Journal of Anesthesia History最新文献

Behind every successful physician there are mentors to light the path. Ralph Waters, founder of the anesthesiology residency at the University of Wisconsin–Madison, was an instrumental part of Virginia Apgar's success; his support of her education and promotion of her professional endeavors proved to shape the medical powerhouse that Apgar would become. In this article, we learn about the professional and personal relationship between Waters and Apgar through personal correspondence from the Ralph Waters Collection at University of Wisconsin Archives, scientific publications, and meeting records. Through his support of her career, she was able to achieve success despite the Great Depression, World War II, and the novelty of being a woman in medicine. In her career, Apgar became the first female full professor at Columbia University, designed and implemented the Apgar score, and led the Division of Congenital Malformations at the March of Dimes among many other accomplishments. Though they lived half of a country apart in Wisconsin and in New York, the mentor and mentee bridged the gap in geography through regular correspondence, American Society of Anesthetists (now American Society of Anesthesiologists) meetings (where Waters served as president and Apgar as treasurer), and exchange of trainees between the University of Wisconsin at Madison and Columbia University. Apgar revealed herself to be a persistent, hardworking, intelligent, and passionate academic physician – the perfect pupil for Waters. This article's aim is to underscore the importance of mentorship – with equal commitment to the relationship from mentor and mentee – then and now.

When teenaged Henry Jacob Bigelow was an undergraduate at Harvard College in 1833-1837, he prepared nitrous oxide gas for demonstrations to other students. Bigelow's son, William Sturgis Bigelow, related the claim, and there is an eyewitness account from Augustus Goddard Peabody, a fellow Harvard undergraduate with Bigelow. Peabody wrote to Henry David Thoreau about a nitrous frolic. College chemistry primed Bigelow to support the concept of inhaled surgical anesthesia when the idea came to Boston in 1845-1846. Bigelow's chemistry professor was John White Webster. According to Harvard alumnus Edward Everett Hale, in addition to demonstrating effects of nitrous oxide, Webster presciently treated two cases of carbon monoxide poisoning with copious volumes of synthetic oxygen gas. The career of Webster was inhibited by financial difficulties that were suspected to be contributory when he was convicted of the 1849 murder of physician George Parkman at the Harvard Medical School, then adjacent to Massachusetts General Hospital and its Ether Dome. Webster suffered the death penalty in 1850.

Background

Acupuncture anesthesia was used instead of intubation anesthesia in the 1970s and 1980s in West Germany and West Berlin. In East Germany acupuncture played no decisive role.

Sources

Different articles and papers in journals, in daily press, statements of contemporary witnesses, films, records in archives.

Results

As in other Western countries, acupuncture was hugely popular in the Federal Republic of Germany in the 1970s. Chief triggers were the state visits to China of the American President Richard Nixon in 1972 and shortly thereafter of West German Foreign Minister Walter Scheel and his wife Mildred, an x-ray technician. During that period observation of an operation under acupuncture anesthesia was an obligatory element in the agenda of a foreign delegation.

Following this showcasing, acupuncture was widely adopted in Western surgery as an alternative to the previously exclusive employment of intubation anesthesia. While the alternative method was soon abandoned in the frontline city of West Berlin, it continued to prevail in other West German cities, e.g. Gießen and Munich. Following the Chinese example, the acupuncture effect was normally enhanced electrically.

In accordance with the animosity between the USSR and the People’s Republic of China, exchange between the German Democratic Republic and China was very restricted through the late 1980s. This made it easier for East German acupuncture sceptics to reject the procedure and brand it as unscientific. Those who advocated it were in a precarious position.

Conclusions

Acupuncture was lauded in the West as ancient savvy destined to complement science-oriented medicine. However, the cultural transfer which accompanied the spread of acupuncture was flawed by misunderstanding and misguidance.

Acupuncture anesthesia instead of intubation was not practiced in the GDR. Acceptance of acupuncture in East German medicine failed to make any headway until the last few years of the country’s existence.

For millennia, mankind has sought a means of altering consciousness, often aided by naturally occurring elements. Psychotropic substances have been an integral part of spiritual, medicinal, and recreational aspects of life. The origin of anesthesiology stems directly from the use of recreational drugs; early inhaled anesthetics were first used as a means of entertainment. Hence, it is no surprise that many medications in the anesthesiologist's armamentarium are diverted for recreational use. In the 172 years following the first successful public demonstration of ether anesthesia, many drugs with abuse potential have been introduced to the practice of anesthesia. Although anesthesiologists are aware of the abuse potential of these drugs, how these drugs are obtained and used for recreational purposes is worthy of discussion. There are articles describing the historical and recreational use of specific drug classes. However, to the best of our knowledge, this is the first comprehensive review focusing on the breadth of drugs used by anesthesiologists.

Certification in pain medicine as a subspecialty in Anesthesiology was conceived in 1989 and first discussed by the American Board of Anesthesiology in 1990. Shortly thereafter, the ABA submitted an application to the American Board of Medical Specialties for recognition to certify in pain management. That was approved in 1991. The Accreditation Council of Graduate Medical Education approved an application from the Anesthesiology Residency Review Committee to accredit programs in pain management education and training in 1992.

The first examination for Pain Management certification was given in 1993. The certificate was modified in 2002 to Pain Medicine rather than Pain Management. Five member boards of ABMS are now approved for certification in pain medicine and all use the ABA Pain Medicine examination.

The modern human, and all progenitor species before it, evolved in a milieu of pain and suffering. Recent innovations in medicine have permitted the development of tools to mitigate these powerful experiences. Anesthesiologists have been on the vanguard of developing treatments and systems to face this challenge. Pain is a heterogeneous entity that requires precise categorization, and targeted, multimodal treatment to optimally manage. Anesthesiologists have developed a system whereby analgesia permits a myriad of life-saving surgeries, and have expanded their role beyond the perioperative setting. This includes unique contributions to how the concept of pain is experienced by infants, and appropriate interventions in this population. Contemporary anesthesiologists have extended their responsibilities to include harnessing robust technologies to manage pain in outpatient clinics, and serving as pain experts within hospital systems. This article serves as a primer to the history of anesthesiologists' contributions to pain management.

Horst Otto Stoeckel was born September 26, 1930, in Lodz, Poland, which was part of the newly founded Second Republic of Poland until it was occupied by Nazi Germany in 1939. After World War II, his family immigrated to Meiningen, Germany, where he obtained his primary and secondary education. He attended Humboldt University and the University Hospital Charité of Berlin for his medical degree. Profs Theodor Brugsch, Karl Lohmann, and Friedrich Dost were important individuals who helped develop his interest in quantitative clinical pharmacology and pharmacokinetics. Prior to anesthesiology, Stoeckel trained in surgery, internal medicine, and obstetrics and gynecology in addition to clinical anesthesiology at a community hospital in East Germany. He completed 2 years of obligatory training to become an anesthesia specialist at the Teaching Hospital Hufeland and the Research Institute for Lung Diseases at Berlin-Buch. He also received training in anesthesia at the Humboldt University of Berlin. After escaping East Berlin through the Brandenburg Gate in August 1961, he obtained a position at the University of Heidelberg and obtained his West German board certification in anesthesiology in 1962. In the following 12-year period, Stoeckel was married, was promoted, passed his “habilitation” or lectureship period, started a family, and was granted the title of “Professor.” His administrative career began in February 1974 when he was selected as the first Chair of Anesthesiology at the University of Bonn, a position he held for 22 years. He also served as Dean of the medical school from 1980 to 1981. As Chair, he developed three areas: patient care, teaching, and research. He developed a long-term research program in the field of “Quantitative Clinical Pharmacology in Anesthesia and the Quantitative Modeling and Control in Anesthesia,” which required an interdisciplinary team of specialists in biochemistry, physics, and modern analytical methods. Over 20 years, the group's research program led to the discovery of basic algorithms providing the foundation of the automatic regulation of dosing control by the closed-loop feedback system, which is a concept important to the target-controlled infusion of intravenous and inhalation anesthetics. Following his career as a clinician, administrator, and researcher, he pursued a second career as a collector and museum founder.

As a medical student and during his preacademic time prior to 1958, Horst Stoeckel was interested in the history of medicine and especially history related to anesthesia. After his retirement from Chair of Anesthesiology at the University of Bonn in 1994, Stoeckel received a gift from Professor Richard Kitz of Harvard University (Boston, MA) that encouraged him to develop his collection of 150 artifacts and 350 books and periodicals into a scientific museum and library. The late librarian, Patrick P. Sim, MLS, of the Wood Library-Museum of Anesthesiology in the United States also encouraged and supported Stoeckel with literature concerning anesthesia history. The Horst Stoeckel Museum of Anaesthesiology (Horst-Stoeckel-Museum fur die Geschichte der Anasthesiologie) was dedicated by the University of Bonn and opened to the public on October 9, 2000, and currently has more than 1000 items displayed in 45 themed display cases. A newly themed concept of Incremental Development of Eminent Anesthesia Landmarks to Operational Routine was developed for the display and explanation of the history of anesthesia related to pioneers, equipment, books, and manuscripts. A display concept combining Person, Publication, and Apparatus is used throughout the museum. A well-stocked library currently holds more than 13,000 books and periodicals. The museum's 10-year anniversary was celebrated with a symposium entitled “German Pioneers in Anaesthesia of the first 100 years,” held at the University of Bonn on October 8, 2010. The museum's Web site in German, English, and French is www.anaesthesia-museum.uni-bonn.de.