BULLETIN OF

ANEST ESIA RY AHA

VOLUME 19, NUMBER 4 OCTOBER, 2001

The Wounding, Amputation and Death of Thomas Jonathan "Stonewall" Jackson Some Medical and Historical Insights. by Maurice S. Albin, M.D., M.Sc. (Anes.) Professor of Anesthesiology and Neurological Surgery University of Texas Health Science Center, San Antonio, Texas

With the exception of the American Revolution, the Civil War was probably the most defining moment in the history of the United States. The primitive giant learned to flex its muscles by the huge industrial expansion brought on by the war, stimulated the population growth and western expansion, developed a formi­dable armed force, and was troubled with the need to grapple with racial justice - a problem that still persists today.

In the philosophy of historiography, these are those who believe that while his­torical events generally proceed along the principle of causality, and within this epis­temological framework room exists where a random act can become the impetus for extraordinary change - "A horse, a horse, my kingdom for a horse," pleads Richard the Third, pleads all to no avail; the ser­endipity of Alexander Fleming noting the peculiar effect that the penicillium mold had on a bacteriological culture. A corol­lary of the type of reflection is the "what if " version - and its applicability can be certainly seen in the Civil War. Critical questions such as "what if Lincoln had not gone to the Ford's Theater on April 15th, 1865?" or, coming to the theme of this paper, "what if Jackson had not been wounded by his own troops at Chancellorsville and was present at the Battle of Gettysburg, the battle that essen­tially decided the war and the fate of the Union?" This brings into play a full range of works considered to be "alternate His­tory" of the Civil War. Among the dozens of titles that have been published in this genre, some of the more interesting tales concerning the Civil War include:

"Stonewall Jackson at Gettysburg" (fig.

Fig 1. Front cover of Stonewall Jackson at Gettysburg. 17lis photograph of Stonewall Jackson, called the "Chancellorsville Photograph" was the last known picture of him, taken nearly two weeks before his wounding and subsequent death. With permission of publishel; Sergeant Kil'lalld's Press.

1) by Douglas Lee Gibboney, who notes that Jackson did not die after being wounded at Chancellorsville and instead he leads the Confederate Army in the in­vasion of the North, with J.E.B. Stuart's cavalry capturing Harrisburg, the Capital of Pennsylvania. Unfortunately, his efforts do nothing but prolong the inevitable de-

fea t of the Confederacy, and Jackson is killed in a skirmish with Union Troops in April 1865.

MacKinlay Kantor's novel, "If the South Had Won the Civil War," (figs. 2 and 3) starts its tale with the death of Gen­eral U.S. Grant during the Vicksburg Battle, shows the defeat of the Union at Gettysburg, the subsequent capture of Washington, D.C. and a peace treaty signed on December 16, 1863. "In The Lost Years" by Oscar Lewis, Abraham Lin­coln loses the presidential election of 1863, leaves government and retires to Califor­mao

A book that involves Gettysburg and another that relates to Stonewall Jackson are also fascinating. In the former, "Re­member Gettysburg" by Kevin Randle and Robert Cornett, 20th Century weaponry intrudes in this 19th century war, when the Confederate attack on the Little Round Top is repulsed by veterans from the Viet­nam period of American History. In the latter book, "The Wild Blue and Gray" by William Sanders, Washington is besieged in 1862 by the Confederate forces led by Stonewall Jackson. Some of the other in­teresting Civil War books on the alternate history were written by Ward Moore (Bring the Jubilee), David C. Poyer (The Shiloh Project) and Harry Turtledove (Guns of the South).

Thomas Jonathan "Stonewall" Jackson was an extraordinarily mystical, ascetic and homeric military figure - in many ways a throwback to the days of Roundheads and Oliver Cromwell, since Jackson was also a devout Presbyterian with an inherent deep belief in predesti-

Continued 011 Page 4

2 BULLETIN OF ANESTHESIA HISTORY

Anesthesia History at the 2001 ASA Annual Meeting in New Orleans, Louisiana

Monday, October IS, 2001 12:30 -2:30 PM Morial Convention Center, Room 268 Wood Library-Museum of Anesthesiology Friends Tea and Booksigning

2- 4 PM Morial Convention Center, Room 298 Open Forum on the Writing of the History of Anesthesiology

6- 9 PM Anesthesia History Association Annual Dinner Meeting Windsor C ourt Hotel

Tuesday, October 16, 2001 9 -11 AM Scientific Paper Poster Session Morial Convention Center, Room B Patient Safety, Practice Management, History and Education: Education and History

1:50 -2:50 PM Morial Convention Center, Rooms 395-396 The 2001 Lewis H. Wright Memorial Lecture

2-4 PM Morial Convention Center, Rooms 398-399 C olorful Figures and Moments of Conflict in the History of Anesthesiology

IIltA

RALPH M .. WATERS, MD, and Professionalism in

Anesthesiology it Celebration of '15 Years

June 6-8, 2002 The Concourse Hotel & Governor's Club

1 W. Dayton SIreet, Madison, Wisconsin 53705

AIIIIstliesia History Assodlltloll (U.S., History of Allllestksla SocIety (Great Britain,

wmI IIDDITIONAl SPONSORS

University of WiS«lllsl1l Me4kal School Depm/lleat 0' Aliest6tslology end Office 01 CoIIfimIIfIg � Etlucetlon

WiKOIISIII SocIety of Aneslheslologhls

Wood IArnry·Mu_ of AIIIIstlieslalogy

THE WOOD

LIBRARY-MUSEUM

OF

ANESTHESIOLOGY

EXCITING OPPORTUNITY!

THEWLM

FELLOWSHIP

The WLM Fellowship will provide recipients with financial suppo1't for one to three weeks of scholarly historical research at the Wood Library-Museum.

The Board of Trustees of the Wood Library-Museum invites applications from anesthesiologists, residents in anesthesiology, physicians in other disciplines, historians and other individuals with a developed interest in library and museum research in anesthesiology.

For further information, contact: Librarian, Wood Library-Museum of Anesthesiology, or call (847) 825-5586. Visit our Web site at <www.ASAhq.org/wlm/ fellowship.html> .

Complete proposals must be received before January 31,2002, for consider­ation.

The Wood Library-Museum serves the membership if ASA and the anesthesiology communit)'.

Wood Library-Museum of Anesthesiology

520 N. Northwest Highway Park Ridge, IL 60068-2573

(847) 825-5586 www:ASAhq.org/wlm

Letter to the Editor In your July, 2001 issue of the Bul­

letin, there appeared two accounts of

how emergency medical services came

about, one by Dr. Safar and the other

by myself. Dr. Safar offered some per­

sonal opinions a t the beginning of his

account, italicized and under the title

"Introduction." In his Introduction he

makes the point that history written by

participants must be inevitably biased.

It is interesting that by definition bias is defined as leaning away from a state of indifference. Participants in a se­ries of events leading up to and includ­ing the establishment of something like emergency medicine will, almost by definition, not be indifferent. They may even be involved and passionate at times! But none of this necessarily means that personal observations thereby derived are either incorrect or wrong. Two participants and observ­ers may disagree on the their respec­tive versions of certain events and their importance but the history is made richer by virtue of their disagreements. Truth and correctness are important in the description of events but subse­quent interpretation of the events and their importance is usually a matter of opinion and argument. Perhaps, in the case of emergency medicine, it might have been well to have the two accounts stand on their own and to let the read­ers decide for themselves as to what was important or critical in the mak­ing of the historical account.

In the case of emergency medicine, there were many early players and the history could be carried back to even Biblical times (Eisenberg). My own article is entitled ''A Memoir" and is thereby restricted to my personal ob­servations starting at about the mid 1950's. My view of the earliest days in the 1960's focused on the individual efforts of certain individuals and the gradual attention of both governmen­tal and medical bureaucracy. In a sense, it reminded me of the general who ran up to one of his soldiers and wanted to know which way the army was going so that he could get in front and leadJ

Since the Bulletin is a Journal de-

voted to history, I'm reminded of an account of a famous battle in WWII as written by the historian, Stephen Ambrose. He speaks of a famous battle and turning point of that war at El Alamein. According to many historical accounts General Montgomery defeated General Rommel and saved Egypt from further invasion and turned the tide in North Africa. The historian Ambrose argues the fact saying that the battle, so to speak, was lost by the Germans three weeks earlier when the Germans bombed Malta incessantly for ten days but could not make the island fortress fall. An Allied convoy sent thirteen ships to re-supply the island and only five made it but it was enough to keep Malta alive. That, in turn, prevented the Germans from re-supplying Rommel with ammunition and petrol. General Montgomery was unsuccessful in the first three days of the ba ttle of El Alamein to secure his objectives but the Germans ran out of ammunition and petrol and had to retreat. The his­tory of the battle, therefore, depends upon one's point of view and the inter­pretation of those events. History is made the richer by the various accounts and points of view and the distillation of that tapestry remains for someone like Ambrose to try and integrate.

The Bulletin is to be congratulated in presenting different accounts of im­portant events and chapters in the his­tory of medicine. The more variations there are upon the theme the more nearly the reader can truly understand and re-live the events being chronicled. I would hope that the readers will read the somewhat disparate accounts of the origins of emergency medicine and to thereby gain their own impression of this recent and important development.

-Eugene Nagel, M.D.

BULLETIN OF ANESTHESIA HISTORY

Bulletin of Anesthesia HistOlY (ISSN 1 522-8649) is published four times a year as a joint effort of the Anesthesia History Association and the Wood-Library Museum of Anesthesiology. The Bulletin was published as Anesthesia HistOlY Association Newsletter through Vol. 13, No. 3, July 1995.

The Bulletin, formerly indexed in Histline, is now indexed in several databases maintained by the U.S. National Library of Medicine as fol­lows:

1 . Monographs: Old citations to historical monographs (including books, audiovisuals, serials, book chapters, and meeting papers) are now in LOCATORplus (http://locatorplus.gov), NLM's web-based online public access catalog, where they may be searched separately from now on, along with newly created citations.

2. Journal Articles: Old citations to journals have been moved to PubMed (http : // www.ncbi.nlm.nih.gov/pubMed), NLM's web­based retrieval system, where they may be searched separately along with newly created citations.

3. Integrated History Searches: NLM has online citations to both types of historical lit­erature -- j ournal articles as well as monographs -- again accessible through a single search loca­tion, The Gateway (http://gateway.nlm.nih.gov).

C.R. Stephen, MD, Senior Editor Doris K. Cope, MD, Editor Donald Caton, MD,Associate Editor A.J. Wright, MLS, Associate Editor Fred Spielman, MD,Associate Editor Douglas Bacon, MD,Associate Editor Peter McDermott, MD, PhD, Book Review Editor

Deborah Bloomberg, Editorial Staff

Editorial, Reprint, and Circulation matters should be addressed to:

Editor Bulletin of Anesthesia HistOlY 200 Medical Arts Building 200 Delafield Avenue, Suite 2070 Pittsburgh, PA 15215 U.S.A. Telephone (412) 784-5343 Fax (412) 784-5350 bloombergdj @anes.upmc.edu

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 submitted as original hard copy, not electronically. Photographs should be original glossy prints, NOT photocopies, laser prints or slides. Photocopies ofline drawings or other artwork are NOT acceptable for publication.

4 BULLETIN OF ANESTHESIA HISTORY

Jackson . . . Continuedfrom Page 1

Fig 2. Front cover of the novel by Mac Kinlay KantOlj If the South Had Won the War (with permission of publishelj Bantam Books).

nation. In fact, whenever possible J ack­son tried to avoid fighting on the Sabbath.l-) While we are addressing the character and fate of Stonewall, we will explore the

Fig 3. Back cover of the novel by MacKilllay KantOlj If the South Had Won the War (with permission of publisher Bantam Books).

imaginative and also brilliant figure of the Surgeon to the Stonewall Brigade, Hunter Holmes McGuire, physician, professor, surgical inn ova tor, anesthetist par excel­lence, postwar President of the American Medical Association and the dear friend and confidente of General Jackson.4-6

A graduate of West Point in the class of 1846, Lieutenant Jackson was brevet­ted to the rank of Major because of his heroism at the Battle of Molino del Rey and Chapultepec during the Mexican­American War ( 1846-1848). It was during this war that on the 29th of March 1847, that Dr. Edward H. Barton (fig. 4) became the first person to give an anesthetic dur­ing a military conflict, when he used ether to amputate the leg of a teamster who was severely injured by the accidental dis­charge of a musket.?

Jackson remained in the U.S. Army until 1852 when he resigned his commis­sion to become a Professor of Natural and Experimental Philosophy at the Virginia MilitalY Institute, Lexington, Virginia. At the outbreak of the Civil War, he was com­missioned as a Colonel in the infantry and was sent by General Robert E. Lee to Harp­ers Ferry to train the many green recruits and organize the defense of this area. In May 1861, Stonewall was put in charge of the First Brigade of the Army of the Shenandoah heavily made up with troops from the Shenandoah Valley. Eventually, this entity became a corps of dedicated hardened veterans given the sobriquet of the " Stonewall Brigade" and they were also often called Jackson's "foot cavalry" be­cause of their endurance and their ability to march speedily through difficult terrain in all types of weather. This hardiness was epitomized by their speed in reaching the First Manassas (or Bull Run) battlefield. Accomplishing a thirty mile forced march from Winchester to Piedmont Station, they boarded a train for the 30 mile ride to Manassas Junction, arriving in the late PM of July 20, 1861, moving up to position near the battlefield. In the early AM the Stonewall Brigade was met by the retreat­ing Brigade of General Barnard Bee. J ack­son moved his own troops in, with Bee try­ing to stop the retreat of his brigade and declaring "yonder stands Jackson like a stonewall, let us go to his assistance" -Thus the beginning of the "Stonewall" leg­end took place.I,2,8 The fortuitous arrival of Jackson carried the day for the Confed­eracy and was a smashing defeat for the Union Army. 1,2 During the First Manassas or Battle of Bull Run, Jackson's middle left finger was hit by a bullet which fractured it and a piece of bone was also avulsed.

Fig 4. Edwards H. Barton) M.D.) who gave the first anesthetic (ether) in a military conflict, the Mexican-American Wm:

Jackson was treated by Hunter Holmes McGuire, the chief medical officer of the Stonewall Brigade. Prior to being seen by Dr. McGuire, another surgeon had advised Jackson that the wound necessitated am­putation of the middle finger. Dr. McGuire did not think that was necessary and placed the finger in a splint along the palmar aspect of the hand. Using gradu­ated finger exercises, the joint motion improved after wound healing and Jack­son was left with a minimal deformity.

Hunter Holmes McGuire, Chief Medi­cal Officer of the Stonewall Brigade, per­sonal physician to and close friend of} ack-

Fig 5. D,: Hunter Holmes McGuire, Medical DirectOlj the "Stonewall" Brigade.

son was born in Winchester, Virginia in 1855, (fig. 5) the son of a physician and surgeon, Hugh Holmes McGuire, who was well known nationally for his interest in ophthalmology. McGuire entered the Winchester Medical College in 1852 and received his medical degree three years later. He then practiced in Winchester as well as teaching anatomy at the Medical

College for about 3 years after which he enrolled in some courses at the Pennsyl­vania Medical College in Philadelphia. Subsequently, McGuire transferred to the Jefferson Medical College which was a Mecca for students from the South with half of the enrollment coming from below the Mason-Dixon line. The execution of John Brown in 1859 exacerbated the ten­sions between the students from the North and South as well as from the local popu­lation in Philadelphia.

On December 22, 1859, more than 300 Southern medical students left Jefferson Medical College to continue their medi­cal studies in the South, most of them transferring to the Medical College of Vir­ginia in Richmond. Hunter Holmes McGuire, however, translocated to Tulane University in New Orleans where he taught at the Medical School. When Vir­ginia seceded from the Union in April 1861, Dr. McGuire returned from New Orleans and enlisted in the Confederate Army as a private in an infantry company. When his record was checked in Rich­mond and it was noted that he was an ex­perienced physician, he was ordered to report to Colonel Jackson at the Harpers Ferry.4-6 When the tall thin Surgeon en­tered his office, Jackson just sat and stared. Finally the Colonel dismissed McGuire by saying, "You may return to your quarters and wait there until you hear from me." Days went by and McGuire heard noth­ing. Finally, about 10 days later an an­nouncement was made that "Dr Hunter Holmes McGuire has been named as Sur­geon of the First Brigade." Later, as J ack­son and McGuire became fast friends, he confided, "You looked so young, I sent to Richmond to see if there was some mis­take." As Brigade Surgeon, he had the equivalent rank of a Major and was paid $ 160-$200 Confederate dollars per month. Dr. McGuire was together with Stonewall during all the campaigns from Harpers Ferry onward.

In order to appreciate the contributions of Hunter Holmes McGuire, one has to understand the terrible conditions that existed in the practice of military medi­cine during the Civil War period. It is to be remembered that it was only after Civil War (in 1867) that Lord Lister's papers relating to antiseptic surgery began to ap­pear and about the same time the germ theories relating to diseases were formu­lated. The combined Union and Confed­erate mortality resulting from the Civil War probably exceeded 620,000, with about 70% dying from disease and wound infections. The medical corps of the

Fig 6. Gunshot fracture of the cranium, caused by a musket ball. (from the Phographic Atlas of Civil War Injuries by Breadley P. Bengston, M.D., and Julian E. Kuz, M.D. With permission of the authors and publishers).

Union armies were mired down in an an­tiquated medical system with roots still in the War of 1812, while the Confederate Medical Organization was non-existent when the war began.

Since both the Union and Confederates thought that the conflict would not last longer than a few months, no important medical battlefield planning took place. This was indicated by President Lincoln's call up of volunteers to serve a period of 3 months. The medical education in the United States was poorly defined with the M.D. title given after a relative short pe­riod of study at a medical college or by serving an apprenticeship with an experi­ence physician. Besides, the physicians in general had little or no experience in car­rying out surgery under emergency battle­field conditions. An example of the cha­otic state of military medicine occurred after the First Battle of Manassas (or Bull Run) on July 21, 1861,9 where the Union

Fig 7. William A. Hammond, M.D., Surgeon-General, U.S. Army, 1862-

1864.

BULLETIN OF ANESTHESIA HISTORY 5

rout was so complete that the "The Sani­tary Commission could find no record of a single wounded searching Washington, D.C. by ambulance."1 0 A case in point lies in the head injury suffered by Private Ed­ward Volk (fig. 6), D. Company 55th Ohio, who was wounded at the 2nd Manassas on August 30, 1862, by a musket ball, which struck the forehead at a point half an inch above the right eyebrow. He remained on the battlefield six days and was then con­veyed to Washington and admitted to the Emory Hospital on the 6th of September 1862. The wound was explored, and bone and brain matter removed. He died on September 25'h, 1862.

Even a year later, "At the 2nd Battle of Manassas (or Bull Run), on August 29, 1862, there was even bigger scandal. Three thousand wounded lay on the field for three days and 600 lay for one week. After the regular ambulance drivers defected, the hirees who replaced them picked the pockets of wounded, stole alcohol from the medical supplies and ignored the com­plaints of the wounded and dying."lo

As mentioned above, the first use of an anesthetic (sulfuric ether) during a mili­talY conflict took place on March 29, 1847, by Dr. Edward Barton'? This came about 5 months after the successful use of sulfu­ric ether by William Thomas Green Norton at the Massachusetts General Hos­pital on October 16, 1856, when the Chief Surgeon, William Collins Warren removed a tumor from the neck of Gilbert Abbott. In the Crimean War ( 1853 - 1856), chlo­roform (first used by Simpson of Edinburgh in 1848), was employed by the British and French Surgeons in more than 45,000 cases with but 1 fatality reported. In spite of the experience which was re­ported in the French and English Medi­cal Journals, there was an initial hesita­tion in its employment in the Civil War because it was thought to prolong bleed­ing, to increase shock because of its de­pressive effect, and robbed the patient of his "manliness" by not allowing him to accept the pain due to the surgely. Many of the lessons from the Mexican-American War of 1846-1848, and the subsequent Crimean War were ignored. It was not un til the beginning of 1863 that both armies developed a reasonable medical system the Union under W illiam Hammond, M.D. (fig. 7) with the able Jonathan Leterman assigned to the Army of the Potomac as its Medical Director. On the other side, Samuel Preston Moore, a former regular U.S. Army Medical Corps officer, did a remarkable job on organiz-

COlllillued Olll/ext page

6 BULLETIN OF ANESTHESIA HISTORY

Jackson. . .Continued from Page 5

Fig 8. Painting of General Robert E. Lee, celebrating his vict01Y at the Battle of Chancellorsville.

ing Confederate States Medicine. In many ways, McGuire was a genius

in the art of medical organization with ideas similar to that of Hammond and Letterman on the Union side. He devel­oped an Infirmary Corps with units of 30 men and an assistant surgeon from each regiment. They acted as a modern mili­tary collecting company, whose task was to treat and collect the wounded on the field of battle and transport the serious injured to the field hospital in the rear.

Fig 9. Joseph Hookel; Commanding Union General (Army of the Potomac) at the Battle of Chancellorsville.

He also organized the Reserve Corps Hos­pitals, a series of mobile field units set up at the site of the impending battle. This included commissary and quartermaster

corps for ambulances, transportation wag­ons, hospital tents, medical supplies, stew­ards, nurses and commissioned medical officers. Hunter Homes McGuire was an expert in the use of chloroform and claimed that he and his staff had used chlo­roform anesthesia in over 28,000 cases without a single death due to the agent. ll Considering the terrible conditions on the battlefield, this was indeed an enviable record. Of interest is that the mortality rates in a study of 8,900 cases studied in the Medical and Surgical History of the War of the Rebellion indicated that the reported mortality from anesthesia was indeed low, being 0.54% with chloroform, 0.30% with ether and 0.24% with the mix­ture of the two.

Dr. McGuire was an innovative surgeon and in the postwar period be was one of

ciation in 1887 and the American Medi­cal Association in 1893. His interest in Medical education was noted throughout his career and Dr. McGuire was a founder of Medical College of Virginia. In the Civil War he was directly responsible for establishing the tradition that captured Surgeons were immediately paroled and sent back to their respective sides.

The Battle of Chancellorville (May 1-4, 1863) was an extraordinary affair that showed the military genius of Robert E. Lee (fig. 8) and again the mettle of Stone­wall Jackson.Il-12 From the first Battle of Manassas (Bull Run), Jackson's talents as a military commander were tested and he was quickly recognized for his brilliant tactics and his ability to move his troops with great rapidity and effectiveness, us­ing the element of surprise as a potent

CHANCELLORSVILLE 2 May. 1862

�=== a'f"

Fig 10. Battle of Chancellorsville with positions of Union and Confederate armies on May 2, 1862. The 14 mile March of Jackson's forces around the Union flank is indicated by the arrows. Neal' the center of the Old Orange Turnpike 1'oad, a small black round circle indicates where Jackson was shot. (From Stonewall A Biography of General Thomas J Jackson by Byron Farwell with permission of the publishers w.w. Norton and Company)

the first to accept the then revolutionary germ theory and to use Lister's methods of antiseptic surgery. He standardized the treatment of appendicitis, defined surgi­cal techniques for gunshot wounds of the abdomen and did pioneer work in prostate surgery, being among the first to recom­mend suprapubic cystotomy. He published numerous scientific papers and in 1868, McGuire reported the ligation of the ab­dominal aorta, which had been success­fully performed only once before by Sir Ashley Cooper in 1817. Among the many honors bestowed upon him, he was elected President of the American Surgical Asso-

weapon. Chancellorville presented a dif­ficult problem for Lee since his opponent, General Joseph Hooker (fig. 9), had 134,000 troops under his command as com­pared to less than 60,000 effectives for the Confederates. Hooker's plan was to send a large cavalry force around Lee's left flank to separate Lee from his source of sup­plies.2 In the meanwhile, Hooker would immobilize Lee's front with a phalanx of 50,000 troops, while the main attack force of five corps would be sent upriver and more around Lee's unprotected rear and left flank. Lee countered with a most dar­ing plan, the major thrust led by Stone-

Fig 11. The wooded area where it was thought that Jackson was wounded by "friendly fire. JJ

wall Jackson (fig. 10)1. Lee gambled on May 2, 1863, by stripping his forces in both the center and on the right flank and let­ting Jackson take nearly 30,000 men on a most difficult and circuitous 14-mile march through the W ilderness. The march took Jackson behind the righ t flank of the Union army and at 5:30 P.M. Con­federa tes a ttacked rolling up General Hooker's flank for more than two miles and creating havoc.2

In the near darkness, Jackson and his staff reconnoitered, trying to straighten out the Confederate lines and ready his troops for another attack12

Thinking they were Union cavalry, troops of the 18th North Carolina Regiment fired on Jackson's entourage, wounding Jackson in the left arm and righ t hand (fig. 1 1). Jackson's horse bolted and running between two trees, his head impacted with a horizontal bough, which almost unseated him. A member of his staff halted his horse and he was laid upon the ground under a tree. His wound was bleeding pro­fusely and spilling into his gauntlets. Jackson's left arm was shattered 2 inches below the shoulder joint by a ball that also severed the brachial artery with a second ball passing through he same arm between the elbow and wrist. One of J ackson's aides dressed his wounds, cutting off his coat sleeves and binding a handkerchief tightly above and another below the wounds and putting his arms in a sling. One of the staff was sent to find Hunter Holmes McGuire and an ambulance to take Gen­eral Jackson to the rear. U nfortuna tely, the area was under artillery fire and he was lifted up and dragged towards the Confed­erate lines. Jackson was then put on a lit­ter and fell off when one of the Litter-Bear-

ers was killed by exploding shrapnel. Jackson was then assisted to move on foot, again placed on a stretcher and again he suffered a painful fall when one of the bearers had his foot en­tangled in a vine and dropped his end. Placed a third time on a litter, J ack­son was carried to the rear, met Dr. McGuire and was then placed in an ambulance to take him to the Corps field infirmary at the Wilderness Tav­ern. Prior to being transferred to the ambulance, Jackson was given some whiskey and morphine. Dr. McGuire takes up the narrative.13

"I knelt down by him, and said, 'I hope you are not badly hurt, general.' He replied, very calmly, but feebly, 'I am badly injured, doctor; I fear I am dying.' After a pause he continued, 'I

am glad you have come. I think the wound in my shoulder is still bleeding.' His clothes were saturated with blood, and hemorrhage was still going on from the wound. Compression of the artery with the finger arrested it, until lights being procured from the ambulance, the hand­kerchief, which had slipped a little, was readjusted. His calmness amid the dan­gers, which surrounded him, and the sup­posed presence of death and his uniform politeness, which did not forsake him, even under these, the most trying circum­stances were remarkable.

After reaching the hospital, he was placed in bed, covered with blankets and another drink of whiskey and water given to him. Two hours and a half elapsed be­fore sufficient reaction took place, to war­rant an examination. At two o'clock Sun­day morning, surgeons Black, Walls and Coleman being present, I informed him that chloroform would be given him, and his wounds examined. I told him that amputation would probably be required, and asked it was found necessary, whether it should be done at once. He replied promptly,

'Yes, certainly; Doctor McGuire, do for me whatever you think best." Chloroform was then administered, and as he began to feel its effects, and its relief to the pain he was suffering, he exclaimed, 'What an infinite blessing,' and continued to repeat the word 'Blessing,' until he became in­sensible. The round ball (such as is used for the smooth bore Springfield Musket), which had lodged under the skin, upon the back of his right hand, was extracted first. It had entered the palm, about the middle of the hand, and had fractured two of the bones. The left arm was then am-

BULLETIN OF ANESTHESIA HISTORY 7

putated, about two inches below the shoul­der joint, the ball dividing the main ar­tery, and fracturing the bone. The second was a several inches in length; a ball hav­ing entered the outside of the forearm, an inch below the elbow, came out upon the opposite side, just above the wrist. Throughout the whole of the operation, and until all the dressing were applied, he continued insensible. Two or three slight wounds of the skin of his face, received from branches of trees, when his horse dashed through the woods, were dressed simply with isinglass plaster."

Recapitulating this surgery along more modern lines we can note:

Date of Surgery - May 3, 1863 Anesthesia Start - about 2:00 A.M. Surgery Start - about 2:10 A.M. Surgery End - about 3:00 A.M. Anesthesia End - about 3:10 A.M.

The duties of the 5 Surgeons present were:

Dr. McGuire: Operating Surgeon Amputation Technique - Circular

Dr. Coleman: Anesthetist Anaesthetic Agent - Chloroform Anesthetic Technique - Open Drop The agent was dropped on a piece of cloth in the shape of a cone, probably less than half an ounce of chloroform used.

Fig 12. The Death Mask of Stonewall Jackson.

Continued on Page 15

8 BULLETIN OF ANESTHESIA HISTORY

An Enduring Controversy: Henry K. Beecher and Curare

by Douglas R. Bacon, M.D., MA. Associate Professor of Anesthesiology Mayo Clinic

This article has been peer reviewed and accepted for publication in the Bulletin of Anesthesia Histmy.

Nothing in anesthesiology has gener­ated as much ire and controversy as an article published by Henry K. Beecher and Donald P. Todd in the Annals of Surgery.! Their paper, entitled ''A study of the deaths associated with anesthesia and surgery", has continued to raise more questions than it has answered. The study has been la­beled a "bad" one, and Beecher has been vilified as somehow being a traitor to the specialty of anesthesiology. Questions have been raised about why the paper was published in a surgical journal, and that the conclusions reached were somehow invalid. Beecher's defenders have coun­tered that the study is a landmark in an­esthesiology since it is the first true out­come study in the specialty. In the zeal­ousness of their defense, they claim that the choice of journal was for safety's sake-Annals of Surgery had the greatest readership and therefore this critical in­formation would be in the hands of the greatest number of physicians affected by the findings. Where does the truth really lie? After almost fifty years, what can be learned from this pioneering work? And, in the end, can anything definitive be said about Beecher's motivations?

Who was Henry K. Beecher? Henry K. Beecher (fig. 1) was a man

full of contradictions. He was born in Wichita, Kansas on February 4, 1904. He studied physical chemistry at the Univer­sity of Kansas from which he received his A.B. in 1926 and his A.M. in 1927. A year later, he matriculated at the Harvard Medi­cal School where he won research fellow­ships for 1929-1931. Beecher graduated in 1932 and began his postgraduate train­ing as a surgeon at the Massachusetts Gen­eral Hospital (MGH). 2 He was assigned to the West Service under the direction of

This work was presented in part at the American Society of Anesthesiologists Annual Meeting, October 1 7, 2000 in San Francisco, California as element of the panel "The Unforeseen Consequences of Anesthesia 1846-2000".

Figure 1

Edward D. Churchill. Interestingly, Churchill was also surgeon-in-chief at the MGH and mentored Beecher throughout his career. After two years of surgical training, Beecher was awarded a Moseley Traveling Fellowship and spent a year in Copenhagen with the renowned physiolo­gist August Krogh. After his fellowship he returned to MGH and completed his surgical training.3

In 1936, Churchill appointed Beecher as an Instructor in Anesthesia and Assis­tant Anesthetist at the MGH. Five months later, the anesthetist-in-chief at the MGH, Howard H. Bradshaw, resigned to return to surgical practice and Beecher assumed the role.4 Moreover, if Beecher were suc­cessful in this new position for the follow­ing five years, Churchill assured Beecher that the Henry Isiah Dorr Chair in Anes­thesia would be his. Shunning additional training in anesthesia for Beecher, Churchill dismissed John Lundy and Ralph Waters, who headed the two most famous training programs, as too tech­nique oriented. Like many surgeons of that day, Churchill felt that anesthesia was

not worthy of special study. 5 Thus, Beecher assumed responsibility for the anesthesia service at the MGH without either completing extensive postgraduate training in anesthesia when it was easily available in several sites across the coun­try, or practicing as an anesthesiologist,4

Beecher made the most of his opportu­nity. He had an immediate impact on the mortality rate at MGH, at least in thoracic surgery, cutting the death rate in lobec­tomy from fifty to five percent. 2 In 1938 Beecher published "The Physiology of An­esthesia," which was one of the first books to emphasize the underlying science in anesthesiology. 6 During the Second World War Beecher was a Lieutenant Colonel in the European Theater and was present at the Anzio beachhead. There he made his critical observation about pain and wounded soldiers. 3 When the war ended, he would continue to act as an advisor to the Armed Services well into the 1950s.

Contributions to the art and science of medicine by Beecher are perhaps better known. In the 1950s, Beecher described the placebo effect. He went so far as to ascribe the efficacy of certain operations like internal mammary artery ligation for the treatment of angina pectoris to the pla­cebo effect,3 In studying these phenom­ena, Beecher became interested in and was successful at quantifying subjective re­sponses. His work on pain, started at the Anzio beachhead would lead to the intro­duction of innovative methods of study like the double blind trial and the inclu­sion of placebos into clinical protocols.?

Beecher, however, remains most famous for his work on the ethics of using human subjects in research. Like his work on the effects of narcotics on pain, Beecher's in­terest began with his experiences in the Second World War. Moved by the horrible experiments carried out by the Nazi phy­sicians during the war, Beecher kept de­tailed records of these atrocities in per­sonal files. From this experience, Beecher began to think about the problems of in­formed consent in human experimenta­tion. In the next twenty-five years after

the war, Beecher would publish a series of

papers that would rock the anesthesia re­

search community as well as medicine as

a whole, clearly demonstrating the ethi­

cal deficiencies in clinical research. In­

formed consent came to be mandated in

all clinical studies as a result of Beecher's

efforts.8

The Curare Study

Perhaps one of the most enduring of

Beecher's many controversies resulted

from the publication in the July 1954 An­

nals of Surgery of his paper with Donald P. Todd entitled ''A study of the deaths as­

sociated with anesthesia and surgery"!. As originally conceived, the study examined peri operative deaths in the leading aca­demic medical centers of the country. The

work was funded by contract number DA-49-007-MD-l03 from the Department of the Army's Medical Research and Devel­opment Board. Each department assigned a surgeon and an anesthesiologist to re­view all deaths that occurred on the sur­gical service between January 1, 1948 and December 31, 195Z,l Beecher and Todd then analyzed the data.

This study is very interesting for many reasons. It is the first large multicenter outcome study in anesthesiology. The data was analyzed in many different ways, from the level of training of the person who administered the anesthetic, to the agents used, to the various techniques, all search­ing for ways to improve anesthetic out­come. ! The conclusions of the study are very interesting, and remain controversial because of their interpretation. In essence, Beecher and Todd found that " . . . when muscle relaxants enter the situation, the anesthesia death rate increases nearly six fold, from an anesthetic death rate of 1:2100 to a rate of 1:370". ! They further found that " . . . many 'curare' patients die of circulatory collapse. It has not, hereto­fore, been recognized that a common cause of death from 'curare' is circulatory fail­ure"!. This observation led Beecher and Todd to conclude that there was an inher­ent toxicity in curare, since those in good physical status died as frequently as those who were "high risk" patients prior to re­ceiving their anesthetic. !

Also interesting to note is that the data was analyzed as it came in, on a yearly basis. Beecher and Todd state that "In­evitably and rightly the mounting data of this study have been widely discussed."! At the time, Beecher was consultant for anesthesia to the United States Army. Un­fortunately, there was a war on, as the United Nations fought to liberate the Ko-

rean peninsula from communist aggres­sion. The Army never approved curare as a drug to be used in its hospitals during the Korean conflict, most likely because Beecher, data in hand, refused as the Army's Consultant to approve it.

E. S. Siker, an anesthesiologist and later president of the American Society of An­esthesiologists and President of the Ameri­can Board of Anesthesiology, has written about his wartime experiences with the 4th Field Hospital between December of 1950 and August of 195 1. Siker commented that "In the absence of curare, I wonder if any of the wounded we cared for died because of the delays in induction and depth of anesthesia required using ether. [T]he absence of curare (intocostrin at the time) was frustrating. One technique for rapid intubation without curare was the rapid IV injection of thiopental when we be­lieved that the patient's blood volume was not depleted. [That the patients didn't die is] another tribute to the inherent resil­ience of young human protoplasm."9

In their conclusions, Beecher and Todd wrote that "[w]e do not believe that they should be banned, but that they should be studied further" and in another section of the paper " [a]re they to be banned as a practical solution of the problem? We be­lieve not."! Yet, in one of the places where Beecher could have approved curare, the US Army, he did not. The question why remains difficult to answer. W hy did Beecher believe that there was an inher­ent danger in the use of curare? In sev­eral places he strongly advocates more study of the agent to learn why the death rate was much higher when curare was used.

Interpretations There are few papers in the medical lit­

erature that still generate as much enmity and controversy as the Beecher and Todd curare study. In looking back some fifty years later, what inferences can be reached about this work? First, it was a well done study that attempted to answer a serious question about perioperative mortality and the anesthetic contribution to those deaths. The data was analyzed in many different ways, and pointed to a problem with curare. Beecher and Todd identified that some of the curare deaths were asso­ciated with hemodynamic collapse, a fact that is now explained by curare's hista­mine releasing properties. They also ar­gued strongly for the proper use of muscle relaxants, as adjuvants where muscle func­tion inhibited surgery, but also argued that they should not be used to cover inad-

BULLETIN OF ANESTHESIA HISTORY 9

equate anesthesia. In several places Beecher and Todd advocated for more re­search into this problem and that muscle relaxants should not be banned.

Yet, even almost fifty years later, there is plenty of room for critique. Perhaps the largest concern was why the paper was published in the Annals of Surgery and not published in any of the journals de­voted to anesthesiology. Part of that ex­planation may rest with the way Beecher felt and was perceived by the anesthesiol­ogy community. He was the last of the "last of the untrained", as one authored phrased it, and had not sought training in the specialty because his mentor, the Homman's professor of surgery at Harvard, Edward Churchill " ... had little regard for either Lundy or Waters, whom he considered to be technique oriented; . . . Churchill apparently considered the techniques of anesthesia not worthy of special study and advised Beecher against formal clinical training. "!O Thus, did Beecher feel the need for surgeons, rather than his contemporary anesthesia col­leagues, to validate his work?

J. S. Gravenstein comments about this situation in a paper presented at the ses­quicentennial of the first public demon­stration of ether anesthesia. Gravenstein observes that the publication of this pa­per in a surgical journal " .. .instead of one of the respected anesthesia publica tions has galled anesthesiologists. Perhaps we should not read into the bias to publish in surgical papers old loyalties to surgery, or the need to impress his former colleagues, or uncertainty about the scientific stature of anesthesia. Perhaps it was just a mat­ter of finding the greatest number of read­ers. But we must ponder why he did not invest his considerable intellectuals capi­tal into anesthesia journals to entice those lagging in scientific achievement to come aboard with academic anesthesia or lend his prestige to the young speciality."2 Given surgical attitudes, publication in a surgical journal might well have lead to increased tension in the operating room when demands about the anesthetic agents employed in the care of the patient were made and thus making the young spe­cialty and specialist jump over one more hurdle.

Yet, the Annals of Surgery is not the surgical journal with the widest circula­tion in the 1950s. However, the Annals was the official journal of four very pow­erful, academic surgical organizations: The American Surgical Association, the Southern Surgical Association, the Phila-

Continued on next page

10 BULLETIN OF ANESTHESIA HISTORY

Beecher . . . COlltilllledji-om Page 9

delphia Academy of Surgery and the New York Surgical Society. Major figures from the history of surgery in mid twentieth century America were members of the edi­torial board including A. O. W hipple, Everts Graham, Michael De Bakey and Edward D. Churchil1.11 The journal was aimed at the academic surgical commu­nity; those who were training the next gen­eration of surgeons. Perhaps the intent was not to reach the greatest number of surgeons, but rather those in influence. Having done so by publishing in the An­nals, the wrath of the anesthesiology com­munity against Beecher was all the greater because the impression of curare specifi­cally and anesthesiology in general would take another generation of surgical edu­cation to change. In the final analysis, it may well have been Churchill's suggestion to publish the paper in a surgical journal, one in which Churchill had some edito­rial influence. Did it please Churchill to see a paper published in the Annals, which confirmed his suspicions about the spe­cialty of anesthesiology?

Even more troubling than the choice of journals was some of the language used to describe the study's findings. Beecher and Todd called the death rate from anes­thesia where curare was employed a "pub­lic health problem" and further stated that this particular anesthetic killed more people in the United States than did po­liomyelitis.I If the language itself was not inflammatory enough, at least one univer­sity center withdrew from the study be­cause it was felt that the wrong conclu­sions were being made from the data. 2 Further, noting the rapid evolution of new techniques in anesthesia and new agents, Beecher and Todd concluded that " . . . the practice of anesthesia is far from stable."1 This characterization caused many strong replies to be published.

One of the most interesting replies was published in the Annals of Surgery a year after the initial publication of Beecher and Todd's paper. Sixteen anesthesiologists, among them three American Society of Anesthesiologists presidents, including the 1954 president Stevens J. Martin and members of Beecher's own department at MGH, critiqued the study. Their major thrust was that the conclusions were based upon inadequate statistical analysis. These prominent anesthesiologists were concerned that surgical factors, such as site of operation, depth of relaxation re­quired, and duration of operation and an­esthesia were not studied. They also had

concerns with how proportionate increases and decreases were dealt with in the study. Finally, these authors note that if the death rate were sole consideration in choosing an anesthetic, ethylene should be the an­esthetic of choice. However, since ethyl­ene has no inherent muscle relaxant prop­erties, it would not produce satisfactory anesthesia for abdominal cases. 12

Some five years later, Robert D. Dripps, chair at the University of Pennsylvania in Philadelphia, published an article entitled "The Role of Muscle Relaxants in Anes­thesia Deaths". Dripps viewed of the Beecher and Todd study, and the firestorm it created, from a perspective afforded by the passage of several years. Dripps pointed out that the circulatory collapse seen with curare could be explained by several factors, especially histamine re­lease, which was known to occur with curare administration since 1946. Dripps also stated that positive pressure ventila­tion caused hemodynamic changes that were not appreciated when the patient breathed spontaneouslyY

In his conclusions, Dripps stated that the reaction to muscle relaxants broadly categorized anesthesiologists three ways. The first believed that muscle relaxants were among the safest adjuvants in the anesthetic armamentarium. The second group wasn't sure, and never administered a sufficiently large dose of the drug to to­tally abolish spontaneous respiration. The third group, Dripps maintained, held that muscle relaxants were inherently toxic agents. This third group equated muscle relaxants with arsenic, claiming that no matter how skillful the arsenic is admin­istered, the patient always dies,u Was this a subtle critique of Beecher's acknowl­edged lack of clinical skills2,IO? Indeed, was Dripps correct in assuming that Beecher's view of curare came from his lack of comfort in the clinical arena?

Conclusions Beecher and Todd's paper is a landmark

in anesthesia. The work is the first multicenter analysis in anesthesiology that can be interrupted as an outcome study. Some fifty years later, the elements of qual­ity assurance and total quality improve­ment are clearly evident in this work. Beecher and Todd identified a problem and made suggestions to improve condi­tions. The statistical analysis was a he­roic effort in those precomputer days. For that reason alone, there is something to be admired in this work.

Yet, the choice of journal and the phras­ing of several of the conclusions caused

more controversy than the study de­manded. By pulling out of the project, as E.M. Papper related to J.S. Gravenstien, he was afraid that the interpterion of the data was biased against anesthesia.2 Call­ing deaths due to curare a public health hazard could only have hurt the delicate evolving relationship between the anesthe­sia community, the surgical community and the lay public. In this sense, the study did far more harm than good.

Reading the work some fifty years later, when the histamine releasing properties of curare are well known, it is difficult to believe that Beecher and Todd could have concluded that there was an inherent dan­ger in the anesthetic. That, however, is an errol' in interpretation, because of knowledge gained over time. Yet, Beecher and Todd provide an excellent example of how an excellent study design, poised to answer a difficult question, can be undone by the vehicle used to communicate the results. That lesson is an important one for all physicians who write to help their specialty.

References 1. Beecher HK, Todd DP. A study of the deaths

associated with anesthesia and surgery. Annals of SlII' gely 1954, 140:2-34.

2. Gravenstein JS. Henry K. Beecher. Anesthesiol­ogy 1998, 88:245-53.

3. Miller EV. Henry Knowles Beecher a man of controversy. In Fink BR, Morris LE, Stephen CR, eds. The History of Anesthesia. Park Ridge: Wood Library-Museum of Anesthesiology, 1992, p. 299-302.

4. Beecher HK, Altschule MD. Medicine at Harvard. Hanover: The University Press of New England, 1977, pps. 413-414.

5. Bunker JP. The Anesthesiologist and the Sur­geon. Boston: Little, Brown and Company, 1972, p. 17.

6. Mushin \Y/W. Anaesthetic books which influ­enced me in my early days. In Atkinson RS, Boulton TB eds. The History of Anaesthesia. London: The Parthenon Publishing Group, p. 15.

7. Greene NM. Henry Knowles Beecher 1904-1976. Anesthesiology 1976,45:377-378.

8. Kopp VJ. Henry Knowles Beecher and the de­velopment of informed consent in anesthesia research. Anesthesiology 1999, 90:1756-65.

9. Siker ES to Bacon DR. Personal communica­tion via email, August 22, 2000.

10. Bunker JP. Henry K. Beecher. In Volpitto PP, Vandam LD eds. The Genesis of Contemporary American Anesthesiology. Springfield: Charles C Thomas 1982. pps 106-107.

11. Frontispiece. Annals of SurgelY 1954; 140:i. 12. Abajian J, Arrowood JG, Barrett RH, Dwyer

CS, Eversole UH, Fine JH, Hand LV, Howrie WC, Marcus PS, Martin SJ, Nicholson MJ, Saklad E, Saklad M, Sellman 1', Smith RM, Woodbridge PD. Critique of ''A study of the deaths associated with anesthesia and surgery". AnnalsofSurgelY 1954; 142:138-141.

13. Dripps RD. The role of muscle relaxants in anesthesia deaths. Anesthesiology 1959; 20:542-545.

MedNuggets by Fred J. Spielman, M.D.

Department of Anesthesiology, University of North Carolina

The anesthesiologist who treats pa­

tients with pain problems will find a cer­

tain number in whom he is unable to bring

about any significant measure of relief. -Frederick P. Haugen

Anesthesiology, 16:490, 1955

It is not the drug, it is not the method,

but the trained man who is giving the an­esthesia. I would rather have a trained anesthetist anesthetize me or my parents than have a much superior method with an absence of training and experience.

-William T. Lemmon Jou1'1lal of the American Medical

Association, 128:263, 1945

Sympathy, honesty, strength, and skill­in that order- are the primary requisites of any able man, regardless of his calling, but those qualities are perhaps particularly desirous in an anaesthetist.

-Campbell Gardner Canadian Anaesthists' Society Journal,

2:215, 1955

Surgeon-anesthesiologist rela tionshi p is comparable to that of a captain of a sea­going ship and the harbor pilot. The cap­tain acquires a pilot to navigate his ship through the treacherous reefs, shoals and sandbars which impede his entrance into the harbor and the ship's piers. The cap­tain is dependent upon the pilot's knowl­edge and competency.

-Paul H. Lorhan American Surgeon, 18:727, 1952

Among the newer surgical specialties, surgery of the chest is coming into greater prominence, and consequently the prob­lems of anesthesia for these operative pro­cedures are confronting the anesthetist.

-Dorothy Wood Current Researches in Anesthesia and

Analgesia 13:260, 1934

In unfolding the literature on local and regional anaesthesia, one is impressed by the slow but steady progress with which these methods have found their way into general surgery.

Although they have not been univer­sally adopted as a routine procedure, in many clinics on the Continent they have given a mortal blow to inhalation narco­sis during the past few years.

-Gaston L. Labat Annals of Surgery 74:673, 1921

The anaesthetist is a man apart ... . The ease and perfection of the opera tion largely depends upon his skill in giving the anaesthetic .... The anaesthetist becomes a sort of prologue to the operations, his in­fluence pervading the whole action, hav­ing an important part in it and in the end vanishing strangely.

-N. Moore History of St Bartholomew's Hospi­

tal, 1918

We must make efforts to influence and further the teaching of anesthesiology at medical schools levels if we hope to attract the desirable student or stimulate his in­terest in our specialty early in his educa­tion.

-Leo V. Hand Report of the President, ASA, 1960

We do not claim that it (spinal anes­thesia) is an ideal form of anesthesia, nor do we think that it will ever be substituted for ether.

-Thomas H. Russell American Journal of SurgelY, 6:201,

1929

In a teaching hospital, operations per­formed by the younger surgeons take longer because of frequent didactic discus­sions during the course of the operation. If we are to be a real aid to the surgical team, there is a definite challenge to us to provide excellent surgical anesthesia for as long as the surgeon needs it, and at the same time, keep the patient in the best possible condition- " A most delightful paradox."

-Virginia Apgar Anesthesiology, 3:522, 1942

Considerable debate has occurred as to whether the brain damage sometimes found after nitrous oxide administration is in truth due to accompanying anoxia or to a specific toxicity of the anesthetic agent.

-Henry K. Beecher Surgery, 8:153, 1940

I would, at the present time, recom­mend pentothal sodium for the early part

BULLETIN OF ANESTHESIA HISTORY I I

of labour; then, from competent hands, nitrous oxide and oxygen for intermittent analgesia should the pains become severe, and cyclopropane anaesthesia for the fi­nal stages.

-Wesley Bourne British Journal of Anaesthesia, 15:1,

1937

No anesthetist will function success­fully when the attitude of the surgeon is that the anesthetist is a necessary but un­desirable adjunct.

-Frank H. Lahey Surgical Clinics of North America, p.

625, June, 1950

The administration of anaesthetics is too often left to those who have no special instruction in the art, a prevailing opin­ion being that no special preparation or fitness is required.

-Editorial Surgery, Gynecology and Obstetrics,

6:200, 1908

Today there is no more a moral obliga­tion to endure pain as " God's will " since we have relatively safe drugs and special­ists conscious of their responsiblitiy.

-Pope Pius XII Anaesthetist, 6:197, 1957

1 2 BULLETIN OF ANESTHESIA HISTORY

Patrick Sim, MLS Celebrates Thirty Years at the Wood Library-Museum by Douglas R. Bacon, M.D., M.A. Associate Professor of Anesthesiology Mayo Clinic

For thirty years Patrick Sim has been the embodiment of the Wood Library­Museum. His long tenure at the WLM was marked this past August with a din­ner in his honor. Surrounded by friends, his lovely wife Shu Mei and his sons Gabriel and Claude, the evening quickly passed as Patrick stories were shared. Dr. Charles Tandy shared his memories of the time when Patrick was hired-calling that decision the best the Wood Library-Mu­seum has ever made. Dr. and Mrs. George Bause donated a rare Murphy Chloroform Inhaler in honor of Patrick and his ser­vice to the organization. The inhaler was made by Down Brothers, London and its design was first described in Edward Wil­liam Murphy's book, Anesthesia and Mid­wifelY, published in 1848. Mrs. Roena Tandy gave She Mei a beautiful bouquet of cut flowers, and a long stem rose to Gabriel's wife Joan.

Dr. Maurice Albin donated a set of Osler manuscripts to the WLM in honor of Patrick Their content covered Sir Wil­liam Osler's known writings on anesthe­siology. Mr. Sim also received a book cre­ated by those who know him best. Each author contributed a letter of congratula­tions, and many included a favorite story about Mr. Sim. Reflective of Patrick's warmth, charm and humility the evening, like the man it honored, will long be af­fectionately remembered. And, the morn­ing following the dinner, the familiar voice, "This is Patrick Sim. May I help you," was on the phone, taking calls and working on his next thirty years of service.

The WLM Librmy Staff' (from left to right) Karen Bieterman, Patrick Sim, and Judith Robins

DI: Doris K. Cope, D,: Lucien Morris, and D,: Chris Stock at the WLM BOT Dinnel:

Mrs. Gabriel Sim, Gabriel Si11l, Mrs. Patrick Si11l, Dr. Donald Caton, Patrick Sim, and Claude Sim at the WLM Board of Ti'Ustees Dinner in honor of Patrick Sim.

At the WLM Board of Ti'ustees Dinner: (from left to right)DI: and Mrs. Adolphe Giesecke, D,: Alan Sesslel; Carole Siragusa, and D,: Frank McKechnie.

Saluting Sim's Thirty Years as ASNs WLM Librarian by George Bause, M.D.

WLM Honorary Curator

On August 16, 20Gl, the Board of Trust­

ees of ASA's Wood Library-Museum

(WLM) saluted Librarian Patrick Sim for

his 30 years of dedicated service to the

ASA. WLM Trustee Doug Bacon pre­

sented Patrick with a wonderful notebook

of personal letters from ASA Officers and

WLM Trustees. As another part of the fes­

tivities, my wife and I dona ted a rare

Murphy Chloroform Inhaler to the WLM

in honor of Patrick Sim, M.L.S.

cious- these words only begin to describe Mr. Sim. Perhaps two of my favorite memories of Patrick will better illustrate this special man. My stories are divided between the current and former sites for the WLM.

My first story begins in the basement of the old W LM haunts at 5 15 Busse High­way, where Patrick and I found ourselves once again "working in the dungeon." My hands were grayish-black from moving several rusting anesthesia machines out of our way. Among the scattered pharmaceu­tical samples and small apparatus, we

This inhaler was de­signed by a Professor of Midwifery at London's University College, Ed­ward William Murphy, M . D . ( 1802 - 1877). Murphy first described the inhaler in his 1848 text Chloroform in the Practice of Midwifery. Our donated Murphy Chloroform Inhaler was manufactured by Down Brothers, London, whose firm began producing surgical instruments in 1874. According to several medical antiques dealers, this particular inhaler was the first Murphy on the British medical an­tiques market in over 25

WLM Librarian Patrick Sim holds a Murphy Chloroform Inhaler donated in his honor by WLM Han. Curator George Bause (right).

years. Murphy Inhalers remain rare be­cause few were made and many were dam­aged- largely due to their small size and delicate construction.

Remarkably, the covel' illustration on K. Bryn Thomas' 1975 book, The Devel­opment of Anesthetic Apparatus, is a Murphy Chloroform Inhaler. Dr. Thomas observed: "Murphy's inhaler was a neat, compact piece of apparatus, one of the first to appear as an alternative to the use of the 'corner of a towel' advoca ted by Simpson. Its efficiency cannot have been high, since the amount of chloroform al­lowed was very small and ail' was admit­ted freely. Nevertheless it enabled Murphy (and, one hopes, the patient) to appreci­ate the effect of chloroform analgesia."

Remember, however, as rare as Murphy Chloroform Inhalers are, rarer still are great individuals like Librarian Patrick Sim. Dedicated, tireless, humble, gra-

spied a metal storage drawer. Inside were several nondescript posters on top of what looked like the corner of an elegant parchment. Excited but con­cerned about my filthy hands, I asked Patrick to extract the parchment. (The consummate professional, Pat always managed to keep his hands clean.) Imagine our excitement upon re-dis­covering a diploma belonging to John Snow, Father of Epidemiology and An­aesthetist to Queen Victoria. Beaming, Patrick spirited the priceless document up to the Rare Book Room.

My second story takes place soon after the W LM's move to 520 North Northwest Highway. We were in­formed that the Chicago Museum of Science and Industry was dismantling our "Conquest of Pain" exhibit. This exhibit was indeed painful-accessible only by a ramp into an elevated pod-like structure.

BULLETIN OF ANESTHESIA HISTORY I 3

Having moved furniture professionally one summer, I volunteered to save the WLM some money by dismantling the ex­hibit cabinets and carting both them and the anesthesia apparatus back to Park Ridge. To Patrick's amusement, I an­nounced that this should be a relatively simple mission. He arranged for a mov­ing van and bravely agreed to "ride shot­gun" while I drove. Well, Patrick and I had the indescribable joy of inching a 35-foot moving van northbound on the bumper-to-bumper Dan Ryan Expressway in the middle of a Chicago snowstorm. Soon after this experience we both sprouted gray hair.

In the seal he designed for the Ameri­can Society of Anesthesiologists (ASA), WLM Founder Paul Wood, M.D., in­cluded a lighthouse of dependable knowl­edge. For thirty years that lighthouse has been tended by a faithful keeper-Librar­ian Patrick Sim. Patrick embodies all that is proud in the "service specialty" that is anesthesiology. His tireless self-sacrifice, his humility, and his quiet perseverance are lessons that few of us have mastered. I join all members of the ASA in saluting the wisdom and grace of W LM Librarian Patrick Sim, M.L.S.

MUiphy Chloroform Inahler

1 4 BULLETIN OF ANESTHESIA HISTORY

From the Literature by A.J. Wright, M.L.S. Department of Anesthesiology Library, University of Alabama at Birmingham

Note: In general, I have not examined articles that do not include a notation for the number of references, illustrations, etc. I do examine most books and book chapters. Books can be listed in this column more than once as new reviews appeal: Older articles are included as I work through a large backlog of materials. Some listings are not directly related to anes­thesia, pain 01' critical care but concern indi­viduals important in the histmy of the specialty [i.e., Harvey Cushing). Non-English articles are so indicated. Columns for the past several years are available in the 'Y!nesthesia Histmy Files" at http://www.anes.uab.edu/aneshist/ aneshist.htm as "Recent Articles on Anesthe­sia HistOlY. " I urge readers to send me any citations, especially those not in English, that I may otherwise miss/-A.]. Wright ajwright@uab.edu

Books Boon MB. The Road to Excess: A History of

Writers on Drugs. Ph.D. dissertation, New York University, 2000. [includes anesthetics]

Fenster JM. Ether Day: The Strange Tale of America's Greatest Medical Discovery and the Haunted Men Who Made It. New York: Harper Collins, 2001. 278pp. [rev. Musto DE New York Times 12 August 2001]

Fink BR, McGoldrick KE, eds. Careers in An­esthesiology, Autobiographical Memoirs, Volume 4. Park Ridge, Ill.: Wood Library-Museum, 2000. 1 8 1pp. [rev. Ellison N. Anesth Analg 93:520, 2001]

McKenzie A. A History of Anaesthesia through Postage Stamps. Edinburgh: Maclean Dubois, 2000 [rev. Ball C. Anaesth Intens Care 29(4):443, 2001]

Safar P. Careers in Anesthesiology: An Auto­biographical Memoir, Volume 5. Park Ridge, Ill.: Wood LibrarY-Museum, 2000. 397pp. [rev. Finestone SC. Anesth Analg 93: 805, 2001]

Sarat A, ed. Pain, Death, and the Law. Ann Ar­bor: University of Michigan Press, 2001. 168pp. [Rev. Kessler M. Law and Politics Book Review 12:412-415, August 2001. Primarily pain in con­nection with capital punishment]

West JE. High Life: A HistOlY of High-Altitude Physiology and Medicine. New York: Oxford Uni­versity Press, 1998. 493pp. [rev. Cueto M. Isis 92(1):141, March 2001]

Articles and Book Chapters Ali HM. Ten years of sanctions against Iraq: a

personal experience in anaesthesia. Acta Anaesthesiol Scalld suppl 1 1 5: 44, 2001 [abstract]

Ball C, Westhorpe R. The history of intrave­nous anaesthesia: the barbiturates. Part 2. Anaesth bUens Care 29(3): 2 1 9, June 2001 [6 refs., I illus. Cover note]

Ball C, Westhorpe R. The history of intrave­nous anaesthesia: the barbiturates. Part 3.Anaesth lmens Care 29(4): 323, August 2001 [3 refs., 1 illus.

Cover note] Ball C, Westhorpe R. Intravenous equipment­

the ongoing development of the syringe. Anaesth llltens Care 28(2) :125, April 2000 [3 refs., 1 illus. Cover note]

Bause H, Lawin P, Opderbecke HW, Schuster HP. History of the development of intensive care medicine. Part 9: architectural development of in­tensive treatmentwards.Anaesthesist 48(9):62-653, September 1999 [German]

Bello CN, Torres MLA. Roberto Simao Mathias. Rev Bras Anestesiol 50(5):415, September-October 2000 [portuguese; obitualY]

Besson JM. Merci, Professeur P.D. Wall. Pain suppl 6: s3-s4, August 1999

Brown K 1\vo worlds of anaesthesia: east meets west, north meets south. Acta Anaesthesiol Scalld suppl 1 15: 44, 2001 [abstract]

Brunton D. A question of priority: Alexander Wood, Charles Hunter and the hypodermic method. Proc Roy Call Physicians Edillb 30:349-351, 2000 [30 refs.]

Burney IA. Fatal exposures: anesthetic death and the limits of public inquiry. In: Burney IA. Bodies of Evidence: Medicine and the Politics of the English Inquest 1 830-1926. Baltimore: Johns Hopkins University Press, 2000, pp 137-164 [76 refs]

Capobianco DJ, Boes CJ. John Locke and the case of Lady Northumberland: a new key to Locke. Headache Q 1 1 (4): 292-294, 2000 [8 refs.]

Carranza R. In memoriam: Dr. Irene Assimes. Newsline: McGill Anethesia Newsletter summer 2001 pp30-31 [1 illus.]

Cohen S, Trnovski S, Zada Y. A new interest in an old remedy for headache and backache for our obstetric patients: a sphenopalatine ganglion block. Anaesthesia 56: 606-607, 2000 [4 refs.]

Dubner R. A tribute to Patrick D. Wall. Pain suppl 6: sl, August 1999

Dunwoody C, Dunajcik L, Edwards A, Ryder L, Sikorski K. In memoriam: Jean Adrienne Guveyan. Pain Management Nursing 2(2):37, June 2001 [1 portrait.]

Ekiert LJ. Historia lekow uspokajajacych i nasennych. Archiwum Historii I Filozojii Medycyny 63(3-4): 126-128, 2000 [Czech]

Elwood PC. Aspirin: past, present and future. Clinical Medicine 1 (2):132-137, March-April 2001

Frolich MA, Caton D. Pioneers in epidural needle design. Anesth Analg 93:215-220, 2001 [21 refs., 2 illus., 1 table]

Gallagher RM. Perry MacNeal, M.D. Physician, teacher and gentleman 1 9 1 3-1997. Headache Q 8(4):353-354, 1997 [1 portrait]

Gates P, Lawrence G. Morton kills pain. In: Gates P, Lawrence G. The History News: Medicine. Cambridge, Mass.: Candlewick Press, 1997, 16-17. [Illus.; juvenile]

Goerig M. The Eppendorf University Hospi­tal, Hamburg-a cradle of German-speaking an­esthesia? Anasthesiol lntensivmed Notfallmed Schmerzther 34(10): 603-615, October 1999

Gunn IP. Pearl Harbor, the Korean Conflict, and COL Mildred Irene Clark. AANAJ 68(6):487-490 [4 refs., 1 illus.]

Hameroff SR. Anesthesia. In: Brockman J, ed. The Greatest Inventions of the Past 2,000 Years. New York: Simon and Schuster, 2000, pp 94-98

Hunt L, Jacob M. The affective revolution in 1790s Britain. Eighteellth-CelltUlY Studies 34(4):491-521, 2001 [135 refs., 2 illus. Includes discussion of the Bristol nitrous oxide experiments and the par­ticipation of Gregory Watt, Humphry Davy, and Thomas Beddoes.]

Kampine JP. David C. Warltier, M.D., Ph.D., to Receive 2001 Excellence in Research Award.

ASA Newsletter 65(8):13, 21, August 2001 [1 por­trait]

Lassio A. Molecules, Miracles and Medicine. St. Louis: Warren H. Green, 2000. 89pp. [Includes historical material on morphine, procaine, aspirin, and diazepam]

Lee MR. Wiliam Withering (1741-1799): a Bir­mingham lunatic. Proc Roy Call Physicians Edillb 3 1 :77-83, 2001 [21 refs., 6 illus. Withering was a member of the Lunar Society, which supported Thomas Beddoes' Pneumatic Institute in Bristol and thus the early nitrous oxide experiments]

Martini J, Vasdev G, Harrison B, Martin D, MacKenzie R. The evolution of the epidural needle: was it Thohy's or Huber's design? IIltJ ObstetAnesth 10(3):249, July 2001 [7 refs.; abstract]

Maurizio B. I;analgeisa locoregionale nella practica ostetrica com pie cento anni. Lalltel'llino 24(1):1 6-19, 2001

McGoldrick KE. Lewis H. Wright Memorial Lecture: Dale C. Smith, Ph.D., to Discuss �naesthetists: Arguments, Attainments and Au­thority, 1870-1920.' ASA Newsletter 65(7):8, July 2001 [1 portrait]

McKenzie AG. The discovery of the pain path­ways of labour. lilt J Obstet Anesth 10(3): 253-254, July 2001 [9 refs.; letter]

Meek T. Anaesthesia in an unusual location. Anaesthesia 56: 608-609, 2000 [2 refs., 2 illus. Trichloroethylene in a home workshop]

Morgeli C. Die Werkstatt des Chirurgen: zur Geschichte des Operationssaals. Basel: Editiones Roches, 1999. 3 19pp. [includes material on oper­ating room history]

Neto GFD. Brazilian Journal of Anesthesiol­ogy, more than fifty years old . . . now BILINGUAL. Rev Bras Anestesiol 5 1 (1):1, 2001

Ouellette SM, Caulk RF. The International Federation of Nure Anesthetists: 10 years later. AANAJ 68(3): 209-214 [4 refs., 5 tables]

Pelis K Transfusion, with teeth. In: Bud R, Finn B, 1tischler H, eds. Manifesting Medicine: Bodies and Machines. Harwood Academic Publishers, 1999, pp 1-30 [114 refs., 7 illus. Describes transfu­sion work ofJ ames Blundell]

Pelis K Blood standards and failed fluids: clinic, lab, and transfusion solutions in London, 1868-

Continued all page 16

The Book Corner by Peter McDermott, M.D., Ph.D.

Book reviews: Crisis in the Corner: A Reviewer Opines The editor of the book reviews for this

publication is distracted. He has lost con­fidence in his ability to evaluate books and present them to potential readers. Should he guide others to read the books he likes? Should he warn them about books he hates? Are the readers of this Bulletin so starved for information about the history of anesthesia that their nutritional re­quirements are not met by the contents of this quarterly publication? Hasn't every­thing worth writing and reading already been published? Must we continue what Donald Kelley has described as "a passion­ate assault upon a refractory past"? Should we not rather see historians as Virginia Woolf did, as those who "address an audi­ence of ladies in hoops and gentlemen in wigs - a vanished audience that has learned its lesson and gone its way. We can only smile and admire the clothes." Why not look at the past - look at history - and declare it irrelevant? Better still, why not declare a victory and move on. Isn't there something pitiful and unhealthy about retrospection? Are we but a group of very old people reading of the lives and deeds of the truly dead? Does anyone seriously believe that the past really inspires or in­forms?

Jackson . . . Continued from Page 7

Dr. Walls: Assisted Dr. McGuire and tied the blood vessels

Dr. Smith: Assisted Dr. McGuire and held the light above the table

Within a short time after termination of the surgery, General Jackson awakened and spoke briefly and with clarity with one of his adjutants. Because of the closeness to the enemy action, Jackson was moved to a safer place, the Chandles House at Guineau's Station. Dr. McGuire then states, "I found his wounds to be doing very well to -day (sic). Union by the first intention, had taken place, to some extent, in the stump, and the rest of the surface of the wound exposed, was covered with healthy granulations. The wound in his hand gave him little pain, and the dis-

Reason and truth exist only in the present. The past is a mass of endless dis­tortion and misunderstanding. The future is so nebulous that prediction or specula­tion is worse than idle. Emerson warned of the dangers of revering the past at the expense of the present: "Man postpones or remembers, he does not live in the present, but with reverted eye laments the past, or, heedless of the riches that surround him, stands on tiptoe to see the future." Why not settle back and watch the bowling channel?

Well, I suppose even anesthesiologists grow restless and discontented with the present. Tense, even. Perhaps the static and immutable nature of the past is at­tractive to clinical physiologists and phar­macologists who spend many of their wak­ing hours in a state of dynamic disequi­librium. Perhaps the relative newness of the specialty is an incentive to create a tra­dition out of rather thin historical mate­rial. Perha ps the past is cynically exploi ted to validate the present, valorizing and magnifying the accomplishments of a few, unremarkable individuals in order to cast a better light upon the present. Perhaps I'm just cranky.

Some of the defects in writing of, by,

charge was healthy." However, early on Thursday morning Dr. McGuire was called because General Jackson was in great pain. He was diagnosed as having pleuro-pneumonia of the right side and all the consulting physicians agreed that it was attributable to the fall from the litter, with contusion of the lung taking place. He was given mercury with antimony and opium and cups were applied. On Friday, he appeared better and was visited by his wife and child. On Sunday morning, his wife informed him that his recovery was very doubtful.

A few moments before he died, he cried out in his delirium, "Order A.P. Hill to prepare for action! Pass the infantry to the front rapidly ! Tell Major Hawks" -then stopped, leaving the sentence unfin­ished. Presently, a smile of ineffable sweet­ness spread itself over his pale face, and he said quietly, and with an expression, as if of relief, "Let us cross over the river, and rest under the shade of the trees," and then

BULLETIN OF ANESTHESIA HISTORY 1 5

and for an audience of anesthesiologists relate to the genre selected and the objec­tives of the author. Autobiographical con­tributions are invariably self-serving: "no one knows me as well as I do and here are all the good things I can think of to say about my self."

Biographies too often take their sub­jects out context and idealize them. Rinsed of their humanity and detached from the events of their time, they are as artificial as museum pieces. Stories of discoveries in science and medicine are frequently couched in triumphalist language -"progress" is not only portrayed as a fact but as an inevitability. Real history is a litany of failures, false starts, and misun­derstandings punctuated by the rare happy accident or insight. A history of conclu­sions and results is a skeleton without meat. Then there is "history-redux." One more story of the same old thing using the same old sources.

A book review is a conversation between the reviewer and the text to which the reader is privy. That discourse must be one of respect and reciprocity and it should nourish the soul. When I discover a book worthy of your attention, I'll invite you to the banquet.

without pain, or the least struggle, his spirit passed from earth to the God who gave it. (fig. 12) 1 3

Who knows how the outcome of the Civil War might have changed had Stone­wall Jackson survived?

References 1. Robertson, J I , Jr. : S tonewall J a ckson.

MacMillan Publishing, New York, 1997, p. 950. 2. Farwell, B; Stonewall - A Biography of Gen­

eral Thomas J. Jackson Company, New York, 1992, P. 560.

3. Tanner, RG: Stonewall in the Valley. Doubleday and Company, New York, 1976, p. 436.

4. Hassler, \VW: Dr. Hunter Holmes McGuire: Surgeon to Stonewall Jackson, the Confederacy, and the Nation 32:52-61, 1982.

5. Schildt JW: Hunter Holmes McGuire-Doctor in Gray, Chewsville, 1986, p. 135.

6. Hunter Holmes McGuire, M.D., LL.D. Un­veiling a Statue in the Capital Square, Richmond, Va., January 7, 1904. With the Addresses Deliv­ered on the Occasion. Southern Historical Society Papers, Edited by R.A. Brock, Secretary of the Southern Historical Society, 31:248-266, 1903.

7. Aldrete JA, Marron GA, Wright AS: The first administration of Anesthesia in Military surgery.

Continued on next page

1 6 BULLETIN O F ANESTHESIA HISTORY

Jackson . . . Continued from Page 15

On occasion of the Mexican-American War. Anes­thesiology 60:585-588, 1984.

8. McGuire HH: Southern Historical Society Papers 1 3:323, 1 885.

9. Cunningham HH: Field Medical Services at the Battles of Manassas (Bull Run). University of Georgia Monographs. No. 16 Athens, University of Georgia Press, 1 968, p. 1 16.

10. Gillett MC: The Army Medical Department 181 8-1 865, Washington, D.C., Center of Military History, United States Army 1987, p 371.

1 1 . McGuire HH: Progress of Medicine in the South. Southern Historical Society Papers. XVII: 77:2-21, 1 889.

12. Early JA: Wounding of Stonewall Jackson. Southern Historical Society Papers. 6:267-282, 1878.

13. McGuire HH: Last wound of the late Gen. Jackson (Stonewall) - The amputation of the arm ­his last moments and death. The Richmond Medi­cal Journal, May 1 866.

Literature . . . Continued from Page 14

1916. HistOlY o/Science 39(pt. 2, no. 124), June 2001 Pembrook L. International Anesthesia Re­

search Society celebrates 75 years. 27(6): 1, 28, June 2001

Quintner JL. From neuralgia to peripheral neu­ropathic pain: evolution of a concept. Reg Anesth Pain Med 26(4):368-372, July-August 2001 [43 refs.]

Rushman G. Obituary: Richard Stuart Atkinson, aBE. Anaesthesia 55:416-417, 2000 [1 portrait]

Bulletin of Anesthesia History Doris K. Cope, M.D., Editor 200 Medical Arts Building 200 Delafield Avenue, Suite 2070 Pittsburgh, PA 15215

Schwarz A. The mercury sphygmomanometer and its inventor. Scalpel & Tongs 45:28, March-April 2001

Severinghaus JW, Priestley, the furious free thinker of the enlightenment. Acta Anaesthesiol Scand suppl 1 l5: 33, 2001 [abstract]

Spielman FJ. The Civil War: anesthesia comes of age.J Civil War Med 5(2):9-12, April-June 2001

Spielman FJ. Transplantation surgery: moment of truth.AmJ Anesthesiol 28: 243-245, June 2001 [3 refs., 1 illus. Art and Anesthesia series]

Sternbach GL, Varon J, Fromm RE, Sicuro M, Baskett PJ. Galen and the origins of artificial ven­tilation, the arteries and the pulse. Resuscitation 49(2):19-122, May 2001 [20 refs.]

van Ackern K. Prof. Dr. Bernd Landauer zum 60. Geburtstag.Anasthesiologie Intensivmed 41: 868, 2000 [1 portrait]

van Ackern K. Prof. Dr. Klaus Geiger zum 60. Geburtstag.Anasthesiologie Imellsivllled 41 :870, 2000 [1 portrait]

Weeks S. In memorial: Dr. Paul Edward Otton. Newsline: McGill Anesthesia Newsletter summer 2001, p. 32

Wetchler BV: Thomas Drysdale Buchanan or Henry Isaiah Dorr: give credit to both.Anesthesiol­ogy 95(1): 271-272, July 2001 [7 refs.; letter]

Yates DW, Can deficiencies of trauma care be identified and treated-changing patterns of trauma care in UK hospitals from 1988 to 1997. Acta Anaesthesiol Scalld suppl 1 15: 43, 2001 [ab­stract]

Yuesha Y, Fanzhi Z. Contribution of Soranus

RECEIVED

O C T 2 9 2001

ASA

Wood Library-Museum of Anesthesiology 520 N. Northwest Highway Park Ridge IL 60068-2573

of Ephesus on Apgar score. Chung-Hua I Shih Tsa Chih 3 1 (2): 1 l 0-1 l2, April 2001 [Chinese with En­glish abstract]

Bulletin of Anesthesia History Editor sighted in Santiago de Compostela, Spain

While attending the Fifth International Symposium on the History of Anesthesia (ISHA), held September 19- 23, 2001, in Santiago de Compostela, Spain, Dr. Doris Cope was interviewed by the local paper, La Thz de Galicia. Please look for more photos and a synopsis of the Symposium in the January 2002 issue of the Bulletin of Anesthesia HistOlY.

"No tenemos miedo. " We are not aft·aid.