Volume 9b - History of Anaesthesia Society

ANAESTHESIA SOClETY *-

Dr T R Boulton 

Tie role of George Washington Crile in the 

developnent of anaesthesia 54 

Dr A Csrreq?l et (31 The first 135 ather anaesthetics in Spin 59 

Dr E T 'Int?7?'is 

Henrv Walter Featherstone; first President 

of the Association of Anaesthetists of 

Great Rcitain and Ireland 62 

Prof H EbLlrer e t 11 Cerebral anaemia for anaesthesia induction 66 

Dr I: ileiss?r at a1 

Martin rtirschner's spi~al zon? anaest%esi.a 68 

Dr J J3erLj.n et 31 The history of hypnosis in anaesthesiolocg 71 

Dr :*I Goeri? et 31. Th? contributions of L Rurc'khardt and 

H I(1nnnel1 to intravenous anaesthesia 76 

&.?E H Ro5rer et aL Crimiial confe~sions under the influence 

of anaest!~etic agents 82 

Dr ?I Yus Cardiac resuscitation in Bland 84 

Dr R Patterson 

Dr M Goerig et sl 

European imprimatur of an American 

discovery 

Georg Hirschel and Didrich Kule-ff: 

pioneers of local anaesthesia 92 

Dr L Vazrruez et .%l !The early ue of chloroform in win 94 

ClhitUdry - Profsssor A Hunter 

An appreciation by Dr J M Horton

Dr T B -ton 

(Oxford) 

George Washingtan Crile (Fig.l), the founder of the mrld renawntd 

Cleveland Clinic in Ohio, wss one of the great pioneers of modern 

surgery. The Mayo brothers and Harvey Cushinq were his contemooraries in 

the United States and, in some mys, he was more fmus and influential 

in his own corrntry than they were. 

Olildhcad and edmaticn 

Crile was the son of an industrious and successful fanner. He was km 

near the smsll tawn of Chili in Ohio in 1864 and mrked his my t:~rough 

college and medical school by doubling as a school teacher. He ms 

awarded L9e MD degree by the Wmster Mdic31 SCao01 in Cleveland. Tnis 

mall insvtution ms later absorbed into the Western Reserve 

University. 

Crile's underqradu-ltn medical 

studios had consi.jt,& of an 

a~prenticeshin Issting a year, 

followed by a tot21 of eight 

mnths of didactic instruction 

spread over two years. Yedical 

courses as short as this were 

not unusual in the (JSA in the 

1383's. 'he Wooster School did 

rlot psssss a microscope and 

Crile had to assist in 

resurrecting cadavers for 

dissect ion f ran pi ipr graves. 

He seems to have been c e l l 

satisfied with the tuition he 

had received rorn fledicated 

tutors 11m~ver. 

f 

mly mqical career 

Crile joined a surgical 

practica in Clevel3nd soon 

after q~alification at what he 

$ describes as the 'hqrse and 

' \ /W .P! hignl era of surgery. 

Hospitals were smal-l and basic 

and many operations were 

carried out irl the ytients' 

beds or on the kitcnen tables 

in their am hhome. me 

surqery of tram fmin 

Fig.1 Gmrge Qile industrial accidents fc1nu?-1 a

l?rqe prorxrtion of surgical practice at the time. Severe tra~mtic 

shock, far which treatment was very elementary, was cmnplace and 

often fatal. The nature of shock, the aetiology of which was not 

~mderstmd w:l?n he q~slified, and its treatment became a life-long stlldy 

for Crsle. 

Clorton's s~mhal dermnstration of ether anaesthesia in 1846 had enabled 

surgeons to carry out 'xdy surface and orthopedic operations, which 

they had Wen undertaking without anaesthesia, with greater facility, 

but the dan~er of sepsis prevented further surgical developat. TFle 

extension of the surrlfeon6s territory, particularly into the aMomen, 

had to wait the developent first of Lister's antiseptic technique in 

the 10601s, and later of aseptic smjery. Crile had the benefit of these 

discoveries then he started to practice in the 18RO's at a time when 

sirjery was rapidly developing: For example, Reginald Fitz had descri 

t3e surnicsl treatment of appendicitis the year before Crile qualified 

9 

and he w,3s an early protagonist of the technique, despite his youth and 

the consh-ierable controversy surrounding the operation. Crile carried 

out tnany major procedures in the 901s, including early laryngectcmies 

and thyroi3ectomies but these operations required deep and greatly 

prolonged etherisation and also occasioned greater blood loss than had 

hen pr4eviously experienced; in the a'osence of intravenous fluid 

replacement, the danger of postoprative shoc!c in elective surgery was a 

constant :ntentF?~l hazard which frequently resulted in a fatal outcame. 

Crile's interest in the prohlem was stimulated further and he began 

an- l research in primitive surroundings. l 

George Crile was an officer in the Reserve, and he was therefore called 

upn to serve in the Spanish-American war of 1898, when Cuba was 

liberated frm wish control and Puerto Rico was ceded to the United 

States. The standard of :IS Army hygiene was low and many soldiers died 

of yellow fever and dysentery. Crile greatly reduced the rate of 

infection in the rmits which were his immediate responsibility by 

insisting on elementary preventative measures. l 

CMparatively few soldiers were wounded in the fighting, but Crile 

mentions one case of ruptured spleen in a troopr who was kicked by a 

horse. The only resuscitative fluid available was saline administered 

subcutaneously. Crile re~rted that the patient survived the operation, 

'but tells us laconically that what he described as the 'inevitable 

change1 occurred some hours after the operation, and the patient died.' 

The kinetic theory of shock and anoci-association 

Crile returned to civilian practice and %came an Associate Professor at 

the bkeside Hospj~in 1901 and developed what he called the kinetic 

theory of shxk. He b c m convinced that shock was the result of 

exha~~stion of the brain as a result of bombardment with nociceptive 

stimuli origimting both from the tramtic wound or the operation site 

and as the result of fear.

He thereEore advocated very gentle surgery in conjlmction xith simple 

local infiltration with procaine to block off the impdses coming from 

the part on which he was operating, and he combined this with generql 

anaesthesia with nitro~ oxide to elimimt? the nociceptive effect of 

fear. He called this technique moci-association. 

The prxedure in 

aWcminal cases was layer by layer infiltration - skin, 

s1'9f2ne0us 

fat, rnilscle, peritoneum, and the mzsentery of the t3rgt orgms. 

Patients operatd on under anoci-association recovered more rapidly and 

had less ~stoprative shock than those ho had had surgery under deep 

ether. The latter did W-11 enough during the opration under the 

symp~thetico~tic stimulus of etherisation ht, in the a5sence of 

fluid replacenent, became shocked in thr? long recovery p2rid before 

autonomic control of Cqe perip~eral vascular system ;.ms restsred; in 

contrast, tine ptients who had had their suirqery under anoci-association 

recovered their vascular tone mfiidly and camparatively quickly 

compensated for their hypovolaemia. Crile did not see it this w3y, 

however; he believed that nitrous oxide had a protective effect on the 

brain, whereas ether did not. He was rather unfair in contrasting 

'nitro~ls oxide1 and 'ether', as he often did in his papers; in fact, the 

nitrous oxide was often e riched with a little e,ther, especially for the 

closure of the a ~ r n n . ~ ~ ~ 

What Crile had act~mlly done was to prcduce a form of what is now called 

'%lanced anaesthesia'. If anoci-association is considered in relation 

to Gray's now familiar triad of an< 3thesi.a (unconsciousness, reflex 

suppression and muscular relsxation) it can be seen that, in Cri.le9s 

anoci-association technique, reflex su.npression and relaxation are 

largely taken care of by local anaesthesia, enabling ~mmnsciousness to 

be maintained by very light anaesthesia. 

John Lucky of the myo Clinic actually originated the term 'tnlanced 

anaesthesia' in 1936 but his technique of 'a moderate amount of 

preliminary hypnotic, a morlerate amount of local anaesthetic, a derate 

amount of nitrow oxide or ethylene and a sufficient anount of ether to 

obtain the desired result1 apparently owas much to Crilels ideas;=of 

course, if you ask the present day examiqation candidate 'what is meant 

by balanced anaesthesia ?', you \rill be referrad to tne nitro:ls oxide, 

oxygen, muacle relay, technique, which Gr2y originally called 

'selective anaesthesia . 

Crile and his assxiates undertook extensive animal work using 

trawtised dogs. They came to tile conclusion that they could 

demonstrate actual histoloqical changes in the brains of t e a imls 

which they believed to have been caused by nociceptive stinuli l 3 0 1 Bit, 

as rmon pointed out in thc 19201s, the hyperchrornatic and chrmlytic 

changes which they observed were identical with t%ose of extreme 

cellular hypxia due to c?oillary stasis which is the primary lesion in 

shoc!c, whatever the callse .'

Qile's use of blood transfusion 

Crile w3s one of the earlier users of bld transfusion in the &ern 

era of surgery; hogever, he regdrded it as an adjunct to the treatment 

of tra~mtic and pstop?rative shock rather than a first-line 

tqerapeutic method. He also tried blood transfusion as a pssible 

treatment for a nwkr of other conditions, including thyrotoxicosis, 

tukercmlosis in cattle, the treatment of sarcm an with 

justification, in tbe treatment of carhn nmoxide poisoning. 1n':4~9 

In orcler to aapreciate Crile's use of blood transfusion, it is important 

to realise that ,alrqough Landqteiner reprted the existence of blood 

groups in 1101, it was not until the work of Jansky in Bohemia (now 

prt of ech~slovakia)~' and of Moss at Jobs Hopkins Hospital, 

Fmltimre.8 working indemndently alrost a decade later, that crossmtching 

k.zame a practical propsition, and not until ustin reported 

t!le use of citrate that anticoagulation was practicable. 1!4 

Crile's earlier transfusions were made before cross matching or 

anticoagulation Iiere available. lie ernployed the direct donor to patient 

method, usually connecting donor radial or ulnar artery to the patient's 

hasilic vein. He was not the first to use this technique but the 

technical pro'hlem had always been clotting in the connecting cannula . 

mile overcame the difficulty by designing a very short cannula; 

by cuffing tile vessels, allowed direct intima to intima continuity. 

If consider,lt,ion is confined to AB0 group compatibility, the chances of 

a cornatible transf!lsion are abut 60% in a European ppllation. Crile 

naturally had complications but the mortality frm incanpatibility was 

I:RIC~I loger than might have keen expected - presumably because of the 

relstively simll amounts of blood transfused before the transfusion was 

disconti:lu~id. T'le quantity of blood transfused was variable: some pf 

Crile's transfusions resulted in serious exsanguination of the donor ! 

Later, when the anticoagulant properties of citrate had become known, a 

combined jlass container and cant-lula r a used. Positive pressure was 

applied with a Aiq~inson's syringe;lr' great care must have been 

necessary to avoid air ehlism ! Modern drip chamber intravenous 

infilsions ere not introduced until 1935 wh n Marriott and Kekwick 

pblished their classic mpsr in the 'Lancet'. 12 

clrile in the Great war 

Crile intrduced bth his anoci-association technique and blood 

transfusion Wen i.le served with an American civilian team in France fran 

1914 to 1315 soon after the start of the Great rmr, lcut it tms not irntil 

he returned as an lkmy surgeon when the United States came into the war 

in 1717, that ile succeeded in establishing its use in American and 

British military hospitals. l

George Washington Crile (1864-1943) ran'cs amongst the very greatest 

surgeons. he had a p asant personality and was not afraid to 

acknwledge his mistakes? The list of his achievenents as a surqeon is 

lengthy, ht he also certainly deserves an honoured place in tie histsry 

of anaesthesia. 

Crile G.M. George Crile. An a~ttobioqraphy edited with sideliqhts 

by Grace Crile. Philadelphia: Lippincott, 1947. 

Fitz RH. Perforat* inflmtion of the vermiform appendix. 

American Journal of Medical Sciences 1886; 92: 321-346. 

Crile GW,Lower WE. Surgical Shock and the Shockless Operation 

through Anoci-Association. Pniladelphia: Saunrlers 1914. 

Crile GW, Lower WE. Sugical Shoclc and the Shockless Operation 

thmugh Anoci-Association. 2nd.Mn. Philadelphia: Saunders 1320 

Gray T. Disintegration of the nervous system. Clover Lecture. 

Annals of Royal College of Surgeons of EngLand lc154;402-419. 

bmdy JS. Balanced Anesthesia. Minnesota Medicine 1926;9:399-405 

Gray E. A reassessment of the signs of anaesthesia. me Irish 

Journal of Mica1 Science 1960; 419: 499-508. 

Cannon WB. !Traumatic Shock. New York: Appleton,1923: 115-120. 

Crile GW. Haemrrhage and Transfusion. An exprkntal, and 

Clinical Research. New York: Appleton, 1909. 

landsteiner K. Ueber agglutinationserscheinungem nomlen mensh 

lichen Blutes. Wiener kliniscbe \iochenschrift 1901; 14:1132-1140 

Jansky J. Etude Hernatolcgiques, dans les mal3des mentales. 

Sbornik Klinicky Praze 1907; 8: 85-139. 

Wss \a. Studies on isoagglutinins and isohemlysins. Bulletin of 

the Johns Hopkins Hospital 1991; 21: 63-70. 

Hustin A. Note sur une nowelle rnethode de transfusion. Bul1.Soc. 

male de la Science de Medicine de Elruxelles 1914;72:104-11. 

Marriot HL Keckwick A. ContL?uous drip blood tranfusions with case 

records of very large transfusions. Lmcet; i: 977-991. 

Anonynous. In menvsriam George Washinton Crile 1564-1943. 

British Jourml of Surgery 1942-1943; 30: 353-354.

Drs A Carregal, S Boveda, M Cid, A Rmco (Santiago de CXmpstela) 

A search of t!~e daily scientific press of Barcelona and mdrid for the 

year 1847 throws light on the introduction of sulphuric ether in Spain 

and the chronology of the first surgical operations performed with this 

anaesthetic. 

Perusal of the Madrid press for 1947 shows that, contrary to some recent 

as~ertionsl-~ the first surrjical, operation carried out in Spain under 

sulphuric et'7er was performed on January 13th of that year by Fmfessor 

Ar-~umoq-Obregan in the Surgical Clinic of the Faculty of Medicine in 

Madrid, ad consisted of lancing and draining a neck abscess. 

Eie:is of tie discovery of this anaesthetic arrived in Spain by several 

route?. Te,, accordiig to the 'Gac,?ta Medica'of Madrid of February 10 

1847, orlglnatd from Dr Forbes, editor of the 'British & Foreign 

hledical Review', who wrote from London to one Senor Barron in Madrid 

who,in turn, cmlnicnted the news to Professor Arqumsa. As well as the 

above operation, ?W.pmsa carricd out at least two others in January, 

with resillts that were not entirely satisfactory. 

Tie first pblic announr:ement in Spain of the discovery of ether 

anaes hesia was made by the Madrid newspaper 'La Opiniont on January 14, 

1847.' in an itsm on Liston's first enpriments. This was followed on 

January 24 by a mre extensive article in the same newspaper describing 

the oprations c;lrrietl out in London in December 1M6 and at the 

beginni-ng of January 1~47.~ The oprations prformerl by Professor 

Arcpmsa tiere mentioned by the scie tific press of Madrid, spcificall 

'Anales de Cimgia' of January 24' and 'b Facultad' of January 283 

(altllough ~itiiout qiving dates), and were imnediately c~#ted on by 

the Madrid dailios 'El Poyxilar' on Friday January 29 and 'El 

Imprcial ' on Saturday January 30. 

L2eanruhile neds of the discovery was also sent £ran Boston to Oliver 

Machechan, a highly respected .lmerican dentist in practice 

According to the Madr'd dailies 'El Tiemp', January 28 

O@inion1, January 1h4 and 

'El Espectadort, January 

performed a nmhr of dental operations under ether, starting on January 

20; wz h ve recently reported this finding in a Spanish scientific 

mgazine . 4 

The news of ether also entered Spain via Barcelona, possibly via the 

English weekly 'T?le Illustrated London News ' , the JarIuary 9,1847 

which mentioned many of the first trials carried out in Ehgland. 

appears to have been these reprts that prompted Castells, Mendoza and 

otl~er rnernkers of the Faculty of Medicine in Barcelona to perform 

expriments on dogs, the results of which they presented to the Real 

Academia de Medicine y Cirugia de Barcelona on February 1, 1047. Later, 

on F&Lu~I~ 16, Professor Mendoza made the first clinical application of 

ether in %rcelona during a leg amputation; this operation was described 

in the Darcelona medical jowl 'El Wleqrafo Medico' February 1847 

issl~e'' and extensively comnented on in the Barcelona daily 'El

Fhnento8, February \$, and 18,18~19 and in the Madrid dpf;fts 

mplarl, February 23 and 'El Heraldo', Fetn-uary 24 and 25. 

'El 

me use of ether anaesthesia spread so rapidly through Spin that by the 

end of Etarch 1847 it had been employed by the great majority of Sp3nish 

surgeons. !The best documented series conprises 56 operations carried out 

in various cities on patients who were mostly aged under 40 years, the 

oldest being 64. Most of t!e operations performed constituted major 

surgery at that time, including a number of mastectomies and several 

amptations of l*; tooth axtracticms and a few self experiments also 

figure on the list. By contrast, we have been able to unearth very 

little infomtion about a group of 79 operations carried out in Madrid 

and Santiago de Cc~npostela. In Septar 1047, the Real kademia de 

Medicine de Madrid awarded Dr Basilio San-Martin a prize for a pper on 

ether in which he described 53 cases of ether anaesthesia, 16 of them 

experiments he carrisd out on himself while, in Santiago de Ccsnpostela, 

Professor Gonzalez Olivaries mentioned on several occasions his 

dissatisfaction with the results obtained in 26 operations with ether 

anaesthesia that he performed in 1847. 

In their first tri3ls of ether anaesthesia, Spanish surgeons 

addnistered it either with apparatu? desir~ned by themselves, or using 

devices that had become popular in other Wopean countries, such as 

those developed by Luer and Charriere (with or without modifications by 

the users). The ad hoc apparatuses designed by Mendoza and Arqnmsa were 

described in detail in the literature, but without illustrations. 

In conclusion, the date of Argwmsals first operation with ether 

anaesthesia in Wrid, January 13 1R47, makes *in the fourth country 

to have employed this anaesthetic, the first three having keen United 

States, United Kingdan and France. We now know about many of the first 

Spanish trials thanks partly to the surgeons who reprted their findings 

in scientific publications, and partly due to the great interest aroused 

by the subject of anaesthesia mng the general pblic, which was echoed 

in the daily press of the time.

References 

Garcia del Real E. Early surgical anaesthesia in Spain. Brit.Med 

Bull. 1946; 4: 146-147. 

Paltar Dami1guez R. Deciamos ayer.(II)Rev.Med.Galicia 1963;3:89-95 

Palboa hoiteiro JM. 1347 Comienza la anestesia en Santiago de 

Compstela. Rev.Esp.Anestes.Rean.1971; 19: 329-332. 

Franco Grande A et a1.Historia de la intoduccion de la anestesia 

eterea en Espma. Rev.Esp.Anestes.Rean.1991; 38: 102-108. 

U.F.deSohre la inhalacion eterea. Gaceta mica 1847;3: 25-27. 

Ex~rimentos quirurgicos. La Opinion,Madrid 14.2.1847. 105:2. 

Insensibilidad en 10s pacientes en las operaciones ... La Opinio, 

Madrid. 24.1.1847; 114:3. 

Descubrimiento imprtantisimo. Anal.de Cirurgia 1,%7;56:57. 

Del eter sul£urico.para adomcer...la Facultad 1847; 4:60. 

Novedad. El Popular, Madrid 29.1.1647; 196:4. 

El Noticioso de Madrid. El Impartial 30.1.1847. 873: 4. 

Gacetilla de Ikdrid. El Tiemp. 28.1.1847. 873:4. 

Gacetilla de Madrid. El Tiempo. 29.1.1847. 874:4. 

Seccion Taracea. La Opinion. Madrid. 31.1.1847; 120:4. 

Seczion variedades. El Espectador. Madrid. 31.1.1347; l42:4. 

Hervas Puyal C. La anestesia en Qtaluna. Tesis Doctoral.1986. 

Plendoza Rueda A. Efcctos de la inhalacion de ether..... 

El Telegrarafo Medico 1R47; 1: 56-58 

El Fomento, 17.2.1847 

El Fomento, 18.2.1847 

Novedad. El Popular, Madrid. 23.2.1847; 217:4. 

Amputation con el awilio del eter. El Heraldo, Madrid 24.2.1848. 

Operaciones pr el medio del eter. El Heraldo, Madrid 15.2.1847.

First President of the Association of Anaesthetists 

of Great Britain and Ireland 

Dr E T Mathews (Binningham) 

Henry Feat5erstone was born in Erdhgton on 5 April 1894; Erdinqton 

became part of Bimingham in 1912. His father was gensral practitioner. 

His mcther was the eldest daughter of a .succ~ssful lxlsinessman from 

Brmklyn, USA. She opened the Erdinqton Lamdry in 1998, u!lmadngly 

providing a generation of medical students with material for jokes about 

anaesthetists washing the surgeons' dirty linen. 

As a child he spent long sumner holidays in Brittany with a French 

family and learnt the language. He visited this family throughout his 

life and descrid their friendship as 'one of the joys of my life'. 

Henry was educated a t King Fdward's Sci1001, Birmingham, Trirlity College, 

Cambridge and the Binningham Weal School. He qualified during the 

Great War 1914-18. 

Service in the (;reat W 1914-18 

Featherstone joined the Royal Army Medical Corps (RAMC) and saw some of 

the terrible aspcts of the 1914-18 war. He was inedical officer to the 

7th Battalion King's Royal Rifle Corps who lost 500 of their origirlal 

strength of 530. He later spent Christmas 1917 in the advanced 3r~ssing 

station at Passchendaele, a place where in 21 days his unit lost half 

its effective strength. Later he was gassed. Iie always drscriSed this 

incident as 'slight' but he was unable to see for a time. Mtsr 3 w2eks 

in hospital in France, he was evacuated to England. His brother, who m9 

in the Royal Artillery, was killed. Henry spoke and wr&e of these 

events, and he subequently revisited the scen-s of his experience and 

maintained friendships with other survivors. 

Featherstone returned to Birmingham after the war and took up resident 

medical psts at the General Hospital. The-;e included that of Resident 

Medical Mficer, which was then the accept4 route to the post of 

Consultant mysician. Such a post had been his father's ambition ht, 

encouraged by Uf W J McCardie who was the first full-time provincial 

anaesthetist,' Xenry took up anaesthetics and was appointed Qsistant 

Anaesthetist in 1919 and Honorary Anaesthetist in 1926. Henry 

Featherstone had great admiration for McCardie, whose professional 

status at one time 'as such that he \ias consulted before the surgeon vms 

selected, and received fees equal to those of the surgeon. 

Featherstone's contributions to the literature included some 27 items in 

journals and chanters in 4 h&,. They covered a wide range of subjects. 

An early @per described a combined nnsk and airtmy and the Feafqerstone 

gag for oral surgery is still used. It has javs lined with soEt 97-

metal. His pper on the pu1,mnary c~nplications of anaesthesia was well 

received and this topic was also the subject of his MD thesis. He also 

had a special interest in explosive vapours, both in anaesthesia and in 

industry, and in this context he worked closely with the Chief of the 

Birmingham Fire Brigade. 

He was intr,ducd iqV> the Section of Anaesthetics of the Royal Society 

of Medicine (KSM) by IlcCardie, who had been its President in 1907. 

Featherstone himself becme President in 1930. He was also Vice 

President of t'le British Medical Association subgroup on anaesthesia, 

and played a leading role in the local medical societies of Birmingham. 

He was at one time President of Bmnhgham Medical Institute and also 

editor of the Birmingham Medical Review. 

Featherstone m& several visits to leading centres in Canada and the 

United States, sometimes with fellow members of the Royal Society of 

Medicine. He discuss4 with them and othar colleagues his concern abut 

the lowly status of anaesthesia, and he believed anaesthetists needed an 

independ-n-t organisation. Others agreed, but it was Featherstone who 

took action. Philip Helliwell has sunnnrised what Featherstone did: 

'Featherstone of Birmingham must be given credit for firstly conceiving 

and then providing impetus and organising ability, which led to the 

fomtion of the Association of Anaesthetists of Great Britain and 

Irel~ld'.~ He was elected its first President 1932-1935, and then held 

the office of Honorary Secretary 1936-1939. His description of these 

events was the first paper in the first number of the journal 

'Anaesthesia . 

Service in the Secad Warld War 

Featherstone was in the Territorial Army reserve. He was already in 

uniform and away at camp as the administrative officer of the 14th 

General Hospital when war was declared. This unit was sent to France on 

1 April 1940 with orders to set up a 1,000-bed tented hospital at 

Etai?le-; across the estuary from Le Touquet. Le Touquet still had its 

colony of English residents; they included Mr and Mrs P G Wcdehouse who 

gave the unit much assistance. meir gifts included a radio which becam 

the unit's only source of infomtian when the blitzkrieg began. The 

hospital mde ready to evacuate imnediately. Ihe convoy was dive-barnbed 

on t9e way to Boulogne and Henry and his colleagues had to take to the 

ditches, but the unit held toqether. They boarded the 'meen of the 

Channel', a London-Southend ferry, which was one of the annada which 

came to the rescrue. She took them safely to Dover, but she was sunk a 

few days later. The deEence of the jetty at Boulogne lasted a further 48 

hours. 

Back in England he had a variety of postings. When the Americans 

arrived, he vlas attac:~c+d to the United States Army as chief anaesthetist 

to a 1,000 bedded hospital. With his American background he enjoyed this 

pz~~tinfl, except that the final meal of L! day was at 5.30 p. He was 

US& to dining much lster and hunger woke him early each mming. His 

early rising impressed the American team. In preparation for the D-Day

landings, he was posted to teach airborne medical officers the use of 

chloroform, the only agent they were permitted to take with them, 

His m role for the D-Day landings was in camand of a hospital ship 

(Mspital carrier 64). In peacetd, she was the 'Amsterdam1 on the 

Harwich to Hook of Iblland route. He trained his teams thoroughly; they 

loaded and unloaded 300 Canadian sailors as mock casualties in simulated 

disasters. Frm D-Day onwards he worked fmn the Normandy landing 

beaches. The ship was anchored close in-shore as Casualty Clearing 

Station for Juno Beach, the scene of some of the heaviest fighting. Many 

of the casualties £ran Juno beach were French Canadians and, 

consequently, his ccm~nd of the language was useful. Featherstone's son 

landed on the adjacent Sword beach and was badly wounded. At 7am on 7 

August 1944 whilst sailing from Juno Beach to Southampton, the 

'Amsterdam' was shaken by two almt simultaneous explosions. 'The ship 

broke in two, and sank in less than a quarter of an hour. The training 

which the unit personnel had received was such that everyone behaved as 

if on another exercise. Over 200 of the 260 ptients were savd; what 

loss of life there was, was caused almost entirely by the explosions. 

Tnere was no rescue ship about and no signal could be sent, It 

eventually a naval launch came along, and a cruiser was called up to 

rescue them. Henry was awarded the OBE for this exploit. His next 

posting was to the hospital ship 'Empire Clyde', sailing between the 

Mediterranean ports and the UK, ht ill-health caught up with him, and 

he was boarded out on the day after V' Day. 

Henry resun4 his pst at Birmingham General Hospital. He had been away 

amst six years, hat he was still only 51 years of age and thile he ~ms 

on active service others had taken over m y of the roles he had played 

at local, regional and national level. Much of his private practice had 

gone, so tm had his seat on the Council of the Association, though he 

became a Trustee. He was still an enthusiastic teacher of r,?edical 

students in his hospital practice and although he was the most senior 

consultant, he would regularly anaesthetise for the minor operations 

list done by the house surgeon. He tauyht the history of anaasthesia and 

demnstrated the use of historical apparatus, including Hewitt's nitrous 

oxide apparatus. He rarely used trichlorcethylene. He objected to its 

price because he lrnew it was supplied , without waxoline blue, for dry 

cleaning at a fraction of the merlical price. He spke highly of its use 

in dry cleaning. He was contracted for four sessions when the Nations1 

Health Service was introduced in 1948. He also continued his overseas 

visits and was invited to present ppers at prestigious conferences in 

Boston ard Montreal. 

The Association of Anaesthetists awarded him the first John Snow Xedal 

in 1946, and in 1947 he received the honorary degree of Doctor of Lam 

fran Edinbyh University as part of the Simpson Chlorofornl Centenary 

Cameroration. He was elected an Honorary Fellow of the Faculty of 

Anaesthetists of the Royal College of Surgeons in 1962.

Chmercial, social and 

interests 

Henry Featherstone took an active interest in the managerent of the 

laundry which, with its subsidiaries, had become a leading laundry and 

dry-cleaning business in the Midlands and he had other cmrcial 

interests. He went to live on his 700 acres (280 hectares) family estate 

which was some 30 miles from Birmingham. He lived first at the Knoll, in 

Barton-under-Nedwxd, and later at Yoxall Lodge, Newchurch. Bartonunder-Needwad 

is mentioned in Dennis Smith's book 'Under the Influence' 

in connection with the first we of nitrous oxide anaesthesia in 

mgland;* surely an appropriate place for an anaesthetist to live; and 

as to his interest in explosions, just to the north of his estate, the 

largest explosion in Britain took place in 1944. Banbs stored in a 

gypsum mine exploded. It tyas wartime secret that was well kept; 46 years 

later in November 1990, a memorial was erected. 

me estate :ms in god hunting country. Henry was a brave horsm; on 

one occasion when he was thrmm from his horse and disclocated his 

shoulder he devised a method of self-reduction using a 5-bar gate. The 

gate also enabled him to remunt without assistance and continue the 

chase. Featherstone fought against ill-health for many years. He had 

several heart attac'w and some serious gastrointestinal bleeds and he 

had to undergo several major operations. He gave the writer this 

valuable advice about postoperative fluids after one operation; the 

patient should have a case of half bottles of charqxgne in his roan ; a 

half bottle being a suitable size to share with a close friend in the 

early postoperative period and later a suitable anrnmt to have with a 

meal; whereas if whole bottles are opened the wrong type of people come 

to the roan ! 

Henry was proud of his membership of the Octette, a select Midlands 

group based on the old hmar Society. He ms a magistrate, a 

Comnissioner of Taxes, Chaim of the YMCA and a Trustee of the William 

Salt Library which houses the major collection of historical material 

relating to Staffordshire. He loved the countryside and endeavoured to 

improve it by planting mre trees on his estate. A few weeks before his 

death in 1967 he and his wife invited a hundred friends to lunch and a 

walk in their wwds. He is lxvied in the churchyard at Newhurch where 

there is a camemrative plap in the church. It records that he was 

the Founder and First President of the Association of Anaesthetists of 

Great Erritdin and Ireland. 

He was indeed a remarkable m, who played 

an impaant part in the developnent of the specialty. He lived in 

interesting times and places and he was - as he once described himself - 

a dutiful old soldier. 

Refemmxs 

1 Thms W. 'Ihe Developnent of Anaesthetic Apparatus. 

Oxford, Blackwell 1975: 256 

2 Helliwell PJ. Editorial. Anaesthesia 1982; 37:394-397. 

3 Featiierstone HW. The Association of Anaesthetists of Great 

Britain and Ireland. Its inception and its purpose. Anaesthesia 

1946; 1:5-9. 

4 Smith m. Under the Influence - a History of Nitrous Oxide and 

Oxygen ~naesthesia. London; I+3anillan 1982; 68.

h e of the main problems in the early days of anaesthesia was during the 

induction period. me excitation phase of anaesthesia induction with 

inhalation agents could be very troublesome to those giving the 

anaesthetic. Young vigorous men particul?rly, could hardly be kept on 

the operating table during this stage. Tnis problem was fizslly resolved 

by the advent of intravenous anaesthesia in the thirties, but several 

special techniques were introduced to circumvent this excitation phase. 

For example the rectal amlication of sedative agents prior to the 

induction of amesthesia became mmmn in Heidelbery. 

An uncarmon, but very efficient solution to the problem was described, 

practised and propgated in the early 1920's by C Ritter of Dusseld rf. 

?he article describing his method in detail was plblished in 1923.' He 

suggested temporary occlusion of both carotid arteries to enhance 

anaesthesia induction. Ritter described his nnnoeuvre as simply 

consisting of bilateral canpression of the carotid arteries with the 

thMs tuwards the cervical spine. 

Ritter's occlusive device

Effect of the technique 

The effect was that the breathing of the patient almost imediately 

became slew, quiet and snoring. Talking and mvement of the limbs 

stopped, and deep anaesthesia was achieved rapidly. Thus, by applying 

this technicpe, patients moved rapidly from excitation to deep 

anaesthesis during ether administration. Ritter found that this 

temprary occlusion of the carotid arteries during anaesthesia also 

reduced the requirement for anaesthetic. Transferring this concept to 

mdern anaesthesia, one wxld have to talk a h t the W-reducing effect 

of the anaemisation of the brain, and would have to add this phenomenon 

to tle liqt of factors which modify MAC. No pstoperatlve neurological 

problems were reprted by Ritter. He stated that all patients woke very 

early after surqery without any problems. 

Occlusive device 

As the hands would get tired, the application of pressure with the thumb 

ims considered unsuitable for longer anaesthetics. A device was 

therefore constructed which allowed occlusion of the carotid arteries 

without exerting digital pressure. (Figure); this was mufactured 

commercially by the Windier Ccmpny of Berlin. As Ritter was still 

exprimenting with this device, he only recamended his manwl manoeuvre 

for routine enhancement of anaesthesia induction. 

Ritter had learned this technique from A Kussmaul who had used it to 

demnstrate that in humans - as opposed to dogs - the vertebral arteries 

would not deliver an adequate blood supply to the brain during bilateral 

carotid occlusion. The effects of bilateral carotid occlusion in young 

healthy patients wzre rapid loss of consciousness, pallor and finally, 

collapse. Consciousness would return each time when pressure was 

released. A welcome positive side-effect was that the patient or 

volunteer had total amnesia for the time of pressure ! 

In his book on artificial bloodlessness2 plblished in 1922, F Mmtuq 

provides us with more details abut Ritterls experiments on reduction of 

cerebral blood volume during neurosurgery. Evidently, Ritter had used 

the technique of interruption of the arterial blood supply for 

operations on the skull and brain in three patients. Periods of 

ischaernia last4 up to 30 minutes, with discontinuation of anaesthesia 

at the moment of carotid occlusion. The first two patients did not pose 

any problems and woke up early after surgery. The third, however, died 

on t'7e operating table. 

References 

1 Ritter C. Anan-dsierung des Gellirns m schnelleren Eintritt der 

Narkose. Zentrelblatt fur Chirurgie 1923; 50: 1390-1391. 

2 Momburg '?.Die kunstliche Blutleere. Neue Deutsche Chirurgie, 

Vol 29. We, Stuttgart 1922; 56-59.

Drs C Weisser & G Sprotte (Wurzburg) 

Inntar anaesthesia was independently developed in 1.998 by k~gust Bier in 

Germany, in 1899 by 'll~heodore Tuffier in France and by Wley Tait and 

ado Caglieri in the USA. Gaining in importance, this kind of regional 

arnesthesia became concurrent with yener31 anaesthesia by other or 

chloroform. Wing the follaving years a n~mhr of attempts were made to 

perfect this technique. Some interesting investigations were made by 

Martin Kirschner, starting in 1925. 

Martin Kirschner (1879-1942) was one of the most outstanding G e m 

surgeons of the early 20th century. He contrihted to many fields of 

surqery as well as to anaesthesia. Even today, surgeons are familiar 

with the nail for fixing bone fraqments associated with Kirschner's 

name. 

Some peculiarities of lumbar anaesthesia were criticised by Kirschner: 

1, the anaesthetic has to be applied in great quantity; 2, a Teat deal 

of the body is anaesthetised needlessly resulting in disturbance of the 

blood circulation; 3, Different effects occur in different individuals 

in spite of d ntical administration; 4, The level of anaesthesia is 

uncantrolled . i, S 

Consequently, he set out the following dernands for an improved technique 

of lumbar anaesthesia: 1, limitation of difkion of the anaesthetic in 

the dural sac; 2, prevention of cranial spread of the anaesthetic; 3, 

placing the anaesthetised segment at the desired heigh 4, individual 

dosage of anaesthetic necessary for the particular case. y2 

Kirschner started hie work on the improvement of lwhr anaesthesia with 

theoretical considerations based on intensive experimental studies.' 

The first problem was to find an anaesthetic drug that would not blend 

with cerebmspinal fluid. Wlt the hypobaric solutions available could 

mt be the definitive answer because the anaesthetic would move to the 

highest position inside the dural sac or'swim' on the surface of the 

CSF. This observation, made during his experimental search for a 

suitable local anaesthetic, led Kirschner to the second idea: the cmdal 

part of the dural sac could be replaced by air so t a t the anaesthetic 

could 'swimm as a 'plug' on the surface of the CSF.'tS 

~ o p u e l rof t the t- 

For the perfonmxe of his technique, Kirschner develop3 specific 

instruments. The end of the spinal needle was made oblique and closed, 

while the outlet was placed at the longitudinal side of the camula. Tne 

idea of this shape was to prevent pmching out of a cylinder of tissue 

and to be able to inject the anaesthetic in the desired direction. The 

syringe set consisted of two cylinders tightly connected; one (10ml) for 

the anaesthetic and the other (50ml) for the air. The plungers were

mved by screws for exact dosage. A rubber tube allowed limited movement 

of t"e syringe -2 

In practice, the patient was placd in a lateral position with an 

elevated pelvis. The spine had to form an angle of 25 degrees to the 

horizontal and the coccyx had to be at the highest point of the spine. 

Lwnbar puncture was then performed approximately at the spinal segment 

of the upper, cranial, level of analgesia. The puncture site recamended 

by Kirschner was L2/L3 for analgesia of the lower extrenities and D12/L1 

for the atdomen and thorax. However, the puncture site had no decisive 

effects on the spread of analgesia. 

Then the double syringe was tightly connected to the pmcture cannula. 

Now the needle was situated approximately at the upper level of the CS'. 

In order to bring this level of C S to the exact position of the desired 

height of analgesia, a certain ~lwre of air had to be insufflated. 

Kirschner suggested 10-15ml air for analgesia below the umbilicus and 

20-25m1 air for analgesia below the breast. The result of this procedure 

was a bubble of air in the sacral part of the dural sac. The tight 

connection of the two cylinders of the syringe set enabled the 

subsequent ii~jection of the ocal anaesthetic without disconnection of 

the syringe from the cannula. 

3 

Because of the lateral position of the outlet of the needle, injection 

of the local anaesthetic was pssible in a designated direction: for 

analgesia of the aManen it was injected cranially, and for the legs, 

caudally. Initially, Kirschner recamended the m i n k dose of local 

anaesthetic. The hypobaric local anaesthetic now f o d a 'pl~' 

snrimning on the surface of t3e CSF just below the sacral mle of alr. 

The segmental spread of spinal anaesthesia was determined by the cranial 

extension of the bubble and the volume of the local anaesthetic 'plug'. 

After some minutes the spread of local analgesia had to be tested. If it 

was insufficient or wrongly placed, an increase in the dose or 

correction of the position of the 'plug' was p3ssible by insufflating or 

removing air. In this way dosage and spread of analgesia could be 

adapted to individual circumstances. Rfter attaining 

anaesthesia, the needle was raved and the patient laid on his back. ""Q?2 

During and after the operation, the patient had to rmin in a head-down 

position for as long as the analgesia took to canpletely wear off. Not 

till then could the patient be brought t,f the horizontal position, and 

some hours later to the head-up position. 

The results of this technique in the hands of Kirschner were very good. 

Cmly one patient died in 1000 cases of the new spinal anaesthesia and 

significant changes in blood pressure did not occur. Each case was 

exactly reprted and documented for later evaluation. An imp3rtant 

innovation ms also a'psychic narcotist' o had always to be present 

with a ptient. Kirschner and his t e 2 gained a great deal of 

experience from this method (some 1OOO cases were reported after 1932 

with excellent results) but it seems that other authors had only limited 

practical knowledge, probably because of the exacting technique.

Kirschner's clinical observations remin valuable for the recent 

discussion of the site of action of local anaesthetics in spinal 

anaesthesia. Because all segments within the bubble of air were sparecl 

from anaesthesia it is unlikely that spinal anaesthesia acts on the 

spinal cord itself but directly or mainly on the spinal roots. This fact 

was already detected and described by Martin Kirschner. In his diagram 

of 1934 he exactly illustrated the clinical observations of the sprzad 

of analgesia dependent on the loc3lisation of the anaesthetic 'plug1. 

1 Kil-schner M. Versuche zur Herstellung einer gurtelfodgen 

Spinalanasthesie. Lmgenkecks Arch.kLin.Chir.1931; 167: 155-769. 

2 Kirschner M. Einer guctelformige, einstellbare und individuell 

closierbare Spinalbetaubung. Cliirurg.1931; 633-644. 

3 Kirschner M,Stawe. Beitrage zur willkurlichen Begrenzung und 

individuallen msierung der Spinalanasthesia. Mahrungen an uber 

1OOO eigenen Fallen. Langenbecks Arch.klin.Chir.1932;173:322-393. 

4 Kirschner M. Spinal zone anaesthesia, placed at will and dosage 

individually gradecl.Surg.Gyn.Obs.1932; 55: 317-329. 

5 Phillipides D. Ein vereinfachtes Verfahren der gurtelformigen einstellbaren 

Spinalanasthesie. Langenbecka Arch.klin.Chir.1937; 189: 

445-451. 

6 t+xitsch P. Die Schmertzverhutung bei Chirurqischen Einqriffen. 

Flaudrich, Wien, 1949, pp185-186.

Drs J Berlin, J Rupreht, W Erdnnnn, H Schwender, M Pfotenhauer, 

J Reissenweber, H Ifanxwrla, E David (Rotterdam & Witten) 

Hypotism goes tuck to antiquity. Mankind has always been fascinated by 

hypnotic phencnnena. Since hunnn nature rejects what it cannot 

understand, m y different explanations have been offerd to try to 

illustrate what hypnosis is and means, and thus we have philosophical, 

religious, anthropological and medical hypotheses depending on the 

backgroimd and provenance of the authors. 

Analgesia and anaesthesia have played an imp3rtant role in medical 

hypnosis; we know of a pleolithic carving on hone which shows a wanan, 

obviously pregnant, lying unconcernedly while a reindeer tramps over her 

My. The theoretical rneaning has been suggested that she was absorbing 

the strength of the animal to aid labour and delivery through hpsis 

which was considered to be a form of magic. 

We 'know tcday that hypnosis is a special state of vigilance 

characterised by specific physiologic changes: 

1. Heaviness or sometimes lightness in the feeling f the arms and 

legs caused by reduction of alpha mtorneurone activity. 4 

2. me feeling of warmth in the extremities caused by reduction of 

peripheral resistance and higher blood flow due to neurogenic 

influence.2 

3. Change of vigilance in the EEG with a shift of activity to the 

right hemisphere in brain mapping with REM phas s and sanetimes 

halucinatory phenomena with selectivity of perception. 3 

These specific physioloqical changes can be obtained through Suggestions 

Under Hypnosis (sUH) and are inprtant in understanding the m y types 

of hypnosis performed by our ancestors. 

Ihe L m ' 'c era of 

In almost all primitive peoples there were natural doctors and sometimes 

priests, trained in the art of healing and using hypnosuggestive 

techniques to treat different illnesses. E.lonotonous singing and 

mnatonous rewtition of words, then considered as prayers to 

naturalistic gods, dancing and music were the basic tools to inhce 

trance. 

Zilboorg and Henry shwed that shamans in different regions in Siberia 

used hypnosis in this way.4 mthu showwl that hyposis can be traced 

* see also the paper by Johnson in Vo1.4 of the meedings of the 

Society, 1988. Ed.

ack to old 

Fakirs and yogis used autohypotic anaesthesia 

and trance for their meditations. Eetween 2350 and 1350 B.C. we find 

hyposuggestive techniques in Persia and Greece, with rituals similar to 

group hypngsis today. Ekr's p3pyrus describs the we of hypnosis for 

analgesia. Specific hypotherapy was carried out in the Egyptian sleep 

hospitds of Isis and Csiris. Wing the sleep (incubation) the god3ess 

of Isis was irmgind to relieve ptients of their complaints. Sleep 

temples of Eqypthad a great influence later on similar constructiuns in 

Greece. 

Ihe pnelWlenhtic era of hyplosis 

In Homer's Odyssey XIX 457, Odysseus stops the bleeding of a wound 

through suggestion. Asklepios learned hypnosis from the Cenuurus 

Cheiron (Cheir - Gr. = hand). 

Achille3 knew the method too (the Iliad IV 219, XI R23). The Delphi 

Oracle used direct suggestive methods as well as herbs and drugs for 

induction. 

Ihe Aelldc era of hyplosia 

'Ihe Asklepion influence was of the greatest importance for hypnosis in 

the Hellenstic era. Patients came to the Asklepionan tarrplzs seeking 

relief from their maladies. The most famy of these temples w?re at 

Epidams, Kos, Knidos, Cmtana and Cyrene. Patients had first to 

perfonn washing rituals at natural wells. After these rituals the 

patients had to sleep outside the tenples for 3-5 nights. AFter this, 

they were admitted to the anteroom of the temple where they had to stay 

several days while praying and listening to the speeches of the priests. 

Later the patients could go into the holy part of the temple (Ahaton) 

which was attrilxlted with a magic force. The basis of t'lis kind of 

hyplosis was the incubation = lying in a relaxed way. Suggestions were 

given before and during the trance period, either directly or by 

prescription of remedies. 

!Ifbe B y Z a I l era ~ of ~ hyplosis 

lhe Aesculapian form of therapy continued for many years, hut was 

changed by Galen of Pergmn (129-199 A.D.). me temple sleap method 

was changed by Galen to pre-sleepsuggestion-induction. me piltient 

received suggestions in the pre-sleep phase with the instn~ction to 

imagine a specific dream. lhis form of hypnosis therapy was ussd well 

into the 6th century. 

Wnile in Byzantine and Islamic states, mejicine reached a high level, 

the situation in mope was quite different. In the middle ages 

hypnotherapeutic techniques wsre used predominantly by mnastic orders 

who performed m y so-called 'wonder healingal with hypnosis. This 

nonastic practice supplanted Calenic medicine. One of the ,advances at 

this time was the use of an associative technique of suggestions to be 

able to distinguish between 'demons' ad real illnesses.

The word 'magnetq was introduced by Pliny the Elder (23-79 A.D.) who 

knew, so the story goes, a shepherd by the name of Magnes who told him 

of the phenomena of magnetism. Other tales say that Lucrez described 

the magnetic phenome.ia of siderite which came frcan Mag~lzsia, a city in 

Asia. Thales of M~let discussed the pssibilities of siderite having a 

soul (525-545 B.C.). Aetius of Amida used siderite for algesiologic 

treatment. Paracelsi~a (1493-1541) used siderite in an attempt to cure 

munds, pain and other kinds of disease. Paracelsus's doctrines lasted 

for over two centuries. 

A Scottish physician, William Maxwell (1679) was one of the first to 

write about empirical knowledge of 'medical magnetism' in his book 'De 

Medicina Wgnetica'. He was one of the first to mention suggestion and 

imagination in this context. 

All this earlier work influenced one of the most outstanding figures in 

hypnosis: Franz Anton Mesmer (1734-1759). He started by using lMgnets 

in th-rapy. In 1776 he put forward his hypothesis of an-l magneti 

in which he descrihd artificial scmmamblism and a mgnetic report. 73 

Medical science discussed Mesmer's theoretical approach to h p i s and 

rejected it, at that time, since no magnetic field could be measured by 

the many conmissions who tried.' Nevertheless, the impact of Me-r 

caused persistent discussion over the phenanena of hyplosis and his 

induction methad is still in use today; it is especially useful in the 

indilction of deaf patients. 

It was Benjamin Rush in the USA, the father of American psychiatric 

research, who taught in his 'Duties of a Physician' the Memric 

approach as a s-us to motivation of the patient to get a better 

therapeutic result. 

Armand Marie Jacques de Chastenet, Marquis de yfiegur (1751-1825), used 

the mesmeric approach and worked with magnets. After being able to 

free his patient, Victor Race, fran respiratory problems, pain in the 

chest, and low back pain, he became farrow and reported abut 5,000 

cases treated by him. He described soinnamhlism as a reprducible 

phenomenon in hypnosis. 

Abbe Paria (1755-1819) described both the nature of the 'somneil lucide' 

which he interpreted as a variation of nonml sleep, and also took an 

opposite vie~~point on hypnosis to Memr, describing this as the res 

of concentration and suggestion of the hyplotised person. '35 

Elrthermof?, he ccmsidered the subject to be the active party in 

hyplosis. mese theories could be considered as coming as closely as 

pssible to the findings of modern psychophysiological research. 

John EUimtscm (1791-1868) was the leader of the mesmeric mvement in 

England. As Professor of Medicine at the University of London, he mde 

one of the first stethoscopes. He published a widely used textbook of 

physiology. From 1R37 he took an extensive interest in mesmerism and

plblished m y articles on this approach to hyp~osis, mainly in a 

journal 'The Zoist'. In these writings he described many operations 

with mesmerism as the only anaesthetic, and stressed the success 

achieved. me first such operation, he stated, was performed in the 

USA. IX Sydney Dcane of New York, removed a neck tmur during a 

mesmeric state of hypnosis. Professor Ackley at the Cleveland Medical 

College also used the method. At the Medical College of Georgia, LW 

Louis mgas successfully rermved a breast during the mesmeric state. In 

1842 in England, Dr Ward aqxtated a leg at the thigh while the patient 

was mesmerised. 

Despite the amrently successful results, the reaction of the Royal 

Medical and Surgical Colleges was hostile. However, esmeric h p - 

anaesthesia was practised by %rd and Elliotson and their results were 

pblished in further volumes of 'The Zoist' which gave detailed accounts 

of mesmerism havFng been used in cases of childbirth, venisection, 

excision of tumxlrs, amptations and dental extractions. 

Jtaaaa BgdaCle (180&1l359) perfonwd ahout 1,000 mbr and about 300 

major operatp in India with patients in the memric state of hypoanaesthesia. 

The introduction of chemical anaesthesia with 

chloroform and ether was a serious drawback for hyploanaesthesia, since 

surgeons felt more ccmfortable using the new method. 

.Rmw Emid (1795-1860) was a Scottish surgeon who practised in 

Mmchester. He observed that a mesmerised patient could not open his 

eyes during a session. After performing experiments himself, he came to 

the conclusion that hypotic phenomena were entirely subjective. In 

1843 he plblished his in a work entitled 'Neurypnology, or The 

Rationale of Nervous Sleep 

Dewlqmmt of hypmmaesthesia in the last 50 years 

Even though chemical anaesthesia took over in various fom, and with a 

wide spectrum of drugs, hypnoanaesthesia has remained, and has been the 

subject of intensive research. The following researchers and clinicians 

have paid special attention to the subject: 

car1 A 

Anesthesiology 

Chppo 

who wrote the book 'Practice of yrplosis in 

Jean Idamer, Professor and Chainmn of the Department of 

Anaesthnsiology at the University of Paris who perfomd a y 

psychophysiological EEC stuclies during hypnonarcosis. l7 

Piner, Professor of Anaesthesiology at the University of Uppsala. 

He studied premedication in autohypnosis and had qood results in 

prdcat- intra- and postoperative drug consmptior;. 

thdolm Ry, Professor and Chairman of the Department of 

Anaesthesiology. He did extensive research on the question of combine3 

chemical and hpoanaesthesia. He suggested this combination would save 

up to 70% of the drug8 used. He contributed to the German literature

and wrote a chapter on hypoanaesthesia in his 

Anaesthesiology ' with 0.Mayrhofer and W.Hugin. l' 

'Textbook of 

Developoent of hypl~a~esthesia resear& in the last 10 yeam 

Rudolf Frey's work has greatly influenced recent research in hplogy. 

Kis former co-workers Wilhelm Gr~kmn and Juan Berlin, have contimed 

that work. For this ywrpose, a European joint research venture rms 

started between the Institute of Anaesthesiology of the University of 

Rotterdam and the Institute of Noml and Pathological Physiology of the 

University of Witten/Herdecker. 

The result.? of the eqerimntal work have been published and are 

continuing. 

Ref e m s 

Willer J.Alpha motorneuron activity in hyplosis.l%inl987;SupQ:192 

Stovis B, Langen B. Lehrbuch der hpse.Karger;Basel:1965 

Berlin J et al.Hypnosebehandlung bei Mig-rane and Cephalgien.. 

Fortschritte der Medizin. 1985 25.24/666-26/668. 

Zilbmrg G, Henry GW. A History of Medical Psychology. W W Norton, 

New York, 1941 

Muthu K. A Short Acount of the Antiquity of Kindu Medicine and 

Civilisation. (3rd Edn)Balliere, Tindall & Cpox, London 1930 

The Ebers Papyrus. Trans.B.Ebbel.O.U.P.,London.1937. 

Stam H, Stanos NP.The Asclepian dream healings and hypnosis- a 

crlticpe. 1ntern.J.Clin.Exp.Fiyplosis 1932; 39: 9-22. 

Meslner FA. Memire sur la derowerte du magnetism anima1.1779 

Franklin B et a1.Ra-rt des camnissaires charges de la roi de 

l'examen du magnetism animal. Moutard, Paris 1784. 

Rush B. Observation of the duties of a physician ..... In Rush B. 

Medical Inquiries and Observations 5thEd.M Carey Philadelphial818. 

Fuysegur AM.Memires pour servir a l'histoire et a l'etablissernent 

du magnetisdm animal. Maison, Paris. 17Mb 

Farm Abbe de.De la cause du s-il lucide.HenriJawe.Paris.lB19 

Lkgado DG.Memire su. la vie de 1'Abbe de E'aria.Jowe.Paris.1906 

Esdaile J.Mesmerism in India and its practical application in 

surgery and medicme. Silas Andrus. Hartford 1851. 

l3raid J. Nuerypnology. Irondon, Edinburqh.1843. 

Copmlino AC.Practice of Idypnosis in Anesthesiology. Grune & 

STratton, New York, London. 1965 

Lassner J. Ed.Hypnosis and Psychosamtic Medicine.Springer Verlag, 

Heidelberg,New York.1967. 

Frey R et al. Lehrbuch der Anaestl~esiologie. Springer 

Verlsg.Heidelberg, New York, 1971. 

Berlin J et al. Inteqrierendes Verfhren von Hypnose.. In 

Chronische Schmerz U Psyche. Ed R Worz,G.Fischer,St1~ttgart,1990

Drs M Goerig, K Ayisi, J Schulte am Esch (Hmhrg) 

Inhalation and intravenous administration of drugs are the main pillars 

of general anaesthesia. Wten, a &ination of Mth techniques is used, 

minimising side effects and and augmenting beneficial properties of the 

aqents . 

me modern era of intravenous anaesthesia began in 1871 when the French 

surgeon Ore, in Bordeaux, reported the successful administration of 

chloral hydrate in anmy1 studies.1 A few years lster he employed the 

drug in human binqs. A monograph about this new technique was 

rxlblishd by him in 1875 but 4espite encouraging results, the method 

fell into disrepute. Thlj canplicatecl technique, coupled with the 

ohsemation that t'le therapeutic dosage was close to toxic levels, was 

the explanation for this. Nevertheless, with the first attemt made, it 

was only a question of time before ot11er researchers in t5is field would 

a-ster less toxic drugs intravenously. 

Rddnn3tus biqm@xical details 

In search of practical 

alternatives, Ludwrig Aurkhardt, 

a surgeon from IWzhrq, (Figure 

1) plblished his first 

experience of a new technique. 

He favoured the infusion of 

chloroform or ether 

intravenously. 

Pigum 1. Iwdwig Rnkhardt 1872-1924 

Bur'khardt was born in lq72 and 

graduated in medicine frm 

Munich in 1995. At the 

Department of PatlioLqy he 

became involved in basic 

research and on the basis of 

thess exceriments, was able to 

perform intravenous ether 

anaesthesia research by himsalE. 

At the beginning of this century 

he entered surqicaL training at 

the University of IGurzburq, . 

where he contin11e-l his 

euperiments. He recomne~ed the 

method enthusias ticall and 

smead its clinical use?-6 In 

1913 he was anpointed chaimwi 

of the Section of Intravenous

Anaesthesia Techniques during the International Vedical Congrass in 

mndon, being reqar

Cne of the most pramin~nt and raprtahle ?&man slx'qeons durirlq this 

period 1 Hermum Kumnell, Chairnun of tie NW Hosnitsl, Eppndorf in 

m-l?' (piqur22) 

m m in 195?, h: st;lrtF?? his me3ic3L c.ireer in Berli~ before he docidc-l 

to go to H-, where he succewled Sckde as t'ie surgiml chairman of 

the ne~ly construztd Eppxd.orF Hospital. lfe w3s an all-round' s'rrjeon 

but realised the need ff3r s3eci~.ilis?tion vithin the suqical field.'' 

?~uR, he became tile protagonist of German anaesthwia, an52,iLg pupils 

Sudek and ScMdt %came two mat outstanding specislists. .4s a 

founder of tha Medical School of Harclhurrl 

University aFter khrld War I in 1919, 5e is still remenhere f2 as the 

'gentleman' amongat swqmns in Hamhrq, where he died in 1337.

From the start of his medical career, he emphasised the use of 

perioprative fluid replacement and it is not surprising that he became 

an enthusiast of the new i.v. ether anaesthesia method. K m l l ' s 

interest in this field t ether with his excellent results, gave a new 

impetus to the method.i61p Like hn!Cnardt. Kmell discus 4 'n detail 

the pro's and con's of t:~e technique in Gemnny and abroad."rl' 

To minimis? possible emlmlic complications, he s~lqgested the u s of a 

canstant flow inf~lsion. T3e apntrls and technique for this were first 

described by Schmitr-Peiffer, an assistant in the smqical depilrtment at 

Eppndorf. Due to its evident advantages, t5e conti 011 infusion 

technicpe became widely accepted and ,was never abandoned. "p2' Over the 

next ye3rs only a few articles were publish4 about the method. Most 

authors praised the excellent results of the technique which had &come 

accepted clinical practice. 

Later devel- 

Amng those W!IO rwomneded this new kind of anaesthesia were the 

American :mqeons Honon and Hasseler. In a r article, lnth 

clescribed the technique and reported their results. 525y Lilce I3urkhanit 

and Kmell, they suggested tha concomitant injection of an hypnotic 

like Isopral 3r Hedonsl to rlchice the volume of et3er infusion and to 

decrease tv, 18,~liod of induction, esnecially in very robust 

individuals. 'Mono-i,v.-anaesthesia' with Wonal had become 

very p~ l in Russia and was for some the called 'The Russian 

Method'.2'-" Wurkhardt as w4l as K m 1 1 tried this Corm of infusion 

anaasthesia tut both disliked the severe ccmplications, such as longlasting 

res i tory dapression or unstable hacmodynamics that were 

cornnonplace. 8,Ti 

A new indication for the methcd was first mentioned by the thoracic 

surgeon, Wendel, of Magdehrg. He diamssed aspects of its use in 

thoracic s~w~ry, especially in situations w!?ere no Sauerbruch Chamber 

unit or Brauer amratus h a s available. Due to technical progress, the 

indication 1-S ytntioned during the meeting of the G e m Surgical 

Society in 1911. It was a lqioll step to use the method for wounded 

soldiers during World War I. Wepfer and Diotrich discussed this 

indication in their review and both were impress& by the results. An 

advantage was seen in the raoid induction and recovery s well as the 

l3ck of pulrronary infections in these high risk patients.'0r31 

In the UK, Rood had become an enthu3iast for the method. As an 

anaesthetist at t'le laneon T'lroat Ifospital !~e discllssed a long list of 

indications for this kind of anaesthesia. In a detail-ed article, he 

considsryj its princinal aspcts in comparison with other general 

methods. F?cd introducd an innovation, a specially designed infusion 

system with intejratsd dripchamker md heat exchange device. This was 

to pravent cmling of the mtient through the infusion of large volunes 

of fluids. Like others, he praised t'le inFllsion anaesthetic technique 

and was most impressed by the stable peri-oprative haemorjynsmics and 

lack of post-operative vomiting and plumnary irritation.

A .€?W years later, a zmwrable indication was dismissed by the 

olatetrician Dymff in Ubo. In hypovol3emic pregnant patients, he 

preferred this technique. In contrast to others, he had dissolved et$er 

'Normosal' in a solution with volune e~nding properties. The 

circulation thus became very stable. He rec-nded ether fusion as 

the wtnod of cnoice in selscted cases in obstetric surgery. 3Y 

In the late twnties, several articles abut ether anaesthesia were 

tlublished. Efembrs of the surgic3l deprtment of the NUrPeg Hospital 

here enthusiastic abut th-. results of more than 1900 conseative ether 

infusion anaesthetics without fatal ccmplication. They called for 

further intensive rese c int? this techniw and disc~issd ~tential 

aspects for the future. 

%36 

Bring the time these articles awared. new short-acting anaesthetic 

?rugs became available - the barbiturates. Rudolf Bmm, a na3mber of the 

Sur.7ical nt of the Charite introduced Fernocton intn srlrgical 

practice. His first report during the amusl meeting of the Gemn 

Surgic,ql Society received little attention :Imver. During file 

thirtie.;, the enthusiasm for ether infusion for anaesthetic ]nlrposes 

decreased. !The tremendo~ls sliccess of t'7e barbiturates and their 

derivatives mde this tschnique superfluou3. Nevgvheless, it was still 

described in rapitable Gennan surgicsl textbooks. 

me use of intravenous anaesthetic ether anaesthesia was an important 

step forward for severs1 reasons: a p a t impetus began for the 

production of short acting dm~s and, at the same time, exact 

dmumentation of the phamccdynamics as well as the sile effects of 

intravenously administered drugs was initiated. It enabled emrience 

with a new technique of phlebotomy to be gained and initiated the 

developnent of the equinment needed for its daily use in practice. Last 

ht not least, t!is strange method of anaesthesia markedly Influenced 

our knowledge of perioperative fluid replacement. 

1 Ore C. CYmptes rendues heMomadaire des seances de l'academie des 

sciences. 1974; T79:79. 

2 Ore C. Etudes cliniques sur lanesthesie chirurgicale par la method 

des injections $3e chloral dans les veins.J.Ehlliere Paris 1895. 

3 Eurkhardt L.person..l cmication about Lul-fwig Wkhardt. 1989. 

4 Eurkhanlt L.Der Einfluss Aer Kochs?lzinhsionen auf die Chloroform 

-wikung wahrerld u~ld nach der narkose .Arch. klin .air. 1905; 75 : 1179 

5 Burkkardt L.Wr Ctllorofom-~md aetllernarkose durch intravenose 

Injektion. An-h,emr.Path.Pfiamr-ol119O9; 61:323-342. 

6 Burkhardt L.Die intraveno:3e iqarkose mit Aet'ler urid 

Chloroform, ..Munch r.le3.!~~h~?nschr. 1909; 46: 2365-2359. 

7 Burkhardt L. Zur F'rage der intravenosen Narkose. 

Munch.1ed.Wochensch.1910: 7: 361-367. 

8 Burkhardt L.Uekr intravenose Narkose. Munch.ed.Wochenscllr. 

1911; 15: 778-782. 

9 Jenkins hp. History of fluid administration during anaesthesia and

operation. In: Anesthesia- Fssays of its History.Ms.J.Ru~recht 

et al.Springer Verlag. Berlin.1985. 

Lexer E. Le'lrkch der Chimgie.1904.Enke Verlag,Stuttgart. 

Straub W. Ein Aptmrat zur Infusion von Flussiqkeiten unter konstanter 

Geschwindigkeit. Munch.n1e~.~Jochensch.l911;28:1514-1515. 

Kumnel M.Permona1 cmnunication about H e m Kumoell.Smmer 1990 

Bier a. Hermann Kmell. Zbl.f.Chir.1932; 21: 11252-1253. 

Hmiat D. hul Sudek. His contriktion to anaesthesia. Anaesthesia 

1989; 44: 847-850. 

Goerig M. Helmt Schmidt-A German Pioneer of Anaesthesia.in prep. 

K m 1 1 H.Uber die Wirksamkeit und die Gefahren der intraarteriellen 

Infusion; Cbl.f.Chir.1382; 19: 305-308. 

K m 1 1 H. Ueber intravenose Aet"lernarkose.Arch.f.klin.Chir. 1911 

XL: 1-15. 

Kunraell H. Weitere Erfahrungen uber intravenose Aethernarkose. 

Bms.Beitr.z.klin.mir. 1914; 92: 27-36. 

Kmnnell H. Intravenous ether anesthesia. Surq.Gyn.Obstet.1914; 

XIX, 334-339. 

Schmitz-Peiffer W. Zur Frage der intravenosen Aethernarkose. 

Bnu1s.Beitr.z.klin.Chir. 1901; 69 :832-341. 

Schmitz-Peiffer G..Personal comnunication abut Wilhelm Schmitz- 

Peiffer. April 1991. 

Graef W. Berichte uber Ehrfal~rungen nit den intravenosen Aether 

und Ispral-Aethernarkosen-RNns.Beitr.z.klin3:173-211. 

Schlimpert H. Versuche mit intravenoser Narkos~. 

ml.f.Gyn.l911:25:833-839 

Honan WF,Hasseler JIi. Intravenou? anaesthesia.Ann Surq.1913;58:900 

Anon.Obit.\~.F.Honan.J.Am.Instit.Home~y.l935;11:708-9. 

Bayer Drug Co. Comnunication. Sumner 1993. 

Kissin 1,'IJright AJ.b?e intrcd~.~ction of Hedonal: a Russian contrih 

ution to intravenous anesthzsia. Anesthesiolo(ly 1988;69:242-S. 

Killian H,IJeese H. Die Narkose.Zrhr und Handbuch.Thieme.1954 p870. 

Wendel W. Bericht zur intravenosen-Aethemarkos~technik. In Verhandlungsixricht 

zllm 40 Cong-ress der Deutschen Gesellschaft fur 

Chirurgie. Arch.f .Uclin.Chir.l911; 95-235. 

Wepeer A. Die intravenose Isopral-Aethernarkose in der 

Kriegschitur~ie. Rmns Beitr.z.Llin.Chir. 1915; 97: 1-6. 

Dieterich W. Uekr intravenose Isopral-Aet3er-Kochsalz-Narkosen. 

Munch.meB.Wochenschr.1916; 30: 1103-1104. 

Rod F. Infusion anaesthesia: t%e use of non1131 saline infusion as 

a means of adminisrering ether. Br.Mef3.J. 1921; 0ct.21:974-977. 

Cyroff R.Eine ven~endungsbereite Infusionslosung fur den Praktiker 

Dtsch.med.Wochonschr. 1926; 44: 1851-1053. 

Iernbscher A. Erfahrungen an 850 intravenosen Narkosen. 

Arch.klin.Chir.1923; 122: 317-319. 

Kreuter E, Streichele H. 1000 intravenose Isopral-Aethernarkosen 

obe ~esfall. Bruns.Beitr.z.klin.Chir.1926; 137: 3451-464. 

Borchardt M,Cruhn H. Erfahrungen mit der intravenosen Isopral- 

Aethernarkose nach Burkhrdt. I3runs.Beitr.z.cl Chir.1926;141:380- 

Bwrm R. Intravenose Narkosln wit Barbitursaurederivaten. 

Klin.bJochenschr.1927; 6: 725-728. 

Blmm K. Personal cononunication about rhidolf B m . Sumner 1990 

Bier-Eraun-Kumell . Chirurgische Operationslehre. '(Io L. 1,50-G5 

Verlag von Johann Ambrosius Barth 1933.

In &ern anaesthesia, the knzodiazepi?e mifiazolm has been found to 

have potent amesic effects. Patients ~rnder the influence of this drug 

my tell you many details atnut their lives and l.iter do not remember 

anything a'mut this occurrence. Years ago, alk3loids or alkslold 

mixtures of certain plmts, for example, peyotl, ololiuhqui, anhalonium 

lewinii \rere kmJwn to have similar groperties. 

me experience of Iorenz 

Anaesthetic agents *re used in the st to o1,tain criminal confessions. 

In the hands of William F Larsnzllil this method was famd to be of 

definite value in the cases of innoc.?nt pole charqed with crime. 

Lorenz had been experirLent.ing with substances such as hyoscine, lllorphine 

and sodium anytill. He finaLly presented his findings at the Regular 

Meeting of the Chic3go Neurolcqicil Society on March 17, 1932. 

Mrenz had found the best results were obtain4 whan sodium amytal was 

injected intravenously at a slow rate of 5hrJ/min. The injection !vas 

continued until anaesthesia was ind11cm-l which w.7~ judged by the 

disapparance of the cone31 reflex. Mministration was then stomd . 

and after ten or fifteen minutes the subject was aroused by talking or 

by the application of cold wet tcn.~ls to the face. For a variable 

period of time the sxbject could then be interr~xpted, and uslially there 

tms soontaneol1s talkativeness. mis mant that the interrogation could 

continue for two to three hours during the recovery pericxi. During this 

state, which Lorenz called 'narcosis', it was possible to mke direct 

suggestions. Thus, it was possi'lle to break d m barriers, with the 

ptients providing vast munts of information. 

In persons charged with crime this technique was us4 with varying 

degrees of success. In several cases where inn~ent persons had 'been 

charged with munler the use of narcosis thoroughly satisfied 

prosecutors. me mthod was consiilered imsatisfactory in the case of 

guilty persons. Evidently, k Tmrenz a150 receive4 nwspper publicity 

about his injections of the 'truth serum'. 

In the discussion of his presentltion of this work at one meeting, it 

!-!!S stated that at a certain stage of narcosis the ptient was unable to 

lie. Another problem suqgested w3s that cornprisons should proixhly not 

be mde ktween actually quilty [xrsons and rubjects who vol~mteered for 

exprimental purps-s. The question, whether tlms? who are actually 

guilty would mkt! confessions th3C imuld incriminate them, re~nained 

unanwvered: as was the question .whether there was incre2sz.j 

niggestibility in such a sitlmtion. A su!>jact would pssibly confess 

things he had not done, if the examiner U:;& an aggressive technique and 

elicited a fear reaction.

The question of hether the technique was ethical at all - even with the 

consent of the patient - also remained msered. It was clearly 

stated that, wit;-~out consent. this wuld be an abzje of the physicianpatient 

relstionship. Ethical prohlema were circmnted with the 

physician acting only in a stand-by psition, concerning himself plrely 

with the physical and mental condition of the patient and leaving the 

questioning in the hands of t!e prosecuting attorney. me presence of a 

friend or relative was always considered necessary. 

The experience of Heinrich 

Adolf Heinrich 3f Hamburq and Leipzig reported his experience six years 

later in 1938. He found confessions under ethzr anaesthesia very 

inconsistent so that they &re of no value. On the contrary, excellent 

results ware obtained with intrwenous hexobarbitone (Evipm) 

administration. 

manination of seventeen patients was carried out under Evim 

anaesthesia. Heinrich questioned ptients during induction as well as 

in the recovery phasa after hexobarbitone had been given. In agreement 

with torenz, he found that tbe bst interrogation could be done in the 

recovery phase. With hexobrbitone, the optimal time period was abut 

five to ten minutes. This the interval would allow for six to ten 

simple questions. These had to be clear and precise. Cne should begin 

with simple details such as date of birth etc. He was surprised that 

patients gave adequate answers and were amnesic on postoperative 

questioning. 

Heinrich concluded that this was a reasonable technique to find out 

about things patients would never have told during their noml state of 

consciousness. For criminal confessions, Heinrich also recomnended 

repeat anaesthesia with hexobarbitone as needed. In contrast to the 

American article of 1932, the G e m paper of 1938 did not contain any 

consideration of ethical problems involved. 

Tne 013 understanding of anaesthesia was that it is an all-or-none 

phenomenon. Possible criminal confessions under the influence of 

anaesthetic agents support the nerv view of anaesthesia as a continuous 

spectrum in which increas' g depth of anaesthesia passss through several 

broad areas of awareness.' And there are even hints in the literatlrre 

that &er adequate yenera1 anaesthesia the brain might be c ble of 

limited processing of infomtion and implicit rnemry function. F 

RefelmlesI 

1 Lorenz W. Crimiml cmfessions under narcosis. Archives of 

Neurology and Psychiatry 1932; 28: 1221-1223. 

2 Heinrich A. Kann man durch Narkose Gestandnisse erzwingen? 

Schrnen, Narkose, Anafsthrsie 1938; 11: 78-82. 

3 Jones JG, Konieczlco K. Hear* and memory in anaesthetisd 

patients. British IMiical Journsl 1986; 292: 1291-1293. 

4 Bennett HI, et al. Von-verbal response to intraoperative 

conversation. British Journal of Anaest!~esia 1985; 57: 174-173.

Dr M Kus (LYacori) 

An un-.rlanted side-effect of early ether and chloroform anaesthesia rms 

sudden ciii~datory arrest. These unham deaths caused concern ammg 

physicians and patients and were the impetus for &king an interest in 

the possibility of circul2tory resuscitation in the second half of the 

nineteenth century. 

Early animal shdies 

Schiff, physiolqist at the University of Florence, was the first to 

perform Yracotany and direct cardiac mssage in experimental animals 

in 1974. He found that it was pssible for the heart to resume 

spontaneous action even aeter eleven and a half minutes of circulatory 

arrest. At the same time, Boe:hm with co-workers at the Institute of 

Pharmacology of the University of Dorpat, Tartu, showed the 

effectiveness of closed chest cardiac canpression in cats.2 

Jan Prus 

In 1399, Jan Prus, Professor of Pathology at the University of Lvov 

performed his own expriments with cardiac resuscitation. Jan Prus was 

born in Wadowice near Cram in 1853. In the years between 1877 and 

1882 he studied mdicine at the Jaqiellonian University in Cracow. FYun 

1882 to 1587 he was an assistant in the Departments of Pathological 

Anatomy and Physiology. In 1887, after winning a scholarship, he rmnt 

to Berlin University and then sub~quently to Paris University where he 

attended h-oEessor Charcot's clinic. In 1896 he bctcame Head of the 

Department of Pathology, Faculty of Fledicine, University of Lvov. In 

1900 he was elected Dean of the Faculty of Medicine. 

Prus's animal -ts 

m carried out his experiments on dogs. Tne results of these 

experiments were recorded on a Marey's cylinder and on a Herig 

kyrmqraph. After tracheotomy, artificial ventilation was performed by a 

bellows apparatus driven by an electric mtor. 

In the first experimental group of forty-four doys circulatory arrest 

was caused by clamx~ing the tracheotomy tube. After a variable arrest 

rime, which varied between one and sixty minutes, Prus opened the thorax 

and gerfanned internal cardiac massage. In thirty-one cases (70%) 

s~nhneous heart beat was restored. Prus noticed that the longer the 

duration of the cardiac arrest, the longer cardiac mssage was 

necessary. In nineteen cases he failed to resuscitate the animals. 

mlve dcqs rere fully resuscitated and one of them was presented during 

a scientific meeting a year later ! In the sacond experimental grow of 

twenty-one dogs the heart was stopped by an overdose of chloroform. It 

was possible to restore the heart action ia seventeen doys (76%). One 

dog survived for eight months.

In a third group of thlrty-five dogs circulation was stopped by an 

electric current. Only five dqs (14%) were resuscitated. Prus fouqd 

that it was most difficult to restore spontaneous action in the doqs 

with ventricular fibrill.ltion. It is interesting to note that durlng 

the experiments the dogs were given a retrograde infusion of saline via 

the fmral artery. Prus wrote that: ' ... the degree of heart filling 

is an indication for s3line injection because.....the mst pwerful 

canpression of the heart filled with too little bloor3 cannot suaport 

blood circulation.' 

Prus 0-erved the following order of recovery of function: 

1. the myocardim turns pink and firm 

2. appearance of spontaneous atrial contractions 

3. spontaneous weak ventricular contractions 

4. strong ventricular contractions-arterial pressure can be measured 

5. the heart beat &comes regular 

6. spontaneous respiration appears 

7. eye reflexes recover 

8. appearanca of active movement 

9. recovery of consciousness 

Pru.3 concluded that his technique could be applied in humans and on thn 

19th January 1900 he used his open chest technique in a man rho 

comnitted suicide by hanging. hru:3 was ahle to restore the hisait action 

only. He campared his technique with closed chest compression and 

concluded that closed chest heart massage could not be effective in 

individuals with a rigid chest. On 18th iqovember 1899 Prus presentd 

the results of his e-riments at the scientific meeting of the Lvov 

medical Society. results ?re than published in the Eblish medical 

weekly 'Prezeglad kkarW1 , and then in '?liener Klinische 

Wochenschriftl and subsequently in 'Archives de ?.ledicine E~perimentale 

et dBAnatomie Patholqiquel. as's tec ipe was ponulnrised in the 

'Lancet' where it was c311ed 'bus Plan'? It consist& of artificial 

ventilation by a tracheotomy tub, own chest cardiac massage and i~traarterial 

saline infusion. 

Prusls technique of cardiac resuscitation was generally accepted in 

Europe an8 was used with varying success tmtil the 1960's. 

Refererces 

1 Schiff r.1. Uhr direckta Reizung der Herzoberflasche .Archiv .&S. 

Physiol. 1882; 28: 200. 

2 Roe'hm R. Ueber Wiederbeletxmg nach Vergiftungen and Asphyxie 

Archiv. f.exyerim. Pathol. 1887; 3: 68. 

3 Prus J. On resuscitation in cases of death due to asphyxia, 

chlsrofon overdose and electric shock. (in Falish) Prezeqlad 

Lekarski 1900; 39: 253. 

4 Prus J. Ueker die Widerbele!xtq in Tbdesfallen in Folge von 

Erstickung, Chlorofonnvergiftung lmd elektrischem Schlage. Wiener 

Klinische Wochenschrift 1900; 13: 4.72. 

5 Anon. Prus's method of resuscitation in chloroform toxaemia. 

Iancet 1901; i: 1;)32-1393.

Dr R W Patterson (Los hgeles) 

Reprts in American medical journ.31~ of 1300 enthusiasticslly acclaimed 

the latest Euro,oean advancement, surgical anal~esia accomplished by 

subrachnold injection of cocaine. Fifteen years previously the reprt 

by an knerican neurologist, Dr Jms Leonard Coming, describing the 

extent of neural blockade resulting Erom the identical technique and 

suggesting tinat such medication would be useful for surgical procedures, 

was totally ignored. l 

Irmrediately following the intrduction of topical cocaine in 1884, the 

demonstration of conduction block of peripheral nervss by injection 

(Halsted) signalled to the dental prof eusion a therapeutic choice free 

from t5e problem of general anaesthesia. Surgeons, though openly 

expressi~g dissatisfaction with anaesthetic complications, neglected to 

investigate in suitable cases, the solution proffersd by Corning. That 

this might have been thr-: act of a s;?lf-conscious cha~ministic sixcialty 

isolatinr~ itself Erom anything the group itselE did not initiate, is 

sllggested by the life-long I-Ialsted antisthy and hatred t~nmrcls Coming. 

However, the relative reticence and ah.ence of proselytising by Coming 

concerning his subs~quent clinical studies, and by other American 

investigators concerning their clinical studi9s involving llonbar 

pllacture during thew yedrs prior to 1900, points to a more encompassing 

hmda~nental determinant of m3dicll practice: confonnity dictated to 

avoid society's scrutiny ,et1161 stricture. 

a3zmingts early Life 

The American Civil war unsettled the faith and bonds of religious 

traditionalism of Coming's father, a Unitarian preacher and spradic 

fundaner~talist, and in 1369 this sixth generation Yan!cee trans~rted his 

entire family to Europe. Thus, unlike m y of his Arwrican rneclic~l 

colleagues who in the latr? ninetzenth century felt obliged t,o add a 

continental cachet ,.iith a year of touc.hg Europan medical clinics and 

surgical theatre;, Coming, from the age of fourteen had been schmled 

in Genmny. He received his m3ica1 degree from Wurzbg in 1878. His 

disszrtation was directed bv the anatomist Rindfleisch in the Demrtment 

of Pathola~. In this milieu, expsuce to lcnuwledge of the spGal cord 

and cdrehrospinal fluid was unavoidable. Throuqhout the 1870's Retzius 

and Axe1 ~e; extensively .investigated and dz?kribed, in German, the 

rnerrlbranes and cavities oE the brain and spinal cord. In 1972 Guincke 

pub~ished his first study on the %;>a echnoid space wherein he adverts 

to the prfomutce of lumbar puncture.' 

In 1079 Corning returned to the United States, to New York City, to 

psue his spcial interasts in diseases of the nervous system. The 

first step in introducing himself into the clos:?d-rank medical 

establishment was to obtain one of tile few, je;ilorlsly quarded, highly 

carrpetitive appintments as Wsistant Physician at an institution where 

there would be clinical material for investigative studies. He began 

the period of required experience in the service of the renowned surgeon 

(and Vice Przsident of the New York Neurolcgic31 Society) Dr J Varion

Sims, where :le became intimately acquainted with general anaesthesia and 

the problem of pain, both topics which would continue to fascinate and 

involve him for the renninder of his life. The following year was spent 

with Dr Edw3rd Seguin, the first Professor of Neurology at the College 

of Pfiysicians and Surgeons, the President of the New York Neurological 

Society and a founding member of the American Neurological Society. 

Thus Corning bcame embroiled in the turbulent strife of the enlarging, 

embttled specialty of neurolqy, the politics of which fonned a 

backgronnd to his work on medication of the central nervous system. 

Resistance to 

General practitioners of the 1'370's and 1880's resisted specialism as a 

chdllenge 'ooth to their conception of medicine as a unitary field and to 

their relative social. and economic status. 'Most threatening to the 

generql practitioners were the specialists who claimed as their dmin 

not the most difficult cases of .f particular type, but all cases 

wrtaining to a class of people'. Pro€sssioml anhsity was not 

confined to those outside the specialty. Extending its field of 

interest far beyond organic disease of the nervous system by asserting 

that 'the mi?d itself was to be understood as a physical phenomenon, a 

function or procl~lct of the brain, and perhaps even of the spinal cord, 

neumlqy had precipitated a schism within its m ranks.14 The eminent 

neurologist, Georqe Beartf, asserted that insanity was as much a physical 

ailment as smllpx or a broken leg. The clinical neurologist, with his 

scientific bowledge of physiology and pathology, therefore considered 

himself the mst ccqetent person to treat the insane patient. In 1878 

an active group of neurolqists attacked the Superintendents of the 

Asylm Association, who had t??e moply on the professional care and 

treatment of the insane, accusing them of being essentially cannitted 

only to the custodial care of the insane; ccmbininq the tradition of 

'mral treatment' with a 'medical response' to a social problem (the 

hospiQlisation of the destitute, aged or the 'difficult'). The 

acrirmnious controversy broke into the public sphere including, as 

reprted in the 'New York Times', the SuperintendentsT stark rekuttal on 

treatment by the upstart neuroloqists 'Direct medicament of the brain 

and nervous syatem is mlpractice.. . .% 

Trial of Guit.edU 

Fuaher unwalcome public observance of the profession's disarray soon 

occurred as the nation's pr.,?ss focussed on the legs1 proceedings 

foll ing the 'W-inspired' assassination of President Garfield in 

1881? Criminal responsibility was the trial issue. There was public 

fear that vengeance might be cheated if the assassin ere declared 

legally insane. Expert testimDny reflected with clarity the personal, 

social and professional ataqonism that split the institutional 

structure of Medicine. The Sqperintendents, whose institutional and 

plblic role mde them conscio~ls of the expressed will of c m n men and 

the mundane stratagems of pol-iticians, were solidly behind the 

prosecution, 'Insanity developed as a result of processes, often flawed 

religious education, taking plac? during life.' For the defence, the 

scientific nucleus of Neurology, with the European trained Spitzka as 

sp:cemn, props& an intzllectual arqment emphasising the hereditary

camation of mental illness and criminality. Such advanced medical 

views were considered with general suspicion as being tainted with 

European sensualism and materialism, atheistic, and inimical to the 

welfare and stability of society. The will of the people prevailed: for 

Guiteau, death: for Medicine, a persistent suspicion of 

uraspnsihility. Many Americans in the 1889's already considered 

physicians a generally impious, mercenary and cynical lot. me 

l~terialisrn of Spitzka dmtised the profession's dereliction of mral 

duty. The bitterness and near unanimity of respectable opp3sition to 

the defence experts' arguments implted a somewhat defensive tone to 

medical writings generally. The striking discordance in the testhny 

of the owsing sides publicly proclaM that medical science was 

clearly unable to settle disagreements within its own camp. 

Comhq and spinal -ia 

Beset by a pervasive flawed public image, clearly it behoved all of 

medicine, and in particular those involved in neurology, to keep a low 

profile and avoid the limeliqht. Accordingly, when there was no 

response to his 1885 paper, Coning's approach was low-key, nonaggressive 

and non-fault-finding. 'I even tried to enlist the co- 

operation of a pruninent surgeon in the matter, but without success. .. 

Nor oughtwe to judge him harshly for this; for at that time penetration 

of the meninges of the cord seemed as adventurous an ~rnd~eftaking as did 

niutilation oE the peritoneum at a mre remte epoch. He quietly 

continued his studies on direct medication of the central nervous 

system. In addition to several journal articles pertinent to spinal 

anaesthesia, he followed up his early book on local anaesthesia, with an 

1894 hook, 'Pain in its neuro-fatholqical, diagnostic, medico-legal and 

neuro-therapeutic relations. In this book, referring to studies 

cond~lcted prim to 1888, his descriptions are the very model of 

explicitness. 'When a needle is thrust down between the spinous 

processes of the third and fourth lwlbar vertebrae,. ..the pint of such 

a needle, after penetrating the dura mater, will find itself directly in 

contact with the filaments of the cauda equina, which from this point 

downward occupies the space of the spinal canal. If such a needle be 

hollow and attached to a hypodermic syringe charged with medicinal 

fluid, it is evident that the solution may be readily depsited upon the 

filaments of the cauda ...[and] the functions of the lower sqments of 

the cord my be psrfully affect& in this manner. We have only to 

conceive of the cerebrospinal fluid bhg, at this pint, thoroughly 

impregnated with the medicinal fluid and lying in direct contact with 

the pia. . . ' 

He then showed an illustration of a trocar and needle (reinvented in 

1928 by Sise) used in treating a 'con~enting' patient, describing the 

procedure thoroughly: 'A small trocar, half an inch long, and of the 

diameter of a wax match, was first thrust through the skin between the 

second and third l&r vertebrae. A long,fine, hollow needle, screwed 

to an ordinary hypdemic syringe, was then passed through the opening 

in the trocar and dawn through the tissues adjoining the ligamenturn 

interspinosum till tile spinal cans1 rvas entered. The entire contents of 

the syringe [cocaine mixture] were then emptied upon the fibres of the 

cauda +a. In from five to eight minutes the subject described a

tingling sensation in both laver lh3s.. .On examination there proved to 

be a decided impairment of tactile sensibility, munting, in certain 

localities, particularly in the lower third of the thigh and ankle, to a 

positive anaesthesia.' 

He then described irrigation of the cauda equina with Micinal fluids. 

His first case of instillation of cocaine into the spinal canal relieved 

the cornplaints of spinal irritation following an operation on the 

urethra. Tne second case, an injection to relievz severe vesical and 

aMominal pains of caisson disease, was equally amenable to meclication. 

fiis case, vith its novel treatment, is nQt mentioned in Coming's, 

later published, 1090 discussion of caisson disease; observations he 

made on patients stricken during construction of the Wson River 

Tunnel. Enquity into the circrunstances of such omission provides a 

further illustration of the 'screen' society interpsas ktween the 

individual and reality; in this mse, between the individual and his 

health. me counterpart to certain diseases which were convenient social 

constructions elabrated by middle-clsss physicians in a capitalist 

society, would be rejection or regulation, by mans of plitical, socioeconomic 

or cultural factors, of treatments or practices that did not 

reflect the rrores of t;le populace. In addition to t'ie prudent cautions 

imposed by strife within the medical comity, there was a pervading 

l~ostility tamrd the profassion in the pblic sector that mandated a 

measure of circrnnspection and reticsnce relating to novel ob.3ervations 

and treatment particularly when an 'aura of experiment' was concernd. 

There is no more apt illustration of this chilling atmsphere than the 

stark pi1 orying of LW Arthur H \Ventworth in the cause of mlic 

relations. 

B 

Public respmse to lwnbr plncture 

At the end of the nineteenth centurr cerebrospinal meningitis was one of 

the deadliest of diseases. Faced with the diagnostic dilemna of 

differentiating cerebrospinal meningitis from other diszsses of the 

brain and spinal cord, in 1875, Wentworth, Professor of Pediatrics at 

Harvarcl Fledical Sc'nool, with exemplary insight performed lunwr puncture 

to obtain cerebrospinal fluid for bacteriolcr~ical examination. Accounts 

of twenty-seven children formed the basis of his 1895 and 1896 

pblications on the diagnostic vslue of lmhr puncture. When he 

presented his research at the Annual ?&etin of the American Fediatric 

Society in 1896 cmentators were emphatic in supprt of his 

investigations and had no doubts as the diagnostic value of the 

procedure - an innovative medical advance, seemingly innocuous, except 

to those who were aware of the latent, brely conceal4 hostility 

throughout those years. 

Within a year, in an article entitled 'Human vivisection' published by 

tne Philadelphia Polyclinic Medical Journal, he was castigated for 

conducting what were seen as experimental operations on children. In 

1896, antivivisectionists proposed a bill to the .%ssachusetts 

legislature restricting animal experimentation in medical schools. 

IIearinys on the bill captured and held the attention of Rostonians in an 

extr,dordinary way. Not since a campus murder 50 years earlier was so 

much Wlic attention, curiosity and cuncern exhibited by the general

plblic atmut the activities of tj~e scientific and medical establishment. 

me scientists and practitioners of Boston stress& that the 

antivivisectionistsl attacks were directed against medical science and 

endangered the fre~com to acquire knawledge. 'lb the President of 

Harvard the propsed legislation repreqented an attack on academic 

fredom and the? entire el~cational process. The bill ms not passed. 

IUt t9e attack rms continued in 1900; 'animl experimentation 

ultimately leads to h m exprimeritation' and the centre piece was to 

be \ientrrrorthts experimental operations in children, i.e.lumbar pmcture. 

Nathaniel Boditch (Desn of Harvard Yeclical School and one of the 

founders of the Anlerican PAy~iologic-11 Society, as well as its first 

President) and members of the Boston Society Yedica'L Defensr Cornittee 

deliberately decided to mount no defence. They felt that a vir~orous 

public debate on the issue might interfere with thsir efforts to raise 

funds for the new Medical Sc~ml hildinys. In an effort to avoid 

controversy during the hearings, Rotditch prepxed a public avlogy to 

defuse the issue: 'Dr Wentworth's expriments on lumbar puncture have 

ken universally and emphatically condemned by the medical profession ... 

Dr Plentworth himself now entirely &Fees with the opinion here axpressed 

and regrets extrmly that his enthusiasm for the advancement of 

rnedicir~e led him to forget his duty to his ptient.' Wentworth I.limself 

had no input to the deliberations, nor to the statement. He resigned 

from Itwvard. No-one at the medical sc'.iool spoke in his defence or in 

the defence of lumbx puncture, not even his chief Dr T ?iI Rotch who had 

m-authored Wentworthls first paper in the 'Boston Medical and Surgical 

Journal ' . 

Such an occlrrence could only emphasise the cultural and scientific 

attitudinal lag txtween &rowan developments and Awrican medical 

assimi.lation that Corning had been conscious of while establishing his 

practice. The contrast rvas stark and severe. In Europe discipline was 

internal to the profession, scientific data and 13bratory tt~hniques 

defined medical practice; achievement was rneasured only in terms defi.ned 

by the world of academic science. Whereas in American medical schcwls 

political and financial consiclerations were still factors in 

professional success and in medical practice, external social attributes 

determined distritmtion of status and influence.. During the years that 

the American publications of Coming, Jacoby (1895) and Caille (18915) 

were pointedly overlooked, similar European studies of Quincke 

(1887,1891), von Ziemssen (1893), Sicard (1898), Bier (1899) and Tuffier 

(1899) were openly proclaimed and discussed at internation31 meetings. 

After the International Medical Congress of August 19K1, 'ILlffierls 

surgical clinics were visited by Mrican surgeons. Impressed, they 

returned to their hospitals, satisfactorily duplicated this new form of 

surgical anaesthesia, and plblished a plethora of enthused reports. Now 

under the protection of 'authoritative1 European approval, no longer 

having to distance themselves from possible accusations of h m 

experiment, ancl with the further competitive impetus of mastering the 

latest medical advances, suddenly t!le American surrJeons could fearlessly 

copy a procedure they could have pioneered. As a Professor of Surgery 

in Chicaqo, John R Mtqhy pointed out: 'It is to be regretted that the 

Americans were so long in awreciating the great original work of

Coming, and it is only another illustration that original work by 

Amricans is mny times not adopted by their countrymen until it is 

retucned to this country with Ehropean sanction. l8 

Coming JL. Spinal anesthesia and local medication of the cord. 

N.Y.Med.J.1885; 42: 483-485. 

Wncke H. Zur Physiolqie de cerebrospinal Flussigkeit. 

A?xh.Anat.Physiol. 1872; 153-177. 

Blustein BE. New York neurolqists and the specialization of 

Amrican medicine. Bull.Hist.Med. 1979; 53: 170-183. 

Blustein BE. A hollow square of psychological science. American 

neurologists and psychiatrists in conflict. In: Madhouses, Madmtors 

and Madmen. ?he Social History of Psychiatry in the 

Victorian Era. F2.A Slcull. Philadelphia; University of 

Pennsylvania F-ress 1981;241-270. 

Treatnent of the insane. NW York Times 1879; 14 November 

p.3,col.l. 

Rosenburg CC. The Trial of the Assassin Guiteau. Chicago: 

University of Pennsylvania Press, 1968. 

Coming JL. Pain. Philadelphia: J B Limincott Co. 1894. 

~fuqhy m. Subarachnoidean injections of cocaine a:3 a substitute 

for general anesthesia in all operations below the diaphragm. The 

micago Cli-iic 1000; 13: 427-430.

Gmrg Hirschel 

Cacq rlirschel wa? horn ii 1375 end s+:u?ierl rnedi~in~. at t'ls Uni~rersitiea 

of Hei?elJxrg, Elrrne, Munich and Berlin. Fle qrad11ate3 in 13'31

techniques, with Bighly concentrated alcoholic solutions, on t\e 

Gasaerian ganglion. 

Several articles dealt with the possibilities of conduction anaesthesia 

for the differential diagnosis of min, such as myocardial infarction or 

gastric perforation, ap-ndicitis or renal colic etc.'' He never ceased 

his search for a cmprei.'nsive understanding of possible interactions 

(looking at the intensity as well aal,ty3 trigrlering of the stimulus) 

1.mich might be the key to the pin. In tile sympthetic nervous 

system, hc vislnlised a central component which resulted in syndromes of 

intractable pain. s We1 of sym1xtheticalLy maintainzd pain is now 

rqarcled as valid. W It is almst i~ssible to dstail a11 

Kulenkarnpff's various publications on this subject. 

In conclu:3ion, Kulenkampff w3s OIIR of the leading pioneers of modern 

anaesthesia as well as of oain therapy in Cemy, as was his father-inlaw, 

Heinrich Bra~m. He w-is s~~cc~ssful in his position as Chain- 

(interrupted for two years) for m y years until 1952. Highly honoured, 

Kulenkmpff died i.1 1961. 

Hirschel-Zipfel F. Personal cannunication 199r). 

Hirsc:hel G. Die Anaesthesierung des Plexus brachialis bei 

Operationen an der oheren Wremitat. Munch.med.Wochenschr.1911; 

29: 1555-1556. 

Hirschel G. LehrZuch der bkalanaesthesie.1913;Verlag J F Berqmann 

Ifirschel G. Die Amdendung cler Lohlanausthesie an Wlst und morax 

(Mamnakaninm,Thorakopl;lstik).Munch.md.lJochenschr.1911;10:1497-9 

Hirschel G. Fortschritte auf dem Gebiet der LOk3larnesthssie. 

PM.Klinik 1911; 45: 1721-1724. 

Wenkampff D. Personal cmnication 1987. 

Kulen'campff D. Ueber den chlorathylral~sch. Dtsch. m&.Mxhenshr. 

1911; 40:1078-1073. 

Kulenkampff D. 

Die anaesthesierung des Plexus hrachialis. 

Zbl.f.Chir. 1911; 40: 1354-1356, 

K1ilen'-wff D. Triqemirl~lsneuralqie. Erqbns . Chir. Ortho . lXl; 14 : 

155-37R. 

KliLedwrpff D. Zur speziellen niagnostik der Rauchkrankheit~n. 

Dtsch.M Iiochensc?r.l~23; 9: 274-275. 

Kulen!ampff 3. Die ortlich? Betal~bung als diagnostisch.?s und 

Rchandl~mgsmittel. Zbl.f.?hir.1.949; 6: 5813-591. 

Srinivasa N2,et a'-. Systamtic al-[ha-adrenerqic blockade with 

phentolamine: a diagnostic test for syln:xthetic3lly mintai,l~d 

pclin. Aneethesiology 1391; 71: 691.

Drs L Va~quez, J Carcellar, J Frente, A Franco 

(Santiag~ de COmpOst~la) 

The history of tile introduction of chloroform anaesthesia in Srmin has 

remined controversial for several yeqrs; our grour, has recently 

investigated this tonic by mans of the scientific and daily press of 

several Spnish cities, mainlv I-ladrid and mrcelona. 

First rep~rts of chlorofolcm anaesthesia 

New.3 of chloroform anaesthesia arrived at Cadiz, Mrcelona, Santiago da 

Ccmpostela and Madrid slmst sirmlltaneously . Qdiz received the 

information in November 1137 by an article published in the magazine La 

Revista de Ciencias Medicas (30 Yovemhr ln47) entitld Nuevo ayente 

p? procurd 13 insensibilitad. El chlorofom. Later, on 20 December, 

tills mgaxne plblished another article abut this anaesthetic entitled 

El chlorofocn~. 

me news of the discovery arrived in Barcelona in Plovember 1937 in 

articles publisl~ed in !nth the lay and scientific press. In Santiago 

de Compstela, Prof.Guamerio wr~>te that he had head the news frm 

French n~mpxpers of 24 November 1047. In the same city, Prof. Casaras 

of the Faculty of Chemistry also had hear:d the nem Erm the foreign 

press. Tne infomtion arrived in Madrid - a few days later it was in 

the daily press of 6 kcemlxr and the Gaceta Hedical of 10 December. 

First Laboratory experinumts 

Chloroform wss prepwed i~ Barcalona by a phamcist of Union Street 

called Francisco mnech. Ilaving obtained t'le drug, Mendoza carried 

out experiments on a d g on Sunday 19 December 1.947 which consisted 

of some painful stimli md minor surgery performed after the anMl had 

inhaled chloroform. 

On 5 December 1847, Frafessor Casares of Santiago de Compostel? had 

obtained a m11 munt of chloroform. By the 19th December he had 

synthesized enongh tr~ perform the first experiments ad clinical trials, 

so on that day ha and some urqeons chlorofomed a dog and also 

prformel ex:seriments on thmelve:?. Tha results wsre satisfactory and 

they decided to try it on ~mtients the following da-4, Monday 20 

December. 

Chloroforn w3s first synthes~aej i~ mdrid on l5 kcnrnber 1g47 ht the 

munt was so sm-l1 that no experimnts could be undertaken. l%e 

anadlthetlc wls oi)td~?ed by th? phamcists Drs Lletqet and Andres Checa 

and on 26 3nd 39 Meer, seven1 eupriments were performed by 

professors of t4a Faculty of Yediclne of Wadrrrl. 

First operations with chloroform 

Cm 20 Decembr 1847, at the Hospital Real de Santiago de Compostel~, 

Professor Glmrnerio amputated, for cancer, the penis of one Doqingo

Rarrier, aged 53. On t'7e same day, Professor Gonzales Olivares 

performed mastectomy on 33 years old Georqina Cmo. Cm the next day, 

the same surqeon qmtated t'le ~ n i of s a soldier, Jose Salvador. 

Surqery c?rried out u,dor chlorofoul anaesthesia achievd good results. 

On !+!onday 20 Dxember L947 in Ehrcelona, Professor Mendoza sl~ccessfully 

amputated the leg of a 31 years old woman who had a huge sarcm of the 

knee. 

In Nadrid, after a n:mker of self-experiments by s-.veraL sluqeons, a 19 

years old ptient ras opratsd on Far anal fistula, with the aid of 

chlorofom, by Dr. AoniEacio Bl.?nco Torres 011 30 neclrmbcr 1347. In the 

same city, Professor Jose C-ilvo Pkrtin amp~tated a leg on 16 ~Tmuary 

lIM3 with the aid of the new anaesthatic. 

First scientific pblications 

References to the early use of chloroforrii in Cadiz are only found some 

years later, e.g. Revista Medica 1956; 1: 4-5 etc. mce t!ie first 

clinical trials with chloroform were completed, t5e srlrqeons frm 

Santiaqo de Cmpstela quickly reprted their results to the scientific 

press - minly to that of I.ladi.-id, e.g. Gu~merio V. Ensayos sobre el 

chloroform. Gaceta Fledica 1347; 3: 292. etc. tut also in the daily 

press, e.g. Operaciones Quirurgicas con el chlorofom. El Herdldo 

1148; 1:l etc. 

The first operation Sy Flendoza uqdw chlorsfon anan~thesia had little 

r?s.mnse in t5e scientif~c or lay press of tne time - notices sppeared 

as: Acerccl del clorofonne, La Abja Wlica 1817; 1:331-335 and in El 

Fomento on 21 tecemkr 1!747 etc. 

Early referenc?~ to experiments and tria1.s in rbdrid cm be found in: 

La Union 1318; 10:55-57, 12:72 .md 12:03 etc and in Gaceta de Madrid of 

4 Jan~iary 1348 etc. 

me new of chlorofom anaesthesia arrive? ra.?idly in Spin through 

Prench and British nesppers and was readily reflected in the 

scientific and daily Spmish p r e of ~ the time. The sceedy synthesis of 

chloroform and rapid experimentation on arlim3ls that follaed resulted 

in its use for surgery, at first in Barcelona and Santiaqo de Cmpstela 

on 20 November liW7. Tie new anaesthetic agent proved very poptlar with 

the surcjeons of the time and quickly repl.%ced ether anaesthesia.

An appreciation fraa Dr Jean M HDrton (Gnubridge) 

Professor Andrew Huitx, an Honorary Yembr of the Hist ,ry of 

Anaesthesia Society (HAS) died in ?larch 1991 aqed 76, havinq been 

pro-fressively d~sa>led for some yews with Par'cinssn's disas?. He wds 

one of the folmler members of t\e HAS qnd a reqular attenler at its 

meetings, his last attzndanca b e i at ~ Southend in 1108. 

Ile was bnrn in Cambuslanq, naar Glasqow, and sducated at Mutchinson's 

School, Glssgow, receiving his medic;ll education at Glasgai Ihiversity 

and qraduating in 1937, After a House Surgeon ?~t 9t Glas~pW Royal 

Infirmary, he spent a year at Falkirk Infimry as residsnt medical 

officer and resident anaesthetist. Scotland's finest exprts are %er 

people, and in 1943 hri w-ls hsad-hunt4 and a ~ i n t d Cons~iltant 

Anaesthetist to the Neurosur~iz~l Unit (lead by the neuroaurqeon Sir 

Geoffrey Jeffarson) at Manchester Royal Infimry. lie was also 

appointed Consultant Anaesthetist to the Thoracic Sur.jic.31 Unit at 

IJythenshaci and Raquley Hospital, and to Cheadle Royal Hospital. Thus 

his main clinic31 .acP.ivities, to which 'ie contrihted so much, ere in 

anaesthasia for neur~s~xlrger;r and thoracic surrIery. Latterly he worked 

minly at Manchester Royal infim~y ((RI) and sltliough officially 

retired in 1978 at the age of 63, he continuetl to work for five years at 

tile rl7I as a Clinic.31 Assistant .and :ms Curatsr of tLle :nuselxn in the 

Anaesthetic Dep3rtment, and Consultant Transplant Adviser ta the North 

\Vest rejion Erom 1975 to 1991. 

These are the bare outlines of the clinic,nl career of a mlch-loved and 

admired anaesthetist, a father figure and mentor to mny. His interests 

in clinical anaesthesia were manifold; he w;ls a giant and pioneer in 

neuro and thoracic atmeat?zsia. He was one of the first to demonstrate 

the value of contmlled ventilation for craniot&es and pioneered total 

intravenous anaest5eaia with his thiopentone (lrips. 

He nust have been one of the few, if not the only anaesthetist with the 

diploma of RFPS (Fellcnv of the Tamlty of Physicians and Surgeons of 

Gl?isgm) which ho 07staine4 in 1340. In 1942 he wds a-~inled the Glasgw 

MD for his thesis on 'Postomrative ~lmonat-y compl-ications', and passd 

the DA. He was elected WAnCS in lr,',3. 

In Manchester. his aca-lemic ,and tesching abilities *;?re rsc-niszd by 

the Faclilty w3o al7pointed him as Honoraty Cecturer in Fharmacolgy in 

1947, (there Seing no academic 4e~rtmnt of anaesthetics). He Tqas 

appointed Honorary Reader in 1961, to a Dersonal chair in 1971 and 

Writus Professor in 1975. He was saddened that he was nqt apwinted 

to be the first holder of the Chair of An-esthcsia at the University of 

Manchester. He founded t:ie rQncllester and District Society of 

Anaesthetists, w'-iich 13t0r Mane t%e Section of Anaesthetics of the 

Ihnc!iester Fledicsl Society of which he ivas Presiclent in 1902. 

Andrew Hunter's sctivities w?re not confined t3 Manchester or clinical 

work. I+e ,.?as al\yays to be seen tnn t'le first Friday of the month, never 

failing to contribute to the disc~issions of the Section of Anaesthetics

of the Royal Society of Medicine which ha served as Council Ffember, 

Secretary and then President in 1973. He rms a Council Member of the 

Assxiation of Anaesthetists from 1956 to 1959 and elected as an 

Honor4ry Member in 1980. In t!~e Faculty of Anaest.l-.ti.its of the Royal 

College of Surqeorls of Engl=ind he serve.l as a member of the Bard for 

sixteen years, ims Vice-Dean and a:mrrlrd the Clover lectureship and 

lXldley Rwton Prize. He r.ns an examinnr for the Primary and Final ETA 

and Chaimn of t;lew PICQ lind core qroup and denmnstrated to critics that 

the ETA examination wis not competitive. 

He was one of the founders of the Neuro-anaestlletists' Travelling Club 

and a founder rnemb~r of tlle Anaesthetic Research Society and Intensive 

Care Sxiety. 

His publications were nlmerou;: three books and many papers and 

chapters, and w:hen wt at meetings 9e altmys seemed to he carrying the 

galley prtmfs of his most recent work. His first piblication wss in 

Volume 1 of 'Anaest'iesia' in 1946 on 'Loc3l analgesia for atdomina1 

operations' and his lqst was also in 'Anaesthesia1 in 1984 when he 

described 'Idiopathic alveolar hypoventilation .in Leberos disease'. One 

of his main contributions ts the anaesthetic literature was in his work 

on 'le developnt and succ?ss of t!le 'British Jowl of Anaesthesia', 

which he served as Treasurer, Assistant Editor of Fustqraduate Nmbers 

and Chalmn of tie Board of the Journ3l from 1959 to 1905. 

An a!3preziation sirch as this cannot do justica to Andrew Hunter's 

contrihtion to t:ie swcialty of anaestl?nsia. For t!io.;e of us wbo 

specialis& in neuroanaesthesia, he tws our mentor. !$e will all 

remenber this t~ll, kind and helpful mm through his writings and the 

fine example and itmdar

Dr C K Adm 

Dr A K Adam3 CBE 

Dr C N Adam 

Dr M S Albin 

Dr J D Alderson 

Dr J I Alexsnd-r 

Dr L All-an 

Dr C P Allen 

Dr J G Allen 

Dr P Anrnrf~so 

Dr T N Awleyard 

Dr G M D Arch?r 

Dr E N Armitage 

Flr S Askill 

Dr R S Atkinson 

Dr D F Flaiqent 

Dr R J B

Dr D D C Horiat 

Dr J D Rutchinson 

Dr M T Inman 

Dr R D Jack 

Dr R H Jaqo 

Dr R L A Jayaweera 

Sir Anthony Jephcott 

Dr B D Jotinson 

Dr A G Tones 

Dr J Jones 

Dr M J Jonas 

Dr R Jonci 

Dr N S Kaduskar 

Dr D Kandela 

Dr L Kaufman 

Dr T Keys 

Dr J D Kinnell 

Dr P A Knappett 

Dr F1 Kncn~les 

Dr K L Kong 

Dr M K!IS 

Dr R S Laishley 

Dr E mdau 

Dr G Lar.rrence 

Dr J I M La,wson 

Lhr A G P Laxton 

Dr M Leahy 

DrKGLee 

nr J F ws 

Dr J M Leiqh 

Dr 4 Leslie 

Z Lett 

T)r I D Levack 

Dr J rl Txr iik 

Dr D G Le:~is 

Or !J Lim 

Dr R G Lindsay 

Dr A Lgan 

Dr W G G Iayn 

Dr P1 C Luxtnn 

Dr A G r&c:Ionald 

Dr P T ?litgee 

Dr P Mahoney 

Dr J Mainzer 

Dr R Maltby 

Dr R E Mansfield MBE 

ttc R S Mark 

Dr H R Flarrett 

Dr R H K Flarsh 

Lhr c4 !.farshall 

Dr A I1 R Plasson 

Dr E T Mathews 

T E McBgan 

S W Mc-n 

Dr R K FWGregor 

Dr R P McKinnon 

Dr C A B WLaren 

Dr I n.lclellan 

Dr S Yehta 

Dr B H Meikle john 

Dr J Mellln-Olsen 

Pro£ M G Mezzetti 

Dr R knller 

Dr A H M Mollah 

Dr J Moore 

~r J A bnro 

Dr L Morris 

Dr P Morris 

Dr M Nowbray 

m J Moyle 

Dr J T Mulvein 

Dr J P Murphy 

Dr P J Plurphy 

Dr A F EJaylor 

Dr N I Newton 

Mr B W Nicholls 

Dr A E L Nicol 

Pro€ J Nomn 

Dr P J 0' Connor 

Dr B Ol~ver 

Dr J Onnrcd 

Dr B Owen 

Dr A OirTies 

Dr R N Packham 

Dr A Padfield 

Dr W K Palllster 

Dr B Fanning 

Dr S M Parr 

Dr G M C Paterson 

Pro€ J P Payne 

D r c m 

Dr D W Perriss 

M W Platt 

~r F S Plumpton 

Dr P Portal 

Dr I Pader 

Dr J Pring 

Dr D T Protheroe 

Dr D L Pryer 

k R Ratcliffe 

Dr N Rdfern 

Dr G J Rees C;IE 

m S Rhys Williams 

Dr L J Rice 

Dr B C Roberts 

DK D S Robrtson 

Dr A-M 

Rollin 

m N M Rose 

Mr N Rosenbaum 

m D J Rowbotham 

m M A Rucklidge 

or J Rupreht 

Dr G B Rushman 

~r M L C Rutledge 

DrDW.lyan 

m J P sale 

1% R H Salt 

m D A Saunders 

Dr S Saville 

Dr D Schiller 

nr J L Scholtes 

Mr M SCOtt 

Dr W SCOtt 

Dr J F Searle 

~r H F Seeley 

Dr 0 Secher 

J Sec'rer Walker 

Dr M G Serpell 

m R K Shah 

m R N Shah 

Dr T C slab1 

Dr P H Simnons 

Dr M A Skivington 

Dr B H Smith 

Pro£ G Smith 

rnGBSmith 

Dr I Smith 

Dr M R Smith 

m T G C Smit'7 

m W A Smith 

Dr 'PJ D A Smith OrlE 

Dr D G Snytil 

Dr G W Snipes 

Dr P M soargo 

Dr D H Spars 

m J R Spears 

Pro£ A 4 Spence 

Dr S Srivastava 

Dr C R Stephen 

J B B Stetson 

Mr D St~wart 

m K A Stewart 

Dr J G L Stock

Dr P J Stow 

Dr B ?I Q Weaver 

Mr B R Rgg 

Dr J R Wedley 

Dr B P Sweeney 

Dr S R Weeks 

Frof M K Sykes 

Dr R W Weller 

Mr P Sykes 

Dr B E Welsh 

Dr P B Taylor 

Dr D K Whitaker 

Dr T H Taylor 

Dr A P Nhite 

Dr T A V ~ m s 

Dr D C White 

J B Thompson Dr G ET J White 

Dr P W Thompson 

Dr M J Whitehead 

Dr B A Thomley 

Dr B R Whittard 

Dr J A mornton 

Dr J 4 W Wildsmith 

Dr M E Thornton 

Dr D J Wilkinson 

Dr S Tirer 

Dr S Willatts 

Dr D C Tarnsend 

Dr J Wilson 

Dr A J Trench 

Dr S Wilson 

Dr W D Turner 

Dr D P Winder 

Dr D G -leedie 

Dr C M Wiseley 

Dr F M Ulyatt 

Dr M J Wolfe 

Mr K W Underwood 

Dr C H M Woolham 

Dr J-P Van Besouw 

Dr D Nright 

Dr M Van Ryssen 

M r M L S Wright 

Dr R S Vauqhan 

Mr P Wright 

hrof D Vermeulen--an& CBE S R m - m i c h r e 

Dr N Volpe 

Dr E young 

Mr J B R Walker 

Dr T M Young 

Dr D A Warmsley 

Dr G L Zeitlin 

Dr J Wandless 

Dr J S M Zorab 

DrCWard 

Dr D Zuck

CRAWORD W LONG 

SESQUICENTENNML 

MDCCCXLII - MCMXCII 

THE HISTORY OF 

- ANESTHESIA HISTORY ASSOCIATION 

Symposium Committee: Chairman, John E. Steinhaus, M. D. 

Emory Clinic, 1365 Clifton Road, Atlanta, CA 30322 

NLANTA. GEORGIA. U.S.A. - MARCH 27-31.1992

Volume 9b - History of Anaesthesia Society

Create successful ePaper yourself

Delete template?

Save as template?