the suffragette movement. Both
organizations were democratic and highly al­
truistic: they sought a better life for women
of all social classes. Differences benveen the
two organizations also merit comment, how­
ever. Although they used similar political
methods, they developed very different strat­
egies for dealingwith physicians and govern­
mental agencies. Ultimately, one organization
had far more impact on the practice ofmedi­
cine than the other.
The American organization, the N a­
tional Twilight Sleep Association, began in
1914 in response to an article written by
j ournalists Marguerite Tra c y a n d
Constance Leupp, which was published i n
the June issue ofMaClures magazine. 1 7 Ear­
lier in the year Tracy and Leupp had accomContinued on Next Page
6
BUlLETIN OF ANESTHESIA HISTORY
Obstetric
.
.
.
Continued fmm Page 5
panied their friend Mary Boyd to Freiburg,
Germany, where she had gone to dcliver her
child under the care of Carl Gauss, a young
obstetrician who had popularized a new
method for managing the pain of childbirth.
The method, called "Dammerschlaff," or
Twilight Sleep, combined small doses of sco­
polamine and morphine.1s
The drugs that Gauss chose, morphine
and scopolamine, were already well known
to physicians. Using either drug during
childbirth, however, contradicted
long-standing medical practice. Physicians
knew scopolamine as a poison: supposedly,
Hamlet's father had been poisoned with
henbane, a variant of the drug. Similarly,
medical textbooks advised against mor­
phine. For decades they had warned that
the drug would stop labor and depress the
child, the same argument that they later
used against ether. They even advised
against giving morphine to lactating
women. In light of the information avail­
able at the time, the advice was reasonable
and safe. For example, morphine was
widely recommended as the most effective
drug for diminishing contractions of
smooth muscle associated with cholera,
ureteral colic, or cholelithiasis. Physicians
believed that it had the same effect on the
uterus. They also recognized the potential
of morphine to damage the child. Some
physicians ascribed intra-uterine deaths
and neonatal addiction to use of the drug. 1 9
Gauss believed that he could circumvent
problems traditionally associated with use
of these two drugs by using very small
doses. Given together, he reasoned, each
drug would enhance the effect of the other
without incurring the risks of either one.
The morphine would control pain and the
scopolamine would provide amnesia. To
achieve an effective but safe level of anal­
gesia and amnesia, Gauss devised a strict
regimen. At proscribed intervals he ad­
ministered a "memory test," to ascertain
whether or not a patient required more of the
mixture. In Europe, Gauss had limited suc­
cess. At the time that the American journal­
ists accompanied their friend to Freiburg, his
method had already been tried and discarded
in many medical centers.
The three Americans, however, were
very enthusiastic. Boyd, who remembered
nothing of her delivery, was pleased. Her
friends, whose information about the de­
livery came entirely from Boyd and Gauss,
were equally happy. Their article, a rous­
ing endorsement for Twilight Sleep, evoked
a tremendous response from American
women. Publishers ofMaClures called it the
greatest success in the history of the maga-
zine. In addition to comments of Mrs. Boyd,
it included statements by Gauss and
Bernhardt Kronig, the director of the clinic.
Kr6nig was already known for challenging
the dominance of Berlin academics and for
finding gynecologic applications for a new di­
agnostic tool, radiography. The article also
included pictures of happy mothers and
well-dressed young children who had been
delivered using the "Freiburg Method."20
To feminists, Twilight Sleep appeared
to be the answer to many of the medical
and logistical problems that had restricted
the use of anesthesia for decades. It was
safe, inexpensive, readily available for de­
liveries in the home as well as hospital, and
could be administered by a nurse. Ameri­
can physicians, however, were critical. They
pointed to the tepid response of European
physicians to Twilight Sleep. They were not
convinced that the method was safe, nor
that the drugs were free of effects on labor
or on the newborn child. They also claimed
that the method was ineffective. Patients
themselves remembered nothing of their
labor and family and friends were excluded
from the labor suite. Medical observers
knew, however, that the women had only
been amnesic. Loosed from their memory
and inhibitions by effects of scopolamine,
patients had to be restrained, blind-folded,
and closely monitored by an attendant lest
they injure themselves. Medical experts
failed to convince feminists, however, who
claimed that American physicians rejected
the technique out of jealousy and greed.
To overcome resistance to Twilight Sleep
among physicians, American feminists be­
gan an extensive campaign. They staged
rallies in department stores, published
books and pamphlets, sponsored lectures,
and arranged tours so that mothers could
exhibit their Twilight Sleep babies to other
women. They also enlisted the aid of the
popular press. In a 12-month period, the
New York Times published more than 3 0
articles and editorials about Twilight Sleep,
most of them supportive of the method and
highly critical of American physicians who
resisted using it.2I
To feminists, their fight for anesthesia
was part of-their struggle for economic and
political liberation. One book suggested
that Twilight Sleep represented"the first
time in the history of medical science that
the whole body of patients has risen to dic­
tate to the doctors." As one advocate of the
method observed, "The insistence of the
American women that they shall have the
benefits of the new method is bringing re­
sults. Keep on ladies! Hammer away with all
your might. Emancipation day has come."22
The campaign for Twilight Sleep lasted
only a year, ending almost as abruptly as it
had begun. Two factors contributed to its
demise. The first was the death during
childbirth of Mrs. Francis X. Carmody of
Brooklyn, an ardent supporter of TWilight
S leep and a frequent participant in public
rallies. Both Mrs. Carmody's husband and
her physician claimed no relationship be­
tween her death and the Twilight Sleep she
had received during her labor. The public,
however, was not convinced. Even editori­
als in theNew York Times became more sub­
dued, calling for more extensive medical
studies of the method.
The second factor was the outbreak of
World War 1. "T\vo short months after pub­
lication of Tracy and Leupp's original ar­
ticle inMaClures, German, French and Brit­
ish soldiers fired the shots that would ini­
tiate the trench warfare of World War 1. Dur­
ing the ensuing carnage everything German
fell from favor as newspapers daily reported
some new atrocity of "the Hun." Even Ger­
man medical science, which had once at­
tracted thousands ofAmerican students each
year, lost its luster. With all this, public sup­
port for Twilight Sleep quickly dissipated.
Despite loss of overt support, however,
the campaign for Twilight S leep left its
mark on the practice of obstetric anesthe­
sia. American physicians, who once had
been so conservative in their use of drugs
for labor, suddenly lost their inhibitions.
Medical journals from 1920 to 1945 con­
tained many reports of new methods for the
management of labor pain: spinal anesthe­
sia, paravertebral, peri-aortic and presac­
ral blocks, and intravenous morphine. One
anesthesiologist, James Tayloe Gwathmey,
developed a method of "combined anesthe­
sia" that involved using virtually every
agent and technique then available. As
their fear of the effects of drugs on labor
and on the newborn faded, physicians
slowly increased dosages until many
women remembered nothing of their labor
and many infants were born depressed.
British Women Campaign for
Anesthesia
In 1928, 13 years after the demise of the
National Twilight Sleep Association, Brit­
ish women began their own campaign for
obstetric anesthesia when they formed the
National Birthday Trust Fund. One divi­
sion of the organization, the "Anaesthetic
Fund," dealt specifically with the problem of
obstetric anesthesia. Chaired by Lucy
Baldwin, wife of Prime Minister Stanley
Baldwin, it was staffed by a group of socially
prominent and politically powerful women.
Leaders of the National Birthday Trust
Fund used many of the same methods that
..
BULLETIN OF ANESTHESIA HISTORY
had been successful in the United States:
they staged rallies, published pamphlets,
enlisted the aid of the popular press, and
raised money by sponsoring social events.
The Sunday edition of The 1Ymes often car­
ried long articles describing events orga­
nized by the Fund. The strategy of this or­
ganization for effecting change, however,
was quite different from its American coun­
terpart and in the long run it was consider­
ably more effective.
One important difference was the tar­
get of the campaign. American feminists
had attacked physicians for failing to adopt
Twilight Sleep. In contrast, British femi­
nists formed an alliance with obstetricians.
Together they attacked government offi­
cials. The alliance helped both groups. Brit­
ish obstetricians were just organizing as a
specialty and fighting to win professional
recognition from other specialties. They
needed public support. Women activists
recognized that they would need coopera­
tion of obstetricians if they were to induce
the government to improve resources for
woman's care. Comments by two prominent
British writers illustrate the tenor of this
campaign. For example, in her book Testa­
ment ofExperience, Vera Brittain railed that
Government after government in­
sists that we can't afford a national
maternity service-we who spend
millions a year on armaments to de­
stroy the bodies, which are produced
at such cost. At such time I was filled
with a vehement anger. I wanted to
batter down the solid walls of the
Ministry of Health; to take the Min­
ister himself and give him a woman's
insides, and compel him to have six
babies, all without anaesthetics.23
In a similar vein, Virginia Woolf sug­
gested that one advantage ofthe political em­
powerment ofwomenwould be a government
that provides "every mother with chloroform
when the child is born." Newspaper articles
described how "Red tape and the die-hard
attitudes oflocal authorities are responsible
for the pain and suffering each day in
child-birth of hundreds ofBritish mothers."24
A second important characteristic of the
British campaign was the kind of support
it offered physicians. For example, the Na­
tional Birthday Trust Fund used the money
it raised to fund research for the develop­
ment of new anesthetic methods. It enabled
anesthesiologists RJ. Minnitt and James
Elam to develop a portable "gas-air" ap­
paratus that could be used for deliveries in
the horne. In the same way Louis Camac
Rivett, consulting obstetrician at Queen
Charlotte's Hospital, devised a method to
encapsulate a unit dose of chloroform,
which could be broken under a laboring
woman's nose to provide analgesia. The
Fund also paid to manufacture these new
devices and distribute them to needy com­
munities. In other projects, they paid the
salaries of anesthetists to work in delivery
suites. Politically influential members of the
Fund lobbied parliament to allow midwives
to administer anesthesia and worked with the
Royal College of Obstetrics to train and cer­
tify midwives to use the new methods. The
Fund also initiated studies to evaluate the
efficacy, safety and patterns of use of anes­
thesia for childbirth.25-3D Even now, 70 years
later, work of the Fund continues.
Statistics illustrate the impact of the
British activists on the practice of obstet­
ric anesthesia. In 1929, a senior public
health official, Dr. Laetitia Fairfield, re­
ported that London maternity units deliv­
ered 7,454 women during the preceding
year. Of these, no more than one in 20
mothers received a sedative or analgesic for
their labor. Even fewer received a general
anesthetic and only then in the event of
some major obstetric problem. In fact, only
1 1 of 22 London obstetric units surveyed
offered any form of relief for normal deliv­
ery. By 1948, however, 288 of295 obstetric
units throughout the country offered some
form of anesthesia for normal deliveries.
Moreover, 50 percent of women who deliv­
ered in hospitals and 8 percent of women
who delivered at home received some form
of anesthesia.31 Noting these changes, a
member of Parliament, Edith Somerskill,32
once remarked, "Enlightened hospitals do
give anaesthetics." In 20 years' time, the
philosophy and practice of obstetric anes­
thesia had changed.
Some Observations
This story has several lessons. First and
most important is the power of social pres­
sure over medical practice. For those of us
trained in the science of medicine, this fact
often comes as a surprise. We assume that
basic science and clinical studies are the most
important factors that shape practice. This
seems to have been the belief of early physi­
cians who opposed using anesthesia for nor­
mal deliveries. They recognized the dangers
of the drugs and chose to wait for evidence
that ether and chloroform could be used
safely. By today's standards of practice, they
behaved in a cautious and rational manner.
Feminists waited patiently for half a century,
but then they forced the issue. Physicians re­
sponded and quicldy adopted practices which
they had resisted for decades. Practice
changed abruptly without any substantive
change in medical science.
This story also illustrates the impor­
tance of the process by which medical sci­
ence and social values reach an accommo­
dation, best seen by comparing the charac­
ter of the interaction between feminists and
physicians in the United States and i n
Great Britain. In the United States, the in­
teraction was marred by acrimony. Both
parties should share the responsibility.
American feminists erred when they
backed Twilight Sleep by allowing them­
selves to become advocates of a specific
medical technique. They were not qualified
to make such a decision. Moreover, they
made a poor choice because Twilight Sleep
had many drawbacks. American physicians
were right to oppose it but they erred too.
They never acknowledged the validity of
the feminist's demands for pain relief; they
never clarified the problems of Twilight
Sleep for the public; and they never offered
a good alternative. As a result physicians
and feminists remained at odds. The pub­
lic squabbling helped no one. In contrast,
British physicians and feminists quickly
found common ground. Feminists provided
money and political support, while leaving
technical medical problems to those best
trained to handle them. Together, they pres­
sured the government for reform.
Last, this story illustrates how rapidly
social goals may change. Within three years
after formation of the National Birthday
Trust Fund, Grantly Dick Read published
the first edition of the book in which he
first described his method of natural child­
birth. Within two decades natural child­
birth had become a cause for a new gen­
eration of feminists who, for the most part,
were unaware of all the work of their pre­
decessors. No less strange, a new genera­
tion of physicians now found themselves
defending the safety of obstetric anesthe­
sia, which by that time often involved ad­
ministration of excessive amounts of drugs.
Within a single generation, feminists and
physicians had exchanged positions-but
the resolution of this conflict is material
for another story.
(Some material in this paper has been taken
from Dr. Caton's book, 'W'hat a Blessing She Had
Chloroform: the Medical and Social Response to the
Pain of Childbirth after 1800, soon to be released by
Yale University Press.)
References
1. JY Simpson, On the inhalation of sulfuric
ether in the practice of midwifery. Edinbu1·gh
MonthlyJournal ofMedical Science, March 1847, pp
721-732.
2. NC Keep, The lethcon administered in a
case of labor. Boston Med SurgJ, 1847, 36:226.
3. JY Simpson, The Works of James Young
Simpson. In The ObSle1ric Memoirs and Contributions
ofJames Young Simpson, edited by WO Priestly and
Continued on Page 23
-
S
BULLETIN OF ANESTHESIA HISTORY
Natural Order-Solanaceae, Genus-Datura:
History of the Jamestown Weed or Thorn-Apple.
by David C. Lai, M.D.
Attending Faculty in Anesthesia, Beth Israel Deaconess Medical Center; Instruct01; Harvard Medical School
Recent Winner, Anesthesia Hist01Y Association Residents' Essay Contest
I first became acquainted with Datura
through a brief article by Gwen Wilson78 be­
fore I even graduated from medical school.
Was it coincidence that one year later, at a
local festival celebrating lilacs, in the base­
ment of a garden castle, I was drawn among
all the dried plants and herbs for sale to a bin
of mysterious priddy seed pods? When the
saleslady identified them as Jimson weed,
used by people as an illicit drug, I remem­
bered that article. Could they be Datura? The
saleslady, however, had never heard of Datura
and I had never before seen its seeds. Upon
confirmation in the botanical library conve­
niently located upstairs, however, I was the
proud owner oftwo dried seed pods of Datura
stramonium. Although they only cost five
cents each, they were priceless to me as my
first anesthetic acquisitions.
The S olanaceae family consists of
Lycopersicum (tomato), Solanum (nightshade),
S. carolinense (horse-nettle), S. melongena (egg
plant), S. tuberosum (POtato), S. dulcamara (bit­
tersweet), capsicum (cayenne pepper), Hyoscya­
mus (henbane), Atropa (belladonna), Petunia,
Nicotiana (tobacco) and Datura (stramonium). 03
Mydriatic alkaloids are found in Hyoscyamus,
Atropa, and Datura species as well as in Duboi­
sia and Scopolia species.66 As the principle
source of the hyoscyamine used in the manu­
facture ofatropine,56with recent imports of over
200,000 pounds of dried leaf of stramonium
annually,7° this article will focus on the history
and use of Datura, and end with a discussion of
its use in an anesthetic that predates the Morton!
L ong ether controversy by four decades.44 ,7 S
An early reference to Datura use was at
the oracular shrine ofApollo in his temple at
Delphi. Here his priestess, Pythia, inhaling
fumes from burning datura leaves, uttered
incoherent responses to questions asked of
her. These replies were then interpreted in
the form of a verse by a priest.7 9
Etymologically speaking, Datura stramo­
nium has its roots (no pun intended) in some
of the most ancient civilizations. Datura is
derived from the Sanskrit dhattura and the
Arabic tatura or tatulaJ2 Stramonium is de­
rived from the Greek Strychnomanikon, re­
ferring t o its causing madness.4 9
The first written reference to Datura may
have been by Dioscorides of Anazarbus, who
wrote his famous De materia medica around
A.D. 65." In Book IV, Chapter 74, he talks
about StruchnonManikon: "Solanum furiale,
which some have called Persion, some Thryon
[some Anydron, some Pentadryon, some
Enoron, some Orthogyion] . . . The root be­
ing drank with wine ye quantity of a dragm,
hath ye power to effect not unpleasant fanta­
sies. But 2 dragms being drunk, make one
beside himselffor three days & 4 being drank
kill him. But ye remedy of this is Melicrate,
much being drank, & vomited up again."32
Atropine rarely occurs in nature and is the
racemic product of naturally occurring
l-hyoscyamine.55 Additionally, atropine re­
sembles cocaine, and has weak analgesic ac­
tivity.68 ''A..tropine, however, has only mild lo­
cal anesthetic actions, and dulls rather than
paralyzes sensory nerve endings". 26 Sir
Alexander Fleming, the English bacteriolo­
gist, in 1862 noted that "painted on the mu­
cous membrane of the mouth and throat, it
dries the part, and-- -chiefly as secondary ef­
fects-impairs both feeling and movement".1 6
Historically, atropine was introduced to
prevent excessive secretions during ether
anesthesia and to prevent vagal bradycardia
during chloroform anesthesia.3,48 Although no
longer a required premedication with the
advent of modern inhalational agents, it still
remains a vital part of anesthetic pharmacol­
ogy. Despite such a long history of use and
implied familiarity, do we know the true back­
bone oftms drug, namely its etymology?
Linne in 1753 named the deadly night­
shade Atropa belladonna both for its lethal
and cosmetic properties. Bella (beautiful) and
donna (lady) came from the Venetian custom
of using the plant to dilate the pupils and
create sparkling eyes.79 This property is still
the basis of an old atropine poisoning test: a
drop of the patient's urine into the eye of a
catwillcausethe pupil to dilate.!l Atropa comes
from the oldest, smallest, and most terrible of
the three Fates (Moirae in Greek, Parcae in
Latin) ofGreekmythology.52,67TheFates,daugh­
ters ofThemis (Law),were originally birth spir­
its, and were described as three old women re­
sponsible for the destiny of every individual.
Clotho, the Spinner, spins the thread of life
which contains the fate of every human being.
Lachesis, the Apportioner and Disposer ofLots,
measures out the thread of life. Atropos, the
Inflexible or "She who could not be turned",
carried "the abhorred shears" and cut the thread
at death bringing life to and end.34,52
Gerarde cultivated Datura in England,
having received seeds from Lord Zouch, who
sent them from Constantinople around the
end of the 16th century (Millspaugh). In his
Herball,23 he describes the plant as having
"round fruit full of short and blunt prickles,"
"of strong favor, and doth stuffe the head, and
causeth drowsinesse," of "greate use in sur­
gery, as well in burnings and seal dings,"
"causing drowsinesse and disquiet sleep." In
summing up its nature, he wrote: "The whole
plant is cold in the fourth degree, and of a
drowsie and numming, qualitie, not inferior
toMandrake." As a plant growing in the wild,
it was inevitable that creatures other than
humans would ingest Datura. Theocritus,
writing about the Thorne-apple, relates:
"Hippomannes ' m ongst the Arcadians
springs, by which even allthe Colts and agile
Mares in mountains mad do fal l."2 3
Datura is also mentioned in John Baptist
Porta's Magia naturalis written in 1562. In a
chapter devoted solely to making people
" . . . mad for a day, without injuring their
health in anyway, for the amusement ofguests
at feasts," the thorn-apple is named, along
with the mandrake and deadly nightshade.69
A poisoning, likely the first reported in
America, as recorded by Beverly,5 occurred
in 1676, at the time of the Nathaniel Bacon
rebellion against the colonial government of
Virginia under Sir William Berkeley. British
soldiers under the command of Captain John
Smith, were sent to Jamestown to deal with
the rebellion. 73 ,75 Although widely
quoted,26,31,37,4 9,7 5 this early case report deserves
another audience: "This being an early Plant,
was gather'd very young for a boiI'd salad, by
some of the Soldiers sent thither, to pacifie the
troubles of Bacon; and some ofthem ate plenti­
fully of it, the Effect ofwhich was a very pleas­
ant Comedy; for they tum'd natural Fools upon
it for several Days. One would blow a Feather
. in the Air, another would dart Straws at it with
much Fury; and another stark naked was sitting up in a Corner, like a Mon}.:::ey grinning and
making Mows at them; a Fourth would kiss and
paw his Companions, and snear in their Faces,
with a Countenance more antik than any in a
Dutch Droll. In this frantik Condition theywere
confined, lest they in their Folly should destroy
themselves; though it was observed that all their
Actions were full of Innocence and Good na­
UIre. Indeed, they were notvery cleanly; for they
BULLETIN OF ANESTHESIA HISTORY
would have wallow'd in their O\\'n Excrements,
if they had not been prevented. A thousand such
simplelhcks they play'd, and after Eleven Days,
return'd themselves again, not remembring any­
thing that had pass'd."37
Nearly 100 years later, six years before
signing the Declaration of Independence,
Benjamin Rush gave an account of Stramo­
nium poisoning in the pediatric population.1i4
The now-classic symptoms of anticholinergic
poisoning ("Hot' as a hare, blind as a bat, dry
as a bone, red as a beet, and mad as a hen")
also come from the pediatric literature.53 This
may seem coincidental until one realizes that
atropine-like drugs used to be commonly pre­
scribed for a multitude of pediatric disor­
ders,53 and Datura plants are frequently ac­
cessible for a child to taste or eat.37,SO Some of
the items with which Datura poisoning by
contamination
has
occurred
111 clude:2,13,31,37,43,57,73 boiled greens, beans, gruel,
salad, tea, wine, chapattis, toothpaste, honey,
cannabis, Ugali (stiff porridge), and ham­
burger. There were 318 reports of Jimson
weed exposure in 1993.51
One of the most common causes ofDatura
poisoning has been due to smoking it for re­
lief of asthma. This does have some scien­
tific merit. Ipatropium. (Atrovent) is a syn­
thetic quaternary ammonium congener of
atropine that may be used to augment
beta-agonist induced bronchodilation.68 The
following is a certificate of analysis on a box
of cigarettes sold by the Spanish Cigarette
Company of London and New York in the
19th century: "Spanish Herbal Cigarettes
when smoked emit an agreeable and fragrant
odor, are soothing and pleasant, and leave no
objectionable after-effect upon the palate.
They are quite free from all ingredients of an
injurious or undesirable character, and in
cases of Coughs, Colds, Bronchitis, Asthma,
and Pulmonary Complaints, generally they
will be found of the greatest value and ben­
efit."4D Further claims were that "the fumes
of this plant afford instantaneous relieffrom
afflictions of the respiratory passages."40
Datura stramonium was the major compo­
nent of these Herbal cigarettes. Some of the
Datura-based asthma preparations available
over the counter in recent years are:
Asthmador powder, Barter's powder,
Kinsman's Asthmatic Powder, Green Moun­
tain Asthmatic Compound, Haywood's Pow­
der, Potter's asthma powder, and Surama
cigarettes.2o,6o These remedies are virtually
harmless if smoked, but can be dangerous if
taken orally.60 Because ofthe rising incidence
of people ingesting these compounds for their
intoxicating effects, the Food and Drug Ad­
ministration in 1968 placed - stramonium­
containing asthma powders in the
prescription-drug categoryJ2
Through the centuries, Datura has been
used in many different ways, with its narcotic
properties21,36 often employed for a less than
moral agenda. In Egypt and India, Datura
has been added to food or beverages to facili­
tate both robbery and murderY The Thugs,
"a society of stealthy fanatic murderers of
India," used various Datura species to make
their intendedvictims unconscious.49 Chevers
in 1856 wrote of these Indian "professional
poisoners" who used Datura in their crimi�
nal activity.75 Christoval Acosta, also in In­
dia, in 1578 related that Hindu whores gave
Datura to their clients because "these mun­
dane ladies are such mistresses and adepts
in the use of the seed that they gave it in doses
corresponding to as many hours as they wish
their poor victims to be unconscious or trans­
ported."70 Knowledge of Datura's effects did
not die out over the years, as witnessed by
none other than Mahatma Gandhi during his
attempt to commit suicide with one of his
playmates: "But how were we to do it? From
where were we to get the poison? We heard
that 'Dhatura' seeds were an effective poison.
Off we went to the jungle in search of these
seeds, and got them."75 Datura was officially
listed in the United States Phannacopoeia from
1820-1910.64 An entry in the Pharmacopoeia
oflndia21 may have been similar to an Ameri­
can entry:3 9 " . . .it is a very energetic poison."
Griffith in 184875 described the use of
Datura to intensify the intoxicating effects
of beer. He also told of its use in the 11th and
12th centuries by assassins in the time of
Omar Khayyam. Datura also has been used
by prisoners against themselvesY Inmates
given Datura become driven to protect their
stash, and upon running to their hiding place,
are promptly robbed. In Colombia, it was the
custom that when a married man with slaves
died, his wife and slaves would join him. Be­
fore they were buried alive with the deceased,
however, they were given D. aurea.2S
Datura's intoxicating properties have also
been used to sexual advantage. Millspaugh49
claimed that "The sexual functions are often
excited, more especially in women, in whom
it causes nymphomania." California Indians
have used a Datura beverage to "stimulate
young females in dancing."49 D. fastuosa was
employed to ensure fertility during female
puberty initiations in Southern Africa.2R
White slavers would use Datura in an aphro­
disiac that left virgins with no memory of
their actions as prostitutes.70
In Egypt, one had to be careful in accept­
ing dates from strangers as they might con­
tain Datura seeds. Datura poisoning in
Nyasaland was elegantly diabolicaL Datura
seeds were inserted the in stem of a glass
which was then carefully filled with beer.
Local custom dictated that the host drink
9
first, which he did. But before innocently of­
fering the glass to his guest, he would give it
a twirl, silently activating the poison.23
Medical practice and knowledge is con­
stantly evolving and changing. B y looking
into the past, we can see the boundaries of
certain treatments, limits that may never
again be attained due to changing standards
of care. Atropine was formerly used in the
treatment of chronic epidemic encephalitis
and post-encephalitic Parkinson's Disease.33
Average doses were 18.5 mg of atropine daily,
with doses up to 195 mg dailyY Atropine was
first recommended by Charcot, and then sco�
polamine by Erb in 19 01 for this purpose.26
The method of high atropine dosage was in­
troduced in 1929 by Kleemann.33 Anticholin­
ergic drugs, namely the naturally occurring
belladonna alkaloids, used to be the one and
only treatment for Parkinson's disease.!
Benztropine (Cogentin), which combines
both the chemical and pharmacological prop­
erties of atropine and diphenhydramine, was
commonly used until the introduction of
levodopa therapy in 1970, and is still used as
adjunct therapyP
Psychiatric somatic therapy was another
arena that used large doses of belladonna al­
kaloids. Forrer developed the idea of atro­
pine toxicity therapy after observing a patient
undergoing insulin coma therapy.22 The clini­
cal state reminded him of an incident he had
witnessed during medical schooL A surgeon
had used 10 cc of 1% procaine for local skin
infiltration around a lesion. Adequate surgi�
cal analgesia was obtained, and the excision
was performed without incident. As the
wound was being closed, some 15-20 minutes
after skin infiltration, the patient was now
found to also have surgical anesthesia. In fact,
IOcc of 1% atropine had been injected. This
error was not immediately discovered as all
observers were more interested in the surgery
at hand rather than the patient. Although the
patient was found to be comatose, he may still
have been conscious when skin incisions oc­
curred. The local anesthetic properties and
structural similarity to cocaine have already
been alluded to. DeElio, using procaine as
the relative standard (1.0) oflocal anesthetic
potency, gave cocaine a 7.4 and atropine a 0.5
rating. 14Since Forrer's initial efforts, atropine
coma therapy continued to be used in psy­
chiatr y well into the mid-1970s, before the
advent of the now widely used psychotropic
drugs.42 In contrast to the Parkinson's pa­
tients, unconsciousness was the goal ofAtro­
pine toxicity therapy. As a result, doses of up
to 250 mg atropine or 2 0 0 mg scopolamine
were used. Therapy was instituted four times
a week, and was continued for up to 2
Continued on Next Page
10
BUlLETIN OF ANESTHESIA HISTORY
Datura .
. . Continued from Page 17
months.47 A typical course of therapy was as
follows: following intramuscular injection of
mass quantities of either atropine or scopo­
lamine, unconsciousness equivalent to
stage 3 insulin coma developed after 45-60
minutes. The paticnt did not regain con­
sciousness until 4-8 hours laterY·24,25,42,47 The
idea of atropine use in psychiatry is not new,
however. Doctor Storck, describing the ratio­
nale behind his experiments with Datura in
1 760, stated: "If the thornapple, by disorder··
ing the mind, causes madness in sound per­
sons, may we not try whether, by changing
and disturbing the ideas and common sen­
sory, it might not bring the insane, and per­
sons bereft of their reason, to sanity, or sound­
ness of mind, and, b y a contrary motion, re­
move convulsions in the convulsed." 13 ,64
We now come full circle to the beginning
of this journey. The story of Seishu Hanaoka
has been told by both Wilson and l\1.atsuki
(44,7ff). Hanaoka was a Japanese surgeon and
anesthesiologist who first performed general
anesthesia using his oral anesthetic
Tsusensan on October 13, 1805. This was 37
years before Crawford Long and 41 years
before William Morton used ether.44
Tsusensan's main component was various
species ofDatura leaves. With the active com­
ponentcontaining 0.4% alkaloids mixed in a
4:9 ratio with the other ingredients, the re­
sulting supernatant of the original seven­
gram mixture dissolved in boiling water prob­
ably contained the equivalent of about 125
mg atropine. Unconsciousness ensued after
3 hours, lasting for 5 hours, enabling
Hanaoka "to perform any kind ofoperation,"
which included cleft palate, cataracts, tongue
cancer, breast cancer, hydrocele testis, and
various traumatic wounds and orthopedic
problems. The patient was given
Ohren-gedokuka-sekkoto (black soy bean
juice) for recovery, which was complete after
6 hours.44 Given this time course, the rever­
sal had no physiological similarities to the
calabar bean (eserine), which is the source of
physostigmine, the only anticholinesterase
with a tertiary amine group allowing it to
cross the blood-brain barrier and reverse at­
ropine CNS toxicity. 18.41.54
Although Hanaoka's Tsusensan is no
longer used, his motto "Naigai-goitsu
Katsubutsu-Kyuri" still holds true. Trans­
lated, it means: "Physicians should master
the principles of surgery and surgeons should
learn those of internal medicine."44 Perhaps,
i n today's buzzwords, he was the first
"perioperative physician."
References
1. Andrews IC and Belonslzy BL: Clinical Anaesthe-
sia. 10(1);11, 1973, Chapter 2, ParaRympatholytics, p
11-29.
2. Anonymous: Datura poisoning from ham­
burger-Canada. ]AMA 1984;251:3075.
3. Barash PG, Cullen Bf; Stoelting RK: Clinical
Anesthesia, Second Edition. JB Lippincott Company,
Philadelphia, 1992, p 346.
4. Bethea OW:PraclicalMateriaMedicaandPrescnp­
tion IWiling. EA.Davis Company, Philadelphia, 1915, p
307-8.
5. Beverly R: The History and Present State of Vir­
ginia. London, 1705, Bool< 2, p 24.
6. Blunt W with the assistance of Steam WT: TIw
New Naturalist, TIle Art ofBotanical fllustration. Collins,
St. James's Place, London, 1967, Plate XXIII.
7. Brendle 1R and Ungcr CW: Folk iHedicine of the
Pennsylvania Germans. Augustus M. Kelley, New York,
1970, p 139.
8. Castaneda C: ©. Pocket Books, New York, NY,
1974.
9. Chan TY Anticholinergic poisoning due to Chi­
nese herbal medicine.
Vet IIuman Toxicology
1995;37:156-7.
10. Chandhoke N: Daturalactone (DQl) isolated
from Datura quercifolia: a new interceptive agent In­
dian] Exp Biology 1978;16:419-21.
11. Coates W: BritMedJ 1947;2:886.
12. Cohen H, and Craw JW: High hyoscine dosage
in chronic encephalitis. Brit Med] 1937;1:996.
13. Corrigan D: The identification ofdrugR of abuse
in the Republic of Ireland during the years 1968-1978.
Bull Na:rcotics 1979;31:57-60.
14. DeElio t]:Acetylcholine antagonists. Compari­
son of their action in different tissues. Brit] Pharmacol
1948;3:108-112.
15. Doerfler HP and Roselt G: IIeilpjlanzen, Gestei"n
und Heum. Urania-Verlag, Leipzig, 1990, p 100-1.
16. Duncrun B: The Development ofInhalation Ana­
esthesia. Oxford University Press, London, 1947, p 392.
17. Dunglison Robley and revised b-y Dunglison
Richard: Dunglison's Medical Dictionmy. Henry C. Lea,
Philadelphia, 1874, p 293.
18. Duvoisin R and Katz R Reversal of central an­
ticholinergic syndrome in man byphysostigmineJAAL4
1968;206J963-5.
19. Eger EI: Atropine, scopolamine, and related
compounds. Anesthesiology 1962;23:365-383.
20. Ellenhom MJ, Barceloux DG: Medical Toxicol­
ogy. Dia[J1wsis and 'Ii"eatnwnt ofHuman Poisoninr;. Elsevicr,
�ew York, 1988, p 267-275.
21. Fluckiger FA and Hanbury D:Phmrnacographia,
a HistOlY of the Principal Drugs of vrgelable OIigin, Met
With in Great Britain and British India. Macmillan and
Co., London, 1879, p 459-62.
22. Forrer GR: Symposium on atropine toxicity
therapy. History and future research.]Nervous andMen­
tal Dis 1956;124:256-264.
23. Gerard J: The Herball or Generall IIistorie of
Plantes. Gathered by John Gerarde of London, Master
in Chimrgerie. Very much Enlarged and Amended by
Thomas Johnson, Citizen and Apothecarye of London.
Norton and %itakcrs, London, 1633, p. 347-9.
24. Goldner RD: Scopolamine steep treatment in
private practice. Int] iVeuroprychiatty 1967;3:234-246.
25. Goldner RD: Symposium on atropine toxicity
therapy. Experience of usc in private practice.] Nervous
and Mental Dis 1956;124:276-280.
26. Goodman L and Gilman A: The Phmmacologi­
cal Basis qfTherapeutics. The Macmillan Compan)� :\"ew
York, 1941, p 460-81.
27. Goodman L and Gilman A: 171£ Phmmacologi­
cal Basis ofTherapeutics, Fifth Edition. Macmillan Pub­
lishing Co., Inc., Ncw York, 1975, p. 227-239.
28. Gossel TA, Bricker JD:Principles ofClinical Toxi­
cology, Third Edition. Raven Press, New York, 1994, p
252-3.
29. Gowdy JM: Stramonium intoxication. ]AMA_
1972;221:585-7.
30. Gray A: Gray's Sclwol and Field Book ofBotany.
Ivison, Blakeman, Taylor, & Company, New York, 1872,
p 265-70.
31. Gunn J: Gunn's Domestic Medicine or Poor Man's
Friend. Saxton & Ahles, New York, Fourth Revised Edi-
tion, 1844, p 628-34.
32. Gunther RT: The Greef? Herbal of Dioscorides,
Englished by John Goodyer, AD. 1655. Hafner Publish­
ing Company, New York,
(Facsimile of the 1934 Edition) 1968, p 470.
33. Hall AJ: The results of high atropine dosage in
chronic epidemic encephalitis.
Brit Med ]
1937;U95-799.
34. Hamilton E: lIifythology. Thc New American
Edition. The New American Library, Inc., New York,
:-.ry; p 43.
35. HaymanJ: Datura poisoning-the angel's trum­
pet. Pathology 1985;17:465-6.
36. Hooper R and additions by Akerly S: Lexicon
Medicum; or Medical Dictionary. J. and J. Harper, New
York, 1829, p 282-3.
37. Jennings RE: Stramonium poisoning. A rcview
of the literature and report oftwo casesJPed 1935;6:657664.
38. Johnson L: A Medical }i'ormulary Based on the
United SraLes and British Pharrn{lCopeias Together with
�Vumerous French, German, and Unofficinal Prepmtions.
William Wood & Company, New York, 1881, p 360-1.
39. King J: The American Dispensat01Y. Wilstach,
Baldwin & Co., Cincinnati, 1880, p 323-6.
40. Le\vis WH, Elvin-Lewis MPF: Medical Botany.
Plants Affecting Man's Health. John Wiley & Sons, NY,
1977, p.54, 296, 419-25.
41. Liebrcich 0 und Langgaard A: Compendium der
ArzJ1cwivel'Ordnung. I-l. Kornfeld, Fischer'sMedicinische
Buchhandlung, Berlin l\:'\"X1, 1896, p lO2-3.
42. Lynch HD and Anderson AliI: Atropine coma
therapy in psychiatry: Clinical observations over a
20-year period and a review of the literature. Dis Ner­
vous System 1975;36:648-652.
43. Marciniak J and Sikorski M: Intoxication with
alcaloids ofDatura stramonium. and Datura inoxia fol­
lowing honey ingestion. Polski 'Jl
ygodnik Lekarski
1972;27:1002-3.
44. Matsuki A: SeiRhuHanaoka, a Japanese pioneer
in anesthesia. Anesthesiology 1970;32:446450.
45. Meyer C: American PoY? Medidne. Thomas Y
Crowdl Company, New York, 1973, p 34-5.
46. l\1ikolich JR, PaulRon GW and Cross CJ: Acute
anticholinergic syndrome due to Jimson seed ingestion.
Ann Int Med 1975;83:321-325.
47. NEller JJ: Symposium on atropine toxicity
therapy. Pharmacology, procedure and techniques in
atropine toxicity treatment of mental illness. J Nervous
and Mental Dis 1956;124:260-264.
48. Nliller RD:Anesthe�'ia. FourthEdition. Churchill
Livingstone, NY, 1994, p 566.
49. Millspaugh CF American Medicinal Plants. Do­
ver Publications, Inc. New, York, 1974. Originally pub­
lished by John C. Yorston & Company, Philadelphia, in
1892 under the title .!Hedicinal PlanlS, p 498-504.
50. Mitchell JE and Mitchell PN: Jimson weed
(Datura stramonium) poisoning in childhood. .J Ped
1955;47227-230.
51. MlvlWR-Morbidity & Mortality u::eeklv &pOlt
1995;44(3):41-4, Jan 27.
52. Morford MPO and Lenardon RJ: Classical My­
thology. David McKay Company, Inc., New York, 1977.
53. Morton HG: Atropine intoxication. Its manifes­
tations in infants and children.] Ped 1939;14:755-760.
54. Nickalls RWD and Nickalls EA: The first use
of physostigmine in the treatment of atropine poison­
ing. Anaesthesia 1988;43:776-779.
55. Oldham FK, Kelsey FE and Geiling EMK: Es­
sentials ofPharmacology. J.R. Lippincott Company, Phila­
delphia, Third Edition, 1955, p 168-175.
56. Osol Arthur, Chairman of Editorial Board:
Remington'sPhannaceutical Sciences. Mack Printing Com­
pany, Easton, Pennsylvania, Sixteenth Edition, 1980, p
403-4.
57. Pcreira CA and Nishioka S de D: Poisoning by
the use of Datura !caves in a homemade toothpaste. ]
Toxicology Clin Toxicology 1994;32:329-31.
58. Polson CJ, Greenl\1Aand Lee MR: Clinical Toxi­
cology, Third Edition. JB Lippincott Company, Phila­
delphia, 1983, p 355-368.
Continued on Page 1 7
BUlLETIN OF ANESTHESIA HISTORY
I I
Gone But Not Forgotten:
Roderick Angus Gordon, M.D.
( 1 9 1 1 - 1 998)
by G.R. Stephen, M.D.
Born in Saskatchewan, Canada, in 1 9 1 1 ,
Dr. Gordon attended High School there
(1923-1 927) and then moved to Toronto
where he enrolled in the Toronto Conser­
vatory of Music, attaining the L.T.C.M. in
1929. His favorite instrument was the vio­
lin, which he continued to play as a hobby
during his life.
Then he returned to Saskatchewan
where he went to the University of
Saskatchewan, obtaining a B.Sc. in 1934.
Once again he returned to Toronto to
attend the University of Toronto Medical
School, achieving the M.D. in 1937. Fol­
lowing an internship he was a Resident in
Anaesthesia at the Toronto General Hos­
pital from 1938-39. With the onset of the
Second World War, he joined the Royal
Canadian Army Medical Corps in 1939. He
was posted to # 1 5 Canadian General Hos­
pital, which moved to England in 1 940.
In 1941 he was posted as an anaesthe­
tist to the Plastic Surgery Team at the
Basingstoke Neurological and Plastic Sur­
gery Hospital in England, where he served
until 1945. It was there that Dr. Gordon
pursued and recommended the use of an
intravenous procaine drip to relieve the
pain associated with thermal burns. His
landmark paper, "Intravenous Novocaine
for Analgesia in Burns" (CMA] 49:478-481,
1943) recognized the value of this unique
technique.
Returning to Toronto in 1 945, he was
appointed Officer Commanding #7 Field
Ambulance (Reserve) as a Lt. Colonel. In
civilian life he returned to the Toronto
General Hospital in 1945 as a Senior At­
tending Anaesthetist and as a Clinical
Teacher in the Department of Anaesthesia
at the University of Toronto. Remaining in
this locale, in 1961 he was appointed Pro­
fessor and Head of the Department of Ana­
esthesia at the University of Toronto and
Anaesthetist-in-Chief at the Toronto Gen­
eral Hospital. Under his aegis the Depart­
ment in Toronto was recognized as one of
the leading institutions throughout the
world. In 1977 he was appointed Professor
Emeritus.
Through the years Dr. Gordon mani­
fested his abilities and energy in many
anesthesia-related fields. Primary in these
endeavors was the time and energy he de­
voted to the Canadian Anaesthetists Soci-
ety in its formative years. From
1 94 6 - 1 9 6 1 , he was Secretary­
Treasurer of this organization.
From 1 96 1 -63 he was elected
Vice-President and in 1963-4 he
became President. The establish­
ment
of
the
Canadian
Anaesthetists Mutual Accumulat­
ing Fund was entirely his initia­
tive. In 1969 the Society presented
him with the Gold Medal, its
highest honor, in recognition of
his meritorious service to Anaes­
thesia. Furthermore, in 1990 the
Society announced the Dr. R.A.
Gordon Clinical Research Award.
A framed certificate was pre­
sented to him, which reads: "The
Canadian Anaesthetists Society
hereby establishes in perpetuity
the R.A. Gordon Career Research
Award in recognition of the life­
long and historic contribution of
Dr. R.A. Gordon to Canadian
Anaesthesia."
In 1 954, seeing the need for a
journal to represent the work of
Canadian Anaesthetists, Dr. Gordon
founded the Canadian Anaesthetists Society
Journal and was its Editor until 1983. Due
to his perseverance and the high standards
he demanded, this Journal has become one
of the several most respected in the world
devoted to anaesthesia.
Dr. Gordon's interests and actions were
not limited to the work which he accom­
plished in Canada. He and some colleagues
assisted in the development of a Depart­
ment of Anesthesia in Lagos, Nigeria. Early
on in the development of the World Fed­
eration of Societies of Anesthesiologists,
Dr. Gordon was appointed to the Execu­
tive Committee of this organization from
1955-64 and was the Organizing Secretary
for the second meeting of this Society,
which was held in Toronto in 1960. He was
appointed Vice-President of the Society in
1964.
Many honors were accorded to Dr. Gor­
don, in addition to those already cited. In
1949 he received the Canadian Forces
Decoration, in 1952 a Coronation Medal
and in 1967 the Centennial Medal. Honor­
ary memberships were conferred by the
Associated Anaesthetists of Great Britain
and Ireland, the Association of Surgeons
of West Africa a n d the Faculty o f
Anaesthetists, Royal College of Surgeons
of England.
Early in his career Dr. Gordon was
elected a member ofthe Academy of Anes­
thesiology (formerly the Travel Club initi­
ated by John Lundy and Ralph Waters) and
became President of the Academy i n
1970-71. I n 1 9 7 8 h e was honored b y the
Academy by presentation of a Citation of
Merit, which concisely describes his unique
career: "To Roderick Angus Gordon, M.D.,
in recognition of his great talents as a
teacher, director and professor; his dedica­
tion to promoting and developing the high­
est ideals in Anesthesiology; his many con­
tributions as an erudite editor and stimu­
lator of precise scientific communication;
his enduring patronage of the World Fed­
eration of Societies of Anesthesiologists;
and his constancy as friend and respected
counsellor of fledgling anaesthetists."
Dr. Gordon is survived by his wife Ruth,
who endeared herself to so m any, his
daughters Catherine and Janet, his son
James and four grandchildren. May he rest
in peace.
12
BULLETIN OF ANESTHESIA HISTORY
The My sterious Chloric Ether:
From Dutch Liquid to Chloroform
by R.]. DeJalque, M.D. and A,J. Wright, M.L.S.
Department ojAnesthesiology, UAB School ojMedicine
Birmingham, Alabama 35233
Within a few weeks of the introduc­
tion of ether for anesthesia in October,
1 846, several Boston and London physi­
cians, unhappy with its slow action, ex­
perimented with compounds variously
called chloric ether, Dutch oil or liquid,
oil of liquefiant gas, and liquid or oil of
the Dutch chemists.I-4 Much confusion
exists in the anesthetic literature on the
nature of those substances; the following
historical review may help clear that con­
fusion . .
The chloric ether story starts a t the end
of the 18th century in Amsterdam (Nether­
lands) where six wealthy amateurs had
formed the Batavian Society (1791-1 804)
to study the new science of chemistry. Their
group is better known as the Society of the
Dutch Chemists 5 In 1794 they reported the
synthesis of a new gas that they named
olefiant gas.6 When they mixed that gas
with chlorine (C1 ) in a hot water bath, they
2
obtained a yellowish, aromatic, oily fluid
referred to in the early chemical literature
as liquid or oil of the Dutch chemists. This
substance had no medical indications.
Modern chemists have identified the
olefiant gas as ethylene (or ethrene, C2H4)
and the Dutch oil as dichloroethane
(C, H CI,) .
4
The name chloric ether, a n abbrevia­
tion for hydrochloric ether, was coined by
Thomas Thomson, a Glasgow physician
and chemist, in the 1820 edition of his El­
ements of Chemistry.1-4 Thomson described
chloric ethcr as the alcoholic solution of
thc oil ofthe Dutch chemists and intimated
that it might be used in medicine as an "ac­
tive- diffusible stimulant". Benjamin
Silliman, Professor at the Yale College of
Chemistry, mentioned Thomson's chloric
ether and its possible medical use in the
1831 edition of his Elements of Chemistry.
In the fall of 1 8 3 1 , Samuel Guthrie, a phy­
sician and amateur chemist of Sackett Har­
bor, NY, reported to Silliman his process
for distilling concentrated alcohol with
soda lime (CaCI,) . Guthrie thought that he
had discovered a simpler and cheaper
method of producing Thomson's chloric
ether (i.e., an alcoholic solution of the
Dutch liquid) and hoped to sell it as a medi­
cal stimulant. He had in fact obtained a
concentrated alcoholic solution of chloro-
form. Silliman published Guthrie's com­
munications in several 1832 issues of his
AmericanJournal ofScience andArts and the
chloric ether that he described in the 1834
edition of his Elements ofChemist1Y was now
Guthrie's solution of chloroform, rather
than Thomson's solution of the Dutch oi1.7
Guthrie's patients and friends had often
drunk and inhaled his chloric ether and
found it to be a tasty, pleasant and euphoric
stimulant. Silliman, fearing its abuse, rec­
ommended that it only be sold by medical
prescription. In 1842 he gave some of this
new chloric ether to his Yale medical col­
league, Professor Eli Ives, for clinical tri­
als. Ives found it useful in pulmonary dis­
eases and in various painful conditions.7
Sometime in 1 83 8 or 1 839, a Dr. Brett,
senior chemist at the Liverpool Apoth­
ecaries' Hall, was asked to fill a prescrip­
tion including ch10ric ether. This com­
pound \-vas unknown to him and he did
not find it mentioned either in the Brit­
ish Pharmacopeia or in any of the contem­
porary British textbooks of l11ateria
Medica. Brett, however, found its descrip­
tion and its preparation in the U.S. Dis­
pensat01Y (1836). This item was, of course,
Guthrie's and Silliman's solution of chlo­
roform. The compound gained some
popularity in Liverpool and was com­
monly prescribed by a renowned local
physician, Dr. Richard Formby, who used
it for various diseases, including hyste­
ria.3
From Liverpool chloric ether made its
way to London and by the mid-1 840s it
was commonly used by the London phy­
sicians topically for cancer sores or orally
as a stimulant or antispasmodic. There
was much confusion among those physi­
cians about the true nature of the chloric
ether that they prescribed. In answer to
their inquiries, several English authori­
ties ofMateria Medica (J. Peireira, J. Ure,
T. Redwood) reviewed the subject4 and
concluded that the name chloric ether
was usually (though not exclusively)
given to two distinct compounds:
a) the oil of the olefiant gas or liquid
of the Dutch chemists, also called hydro­
chloric ether, or (in Liebig's German ter­
minology) hydrochlorate of chloride of
acetyl. This chemical is our modern
dichloroethane and had no medical indi­
cation.
b) an
alcoholic
solution
of
perchloride o f formyl (Liebig's name for
chloroform). This was the compound pre­
pared in various degrees of purity and
strength for the London physicians.
By that time, of course, the chemical
structure of chloroform had been well
elucidated by the researches of Dumas,
Soubeiran and Liebig in the early 1 830s.
The chloric ether used for anesthesia
in late 1846 and early 1847 in Boston by
H . J . Bigelowl,2 and in London by J .
Tomes, J. Bell, H. Coote, M . C . Furnell
and Wm. Lawrence3,4 was a 1 2 to 1 6 %
solution o f chloroform in alcohol. Those
anesthetic trials produced uneven results
because of differences in strength and
puri ty and chloric ether was generally
judged to be unpredictable and expen­
sive. The substance was thus easily dis­
placed by Simpson's chloroform after
November, 1847.
J.Y. Simpson had met David Waldi e,
his former childhood and medical school
friend, in Scotland in October, 1 847.
Waldie had given up medical practice and
followed Brett as senior chemist at the
Liverpool Apothecaries' Hall. He was fa­
miliar with chloric ether and had distilled
pure chloroform from. it. Simpson de­
scribed to his friend his unsuccessful
self-experiments with various substances,
including chloric ether, to find a substi­
tute for ether. Waldie suggested that he
try pure chloroform, rather than its alco­
holic solution, and promised to prepare
some for him. He was unable to do so at
once because of a fire in his laboratory
and back in Edinburgh Simpson obtained
pure chloroform from the local firm of
Duncan and Flockhart. On the night of
November 4-5, 1 847, he and his assistants
M. Duncan and G. Keith and his niece
Miss Petrie discovered on themselves the
potent anesthetic effect of chloroform
and within a few weeks had insured the
triumph of the new agent in surgery and
in obstetrics.
In early 1 848, J. Snow1 ,2 prepared an
alcoholic solution of the Dutch liquid
and tested it on mice and on a few paContinued on Next Page
BULLETIN OF ANESTHESIA HISTORY
13
Spinal Opioid Administration:
W hy Did It Take So Long for
This Clinical Technique To Emerge?
by David C. Mackey, M.D.
Deparrment of Anesthesiology, Mayo Clinic, ]acksonvilie, Florida
A series of papers published in the 18908
by Sicard, jaboulay, jacob, von Leyden and
others reported animal and human experi­
ments involving the intrathecal injection
of a number of substances, including po­
tassium iodide, potassium bromide, mor­
phine and cocainc. Various bacteria and
tetanus, diphtheria and meningococcal an­
titoxins followed the first mention of thera­
peutic intrathecal injection by Ziemssen in
1893. In August of 1898 Dr. August Bier
performed a series of six orthopedic opera­
tions under cocaine spinal anesthesia,
which he reported in the April, 1899, issue
of the Deutsche Zietschrift jur Chirurgie, in a
paper entitled "Experiments with cocain­
ization of the spinal cord."! Subsequent
1899 reports on this anesthetic modality by
Seldowitsch in Russia, Tuffier in Europe
and Tait, Caglieri and Matas in the U.S.,
were followed by a cascade of others, and
it was estimated that by January, 1901, there
had been nearly 1,000 publications on this
new anesthetic technique.2
The modern era of spinal opioid use was
ushered in by the 1976 report ofYaksh and
Rudy of analgesia induced in rats by sub­
arachnoid opioid administration, and by
the 1979 report by Wang et 01. of pain re­
lief in cancer patients also obtained via in-
Ether
.
.
.
Continued from Page
trathecal morphine injection.3,4 With such
intense early interest in spinal drug admin­
istration, why did nearly 80 years elapse
before the emergence of spinal opioid use?
In fact, clinical spinal opioid use did
quickly follow Bier's first cocaine spinal
anesthetic. Sicard published his initial ex­
periencewith intrathecal morphine admin­
istration in animals in 1898, and this was
followed by the reports of intrathecal mor­
phine injection in patients by Marx and by
Matas in 1900, and by Kitagawa in 1901.5-8
Matas remarked that he incorporated mor­
phine for its sedative effect and in order to
amplify and prolong the anesthetic action
of cocaine.
In his 1 9 1 5 textbook of regional anes­
thesia, Carroll Allen mentioned the cau­
dal epidural administration of various so­
lutions, including those containing codeine
or morphine.9 However, no further reports
of the clinical practice of spinal opioid ad­
ministration followed until 1979, which
most likely is due to the side effects ob­
served in the initial investigators' experi­
ences. Although Sicard did not mention the
dose of intrathecal morphine he adminis­
tered in his dog experiments, he did note a
more intense and more rapid opioid effect
relative to the same dose given intrave-
nously or subcutaneously. While Matas
used 1/40 gr (1.6 mg) intrathecal morphine,
Marx used 1/6 gr (10.8 mg) and he reported
"dangerous symptoms of morphine poison­
ing" with this technique-remarks which
were quoted in a 1900 editorial in theJour­
nal of the American Medical Association en­
titled "The danger of spinal anesthesia."!O
References
1 . Bier A: Deutsche Zietschrift fur
Chirurgie 5 1 :361-369, 1899.
2. Anonymous: Lancet 1 : 137-138, 1901.
3. Yaksh TL, Rudy TA: Science
192 : 1 357-1358, 1976.
4. Wang JK, Nauss LA, Thomas JE:
Anesthesiology 50(2):149-150, 1979.
5. Sicard JA:
Comptes Rendus
Hebdomadaires des Seances et Memoires de la
Societe de Biologic 50:1 057-1058, 1898.
6. Marx S: Med Record 58(14):521-527,
1900.
7. Matas R: Philadelphia Med J
6:820-843, 1900.
8. Kitagawa 0: J Japan Soc Surg
3:1 85-191, 1901.
9. Allen CW: Local and Regional Anes­
thesia. Philadelphia, WE. Saunders, 1 9 1 5 .
10. Shoemaker JV:JAMA 35:1339-1 340,
1900.
12
tients, but found it slow, unpredictable
and irritating to the airway. During the
same first months of 1 8 48, Thomas
Nunneley, a Leeds ophthalmologist
tested in animals and in a few patients a
multitude of compounds, including
Guthrie's chloric ether, the olefiant gas,
the Dutch liquid and an alcoholic solu­
tion of chloroform. He claimed to have
produced good anesthesia with chloric
ether and with the olefiant gas.9
After the first chloroform fatalities in
early 1848, dilute solutions of chloroform
in alcohol were tried by J.c. Warren and
H.J. Bigelow in Boston (30-50%) and by
J. Snow in London ( 1 5 to 1 8% ) . Those
solutions were also called chioric ether.
They did not prove to be safer than the
pure chloroform.
By the rnid-1848s, chloroform had tri­
umphed in most operating theaters ofEu­
rope and chloric ether had been forgot­
ten both in surgery and in internal medi­
cine.
References
1 . Snow ].
On Chlorofo rm and other
Anaesthetic s . London. J Churchill. 1848;20-22.
2. Snow J. On Narcotism by the Inhalation of
Vapours (Facsimile Edition) London. Roy S o c
M e d Press, 1991 ;57-65.
3. Ellis RH. Edinburgh threads in the tapes­
try of early British anaesthesia. In: Essays on the
History of Anaesthesia. Barr AM et al., cds. Lon­
don, Roy Soc Med Press, 1989;49- 5 8 .
4. Dinnick OP. Jacob Bell a n d his trial of
chioric ether at the Middlesex Hospital. Phar­
macy in Hist01Y 1991;33:70-75.
5 . Sne1dcrs HAM. The new chemistry in the
Netherlands. OSIRIS (2) 1988;4:121-145.
6. D e i m a n JR e t al. R e c h e r c h e s sur l e s
diverses e s p e c e s d e s gaz que 1'on obtient e n
melant l'acide sulfurique concentre avec l'alcoo!.
Journal de Physique 1794;45:178-191.
7. Duncum BM. The Development of Inhala­
tion Anaesthesia. London, Roy Soc Med Press,
1994;166- 172.
8 . Florence A. David Waldie and the chloro­
form scene in Liverpool. His! Anaesth Soc Proc
1997;21:30-34.
9. Nunneley Th. On anaesthesia and anaes­
thetic substances. Trans Prov Med SUTg Assoc
1849;NS 4:167-381.
14
BUllETIN O F ANESTHESIA HISTORY
Victorian Anesthetics and the Issue of Control
by Corey Brady
Department of English, University of Virginia
Charlottesville, Virginia
Before anesthetics could be fully incorpo­
rated into medical practice, they had to be
accepted by the Victorian public. And from a
late 20th century point ofview, the reluctance
that the public exhibited may be extremely
difficult to comprehend. In this paper I will
examine a number of Victorian texts to see
how they express popular anxieties about
anesthetics. If we take these texts individu­
ally and read them unsympathetically, their
fears may seem unconvincing or even trivial.
However, by gathering them together and
making a concerted effort to/eel the anxieties
they express about the new realm of experi­
ence that Oliver Wendell Holmes dubbed
"anesthesia," we may come to understand the
Victorians' reticence. In addition, we may also
learn more about ourselves through such an
effort. We still do have residual fears about
anesthesia, and by tracing these fears to their
historical roots we may learn more about
them.
A short poem by Emily Dickinson may
help us begin to relate to the Victorian frame
of mind:
Surgeons must be very careful
When they take the knife!
Underneath their fine incisions
Stirs the Culprit-LifeP
This poem seems quite simple at first
glance, but let us see how much we can un­
cover by putting it in its cultural context.
Dickinson wrote it in 1862, and the sur­
gery it describes certainly involves anes­
thetics. For one thing, the "fine incisions"
indicate a docile patient. But the poem also
directly engages with anesthesia in its para­
doxical rhetorical form. On one hand, it is
essentially a plea addressed to surgeons and
written from a perspective identified with
the patient. On the other hand, the poem
refrains from direct address. The speaker
urgently wants the surgeons to be careful,
but she exhorts them only indirectly, as a
distant "they." In effect, the speakq has
been grammatically and rhetorically re­
moved-linguistically anesthetized-and
is not consciously present at the scene of
the operation.
But Dickinson's poem also emerges from
a context when anesthetics were new, and it
relies on this sense of newness for its effect.
In order to feel the force of the imagined stir­
ring of "the Culprit-Life," we need to be
struck by the contrast of that stirring move-
ment with the physical stillness of the anes­
thetized patient's body. The poem demands
that we remember vividly that this motion­
less, insensible body would have been racked
by horrible struggles in the recent past.
Dickinson asks us to see these struggles trans­
ferred to the soul and undergone instead by
the abstraction "Lzfo/" The hidden simile is
absolutely crucial-this soul in the present
operation is likethose bodies in past operations.
As we will see, this imaginative parallelism
between body and soul is in fact a central
characteristic of many Victorian conceptions
of anesthesia.
With the advent of anesthetics, the op­
erating room that had been a scene of noisy
tumult suddenly became terribly silent. But
had the struggle actually ended, or had it
merely gone under the surface? The expe­
rience of the patient had changed abruptly
from an unspeakable physical torture to an
absolute unknown, an emptiness like that
of death, waiting to be filled by the fearful
patient's imagination. Thus, while the an­
esthetic state offered patients a miraculous
release from pain, it was also very naturally
. a mysterious and potentially threatening
realm.
Moreover, while the state of full anesthe­
sia was fearful because ofwhat it hid, the tran­
sitional phase on the way to full anesthesia
excited fears because of the alarming phe­
nomena that it exhibited. In the Victorian an­
esthetic experience, this transitional phase
was much more extended and dramatic than
it is for us today, and it is quite striking to
read their written descriptions of it, either as
it appeared under the proto-hypnotic tech­
nique known as mesmerism or under inhala­
tion anesthetics.
Under mesmerism, some patients in this
transition phase exhibited strange powers
such as mind-reading or even clairvoyance.
Other mesmeric subjects could be induced
to act in direct contradiction to their waking
character; as the mesmerist could exhibit con­
trol over their sensations and actions by
stimulating one or another of the so-called
"phrenological organs" on their skulls. For
example, he could induce temporary klepto­
mania by stimulating the organ of Acquisi­
tiveness, or provoke a verbal or even physi­
cal attack by stimulating the organ of Com­
bativeness.
Under ether, many patients would begin
the transition phase by struggling and cry-
ing out that they were being suffocated. Fur­
ther into anesthesia, women of the most up­
right character were known to conduct them­
selves in a manner that they were later horri­
fied to hear about-writhing lewdly or act­
ing as though intoxicated.
As we will see, many of the deepest fears
about anesthesia derived from the various
phenomena exhibited in this transition
phase.
One commonly-expressed concern was
that a patient might suffer under anesthe­
sia-as much as, or even more than without
anesthetics-but that he simply might not be
able torememberthe torture. After all, patients
in the transition phase seemed to experience
heightened, rather than reduced, sensations.
The French physician Blandin summed up
this fear when he said,
[1]t would be wrong to conclude
that [patients under anesthesia] have
not suffered: everything points- to con­
cluding that, on the contrary, they suf­
fer but have no memory of it.2
To see more clearly how this fear would
arise, let's look at an account of a tooth ex­
traction. The patient was later interviewed,
and she insisted that she had felt no pain
during this procedure:
The patient gasped painfully, and
after a few seconds struggled to free
herself, and the operator was c_om­
pelled to hold [the chloroform-soaked
sponge] forcibly; pinching her nose to
close the nostrils, while her hands were
held by his assistant; in fact, to the
beholder, it was the most complete ex­
hibition of burking. She never ap­
peared to lose consciousness at all, but
continued to struggle and oppose
throughout the operation, calling out
in broken English. . . like a person in
an hysterical paroxysm. She closed her
teeth to resist the introduction of the
instrument, and bit Mr. Wood's finger
sharply, when he succeeded in forcing
them open.
At the moment of extracting the
tooth I watched her, and she evinced
the usual amount of suffering in the
usual manner, by contracting her
body and crying out, striving to re­
move the instrument from her
mouth."
BULLETIN OF ANESTHESIA HISTORY
Early anesthetic demonstrations like this
one fed fears that pain might be felt though
not remembered. But these fears did exist
even before such demonstrations. When
Henry Hill Hickman in 1 824 published the
results of his anesthetic experiments on ani­
mals, The Gentleman's Magazine wrote the fol­
lowing review:
Dr Hickman, ofShiffnall, has pub­
lished a letter, in which he endeavours
to prove that a man who is to undergo
any painful operation, may previously,
and with safety, be rendered torpid, or
be subjected to a temporary suspension
of animation, and that whilst in this
state the requisite operation may be
performed on him, unattended with
the ordinary suffering, or any hemor­
rhage. Dr. Hickman, in support of his
theory, details eight experiments which
he has made on animals, and says he
should not hesitate a moment to be­
come the subject of the experiment he
recommends, if he were under the ne­
cessity of suffering any severe opera­
tion. Notwithstanding Dr. Hickman's
confidence, it may be doubted whether
the pain of the operation, and espe­
cially in the recovery, would not equal,
or perhaps surpass, that experienced
in the usual mode of operation.4
The early date of the review suggests
that this fear was driven by deep and com­
plex cultural forces, rather than simply by
imperfections in early anesthetic methods.
The literature of the cult of opium, as gen­
erated by Coleridge and DeQuincey, may
have contributed to the related idea that
altered states of consciousness like anes­
thesia could give rise to intensified, and
even artistic, experiences. In fact, London's
Punch ran a lampoon about this connection,
in which failed artists experienced visions
of grandeur under ether used
recreationally. And the following quotation,
which appeared in the prestigious
Blackwood's lvfagazine, is one example
among many of how this tradition could
affect ideas about medical uses of anesthe­
sia:
[IJ t must be asserted that the som­
nambulist is an inspired person, and
that, in this state, he is at once in and
out of the body,-that he can make
all his bodily organs dead, inopera­
tive; and that he acquires from a new
source all their powers, and these
enlarged.s
In the last quotation the writer also
claimed that anesthesia made the bodily or­
gans dead. This brings up a second source
of fear about anesthesia, which derived
from its analogy with physical death. A
volume, published in 1838 and titled The
London Chirurgico-ComicalAlphabet Pillbox,
represented this fear concisely and humor­
ously.6 Clearly, here, suspended animation
equals death. But even this connection is
more complex than it might seem to us
because, in the Victorian imagination,
corpses were often remarkably sensitive
and even mobile things.
The 1 9th century was an age of
corpse-stealing "resurrection men," as well
as a time when writers like Poe played on
fears about premature burial. Bodies that
appeared to be dead might really be alive;
and bodies that one thought were buried
might reappear later. In another Emily
Dickinson poem, the speaker refers to her
grave as "the Ether Acre"-but after hav­
ing been buried in the opening line, she
goes on to narrate experiences in the rest
of the poem that are as vivid as any one
might experience above groundJ
A paradigmatic example of fears about
the inanimate body comes from a broad­
side printed in 1824. Its narrator, John
Macintire, describes what happened to him
when he fell into a disease-induced trance.
He writes,
I was seized with strange and inde­
scribable quiverings. . . I tried to move,
but I could not. . . I heard the sound of
weeping at my pillow,-and the voice
of the nurse say, "He is Dead." I can­
not describe what I felt at these words.
I exerted my utmost power to stir my­
self, but I could not move even an eye­
lid. My father drew his hand over my
face and closed my eyelids. The world
was then darkened, but I could still
hear, and feel and suffer.8
Incidentally, John)s description here is in
fact directly relevant to anesthesia, since it
was generally accepted that anesthetics were
simply an artificial means of producing pre­
cisely the kind of "trance" or catalepsy that
he experiences.
But the account continues: John narrates
his burial, his resignation to death, and the
leap of joy he feels as he hears digging in the
ground above him. His exhumers turn out to
be body-snatchers, however, and at this point,
the story begins to match even more precisely
with popular fears about surgical anesthesia:
Being rudely stripped of my
shroud, I was placed naked on a table.
In a short time, I heard by the bustle
in the room that the doctors and stu­
dents were assembling. When all was
ready the Demonstrator took his knife,
IS
and pierced my bosom. I felt a dread­
ful crackling, as it were, through my
whole frame; a convulsive shudder in­
stantly, followed, and a shriek of hor­
ror rose from all present. The ice of
death was broken up; my trance was
ended.9
So the link with death only made ideas
about the state of anesthesia more complex.
Like the corpse, the anesthetized patient was
sealed offfrom communication and could not
give a report of its possibly vivid sensations.
For the Victorians, such a state was, in
Dickinson's words,
The Horror not to be surveyed­
But skirted in the DarkWith Consciousness suspended­
And Being under Lod:::_10
A third fear was that anesthesia might
cause the patient to lose his individual au­
tonomy, either simply because the state in­
volved a suspension of the will, or because it
made the patient more vulnerable-spiritu­
ally as well as physically-to outside influ­
ences.
The basic dynamics of mesmerism ex­
posed it in obvious ways to the interpreta­
tion that the mesmeric operator was possess­
ing, or at least subduing, the soul of his pa­
tient. Nathaniel Hawthorne, among others,
often used mesmerism in his fiction to dra­
matize the domination of one character by
another. But it was more than a device: in
1841 Hawthorne urgently wrote to his fiancee
to warn her about the dangers of mesmer­
ism. He said,
I am unwilling that a power should
be exercised on thee, ofwhich we know
neither the origin nor the conse­
quence. . . If I possessed such a power
over thee, I should not dare to exer­
cise it; nor can I consent to its being
exercised by another. Supposing that
this power arises from the transfusion
of one spirit into another, it seems to
me that the sacredness ofan individual
is violated by it; there would be an in­
trusion into thy holy of holies,u
And this fear was not limited to mesmer­
ism: it's very interesting that undergoing
chemical anesthetics was also seen to com­
promise a patient's autonomy. As one com­
mentator succinctly put it,
Let everyone who values free
agency beware of the slavery of ether­
ization. \2
Moreover, both medical professionals and
criminals also actually used the powers of
Continued on Next Page
16
BUlLETIN OF ANESTHESIA HISTORY
Victorian
.
.
.
Conlinued fwm Page 15
chemical anesthetics to take advantage of
people. In the first months after the intro­
duction of ether, the London Medical Gazette
described how it could be used to control
mentally ill patients and to expose young men
who supposedly tried to avoid conscription
by contorting their bodies to feign disabili­
ties. On the criminal side, within a year of
Ether Day, the first charge of sexual assault
was brought against a French dentist named
Laine by a patient whom he had anesthetized.
Chloroform also quicldy appeared on the
streets of London in crimes ranging from
theft to rape. In fact, this situation was seri­
ous enough for a clause relating to chloro­
form to be inserted into an "Offenses against
the Person Bill" introduced in the British par­
liament in 1851.
A fourth kind of fear arose from the idea
that anesthetics acted bydividing up the self.
Thus, to undergo anesthesia was to disrupt
the hierarchy of the soul and release a lower
nature from the dominion of a higher nature.
The French physiologist Longet saw the ad­
vantage of such a tool for research, saying:
I !
, ;
,
[I]n ether, the experimenter is in
possession of a new means of analysis,
which. . . allows him to isolate the site
of general sensibility from the site of
intelligence and will. 13
For patients, though, this idea was of
course absolutely horrifying. The obstetrician
W Tyler Smith, who opposed the use of ether
in childbirth, played upon this fear, arguing
that the drug released animal sexuality in
otherwise respectable women. He wrote:
In . . . women, rendered insensible
for the performance of surgical opera­
tions, erotic gesticulations have occa­
sionally been observed, and in one
case, in which enlarged nymphae were
removed, the woman went uncon­
sciouslythrough the movements atten­
dant on the sexual orgasm, in the pres­
ence ofnumerous bystanders. . . .I may
venture to say, that to the women of
this country the bare possibility ofhav­
ing feelings of such a kind excited and
manifested in outward uncontrollable
actions, would be more shocking even
to anticipate, than the endurance of the
last extremity of physical pain. 14
In addition to the basic idea that anesthet­
ics divide the soul, a fear also arose that it
would prove easier to divide a soul than to
reunite its components again. Speaking about
mesmerism, Dr James Esdaile explains why
this might be true:
[I]f the excitement of the nervous
system is kept up by frequent mesmer­
izing, an independent diseased action
is set up in the constitution; we have,
in fact, inoculated the system with a
nervous disease, acting spontaneously,
and obeying natural laws we do not
understand.15
Anesthesia here gains a degree of au­
tonomy-even an identity; as a disease, it
develops a life of its own within the soul of
the anesthetized patient. The attempt to es­
cape pain seemed to open a Pandora's box of
unknown forces in the personality. Realizing
that the transition phase on the way to full
anesthesia was a serious concern among pa­
tients and a great liability for the profession,
medical practitioners sought to get rid of it
by using what was known as the "Edinburgh
method"-administering an overwhelming
dose of ether or chloroform to cause patients
to succumb more quickly. But the nightmare
visions of the transition phase were not soon
forgotten.
My final text, Robert Louis Stevenson's
famous story, The Strange Case of Dr Jekyll
and Mr Hyde, is an extended literary mani­
festation of many of these nightmare vi­
sions that we've been exploring. The story
dramatically brings to life the fear that the
human character or soul is unstable; and
that a chemical agent could permanently
disrupt that balance. It explores the idea
that an immoral inner self could come to
the fore when the will and the conscious­
ness had been put to sleep, and that while
in a state of insensibility one could act in
ways that would compromise one's charac­
ter or put one's very soul in danger. In the
remainder of this paper, I want to consider
this story more closely.
To start with, there are several direct and
literal links between this story and the his­
tory of anesthetics. Jekyll's self- experimen­
tation, although perhaps surprising today,
was standard and expected scientific proce­
dure in pneumatic medical research from
Humphry Davy to James Simpson. A second
link between the story and history can be
found in Stevenson's choice to provide Jekyll
with actual chemicals. And though I don't
want to make too much of the fact that his
drug contains a "volatile ether,"16 a look at
the manuscript drafts of the story does show
that Stevenson made his chemical references
more explicit as he revisedY
Stevenson also describes Jekyll emerging
from his drug-induced state in the same terms
one might use to describe a patient coming
out of anesthesia. When Hyde takes the re­
storative drug and becomes Jekyll again,
Stevenson describes him as " . . . pale and
shaken, and half fainting, and groping be­
fore him with his hands like a man restored
from death. . . "18
The literal parallels between the story and
aspects of anesthesia are indeed striking. But
even more compelling are the shared meta­
physical anxieties that lie behind both
Stevenson's narrative and the discourse of
anesthetics. In Stevenson's literary world,
physics and metaphysics merge: a drug can
disrupt the soul, and it can do this through
its action on the body. Here Jekyll describes
how his chemical compound' represents a
contribution to what he calls "transcenden­
tal medicine." He says,
.I not only recognized my natu­
ral body for the mere aura and
effulgence ofcertain ofthe powers that
made up my spirit, but managed to
compound a drug by which these pow­
ers should be dethroned from their
supremacy, and a second form and
countenance be substituted, none the
less natural to me because they were
the expression, and bore the stamp, of
lower elements in my souL 19
Like a nightmare anesthetic, Jekyll's drug
divides his character into higher and lower
powers, putting to sleep the higher powers­
those that feel pain and remorse. As Jekyll
puts it, "complete moral insensibility and
insensate readiness to eviL . . were the lead­
ing characters of Edward Hyde."20 Certainly,
Sigmund Freud would have recognized these
"lower elements" that comprise Hyde as
Jekyll's Id, but witnesses of the lewd or vio­
lent ether dreams from the 1 840s would also
have felt that they had seen Hyde before. Just
as the image of the writhing libidinal crea­
ture on the dental chair seemed the moral
negation of the upright young woman when
she was conscious, so Hyde appears as the
moral negation of JekylL He is, for example,
responsible for "a copy of a pious work for
which Jekyll had several times expressed a
great esteem, [being] annotated, in his own
hand, with startling blasphemics."21
Thus Hyde embodies the altered moral
character that could be produced under an­
esthesia. Mirroring the fears that we saw ear­
lier, Jekyll's drug has split his soul into dif­
ferent factions that are difficult to reunite
stably; and under repeated applications ofthe
drug, the anesthetic identity Hyde gains su­
premacy. Quite appropriately, Hyde's domain
is sleep, and by the end of the story, he gains
enough power to bring on the transformation
spontaneously whenever Jekyll falls asleep.
Aware that he's losing control, Jekyll says,
horrified, "I had gone to bed Henry Jekyll, I
had awakened Edward Hyde."22 And by the
end of the story, he says, "if I slept, or even
dozed for a moment in my chair, it was al­
ways as Hyde that I awakened."23
BULLETIN OF ANESTHESIA HISTORY
Working in a literary mode, Stevenson can
endow the fears of his readers with a body­
a physical existence. And in fact, characters
in the storywho have exposure to both Jekyll
and Hyde believe that they are two people
and that Hyde is merelyblackmailing JekylL
As Jekyll's friend Utterson surmises, Hyde
must be "the ghost of some old sin [of
Jekyll's], the cancer of some concealed dis­
grace."24 Although he means this metaphori­
cally, he is literally correct. Continuing in this
train ofthought, Utterson imagines Hyde in­
vading his .friend's bedroom:
The door of that room would be
opened, the curtains ofthe bed plucked
apart, the sleeper recalled, and, lo!
there would stand by his side a figure
to whom power was given, and even at
that dead hour he must rise and do its
bidding.25
Here again, Utterson's instinctual fears, taken
metaphorically, are right on target. Hyde is a
monster.
And in fact, this passage is one of several
references inJekyll and Hyde to another great
19th-century monster: the one produced by
Victor Frankenstein's scientific overreaching.
Compare Utterson's vision with Mary
Shelley's description ofan encounter between
Victor and his creature.
He sleeps; but he is awakened; he
opens his eyes; behold the horrid thing
stands at his bedside, opening his cur­
tains, and looking on him with yellow,
watery, but speculative eyes.26
Despite the similarities here, there is an
absolutely crucial difference. The monster in
Stevenson's story is Jekyll's own drugged and
transformed self. But this actually adds to the
horror ofJekyll and Hyde: under anesthesia,
the monster is within us-is ourself-and
Datura .
before we recoil in disgust, we experience
what Jekyll describes as a horrid "leap of
welcome."27 We, too, experience the same
complex response with respect to our anes­
thetic life: we welcome the end of pain, but
we also feel the horrible danger of giving in
to this dark side of our natures, from which,
for Jekyll at least, there is no return.
At the end of his story, Jekyll claims that
it is impossible for humans to escape from
conscience, pain, or moral consequences. He
says,
. . .I have been made to learn that
the doom and burthen of our life' is
bound for ever on man's shouldcrs;'and
when the attempt is made to cast it off,
it but returns upon us with more un­
familiar and more awful pressure.28
This statement might plausibly have been
found in an anti-anesthetic pamphlet from
the 1 840s or 1850s. It's easy to see such argu­
ments as reactionary or inhumane, especially
when they are applied against relieving the
pains ofchildbirth. But it's also important to
remember that in the time when anesthesia
was new and strange, many of the fears and
beliefs that stood behind arguments like these
were held in good faith.
References
L Emily Dickinson, "Surgeons must be very
careful" [108J The Complete Poems ojEmily Dickinson,
ed. Thomas H. Johnson (New York: Little, Brown and
Company, 1961) 52.
2. Rose1yne Rey, HislOry of Pain. trans. Louise
Elliott Wallace and JA & SW Cadden (Paris: Editions
La Decouverte, 1993) 175.
3. The Zoist: Ajournalofcerebralphysiology &mes­
merism, and their applications to human welfare. [Lon­
don: H. BailIii;:reJ Vol. V (1848), 378.
4. The Gentleman's Magazine and Historical
Chronicle. Vol. XCv, Part 1. (1825) 628.
S. "What is Mesmerism?" Blackwood's Magazine,
Vol 70 Quly 1851) 72.
6. "Suspended Animation" The Chirurgica Comica
17
Alphabet Pillbox. (London: Henry Renshaw, 1838) 37.
Available online through the National Library of
Medicine's "Images from the History of Medicine"
Collection, at http://wwwihm.nim.nih.gov/
7. Emily Dickinson, "Dropped into the Ether
Acre" [665J The Complete Poems of Emily Dickinson,
ed. Thomas H. Johnson (New York Little, Brown and
Company, 1961) 330.
8. "Miraculous Circumstance" [Broadsheet]
(Gateshead: Stephenson, 1824).
9. Ibid.
10. Emily Dickinson, "The Loneliness One dare
not sound-" [777J The Complete Poems of Emily
Dickinson, ed. Thomas H. Johnson (New York: Little,
Brown and Company, 1961) 379.
I I . Nathaniel Hawthorne, [to Sophia, October
18, 18411 quoted in Seymour L. Gross, cd., The House
of the Seven Gables. (New York: WW Norton & Co.,
1967) 328.
12. Philadelphia Presbyterian (1 847) 17:120, re­
print from the London Times, quoted in Martin S.
Pemick, A Calculus ofSuffering: Pain Professionalism,
and Anesthesia in Nineteenth-Century America. (New
York: Columbia University Press, 1985) 62.
13. Francois Achille Longet, ''Actions des vapeurs
d'ether" Bull Acad Roy Med T XII (1846-7). Quoted
in Rey, 178.
14. W Tyler Smith, "On the Utility and Safety of
the Inhalation of Ether in Obstetrical Practice."
(1847), quoted in Mary Poovey, Uneven Developments:
the Ideological work ofgenderin Mid-Victorian England.
(Chicago: University of Chicago Press, 1988) 3 l .
1 5 . The Wesrminsler Review. Qanuary, 1959) 60.
16. Robert Louis Stevenson, The Strange Case of
Dr Jekyll and Mr Hyde and Other Stories. (New York:
Pengui n Books, 1979) 76.
17. For a collation of Stevenson's drafts, see Wil­
liam Veeder "Collated Fractions of the Manuscript
Drafts of Strange Case of Dr Jekyll and Mr Hyde" in
William Veeder and Gordon Hirsch, eds. . Dr Jekyll
and Mr Hyde After One Hundred Years (Chicago: Uni­
versity of Chicago Press, 1988) 14-56.
18. Jekyll and Hyde, 80.
19. Jekyll and Hyde, 83.
20. Jekyll and Hyde, 90.
21. Jekyll and Hyde, 71.
22. Jekyll and Hyde, 88.
23. Jekyll and Hyde, 95.
24. JekJill and Hyde, 41.
25. Jekyll and Hyde, 37.
26. Mary Shelley, "Introduction" to Frankenstein
[1831 edition] (New York: Oxford University Press,
1980) 9.
27. Jekyll and Hyde, 84.
28. Jekyll and Hyde, 83.
. . Continued fi'om Page 10
59. Poulsson E, English Edition Edited by Dixon
WE: A Text-Bool< ofPharmacology and Therapeutics. Wil­
liams & Wilkins Company; Baltimore, 1923, p 103-116.
60. ProudfootAT:DiagnosisandManagementofAcute
Poisoning. Blackwell Scientific Publications, Boston, 1982,
p 64-70.
61. QuekKC, CheahJS: Poisoning due to ingestion
of the seeds of kechubong (Datura fasmosa) for its
ganja-like effect in Singapore. J l}op Med & fi:yg
1974;77:111-2.
62. Riddle JM: Dioscol'ides on Phmmacy and Medi­
cine. UniversityofTexas Press, Austin, 1985, pp 65, 107-8.
63. Rosen CS and Lechner M: Jimson-weed intoxi­
cation. .lv.EJM 1967;267:448-50.
64. Rush B: An account of the effects of the stramo­
nium, or thorn-apple. CUn Ped 1973;12:50-53. Read Nov
2, 1770, before the American Philosophical Society. Re­
printed from TransAmPhiJ. Soc, Vol. II, pp 384-88, Phila­
delphia, 1786.
65. Rwiza HT: Jimson weed food poisoning. An
epidemic at Usangi rural government hospital. Trap &
Geo Med 1991;43:85-90.
66. Shutt LE and Bowes JB: Atropine and hyoscine.
Al'/l1esthesia 1979;34:476-490.
67. SoJlmann T: A Manual of Phannacowgy and its
Applications to Therapeutics and Toxicowgy. WE. SmUlders
Compan}� Philadelphia, 1918, p 276-297.
68. Stoelting RK: Pharmacology and Physiowgy in
Anesthetics. J.E. Lippincott Company, 1988, p 242-251.
69. Straub W: Lane Lectures on Phannacowgy Vol. III,
Intoxicating Drugs. Stanford University Press, Stanford
University; California, 1931, p 18-21.
70. 1aylor N: Plam Drugs that Changed the Wilrld.
Dodd, Mead & Company, New York, Second Printing,
1965, p 1399.
71. Trousseau A and Reveil 0: EArt de rmmuler.
Paris, 1851, p 190-91.
72. Tyler VE, Brady LR, Robbers JE: Phannacog­
rwsy, Ninth Edition. Lea & Febiger, Philadelphia, 1988.
73. Van Meurs A, Cohen A, Edelbroek P: Atropine
poisoning after eating chapattis contaminated with
Datura stramonium (thorn apple) . l1uns Roy Soc H
' op
Med & Hyg 1992;86:221.
74. Waters RM:Toxic by-effects ofthe auopin group.
AmJ ofSurg, October, 1922.
75. Weintraub S: Stramonium poisoning. Fastgrad
Med 1960;28:364-367.
76. Wellendorf M: Morphology and micrography
ofthe leaves of Datura comigera Hooker. Dansk Tulsskrift.
for Fa:rmaci 1967;41:11-16.
77. Wellmann KF: North American Indian rock art
and hallucinogenic drugs. JAMA 1978;239:1524-1527.
78. Wilson G: Coincidence? Anaesthesia Int Care
1993;2U03-104.
79. Wolff.ME, editor: Burger's Medicinal Chemistry,
Fourth Edition. John Wiley & Sons, Nevi' York, 1981.
80. Zuidema PJ: Poisoning caused by Datura
fastuosa (ketjubung). Nederlands Tijdschrift VOOI"
Geneeskunde 1985;129:1386-8.
18
BUllETIN OF ANESTHESIA HISTORY
Spring Meeting of
Anesthesia History Association (A.H.A.)
There follows a number of photographs
which were taken at the Reception on May
6, 1998, which was held preceeding the
meeting on May 7.
Dr. J.G. Diz and Dr. A. Franco, both of Santiago,
Spain
Dr. Leslie Rendell-Baker; Dr. Michael Goerig ofHamburg, Germany, and
Dr. Ray J. DeJalque
From left to right: Dr. Lucien Morris, Former President ofA.H.A.; Mrs. Susan Shipper­
Smith,- Dr. Ted Smith, Vice-President ofA.H.A.; and Mrs. Jean Morris
Dr. Douglas R. Bacon, Secretmy­
Treasurer ofA.H.A.
BULLETIN OF ANESTHESIA HISTORY
.Mr. Patrick Sim, M.L.S., Librarian of Wood Library-Museum and
Dr. Yung-Fong Sung ofEmory Clinic
Mr. AI Wright, M.L.S., Organizer of
the Spring A.H.A. Meeting
Dr. CR. Stephen, President ofA.H.A.
Dr. David C. Lai, who provided entertainment at the piano
19
20
BULLETIN OF ANESTHESIA HISTORY
From the Literature
by AJ. Wright, M.L.S
Department ofAnesthesiology Library
School of Medicine, University ofAlabama at Birmingham
Ball C, Westhorpe R. The EMO vapor·
izer. Anaesth Intens Care 26:347, 1998 [1
illus., 3 refs.]
facture and a Directory ofInstrument Makers
to 1900. San Francisco: Norman Publish­
ing, 1997
Baszanger I. Inventing Pain Medicine:
From the Laboratory to the Clinic. Rutgers
University Press, 1998
Fujita T. Sir Humphry Davy, the discov­
erer of anesthetic action of nitrous-oxide­
Davy and poets of British Romanticism and
inhalation of laughing gas by his friends.
Masui: Jpn ] AnesthesiaI 47:102·106, 1998
[Japane'se; 3 portraits, l3 refs.]
Bednarska-Zytko 1. August Karl Bier­
one hundred years of cocaine use in spinal
anesthesia. Pol Merkuriusz Lek 3:303-305,
1997 [Polish]
Bergman NA. The-Genesis ofSurgical An­
esthesia. Park Ridge, Illinois: Wood
Library-Museum of Anesthesiology, 1998
[reviewed by Bailey R,Anaesth Inlens Care
26:467-468, 1998]
Booth M. Opium: A History. St. Martin's
Press, 1998
Brain AU. Historical aspects a-nd future
directions [of the laryngeal mask airway] .
Int Anesthesial Clin 36(2) : 1 · 1 8, 1 9 9 8 [15
illus., 3 5 refs.]
Bud R, Warner DJ, eds. Instruments of
Science: An Historical Encyclopedia. Garland,
1998 [includes medical]
Camann WR. Zuspan crisis?-a clarifi�
cation. ASA Newsleuer 62 (7):34, July 1998
[letter; response to OB epidural history ar­
ticle by Clark RB in March 1998 issue]
ClarkRB. OB epidural historyreprisedASA
Newsi£lter 62(7): 34·35, July 1998 [letter]
Cottineau C, Cocaud J, Jacob JP. The be·
ginnings of anesfhesia.Allerg Immunol (Paris).
30(5):135·137, 1998 [French]
Dick W Hermann Kreuscher and Hans
Nolte.Anasthesiol Inlensivmed 39:276277,1998
[German; obituaries]
Duffin, Jacalyn. To See Wzth a Better Eye:
A Life of R. T.H. Laennec. Princeton Univer­
sity Press, 1998 [reviewed in NEJM
339:353·354, 1998]
Ebner H. An historical eulogy for spinal
lidocaine?] Clin Manit Camput 14:21 1, 1998
[5 refs.]
Fink BR. Nothing good ever comes from
death.ASA Newsletter 62(7):35, July 1998 [let·
ter; note on achievements of Dr. John J.
Bonica]
Edmonson JM.American Surgical Instru­
ments: An Illustrated History of 77zeir Manu-
Gillardeau G . Michel Sabathie
( 1 929·1998). Ann Fran Aneslh Reanim
17:358, 1998 [French; obituary]
Greenwalt TJ. The birth of Transfusion.
Transfusion 37:1206·1208, 1997
Gustafsson LL, Schildt B, Jacobsen K.
Adverse effects of extradural and intrathe­
cal opiates: report of a nationwide survey
in Sweden.Br]Anaesth 8 1 : 8593, 1998 [En·
try in the Citation Classic series; first pub­
lished 1 9 8 2 . Commentary by JAW
Wildsmith]
Lear E. History of epidural usage in ob­
stetrics-final chapter. ASA Newsletter
62(7):35, July 1998 [letter; notcs use of
epidurals during mid-1950s at Brooklyn's
Jewish Hospital under anesthesia chair Irv­
ing M. Pallin, M.D.]
Lyons SM. Anaesthesia and the broken
hearted. 1 7 0 th annual oration: Royal
Victoria Hospital, Belfast, 2nd October
1997. Ulster Med] 67:49·58, 1998
Maggioni F, Occhipinti C, Zanchin G.
Headches in Domestic Medicine by Will­
iam Buchan. Ital ] Neural Sci 19:109·115,
1998
McGoldrick KE. Lewis H. Wright Me·
morial Lecture: Steven M. Zeitels, M.D.,
to present "The Origin and Development
of Laryngoscopy and Laryngology." ASA
Newsletter 62(7):8·9, July 1998 [I portrait]
Menzel H. Jochen B arlc Anasthesiol
Intensivined 39:332-334, 1998 [German; bio­
graphical note]
Hanson-Matouskova AL. Development
of epidural analgesia in obstetrics, a de­
creased number of complications and ad­
verse effects in the mother and child. Ceska
Gynekol 62 suppl: 5·8,1997 [Czech]
Moreno Gonzalez A. Indications for as­
pirin on the centennial of its discovery. An
R
Acad
Nae
Med
(Madrid)
1 14:765·770,1997 [Spanish]
Hedner T, Everts B. The early clinical
history of salicylates in rheumatology and
pain. Cli" Rhematol 17:17·25, 1998 [29 refs.,
8 illus.]
Naqvi NH. Who was the first to moni­
tor blood pressure during anaesthesia? Eur
] Anaesth 15:255·259, 1998 [I illus.; 2 por·
traits; 1 5 refs.]
Incze F. Advances in anesthesiology in
the 90 s. Orv Hetil 1 3 9 : 1 003·1010, 1998
[Hungarian1
Parizek A. Development of obstetrical
analgesia and anesthesia in the Czech Re­
public. Ceska Gynekol 62 supp!: 3·5,1997
[Czech]
'
Jurczyk W, Szulc R. In memoriam: Pro­
fessor Marek Sych. Eur ] Anaesth 1 5 : 5 12·
5 1 3, 1998 [obituary]
Kerr NW. Dental pain and suffering
prior to the advent of modern dentistry. Br
Dent] 1 84:397·399, 1998 [3 illus.; 20 refs.]
Kirkup J. The history and evolution of
surgical instruments. VIII. Catheters, hol­
low needles and other tubular instruments.
Ann R Call Surg Engl 80:81·90, 1998 [2
tables, 8 illus., 76 refs.]
Landauer B. Heribert Weigand-70th
birthday. Anasthesiol Intensivmed 39:335,
1998 [German; biographical note]
Landauer B . Eberhard Gotz-60th
birthday.AnasthesioI 39:336, 1998 [German;
biographical note]
Pasqualini RQ. A century and a half of
the first surgical anesthesia. Medicina
(Buenos Aires) 57:254·255, 1997 [Spanish;
letter]
Rose W Anesthesiologic retrospective
view of the surgeon Hans Kehr. Zentralbl
Chir 123 suppI 2:13·18, 1998 [German]
Russo E. Cannabis for migraine treat­
ment: the once and future prescription? An
historical and scientific review. Pain 76:3-8,
1998 [numerous references]
Rutkow 1M. American Surgery: An Illus­
trated History. Lippincott-Raven, 1998. [In­
cludes chapter "Surgical Anesthesia,
Continued on Page 23
BULLETIN OF ANESTHESIA HISTORY
21
Ilya Ilyich Metchnikoff
( 1845-1916)
Thefollowing article appeared in theJanuary-February, 1 996, issue a/Old News.
iVIetchnikofFs discovery of the phagocyte marked the beginning of the science of
immunology. He was born in the Ukraine and studied zoology at Giessen and
Gottingen Universities and at the Siebold Institute in Munich. Later he became
a Professor of Zoology at Odessa University_ Still later he became a citizen of
France and was appointed Director of the Pasteur Institute following Pasteur's
death in 1895. We are indebted to the editor of Old News and to Afr. John
Risser, the authm)for the following insight into the life ojMetchnikoJf -Editor
Immune System Discovered
by John Risser
In the early 1860s, when EUe Metchni­
koffwas still a student at the University of
Kharkov in Russia, he predicted that he
would soon win fame as a scientific genius.
"I have zeal and ability," Metchnikoff
said. "1 am naturally talented. I am ambi­
tious to become a distinguished scientist."
Young Metchnikoff regarded himself as
an expert on almost any question. In the
coffee houses where he sat up late most
nights, drinking endless cups of tea, he was
known as a highly opinionated fellow.
Were women as intelligent as men? Ac­
cording to young Metchnikoff, the average
woman was just as intelligent as the aver­
age man. However, no woman could be­
come a true genius, like himself.
Did God exist? No, said Metchnikoff,
with an air of certainty that earned him the
nickname of "God-Is-Not."
Metchnikoff's major field of study was
zoology. Whenever he dissected a worm in
the university laboratory, he tried to make
some important scientific discovery that
would demonstrate his brilliance to the
world. In The Microbe Hunters, Paul de
Kruif wrote:
Metchnikoff was always trying to
get ahead of himself. He sent papers
to scientific j ournals while he was
still in his teens; he wrote these pa­
pers frantically a few hours after he
had trained his microscope on some
bugs or beetles; the next day he
would look at them again, and find
that what he had been so certain of,
was not quite the same now. Hastily
he wrote to the editors of a scientific
journal: "Please do not publish the
manuscript I sent you yesterday. I
find I have made a mistake." At other
times he became furious when his
ideas were turned down by the edi­
tors. "The world does not appreciate
me!" he cried, and he went to his
room, ready to die.
1\1etchnikoff possessed a
photographic memory that al­
lowed him to earn top grades
almost effortlessly. After
graduating from the University
of Kharkov in two years in­
stead of the customary four, he
pursued graduate studies in
zoology at various universities
in Germany, Russia, and Italy.
He did not stay long at anyone
university. Wherever he stud­
ied, he got into furiol1-s quar­
rels with his professors and left
in a huffto enroll at some other
school.
As a graduate student, Metchnikoff
claimed credit for one scientific break­
through: he discovered that certain worms
can not only reproduce sexually, but can
also produce clones of themselves by an
asexual process. Unfortunately for Metch­
nikoff, who was outraged, one of his pro­
fessors took credit for the discovery.
In addition to searching for some great
discovery in the field of biology, Metchni­
koff also tried to revolutionize modern
philosophy with his original "theory of sci­
entific optimism." The basic tenet of this
doctrine was that humanity was evolving
into a morally superior species, thanks to
selection.
Darwinian
natural
Metchnikoff's new philosophy made little
impression on the world, but he found his
own logic convincing. Whenever he felt like
committing suicide because no one else
appreciated his great ideas, Metchnikoff
thought about his "theory of scientific op­
timism," and was inspired to live.
In 1868, when Metchnikoffwas 23 years
old, he finally met somebody who seemed
to admire him as much as he admired him­
self. Her name was Ludmilla. Unfortu­
nately for Metchnikoff, Ludmilla fell sick
with tuberculosis shortly before their
scheduled wedding. The ceremony was
held anyway, with the bride in a wheelchair.
After his marriage, Metchnikoff tried to
settle down as a university instructor, but
his life was disrupted as his wife's health
continued to deteriorate:-When Ludmilla
died in 1872, Elie Metchnikoff was so up­
set that he tried to kill himself with mor­
phine. He miscalculated and merely put
himself to sleep. Waking up in his bedroom
in the middle of the night, Metchnikoff
immediately prepared a larger dose of the
drug. Before drinking it, however, he hap­
pened to glance out his bedroom window
and found himself distracted by the sight
of a cloud of mayflies swarming around a
candle in a lantern.
"These insects live only a few hours!"
he thought. "How can Darwin's theory of
the survival of the fittest be applied to
them?" So Metchnikoff decided to live, in
order to study this question.
A few weeks after his wife's funeral,
Metchnikoff found a new admirer, a teen­
aged student named Olga, who had a prop­
erly worshipful attitude towards him. "He
is so pale and seems so sad," Olga said of
her mentor. "His appearance is not unlike
that of Christ."
Metchnikoff married Olga, then worked
uneventfully as a professor of zoology at
Continued on Next Page
21
BULLETIN OF ANESTHESIA HISTORY
Metchnikof[
.
.
ContinuedfromPage 21
the University of Odessa, in Russia, for
seven years. His marriage was childless,
but apparently happy.
In 1 8 8 1 , upset by political turmoil on
campus, Metchnikoff made another of his
periodic suicide attempts. He decided to
combine his suicide with an experiment
to test Louis Pasteur's germ theory of dis­
ease.
At that time, Pasteur had not yet con­
clusively demonstrated that bacteria cause
serious diseases in human beings. So far,
Pasteur had demonstrated only that bac­
teria cause acne; he had found that the pus
from pimples was full of bacteria.
To prove that germs can cause fatal dis­
eases in humans, Metchnikoff resolved to
infect himself with germs frpm the blood
of a patient dying from a feve,I.
Metchnikoff scratched the patient's arm
and his own arm. He then rubbed the
patient's infected blood into his own
wound.
To his delight, Metchnikoff's experi­
ment was a success; he caught the fever.
His suicide attempt was, however, a fail­
u r e . After a very painful illne-ss,
Metchnikoff recovered.
Still unhappy, Metchnikoff quit his pro­
fessorship and retired with his wife to one
of her family's villas near Messina, on the
island of Sicily. There he studied the pro­
cess of digestion in the local starfish and
sea anemones.
Metchnikoff later recalled:
I was resting from the shock of
the events which provoked my res­
ignation from the university and in­
dulging enthusiastically in re­
searches in the splendid setting of
the Straits of Messina.
One day when everyone in the
household had gone to a circus to
see some extraordinary performing
apes, I remained alone with my mi­
croscope, observing the life of the
mobile cells of a transparent starfish
larva, when a new thought suddenly
flashed across my brain.
He was studying mobile cells within the
starfish-cells which were part of the ani­
mal that contained them, but which were
free to wander independently through the
entire starfish. Their means oflocomotion
was to flow from one location to another,
like amoebas.
Metchnikoff knew that similar cells
existed in the blood of humans: the pus
from human pimples contained wander­
ing cells, as well as bacteria. Metchnikoff
thought that the mobile cells must play
some role in digestion.
To observe digestion in a sea anemone,
Metchnikoff fed the creature a few grains
of bright red dye, which he squirted into its
mouth-like opening. He watched with de­
light as the free-flowing cells in the larva
congregated around the dye, and then ate
it up.
Suddenly, it occurred to Metchnikoff
that what he was witnessing was not diges­
tion. The dye was not food. To the sea
anemone, the dye was probably a mild poi­
son.
The action of the mobile cells must be
defensive, Metchnikoff thought. He imme­
diately leaped to the conclusion that mo­
bile cells must protect all animals, and all
humans, from the attacks of harmful bac­
teria.
If IVl.etchnikoff was correct, he had ex­
plained how people are able to survive in a
world full of disease germs. He knew, of
course, that he had proved nothing; he did
not have any evidence to support his theory.
He was jumping to a wild conclusion-and
yet he - felt he was right: strange- little crea­
tures beyond our awareness were fighting
our microscopic enemies in the recesses of
our bodies.
Metchnikoff wrote:
I felt so excited that I began strid­
ing up and down the room and even
went to the seashore to collect my
thoughts.
I said to myself that, if my suppo­
sition were true, a splinter introduced
into the body of a starfish larva, de­
void of blood vessels or a nervous sys­
tem, should soon be surrounded by
mobile cells as is to be observed in a
man who runs a splinter into his fin­
ger.
Metchnikoffknew that, when a man fails
to remove a splinter from his skin, pus forms
around the splinter. He knew that this pus
contains white blood corpuscles-human
mobile cells-as well as the bacteria that
Pasteur had found in the pus from pimples.
Metchnikoffbelieved that ifhe inserted
splinters into a starfish, wandering cells
from within the starfish would move to the
wounded area of the starfish in order to
protect it. He wrote:
fetched a few rose thorns and
introduced them at once under the
skin of some beautiful starfish larvae
as transparent as water.
I was too excited to sleep that
night in the expectation of the results
of my experiment, and very early the
I
next morning I ascertained that it
had fully succeeded.
Without further ado, Metchnikoff
rushed off to Vienna to announce his great
discovery that mobile cells provide immu­
nity from disease. He did not have a shred
of real evidence to prove his theory, and had
never seen a mobile cell eat one bacterium.
Nevertheless, he published a paper in
which he called the mobile cells "phago­
cytes," from Greekwords meaning "devour­
ing cells."
Luckily for Metchnikoff, his guesses
turned out to be correct. He eventually
found real evidence that phagocytes pro­
vide immunity in little aquatic creatures
called water fleas. The water fleas are trans­
parent, so Metchnikoff could look right
through them with a lens.
Metchnikoff noticed one of his water
fleas being invaded by spores of yeast. Then
he saw the mobile cells of the water flea,
its phagocytes, flow towards the yeasts.
Like a miniature army defending the wa­
ter flea, the phagocytes engulfed the yeasts,
melted them, and digested them.
Metchnikoff saw this defensive process
work successfully in many water fleas. He
also saw that, when the phagocytes were
slow to attack invading yeasts, the yeasts
multiplied inside the water flea until they
poisoned and killed it.
Elie Metchnikoff's discovery of the ph­
agocyte marked the beginning of the sci­
ence of immunology. Thereafter, the rest
of the world shared Metchnikoff's convic­
tion that he was a scientific genius. He be­
came far less miserable than before, and
attempted suicide less often.
He became an administrator at the Pas­
teur Institute in 1888, and eventually - be­
came its director. He published a book pro­
moting his philosophy of scientific opti­
mism, and another book on his theory that
a man will live to be a hundred if he eats
enough yogurt. His contribution to the de­
velopment of microbiology was recognized
when he was awarded the Nobel Prize for
physiology in 1908.
Despite eating large quantities of yo­
gurt, Metchnikoff died at the age of 71 in
1916.
Sources
Microbe Hunters, by Paul DeKruif, Blue
Ribbon, New York, 1926.
Major Prophets of Today, by Edward E.
Slosson, Books for Libraries, Freeport, New
York, 1968.
The Thorn in the StarfISlz: the Immune Sys­
tem and How It Works, by Robert S. Desowitz.
WW Norton & Co. New York. 1987.
BULLETIN OF ANESTHESIA HISTORY
Literature.
. . Continued from Page 20
1 846-1860"; reviewed in JAMA 279:14931494,1998]
Schirmer U. I_aughing gas--development
and present status. Anaesthesist 47:245255,
1998 [4 tables, 2 figures; 6 refs.; German]
Shephard DA. The value ofbiography for
medical history. Bull Can Hist Med
13:186-188, 1996 [Shephard is biographer of
John Snow]
Sheplock
GJ.
. . . the
Wood
Library-Museum: take a virtual tour. ASA
Newsletter 62(5):26, May 1998
Sleth Je. The Bonian anaesthetic mixture:
a forgotten ancestor of EMLA cream? Ann
FranAnesthReanim 17:348-349,1998 [French]
Starr, Douglas. Blood: An Epic History of
Medicine and Commerce. Knopf, 1998
Surgical and Dental Instrument Catalogues
from the Civil War Era. San Francisco:
Norman Publishing) 1997 [reprint ofcatalogs
of two companies, Snowden and Brother and
John Weiss and Son]
Teague BI; Levin We. The explosion that
produced the American Association ofElood
Banks. Transfusion 37:1209-1210, 1997
Vandam LD. On the origins of intrathe­
cal anesthesia. Reg Anesth Pain Med
23:335-339, 1998 [4 illus., 15 refs]
Weil MH. The assault on the Swan-Ganz
catheter: A case history of constrained tech­
nology, constrained besdide clinicians, and
constrained monetary expenditures. Chest
1 13:1379-1386, 1998
West JE. High-Life: A History of
High-Altitude Physiology and Medicine. Oxford
University Press, 1998
West JE. RPpirat01Y Physiology: People and
Ideas. Oxford University Press, 1996. [re­
viewed in JAMA 278:1200,19971
Winckler C. Charles Rouet (1923-1996).
Ann Fr Anesth Reanim 1 5 (8): 1 1 5 1 , 1996
[French; obituary]
Wulf HFW The centennial of spinal an­
esthesia. Anesthesiology 89:500-506, 1998 [2
illus., l portrait, 26 refs., reprint of Bier's ar­
tiele1
Wynbrandt J. The Excruciating Hist01Y of
Dentistry: Toothsome Tales and Oral Oddities
from Babylon to Braces. St. Martin's, 1998 [in­
cludes discussion of different anesthetics]
Zaitsev EL 150 years of the use of ether
anesthesia in Russia. Tfstn Khir Im I I Grek
157:66-67, 1998
Southend.
. . Continued ft·om Page 3
grave spinal cord paralyses caused by spi­
nal anesthesia." These led to the marked
diminution in the use of spinals in both
countries in the '50s and '60s. The tech­
nique was rescued from oblivion by the
publication of the paper by Vandam and
Dripps on 10,089 spinal anesthetics. Dr.
Wildsmith completed this review of the
subject by looking at the second 50 years.
He said the difficulty with the Kennedy
report was that there was no attempt to look
for the causes of these tragedies.
Dr. Weaver, a veterinarian, nicely cov­
ered the use of regional anaesthesia in large
animals; she surprised us with such mat­
ters as the use of epidural anaesthesia in
the pregnant cow with dystocia and sen­
sory nerve blocks in goats for surgery on
the horn bud. Dr. Armitage reviewed the
life of Dr. Massey Dawkins, who is gener­
ally credited with being the first to intro­
duce epidural anaesthesia in the United
Kingdom. He was probably the first to use
an epidural infusion for pain control in the
early '60s. Dr. Armitage also said that the
only other British anaesthetist to use the
method frequently at that time was Dr.
Alfred Lee.
Dr.
Rucklidge
described
the
Coxeter-Mushin absorber, which was de­
signed in the middle of the London blitz
and which would still be as efficacious to­
day. He gave us a dramatic demonstration
of the luminescent knob which was con­
nected to the bellows so that one could
watch the patienfs respiration if the lights
in the operating room should fail in the
middle of a raid. To make the scenario en­
tirely convincing, he switched the lights off
in the lecture hall and played a recording
of the air raid siren sounding the alarm,
the sound of the engines of the German
planes and then the antiaircraft guns.
Dr. McKenzie summarized the life and
work of Harold Griffiths; among his many
contributions was the paper on the use of
IPPV for crushed chest-which ultimately
led to the abandonment of mechanical but
unphysiological devices such as hooks and
pins and wires. Dr. Zeitlin described Win­
ston Churchill's accident on Fifth Avenue
in New York. Dr. McLellan reviewed all the
many expiratory valves from the beginning
of our history.
As we said goodbye after lunch, we
vowed to meet next May in Bristol to
honour Sir Humphrey Davy. We stepped
out into warm sunshine to go home.
Obstetric .
23
. . Contmued ft·om Page 7
HR Storer. Anesthesia. Edinburgh, Adam and
Charles Black, 1871, pp 57, 1 1 1 -112, 199-200.
4. D Caton, Obstetric anesthesia: The first ten
years. Anesthesiology, 1970, 33:102-109.
5. AD Farr, Early opposition to obstetric ana­
esthesia. Anaesthesia, 1980, 35:896-907.
6. J Duffy, Anglo-American reaction to obstet­
rical anesthesia. Bull IIist Med, 1964, 38 :32-44.
7. AD Farr, Religious opposition to obstetric
anaesthesia; a myth? Ann Sci, 1983, 40:159-177.
8 . Proceedings of the Woman's Rights Conven­
tions held at Seneca Falls and Rochester, NY New
York, Robert J. Johnston, Printer, 1870.
9. I Loudon, Death in Childbirth; An interna­
tional study of maternal care and maternal mortality
1800-1950. Oxford, Clarendon Press, 1992, pp 187,
220-223, 172-233, 216-232.
1 0 . VG Drachman, Hospital with a Heart;
Women, Doctors, and the Paradox ofSeparatism at the
New England Hospital 1862-1969. Ithaca, Cornell
University Press, .1984.
1 1 . EC Stanton, Letter to Susan B. Anthony,
April 2, 1852. Quoted in TIre Oven Birds; American
Women on Womanhood 1830-1920. Edited by Gail
Parker, Garden City, Doubleday Books, 1972, p 260.
1 2 . MN Kleinert, Medical women in New En­
gland; history of the New England Women's Medi­
cal Society.] Am Med Women's Assoc, 1956, 2:63-67.
13. VA Metaxas Quiroga. Fcmale lay manag­
ers and scientific pediatrics at Nursery and Child's
Hospital, 1 8 54-1910. Bull Hist Med, 1 9 8 6,
60,194-208.
14. S Rothman, Woman's Proper Place; A Hiswry of
Changing Practice> 1870 to the Present. N"ew York, Basic
Books, 1978.
1 5 . \X!L O'Neill, bVlJ1yone was Brave; A History of
Feminism inAmenca. :-lew York, Quadrangle, New York
-lImes Books, 1974.
16. KJ Blair, The Clubwoman as Feminist; TnlR Wom­
anhood Redefined 1868-1914. New York, Holmes and
Meier Publishers Inc., 1980.
17. M Tracy and C Leupp, Painless childbirth.
MaClures Magazine, June 1914, 413:37-51.
1 8 . CJ
Gauss,
Die
Anwendung
des
Skopolamin-Morphium Dammerschlafes in der
Geburtshilfc. Medizinische Klinik, 1906, 2:136-138.
19. D Caton, In the present state ofour knowledge;
early use of opioids in obstetrics. Anesthesiology, 1985,
Sn79-784.
20. LG Miller, Pain, parturition, and the profession;
Twilight Sleep in America. In Healrh Care inAme1"ica, Es­
says inSocialHistO'lY. Edited by S Reverby and D Rosner.
Philadelphia, Temple University Press, 1979, pp 19-44.
21. M Sandelowski, Pain, Pleasure, and American
Childbirth; From the 'lwiliglu Sleep to the Read MetJwd,
1914-1960. Westport, Greenwood Press, 1984.
22. RK Carter, The Sleeping Car "1ivilight" or Moth­
erhood Wtthout Pain. Boston, Chapple Publishing, 1915,
p 176.
23. V Brittain, Testament of Hxperience. Wideview
Books, USA, 1970, pp 51-52.
24. V Woolf, Three Guineas. London, The Hogarth
Press, 1943, p 293.
25. Chloroform Capsules. Lancet, 1932, 223:1015.
26. J Cahn, Chloroform Capsules in Childbirth.
Letter to the editor. Lancel, 1932, 223:1024.
27. RJ Minnitt, SeU:administcred Analgesia for the
Midwifery of General Practice. Proc Roy Soc Med, 1934,
27J313-1318.
28. RJ Minnin, A new technique for the
self-administration of gas-air analgesia in labour. Lan­
cet, 1934, 226:1278-1279.
29. J Elam, Gas-and-air apparatus for midwives.
Lancet, November 1935, 30:1253-1254.
30. J Elam, Analgesia in domiciliary midwifery. ]
Obstetric Gyn Brit Empire, 46(1):61-70.
3 1 . Report of London County Council 1932 by
Letitia Fairlield, CBE, MD, Chb, DPH Seruor Medical
Officer, Public Health Department.
32. We've changed our minds about having babies.
The Daily Mirror, May 17, 1945, pp 7.
III
24
BULLETIN OF ANESTHESIA HISTORY
Fifth International Symposium on the
History of Anesthesia, September 12-15, 2001
The preliminary program of the Fifth
International Symposium in the year 2001
is now available. The Symposium is being
organized by the Department of Anesthe­
sia and Critical Care in Santiago de
Compostela. The meeting will be held in
the School of Medicine, a neoclassical
building close to the Cathedral in the old
city. Within walking distance are several
hotels of different categories. In the School
of Medicine one can also visit the National
Museum of the History of Anesthesia.
Special rates for travelling and lodging
are being offered through a local travel
agency, the "Ultratur S.A. Avda, Figueroa
6 bajo, 1 5 705 - Santiago, Spain." This
agency will also offer pre- and
p ost-symposium tours in Galicia and
Spain.
During the symposium an interesting
social program is being planned, which
includes visits to the city, a tour of the Ca­
thedral to see the show of "Batafumeiro"
and a gala dinner in one of the refectories
of the Monastery of San Francisco, close to
the School of Medicine.
Topics for the symposium include:
1 . History of Oxygen-discovery; oxy­
gen and medicine; oxygen in anesthesia;
oxygen in critical care; and toxicity.
2. Anesthesia and Society: Historical
Perspective-social image of anesthesia;
social position of anesthesiologists; legal
issues; and ethical aspects of anesthesia.
3. Anesthesia and the Arts�painting;
literature; movies and theater; and sculp­
ture.
4. A Century of Spinal Anesthesia
5 . History of Anesthesia in South
America
There will be sessions about the above
topics with invited speakers and also free
paper sessions (both oral and poster pre­
sentations).
Anyone who wishes to obtain Abstract
forms or more information should contact:
Dr. J.C. Diz; Servicio de Anestesiologia y
Reanimacion; Hospital General de Galicia;
cl Galerias sin; 15705 - Santiago, Spain.
Tel: 3 4 - 8 1 -540223; Fax: 34-81-5401 72;
E-mail: cifranco@uremail-USC.es
Bulletin of Anesthesia History
The Bulletin ofAnesthesiaHistmy is published
four times a year as a joint effort of the
Anesthesia History Association and the
Wood-Library Museum of Anesthesiology.
C.R. Stephen, M.D., Editor
Doris K. Cope, M.D.,
Associate Editor
Donald Caton, M.D.,
Associate Editor
Debra Lipscomb, Editorial Staff
Editorial, Reprint, and Circulation
matters should be addressed to the Edi­
tor, 15801 Harris Ridge Court, Chester­
field, MO 63017 U.S.A.
Manuscripts may be submitted on disk
using Word for Windows or other PC text
program. Please save files in RICH TEXT
FORMAT (.rtf) if possible and submit a
hard copy printout in addition to the disk.
All illustrations/photos MUST be submit­
ted as original hard copy, not electroni­
cally. Photographs should be original
glossy prints, NOT photocopies.
i�5t�;����
};
C. Ronald Stephen, M.D., C.M., Newsletter Editor
1 5 801 Harris Ridge Court
Chesterfield, MO 63017 U.S.A.
Wood Library-Museum
American Society of Anesthesiologists
520 N. Northwest Highway
Park Ridge IL 60068-2573
RECEIVED
o c r 1 2 1998
ASA