october 2004, vol 22

OCTOBEROCTOBEROCTOBEROCTOBEROCTOBER, 2004, 2004, 2004, 2004, 2004VOLVOLVOLVOLVOLUME 22, NUMBER 4UME 22, NUMBER 4UME 22, NUMBER 4UME 22, NUMBER 4UME 22, NUMBER 4

A H A

Manuel Martinez Curbelo And ContinuousLumbar Epidural AnesthesiaBy J. Antonio Aldrete, M.D., M.S.Aldrete Pain Care CenterArachnoiditis Foundation, Inc.Birmingham, AL

Humberto Sainz Cabrera, M.D.Professor of AnesthesiologyPresident of the Cuban Society of Anesthesiology and ReanimationSecretary of the Confederation Latin American Societies of Anesthesiologists

Amos J. Wright, M.L.S.Associate ProfessorSection on History of AnesthesiaDepartment of AnesthesiologyUniversity of AlabamaBirmingham, AL

Seldom are new techniques in anesthe-sia the product of serendipity. Davy, Wells,Morton, Snow, Simpson, Waters and oth-ers, to mention a few, spent considerabletime in “bench research” and/or clinicalobservations before they announced theirdiscoveries. However we mostly know oftheir most relevant contributions and some-how their other work is unappreciated.This situation is also the case with ManuelMartinez Curbelo, a Cuban anesthesiolo-gist who is known for first having pro-duced continuous lumbar epidural anes-thesia through the publication of an ar-ticle written during one of his visits to theMayo Clinic.1 However, how this cameabout has not been known, nor have someof his other contributions to our specialtybeen identified.2 A search and review ofthis author’s medical career developmentwere conducted to further gain an insightinto the events and the leading charactersof the time that led him to the idea of in-serting a uretheral catheter into the lum-bar peridural compartment. We alsowanted to know how he gained the insightto apply this technique not only for surgi-cal anesthesia but also its application forchronic pain conditions outside of the op-

erating room.Pio Manuel Martinez Curbelo, as was

his complete name, was born in la Havana,Cuba, in 1905. He completed his medicaleducation at the National University of LaHavana in the late 1920’s. Not much isknown of his motives for choosing anesthe-sia as his specialty but his inclination fornew modifications and improvements ofestablished techniques was evident early inhis career as an anesthesiologist. He de-scribed a modification of the supraclavicu-

lar approach to the brachial plexus blockas it was described by Kulenkampff. Heperformed this block with the patient sit-ting on a chair and rationalized it by indi-cating in a diagram (Figure 1) that in thisposition the shoulder falls, making theplexus more accessible as it crosses overthe first rib, with less possibility to injurethe lung.3

Before embarking on this enterprise

Continued on Page 4

Fig. 1. Photograph including a diagram of the brachial plexus (after Labat)and on the right Manuel Martinez Curbelo demonstrating the position of thesyringe held in his right hand, while his left hand steadied the needle.

22222 BULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORY

History at the ASA 2004 Annual MeetingForum on the History of AnesthesiaThe ASA at 100: A HistoryOctober 25, 20042:00 - 4:00 PMLas Vegas Hilton - Pavilion 4

Objectives: The learner will understand several important pointsin the history of the American Society of Anesthesiologists andhow those decisions affect the current structure of the ASA.

ModeratorDouglas R. Bacon, M.D., M.A.Professor of Anesthesiology and History of MedicineMayo Clinic College of MedicineRochester, Minnesota

In the Beginning: The Long Island Society of Anes-In the Beginning: The Long Island Society of Anes-In the Beginning: The Long Island Society of Anes-In the Beginning: The Long Island Society of Anes-In the Beginning: The Long Island Society of Anes-thetists and Adolph Frederick Erdmannthetists and Adolph Frederick Erdmannthetists and Adolph Frederick Erdmannthetists and Adolph Frederick Erdmannthetists and Adolph Frederick ErdmannJames C. Erickson, III, M.D.Emeritus Professor of AnesthesiologyNorthwestern UniversityChicago, Illinois

The Creation of ASAThe Creation of ASAThe Creation of ASAThe Creation of ASAThe Creation of ASADouglas R. Bacon, M.D., M.A.

The 1960s - The ASA Comes of AgeThe 1960s - The ASA Comes of AgeThe 1960s - The ASA Comes of AgeThe 1960s - The ASA Comes of AgeThe 1960s - The ASA Comes of AgeAdolph H. Giesecke, M.D.Former Jenkins Professor of AnesthesiologyUniversity of Texas Southwestern Medical CenterDallas, Texas

The American College of AnesthesiologyThe American College of AnesthesiologyThe American College of AnesthesiologyThe American College of AnesthesiologyThe American College of AnesthesiologyPeter L. McDermott, M.D., Ph.D.Past PresidentAmerican Society of AnesthesiologistsCamarillo, California

The Issues of the 1980s - The ASA and Professional-The Issues of the 1980s - The ASA and Professional-The Issues of the 1980s - The ASA and Professional-The Issues of the 1980s - The ASA and Professional-The Issues of the 1980s - The ASA and Professional-i s mi s mi s mi s mi s mBradley E. Smith, M.D.Professor of Anesthesiology, EmeritusVanderbilt University School of MedicineNashville, Tennessee

History - Foundations of AnesthesiologyOctober 26, 20043:15 - 5:15 PMLas Vegas Hilton - Ballroom E

Objectives: The learner will understand the importance of theFoundations to the specialty of Anesthesiology in the UnitedStates.

Co-ModeratorsDouglas R. Bacon, M.D., M.A.Professor of Anesthesiology and History of MedicineMayo Clinic College of MedicineRochester, Minnesota

Maurice S. Albin, M.D., M.Sc.Professor of AnesthesiologyUniversity of Alabama at BirminghamBirmingham, Alabama

FFFFFrom Roslyn Boat House to Showplace of Prom Roslyn Boat House to Showplace of Prom Roslyn Boat House to Showplace of Prom Roslyn Boat House to Showplace of Prom Roslyn Boat House to Showplace of Park Ridge -ark Ridge -ark Ridge -ark Ridge -ark Ridge -The WThe WThe WThe WThe Wood Library-Museumood Library-Museumood Library-Museumood Library-Museumood Library-MuseumGeorge S. Bause, M.D., M.P.H.Associate Clinical ProfessorCase Western Reserve UniversityCleveland, Ohio

Anesthesia PAnesthesia PAnesthesia PAnesthesia PAnesthesia Patient Safety Fatient Safety Fatient Safety Fatient Safety Fatient Safety Foundation: History of a Suc-oundation: History of a Suc-oundation: History of a Suc-oundation: History of a Suc-oundation: History of a Suc-cess Storycess Storycess Storycess Storycess StoryRobert K. Stoelting, M.D.President, Anesthesia Patient Safety FoundationIndianapolis, Indiana

The Foundation for Anesthesia Education and Research:The Foundation for Anesthesia Education and Research:The Foundation for Anesthesia Education and Research:The Foundation for Anesthesia Education and Research:The Foundation for Anesthesia Education and Research:TTTTTaking A Long Bet on the Faking A Long Bet on the Faking A Long Bet on the Faking A Long Bet on the Faking A Long Bet on the FutureutureutureutureutureAlan D. Sessler, M.D.President, FAERRochester, Minnesota

Caring for Residents - The Anesthesia FoundationCaring for Residents - The Anesthesia FoundationCaring for Residents - The Anesthesia FoundationCaring for Residents - The Anesthesia FoundationCaring for Residents - The Anesthesia FoundationWilliam D. Owens, M.D.Professor of AnesthesiologyWashington University School of MedicineSt. Louis, Missouri

Why Bother? The Importance of the Foundations to theWhy Bother? The Importance of the Foundations to theWhy Bother? The Importance of the Foundations to theWhy Bother? The Importance of the Foundations to theWhy Bother? The Importance of the Foundations to theASA and the SpecialtyASA and the SpecialtyASA and the SpecialtyASA and the SpecialtyASA and the SpecialtyDouglas R. Bacon, M.D., M.A.

Each year the Anesthesia History Asso-ciation conducts a resident essay contest,offering $500 and publication in the Bulle-tin of Anesthesia History to the winningessay’s author. Other entries may be pub-lished in the Bulletin as well.

At the AHA’s annual dinner meeting,to be held October 25, 2004, in Las Vegas,Nevada, during the ASA, the following win-ners of the 2004 contest will be announcedby William D. Hammonds, M.D., M.P.H.,Chair of the Resident Essay Contest Com-mittee:

AHA 2004 Resident Essay AwardWinners

First PlaceMatthew Mazurek, M.D.“Sir William Macewen, a History of OralTracheal Intubation for Anesthesia, and aMissed Opportunity”

Second PlaceGeorge A. Mashour, M.D., Ph.D.“Altered States: The Psychedelic Researchof Henry Knowles Beecher”

Third PlaceGeorge A. Swanson, M.D.

“The Religious Objections and MilitaryOpposition to Anesthetics, 1846-1848”

BULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORYBULLETIN OF ANESTHESIA HISTORY 33333

Letters to the EditorTo the Editor:

Dr. Peter McDermott has long been anexcellent reviewer of publications for theBulletin of Anesthesia History. However, Imust take some exception to his recent opin-ions on WWWWWorld Forld Forld Forld Forld Federation of Societ-ederation of Societ-ederation of Societ-ederation of Societ-ederation of Societ-ies of Anesthesiologists—50 Yies of Anesthesiologists—50 Yies of Anesthesiologists—50 Yies of Anesthesiologists—50 Yies of Anesthesiologists—50 Yearsearsearsearsears.Most especially, I am deeply troubled byhis allegation that documentation was lack-ing on the assertion that fear of commu-nism was one of the factors in the Ameri-can Society of Anesthesiologists’ reluctanceto join the WFSA. The best known argu-ment was used for the essay—letters to theeditor from the Bulletin of the New York StateSociety of Anesthesiologists at the time. Theletters are referenced and sections arequoted directly from their published text.The argument clearly centered on bothmoney and the fear that the WFSA wassome sort of communist organization.While this may not speak to the mood ofthe entire ASA, the New York Society, likethe California and Texas societies, is largeand of enormous influence. I wonder whatmore documentation our intrepid reviewerdesires.

As to the charge of young men venerat-ing their elders, I do plead somewhat guilty.However, as authors of the chapter we wereasked by the editors to sum up “the Ameri-can character” that led to the reluctance ofthe ASA to join the WFSA. This is a dan-gerous essay to write, and as Dr.McDermott has rightly pointed out, thereis much contradictory evidence to the broadbrush strokes painted by Dr. Papper andmyself. One of my Professors of History,in graduate school, gave a lecture on theAmerican character at the Sorbonne. As myprofessor related the story, he related thateach point he made he had reams on con-tradictory evidence as well as reams of sup-porting evidence. As dual authors, Dr.Papper and I chose themes we thoughtmight help others from outside the UnitedStates understand the American charac-ter.

It is my hope that Dr. McDermott con-tinue his sanguine reviews as I find themmost helpful in picking out those bookswhich to purchase for my personal historyof anesthesiology library. Long may hecontinue his sterling efforts!

Douglas R. Bacon, M.D., M.A.

To the Editor:

I am grateful for Dr. Bacon’s responseto my review of the Papper/Bacon essay inthe recently published WWWWWorld Forld Forld Forld Forld Federa-edera-edera-edera-edera-tion of Societies of Anesthesiologiststion of Societies of Anesthesiologiststion of Societies of Anesthesiologiststion of Societies of Anesthesiologiststion of Societies of Anesthesiologists– 50 Y– 50 Y– 50 Y– 50 Y– 50 Yearsearsearsearsears. His view, as I understand it, isthat I erred in saying “the assertion thatASA was reluctant to join WFSA becauseof fear of communism is without documen-tary support.” In reading (and re-reading)the article, I looked for citations to supportthe assertion that “any society that admit-ted communist groups was inappropriatefor American participation.”1 What I foundwas a reiteration of the claim that centuriesof American isolationism was manifestedin the reluctance of American anesthesiolo-gists in the 1950s to associate with any or-ganization that admitted communists. (TheUnited Nations?)

The evidence presented supports theview that American concerns, particularlythose of the New York Society, were aboutthe dues assessment, the haste with whichmembership was urged, the need to secureprior approval by the ASA House of Del-egates, and the “socialist structure” ofWFSA organization.2 None of this speaksto either fear of communism, which is dis-tinctly different from socialism, or ofchronic isolationism. I repeat, the UnitedStates has been deeply engaged in relation-ships, exchanges, associations, and alli-ances since its inception. It is true thatAmericans reacted by withdrawal fromEuropean political affairs after World WarI, failed to join the League of Nations (theproposal, by the way, of an American,Woodrow Wilson), and retreated behind theillusory safety of its two large oceans to pur-sue its domestic self-interests. This wastransient, exceptional, and not at all repre-sentative of America’s involvement with theworld.

I am more concerned by Dr. Bacon’sclaim that the goal of the article was to por-tray “the American character” in responseto editorial demand. That is odd. A historyof the WFSA on its 50th birthday demandsan American contribution based upon asupportable historical record, not themushy subjectivity of personal opinions.More worrying to the historian is the con-

fession that the authors “mined” theirsources to support their pre-conceived no-tion of the American character. With thisapproach, one only finds what one is look-ing for. If the evidence would support dif-ferent views of the American character, asDr. Bacon asserts in his response, then itis a disservice to the historical record topresent a partial truth as a whole truth.Historical integrity requires that the pastdo more than serve the interests of thepresent. It must be allowed to speak foritself. To fashion an American characterthat endures over centuries with consis-tent qualities is to fashion myth, not his-tory.

I have said nothing that Dr. Bacon doesnot already know. As he knows, and youshould too, he has been a valued friendand much-admired colleague of mine formany years. He is tireless in his efforts onbehalf of the history of anesthesiology andthe scholarly pursuit of excellence. Mycriticisms are reluctantly directed, I sus-pect, at the attempts of Dr. Papper topresent a universalist view of the Ameri-can character and the course of Americanhistory.

Peter McDermott, M.D., Ph.D.

1WFSA– 50, p.48. In the period after World War II, the

US was a member of the United Nations, an organization

that included communist nations. NATO included many

countries with socialist governments.

2 Ibid., 50.


Martinez Curbelo studied the techniquesdescribed by Pages,4 Dogliotti,5 Gutierrez6

and Odom,7 who visited Alberto Gutierrezin Buenos Aires in 1935. Martinez Curbelobecame acquainted with their techniquesof peridural anesthesia; he cited all of themin his publications. In addition, he hadfirst hand instruction from A H. Ferro,8

the physician who introduced this tech-nique into Cuba in 1937. He began to use itin 1942, and by 1944, together with PerezValdez and Mesa Quinones,9 they reportedon their earlier experience with single shotepidural anesthesia for a variety of surgi-cal procedures at a surgical meeting heldin La Havana describing 648 cases in pa-tients ranging from 10 to 100 years with-out any apparent serious complications.

Martinez Curbelo was aware of themetameric sensory blockade concept intro-duced by Pages,4 as he had realized that inorder to obtain an optimal visceral block-ade, he had to obtain a continuous sympa-thetic blockade as first proposed by Eu-gene Aburel, a Romanian, who in 1931, hadadvocated blocking first the lumbo-aorticplexus at an early stage of labour followedby a caudal injection for the expulsionphase10 to achieve complete obstetric anes-thesia. He produced the first block by in-troducing an elastic silk catheter througha needle inserted at the left flank, leavingthe catheter after removing the needle andrepeatedly injecting 0.5% percaine.

Clinicians realized that to provide con-tinuous anesthesia for long lasting surgi-cal procedures, there had to be a way torepeatedly inject local anesthetics.Lemmon11 achieved it by using malleableneedles to prolong spinal anesthesia, evento the point of making special mattressesand OR tables that would permit placingthe patients supine with the bent needle intheir backs. This need was addressed inobstetric anesthesia by Hingson andSouthword12 after trying malleable needlesinserted caudally, in 1942 used continu-ous epidural anesthesia by the caudalroute, injecting local anesthetics throughuretheral catheters.

Edward B. Tuohy tried the malleableneedles too,13 but then decided to modifyLemmon’s approach by adapting a 3.5inch-long Becton–Dickenson 15 gauge tro-car-needle to a Huber tip already in use(Figure 2). This technique allowed him toinsert a uretheral catheter into the sub-arachnoid space and to direct it eithercephalad or caudad.14 In this scenario itwas obvious that a reliable, simple and safemethod to prolong peridural anesthesia

Curbelo. . . Continued from Page 1

was needed; Martinez Curbelo, visited theMayo Clinic in November 1946. He ob-served Ed Tuohy using his recently devel-oped needle to allow for the insertion ofuretheral catheters intrathecally and notedthat by injecting small, fractionated dos-ages of local anesthetics, repeatedly, longterm analgesia could be achieved (Figure2).

Armed with a number of needles andcatheters given to him by Tuohy, he re-turned to Cuba in December 1946. On Janu-ary 13 1947, at the Hospital Municipal dela Havana, he inserted a catheter into thelumbar epidural space in a 40 years oldwoman about to have a laparotomy for re-moval of a giant ovarian cyst.15 He foundthe epidural space by the “loss of resis-tance” method, then passed a No. 3.5uretheral catheter through the needle (Fig-ure 3) then injected 15 ml of 1% procaineafter diluting the crystals produced byWinthrop Laboratories in ampules con-taining 150 mg diluted in normal saline.An injection of a supplementary dose was

given 40 minutes later. On January 26, hereported his success in a meeting of theSurgical Society of La Habana.15

Eventually he tried 0.1% tetracaine fromthe same manufacturer, containing either10 or 20 mg in ampules, to be diluted in0.9% NaCl solution. However, because thecatheter allowed him to reinject as manytimes as necessary, he used procaine crys-tals dissolved at the time of injection, with-out epinephrine.16

In those days, young doctors trained inanesthesia by spending months or yearsworking with experienced anesthesia prac-titioners; those who knew MartinezCurbelo remember him as a compulsiveperfectionist, insisting that for the proce-dure, patients had to be placed in lateraldecubitus with complete flexion of thespine; he emphasized the need to have theshoulders even to prevent rotation of thelumbar spine, which will make the punc-ture difficult. The side to be operated wasto be dependant. The tray that he used con-tained:

Fig. 2. Tuohy’s needle made out of 16 gauge trocar attached to a “Huberpoint” (seen from frontal and lateral views).

Fig. 3. Ureteheral catheter threaded through Tuohy’s needle


Continued on Page 6

• “A- Special Becton-Dickenson tro-car of Tuohy, 16 gauge, with a Huberpoint”• “B-One uretheral No. 3.5 catheterwith guide”• “C-Two syringes: one of 2 or 3 ccand another of 10 cc capacity”• “D-Two one inch B-D needles, onewith sharp bevel to anesthetize theskin and the interspinous space andthe other a 23 gauge with dull tip toadapt it to the distal end of the cath-eter.”1

The instruments were sterilized by au-toclave or by boiling them in distilled wa-ter. He mentioned that the “trocar designedby Tuohy was 9.5 cms, in length, of an ap-proximate caliber of 3.5 mm in outer di-ameter; adapting to it, in the distal point,a Huber tip bevel made by following a par-allel cut to the length of the needle, plac-ing a lateral bevel that allowed to orientthe catheter in a perpendicular plane tothat of the needle, and longitudinal to thatof the spine and the epidural space.”

The No. 3.5 catheter was made of nylon,had a 1.6 mm of internal diameter withexternal centimeter marks, it was “opaqueto X-rays, flexible and resistant” (Figure3). Martinez Curbelo made the punctureat the L1-L2 intervertebral space after hav-ing infiltrated the skin and the inters-pinous ligament with “one cc of procaine,each.” He used the “Pages-Dogliottimethod of the loss of resistance” to iden-tify the epidural space utilizing the 2 ccsyringe containing 1.5 cc of normal saline(Figure 4). Occasionally he lubricated the

outside wall of the needle with sterilevaseline and advanced it millimeter bymillimeter. In addition, he was known toplace a drop of chloroform on the plungerof the syringe to obtain optimal seal whileallowing free movement. Specifically, hemade the point to always “feel the threeopening steps, when the needle approachedit, when it contacted it and finally when itpenetrated” the ligamentum flavum, perceiv-ing then a sudden disappearance of the re-sistance.

Some may consider that the L1-L2 in-tervertebral space, was too high; howeverMartinez Curbelo felt that in order to havea “quiet abdomen” the origin of the splanch-nic and the solar plexus (the sixth dorsalsympathetic nerve) needed to be blocked.For thoracotomies, he felt that the sympa-

thetic system ought to be blocked from T1to T10.

After negative aspiration, he advancedthe needle one more mm to “make sure thatthe whole bevel was in the peridural space.”He then described16 the insertion of the cath-eter as follows:

The guide is introduced up toone cm from the tip of the catheter,which is inserted into the needle 9.5cm, then placing the index finger ofthe left hand at the entry point ofthe needle into the skin and holdingits hub with the left thumb andmiddle fingers (Figure 5), the cath-eter is advanced with the right handone more cm and the guide was re-moved one cm at a time, alternatingthis move with the advancing of thecatheter, the same distance, until12.5 cm indicating that the catheteris 3 cm in the epidural space. Slowly,the guide is removed and the 23gauge needle, connected to a syringeis adapted to the catheter. First, as-piration is done, if negative, one ortwo cc of normal saline are injectedto determine its patency. At thatpoint the needle and syringe are re-moved from the catheter while hold-ing the trocar with the left handrested on the patient’s back. Theneedle is then removed soft andgradually, while the right hand holdson to the catheter closed to the hub,maintaining gentle inwards pres-sure. Once the trocar is removed, 5cc of the anesthetic solution is in-jected, with the patient, in the sameposition, then the patient was ob-

Fig. 4. Finding the epidural space using a 2 ml syringe, by the loss of resistancetechnique, as illustrated by Martinez Curbelo, (above) before penetrating theligamentum flavum and (below) in the epidural space.

Fig. 5. Advancing the catheter through the needle.


served for five minutes. If there areno signs of anesthesia and no sup-pression of the muscular functionof the lower extremities, all been asign that the injection was done inthe peridural and not in the sub-arachnoid space, 10 cc more are in-jected, making a total of 15 cc fol-lowed by 0.5 or 1.0 cc of distilledwater to keep the lumen of the cath-eter from becoming obstructed. Theneedle and syringe are re-attachedto the proximal end of the catheter.A wide strip of sterile adhesive tapeis applied over the entire length ofcatheter fixing it to the skin of theback making it accessible for ulte-rior supplementary doses; thereaf-ter, the patient is placed in the su-pine position.

Apparently the first needles devisedfrom the trocars to which a Huber tip wasattached, ended up being 9.5 cm whereasnow both the spinal and epidural needleshave a length of 9.0 cm. The onset of anes-thesia was expected to be between 10 and20 minutes.The volume of the local anes-thetic injected did not surpass 50 ml.

On January 26, 1947, at the AnnualCongress of Cuban Surgeons held in LaHabana, he presented a paper entitled“Continuous , segmental, peridural anes-thesia with a uretheral catheter utilizing a16 gauge Tuohy needle with Huber point.”15

A few months later, on September 9, 1947,at the 22nd Joint Congress of the Interna-tional Anesthesia Research Society and theInternational College of Anaesthetists,held in New York City, Martinez Curbelo16

lectured on “Continuous peridural, seg-mental anesthesia by means of a uretheralcatheter.”16 He then returned to the MayoClinic in 1948, where he presented his ex-periences; from that visit and with the helpof Ed Tuohy and Tom Seldon, his classicpublication appeared in the 1949 January-February issue of Anesthesia and Analge-sia.1 This technique was promptly tried byothers and resulted in publications byUmstead and Dufresne,17 who were presentat the lecture given by MMC in 1947, inNew York City, and applied this techniquein obstetrical patients in labour, followedby Nunziata from Buenos Aires,18 and thenFoldes19 and Bonica20 in the U.S.A.

Soon after his initial experience,Martinez Curbelo realized that the sym-pathetic blockade obtained from the epi-dural injections of local anesthetics couldbe applied to treat cases of chronic pain.

So on July 10, 1947, he proceeded to treat ayoung woman with postpartum throm-bophlebitis21 “for one week, administeringa total of 15 supplementary doses of 10 to15 cc of 1% procaine with an average of twoinjections per day, at intervals of 9 to 14hrs in between”; his rationalization for thisapproach was that by blocking the nocice-ptive stimuli coming from the thrombosedvein, the reflex vasospasm will be prevented(Figure 6). With a great sense of predic-tion, he subsequently treated patients withchronic pain from peripheral vascular dis-


Fig. 6. Diagram, by Martinez Curbelo depicting how nociceptive stimulioriginated in a thrombosed vein and transmitted through the pre-ganglionic axons,may produce reflex arteriospasm, in cases of thrombophlebitis.

ease,22 indicating that this approach wasmore effective and practical than repeatedlumbar sympathetic blocks.

His method become well known in othercountries and in October 17, 1954, he pre-sented his work at a conference held in theHospital Espanol in Buenos Aires; thenhe went to Sao Paulo, Brazil, as one of thelead speakers at the 2nd Latin AmericanCongress of Anesthesia. Furthermore, onNovember 13, 1957, at the Miami BeachAuditorium, at the 51st Congress of theSouthern Medical Association, as a dis-

Fig. 7. Dr. Fernando J. Polanco receiving a diploma and a check as therecipient of the Celestino Somoano prize for his paper on “Hypobaric spinalanesthesia, of long duration, for rectal surgery.” Manuel Martinez Curbelo ishanding the prize and the witnesses are Dr. Celestino Somoano (on the right)and Prof. Henry Beecher (on the left).


Continued on Page 8

tinguished guest speaker, he showed tenlantern slides and a 16 min. movie entitled“Lumbar sympathetic blocks by continu-ous peridural anesthesia as treatment oflower extremity vascular diseases.” In thisstudy, the author reviewed the pathophysi-ology of peripheral vascular diseases, ra-tionalized the application of “continuouslumbar sympathetic block obtained by therepeated administration of local anesthet-ics into the epidural space by reaching thepre-ganglionic axons” (Figure 6). In thisconference he showed femoral angiogramsbefore and after treatment and described apatient who was about to have an A-K am-putation from gangrene of the foot withsevere pain and edema on the leg. He thenwrote, “After 11 blocks, the final operationconsisted only in the amputation of thefoot.” Photographs of histological speci-mens revealed “an old organized and cana-lized thrombus in the posterior tibial ar-tery with duplication of the internal elas-tic lamina of the arteries and an inflam-matory collection of lymphocytes in themedial layer of the muscle fibers, as wellas adventitia.”21

This recognition to Manuel MartinezCurbelo cannot be concluded without de-scribing some of his personal characteris-tics and personality. These traits likely ledhim to achieve the contributions hereinlisted. Those that knew him insisted thathe was always thriving for the best, de-manding time, dedication, and study ofthose who trained under him. MartinezCurbelo gained the respect and admira-tion of the surgeons and other colleagueswho recognize the advantages of continu-ous epidural anesthesia.20 Moreover, in1950, in a separate observation, he con-firmed that the size of the spinal needleswas the main causative factor for postduralpuncture headaches and advocated the useof 24 gauge needles to prevent them.21

Together with Alberto Fraga who hadtrained in Wisconsin under Ralph Watersand Celestino Somoano, they founded theCuban Society of Anesthesiology and Re-animation in 1952. In 1955, he became thepresident and was instrumental in foster-ing clinical research instituting the “Dr.Celestino Somoano” annual prize (spon-sored by the Compania Cubana deOxigeno) consisting in a 500.00 dllsawarded to the best clinical research project.That year, the recipient of the award wasDr. Fernando J. Polanco who in Figure 7is seen receiving the diploma and the check,handed by Martinez Curbelo.22 To his rightis Dr. Somoano and to his left is Prof.Henry K. Beecher from Harvard Univer-sity who in Figure 8 is shown (chalk in

Fig. 8. Newspaper clipping from 1955, showing Prof. Henry Beecher, fromHarvard University (chalk in hand) lecturing on “Immediate Care of theGravely Injured.” Martinez Curbelo is in the background.

hand) giving a conference entitled “Imme-diate Care of the Acutely Injured” for whichhe was named Honorary Member of theCuban Society of Anesthesiologists;Martinez Curbelo is in the background.

His participation in meetings in theU.S., Latin America and Europe gave himconsiderable pre-eminence in anesthesiacircles and he was elected First Vice Presi-dent at the World Federation of Societiesof Anesthesiologists’ first Congress heldin 1955,23 precisely the year that he pre-sided the Cuban Society of Anesthesiol-

Fig. 9. Opening Ceremony at the First W. F. S. A. Congress held in September1955, in The Hague, Holland. Pio Manuel Martinez Curbelo is shown at themain table (under vertical white arrow and behind horizontal black arrow).

ogy, in The Netherlands (Figure 9). An an-ecdote that confirmed his strong patrioticcharacter has been passed from generationto generation among anesthesiologists inLa Havana. Apparently when at the open-ing ceremony, Martinez Curbelo realizedthat the Cuban flag was missing on theterrace, where the flags of all the countriesrepresented were being flown. He promptlytook a taxi to the Cuban embassy where heobtained a flag and returned to the Con-gress Hall; since there was no one in theimmediate surroundings who could rise it,



nor was there the usual “wire on a poly”gizmo to elevate it, it is said that he climbedthe pole and tied his flag to it, just beforethe opening ceremony.

In 1964, at the III World Congress ofthe WFSA, held in Sao Paulo, Brazil, post-humously Pio Manuel Martinez Curbelowas officially recognized as the initiator ofcontinuous lumbar epidural anesthesia.24

The precise date of his death is not known.Throughout his career it is evident that

Manuel Martinez Curbelo was a specialindividual reluctant to accept the statusquo, an attitude that most likely motivatedhim to challenge old theories and tradi-tions. He insisted on professionalism inthe care of patients, was on the outlook fornew developments, believed that estab-lished techniques could always be im-proved and settled for nothing but the bestthat could be obtained in his time.

AcknowledgementsThough some of the information herein

described had been available in the classicarticle by MMC published in Anesthesiaand Analgesia of 1949, several colleagueskindly provided valuable information. In-cluded were Dr. Fernando J. Polanco, whoreceived direct instruction and the 1955Award from MMC, and Dr. Mirta Abad,who also was partly trained by him. Oth-ers included Dr. Alberto Gonzalez Varela,Director of the Anesthesia Museum of theArgentinian Federation of Associations ofAnesthesiologists in Buenos Aires, Argen-tina; Dr. Carlos Parsloe, Past President ofthe WFSA who knew MMC during one ofhis visits to Minnesota and later in hisvisits to Sao Paulo, Brazil. Mrs. ManuelMartinez Curbelo gave a great deal of in-formation and documents and the set oflantern slides to one of the authors (HSC)who cared for her until her passing; andDr. Jorge Yera, Algiologist from La Ha-vana, who provided anecdotal informa-tion.

References1. Martinez Curbelo M. Continuous peridu-

ral segmental anesthesia by means of uretheralcatheter. Anesth Analg 1949;28:13-8.

2. Aldrete JA Original contributions of Latin-Americans to Anesthesia. Bulletin of AnesthesiaHistory April 2002;20(2):1-11.

3. Martinez Curbelo M. Nueva tecnica de laanesthesia del plexo braquial: Ventajas de estaanesthesia regional en clinica de ortopedia. RevMed Cubana 1933;5:27-31.

4. Pages F. Anestesia metamerica. Rev SanMilitar Madrid 1921;11:351-4.

5. Dogliotti AM. Eine neue Methode der re-gional Anaesthesie “Die peridurale segmentareAnaesthesie” Zentralfl F Chir 1931:58:3141-5.

6. Gutierrez A. Anestesia Extradural. Buenos

Aires, Argentina, 1930.7. Odom CB. Epidural anesthesia. Am J Surg

1936;34:547-58.8. Ferro AH. Consideraciones sobre anestesia

epidural. Informaciones Medicas. La Havana.1937;1:9-14.

9. Martinez Curbelo M, Perez HR, Mesa Quino-nes C: Anestesia Extradural segmentaria. CongSoc Nacion Cirugia, La Havana, June 29, 1944.

10. Aburel E: L’anesthesie local continue(Prolongee) en obstetrique. Bull Soc Obst et Gyn deParis 1931.

11. Lemmon WT: A method of continuous spi-nal anesthesia: A preliminary report. Ann Surg1940; 111:141-4.

12. Hingson RA, Southworth JL. Continuouscaudal anesthesia during labor and delivery. AnesthAnalg 1942:21:301-6.

13. Tuohy EB. Continuous spinal anesthesia;its usefulness and technique involved. Anesthesi-ology 1944; 5:142-8.

14. Tuohy EB. The use of continuous spinalanesthesia utilizing the uretheral catheter tech-nique. JAMA 1945;128:262-3

15. Martinez Curbelo M. Anestesia periduralcontinua segmentaria con cateter ureteralutlizando la aguja de Tuohy caliber 16 con puntade Huber. Reunion Anual de Cirujanos Cubanos.La Havana, Enero 26, 1947.

16. Martinez Curbelo M. Continuous peridu-ral segmental anesthesia by means of a uretheralcatheter. 22nd Joint Annual Congress of the Inter-national Anesthesia Research Society and the In-ternational College of Anaesthetists, New YorkSept 8-11, 1947.

17. Umstead HW, Dufresne MJ. ContinuousLumbar peridural anesthesia in Obstetrics. RhodeIsland MJ 1948;31:489-493.

18. Nunziata I. Analgesia peridural continua.Bol Soc Arg Cirugia 1950;6:202-7.

19. Foldes FF. Epidural anesthesia: a reap-praisal. Anesth Analg 1956;35:89-100.

20. Bonica JJ. Peridural block: analysis of 3,637cases. Anesthesiology 1957;18:723-784.

21. Perez Rojas L, Diaz M. Tratamiento de latromboflebitis post partum por el bloqueo continuodel simpatico lumbar por via peridural. Tecnicade Martinez Curbelo. Rev Cub de Obst Ginecol1950;11:1-16.

22. Polanco FJ. Personal Communication.23. van Lieburg MJ. The World Organiza-

tion. On Anaesthesia: Essays on its History. JRupreht, MJ Van Lieburg, JA Lee, W Erdman(eds). Springer Verlag, Berlin. 1985:307-310.

24. Gonzalez VA. Anestesia Peridural. In, Porel Camino de La Anestesia, A Gonzalez Varela (ed).Editorial FAAA, Buenos Aires. 1994:132-135.

Anesthesia History Association12th Annual Spring MeetingApril 6-7, 2005Sheraton Birmingham HotelBirmingham, Alabama

Call for Abstracts

Abstracts for 20-min. papers are invitedon historical aspects of anesthesia,critical care medicine and pain medicine.Abstracts on medical humanities orethical topics that relate to the history ofone or more of these broad areas are alsoinvited. Abstracts should be no longerthan two or three pages in length; textshould be in 12-point font size. Ifpossible, abstracts should indicate theresearch problem, sources used, method-ological approach and should contain nomore than fifteen references. An excellentguide/bibliography for abstract prepara-tion is available on the annual meetingpage of the American Association for theHistory of Nursing.

Abstracts may be submitted by regularmail, fax, or electronic mail [in plain textformat]. Disc submission in Word is alsopermitted. Abstracts submitted inelectronic format may be made availableto registrants in advance of the meetingand on the AHA WWW site as decidedby the Organizing Committee. ALLaccepted abstracts will be included inmaterial distributed to meeting regis-trants.

Individuals who wish to organize apaper session around a theme shouldcontact the committee as soon as pos-sible.

Further updates, tentative program, andother material can be found on theconference web page atwww.anes.uab.edu/aneshist/aha2005.htm.

WHEN: Deadline for submission of allabstracts is 31 January 2005.

WHO: Send abstracts, inquiries, etc., to:A.J. Wright, MLSDept of Anesthesiology LibraryUniversity of Alabama at Birmingham619 19th Street South, JT965Birmingham AL 35249-6810205-975-0158205-975-5963 [fax][email protected]

AHA2005 Call forAbstracts


Continued on Page 10

The History of the Midwest Anesthesia Residents’Conference -- MARC*By Silas N. Glisson, Ph.D.

IntroductionEach year anesthesiology residents

across the United States gather at regionalmeetings to present and discuss their re-search activities and to become part of acollegium of fellow residents and faculty.Shared experiences at these meetings formthe foundations for life-long friendships,both academic and personal. Had suchmeetings not been started, anesthesiologyresidents would not have been exposed tothe full breath of anesthesiology beyondclinical practice.

As a pharmacologist who’s career in-volved research into the mysteries of anes-thesia, and as a mentor since 1973 to resi-dents who presented their studies at theMidwest Anesthesia Residents’ Conference(MARC), I have observed first hand thepositive impact of resident’s participationin the MARC on their overall perspectiveof anesthesiology and their approach tocaring for patients. The importance of resi-dent research meetings to the specialty ofanesthesiology cannot be overstated. I be-lieve the history of the MARC includingwhy it was started, what were its objectives,and the details of that all important firstmeeting is a significant contribution to thelegacy of anesthesiology and should bepreserved. With this as my goal, I havecompiled historical information, both writ-ten and verbal, from several anesthesiolo-gists who were personally involved in theMARC beginning. I have included scannedcopies of several original documents aboutthe MARC beginning that I retrieved. As ahistorian in this quest I have experienceda real excitement reading over these origi-nal documents. It is almost like being therewhen plans and decisions were made aboutthat first Midwest residents meeting. I canonly hope that as you read this historicalaccount, you too will have that sense ofbeing there. It is not often that such origi-nal documents are preserved after so manyyears have passed.

In compiling this historical informa-tion I am deeply indebted to WilliamHamilton, MD, “Bill,” who served as Chairof the Department of Anesthesiology at theUniversity of Iowa and was the individualwho with the help of Jack Moyers, MD,

conceived and started the Midwest Anes-thesia Residents’ Meeting, as it was origi-nally called. Dr. Hamilton who now en-joys 81 years of age provided me with avivid personal account of the MARC’searly history and supplied the originaldocuments on its founding. Adel A. El-Etr,MD, who was the third resident presenterat that first MARC and later Chair of theDepartment of Anesthesiology at LoyolaUniversity Stritch School of Medicine,Maywood, IL, provided me with aresident’s perception of presenting his pa-per at that first meeting. Alon Winnie, MD,who was the first resident enrolled into theAnesthesiology residency program at theUniversity of Illinois Medical School,Chicago, IL, and a participant at earlyMARC meetings provided me with valu-able details on those early meetings. I havebeen fortunate to have received detailedinformation from many of the residencyprograms that participated in the firstMidwest Anesthesia Residents’ Meeting in1961. Without these first-hand accountsthis endeavor to record the history of theMARC would have been far more difficultand I am grateful to all who shared theirtime and memories with me.

Original Concept for a MidwestResidents’ Meeting

According to Bill Hamilton, MD, theMidwest in the late 1950’s had only a lim-ited number of academic anesthesia pro-grams with few faculty. Mayo Clinic andthe University of Iowa were among the big-ger programs. In 1960, at Iowa, the anes-thesia program was formally listed as theDivision of Anesthesia. WilliamHamilton, MD, succeeded Stuart “Stu” C.Cullen, MD, as Chair at Iowa later to befollowed by Jack Moyers, MD. Their pro-gram at that time included four facultyand twelve residents and there were twelveoperating rooms. Because of the increas-ing demand for anesthesia service, the de-partment was continually expanding insize, as new residents and staff becameavailable. The residency program for themost part focused on clinical training, al-though whenever possible Stuart Cullen,MD, encouraged research studies by hisresidents and staff. Only at Mayo Clinicwas there a regular program of residentresearch with studies lasting up to a yearduring their residency training. The lack

of research training by anesthesia residentswas due in part to the limited availabilityof financial support for such endeavors.In the early 1960’s, N.I.H. programs wereproviding very little support for medicalresearch and clinical income was justenough to maintain the faculty. Anesthe-sia faculty attending national meetingshad informally talked about the idea of aregional anesthesia residents’ meeting fromtime to time. However, the idea became morethan wishful thinking as a result of directefforts by Bill Hamilton and Jack Moyers.Over the years Bill had conducted a vari-ety of research studies and he was im-pressed with the beneficial effects of re-search on graduate medical education.Following in Stuart Cullen’s footsteps,Bill, as Chair, encouraged his residents tobecome involved in anesthesia research.And from time to time, prior to 1960, Billtook some of his Iowa residents to presenttheir research findings at the residents’meeting associated with the New YorkPGA. He remembers his Iowa residentswinning first prize for their research pre-sentations one or two times. It was appar-ent to Bill that the East Coast was ahead ofthe Midwest in its scope of resident in-volvement in research and having an an-nual event where the residents couldpresent their findings. It was in 1960 thatBill and Jack Moyers decided that a resi-dents’ meeting was needed in the Midwestand steps were taken to organize such ameeting. They began working on the ideaof a Midwest meeting where residents fromIowa and nearby anesthesia residency pro-grams could present their research papers.A key concern in planning a resident meet-ing was the cost. At that time residencyprograms had few budget dollars availableto send resident’s to scientific meetings.National meetings were costly and to en-sure wide participation by Midwest resi-dents, Bill and Jack envisioned that theMidwest residents’ meeting should utilizelocal resources to keep the expense to aminimum.

Area anesthesia Chiefs were contactedby Bill in May of 1960, by phone and letter,to get their input on the feasibility of anannual residents’ meeting. His initial ideawas that the meeting should be held at theUniversity of Iowa. Iowa was geographi-cally central to the other Midwest anesthe-

*Meeting participants and other speechesand programs available from the authoron request.


MARC. . . Continued from Page 9 Dr. Max Sadove, Chicago.The original intent and purpose were

explained and discussed. It appears that,although this particular session was insti-gated by Hamilton, the idea of a Midwestmeeting has been informally mentioned byseveral in the past few years. Moreover, arather common agreement exists that thereis a need for a meeting which residentscould relatively easily attend at modestexpense, the format of which would clearlyencourage participation of those in theirformulative years in anesthesiology. Ratherunanimous sentiment was expressed thatour various programs could be enrichedby visits from teachers in other centers.Although no specific program for such vis-its was outlined general cooperation ap-pears predictable.

Getting to specific aspects of a residents’meeting, these thoughts emerged:

1) Purpose: This would be an an-nual meeting designed to improve thetraining of residents. A general an-nouncement would be made in vari-ous journals. Although the “memberschools” would furnish the bulk ofthose attending, residents from otherplaces would be welcome. Directorsof individual residency programswould decide which of his groupwould attend. In some instances itappeared that only second year menwould attend; all available wouldattend; and in at least one instanceresidents who “deserved to go” wouldbe sent. Estimates of total attendanceranged from 50-80. Obviously, thesite of the meeting and other factorswould determine the number in anygiven year. Practicing specialistswould not be specifically invited, butundoubtedly would be allowed to at-tend. Participation by senior staffpersonnel would be encouraged.

2) Location of meeting: As a start,the first meeting will be held in IowaCity, and Holaday has invited us forthe second meeting. A look at the mapwill quickly show that we are talk-ing about an area that is bounded byDetroit, Indianapolis, OklahomaCity, Kansas City, Minneapolis, andMilwaukee. From “corner to corner”is quite a distance. One could expecttransportation difficulties, in termsof money and time, if meetings wereheld in Oklahoma City or Detroit,for example. On the other hand ameeting in Chicago would offer easiertransportation of a shorter mean dis-

tance and probably better atten-dance. To allow full participationby all in sponsoring and planningmeetings, and yet to avoid great dis-tances, it was suggested that some ofthe peripheral schools join morecentrally located schools as hosts butthat the latter be the sites of the meet-ings. General acceptance of this ideawas gained.

3) Date of meeting: This in thefinal analysis would be the decisionof the hosts based upon local accep-tance and with an eye toward theweather, state medical meetings, andnational meetings such as the Inter-national Anesthesia Research Soci-ety. As a generalization it appearedthat the last week in April or thefirst week in May might be optimum.Meetings would start about Satur-day noon and end Sunday noon.

4) Local arrangements: Whenpossible, inexpensive housing andfood services should prevail. In mostinstances hospital dining facilitiescould be used and in many locationsthere are dormitories available forsuch conferences. With the exceptionof perhaps a Saturday night “social”session, gatherings should be heldin hospital or medical buildingclassrooms or auditoria.

5) Format of meeting: It wasagreed that the host would be thefinal authority regarding programplanning. Several thoughts, how-ever, should flavor his thinking. (a)This is primarily a meeting for resi-dents and they should participatewhen possible. (b) It is equally truethat there is great value in havingresidents hear presentations, dis-cussion and comment by senior menwith whom they are not in daily con-tact and the silent attendance of anumber of good teachers would beunwise. (c) Although one school isserving as host, it would be expectedthat papers would be sought fromother schools. Other residency train-ing directors should make the hostaware of residents who have accept-able work to present. The basic ideais to acquaint our residents withwhat some other residency programsthink about anesthesia, how they areinvestigating some of its problems,and how they are applying it toclinical and academic situations.

sia residency programs. It would keeptransportation costs low allowing groupsof residents to drive there within a day.Campus housing was cheap and being anacademic setting and holding the meetingon campus would facilitate focus on themeeting per se. In his letter to those resi-dency program Chiefs, Bill presented hisvision for the meeting and asked for theirfeedback.

The result of Bill’s initial query was aconsensus that a Midwest anesthesia resi-dents meeting should be developed alongthe lines that Bill’s letter proposed. Basedupon the positive response from the Chiefsqueried, a follow up planning meeting ofanesthesia residency program Chiefsthroughout the Midwest was organized byDuncan Holaday, MD, and Jack Moyers,MD, representing Iowa, to discuss BillHamilton’s (affectionately known as“Hambone”) letter and the proposal for aMidwest residents’ meeting. The planningmeeting was held during the 1960 Ameri-can Society of Anesthesiologists annualmeeting in New York at 17:00 hours on Tues-day, October 4, 1960, in the Statler-Hiltonhotel in New York City.

Other individuals and residency pro-grams were invited to the meeting but wereunable to attend. (see minutes below) Thetopics discussed by those present were (1)the overall purpose of an annual residents’meeting, (2) the geographic boundaries ofresidency programs to be included in theMidwest meeting, (3) an appropriate timefor the meeting relative to conflicts withother national meetings of anesthesiolo-gists, (4) details of the meeting itself, and(5) how the meeting was to be organized.Jack Moyers served as the unofficial re-corder at the meeting. His minutes of thatmeeting are duplicated below:

Summary of Meeting Called by Dr.Holaday to Discuss a Midwest Resi-dents’ Meeting

The meeting was held on Tuesday, Oc-tober 4, in the Statler-Hilton in New YorkCity. It was attended by the following:Bamforth and Siebecker (Madison), White(Oklahoma City), Greifenstein (Detroit),Van Bergen (Minneapolis), Jacoby (Mil-waukee), Sweet (Ann Arbor), Moyers (IowaCity), Frederickson (Kansas City),McQuiston (Peoria), and Holaday (Chi-cago). Others invited but unable to attendwere: Dr. Mary Karp, Chicago; Dr. PaulDumke, Detroit; Dr. Vergil K. Stoelting,Indianapolis; Dr. Kenneth Keown, Colum-bia; Dr. Albert Faulconer, Rochester; and


In such a short preliminary meet-ing there are certain to be only asmall number of problems solved andeven these with only modest success.It would be fair to say, however, thatthe group assembled was enthusias-tic toward the idea of a residents’meeting and felt a need for such un-dertaking. This is an encouragingattitude and will make for easier so-lution of the detailed problemsahead. Your comments and criticismare now solicited.

Jack Moyers, M.D.Temporary, Self-appointed

and Unpaid Secretary

JM/mj

The First Midwest Anesthesia Resi-dents’ Meeting

William Hamilton, MD, and the fac-ulty of the Department of Anesthesiologyat the University of Iowa University Hos-pital agreed to organize and host the firstMidwest Anesthesia Residents’ Meeting,March 18-19, 1961, at Iowa City. A “call forpapers” sent out to area residency programsgenerated a response of twelve scientificpapers and one scientific movie from anes-thesiology residents. Bill Hamilton andJack Moyers created the program scheduleof presentations. Forty-five minutes wereallotted per paper. The resident presenterhad 15-20 minutes for his formal presenta-tion. It was decided that a formal discus-sion of the paper by a faculty/staff memberwould enrich the experience of the speakerand offer additional information to theaudience. Each resident presenter was as-signed a discussant in advance of the meet-ing. Residents were encouraged to send theirdiscussant a copy of their paper severalweeks before the meeting. The inclusion ofa formal discussant for each scientific pa-per was a practice also employed by theInternational Anesthesia Research Societyuntil the 1980’s at their annual scientificmeeting. Following the resident anddiscussant’s presentations, the paper wasopened for discussion and comment by theaudience.

A letter outlining the arrangements foraccommodations, meals and the programalong with a timetable of presenters andtheir discussants was sent out to individu-als and residency programs thought to par-ticipate. It should be noted that the meet-ing was open to private practice anesthesi-ologists in the Midwest. It was thought thatby attending, they would learn of the latesttrends in the practice of anesthesiology.

In addition to the collegial interaction

of residents and staff from different resi-dency programs during the paper presen-tations, a social hour and dinner wasplanned on Saturday evening for the at-tendees. This social program was held atthe University Athletic Club in Iowa City.Following cocktails and the dinner, a talkwas made by Thomas Hornbein, MD, ananesthesiology fellow at Barnes Hospital,St. Louis, on his climb of theMasherbraum, elevation 7821 ft., on thePakistan/India border not far from Mt.Everest. Dr. Hornbein was an avid moun-tain climber and a few years later he suc-cessfully made the climb to the summit ofMt. Everest. I have no doubt that his talkwas very stimulating because during myinterviews with Dr. Hamilton, Dr. Winnie,and Dr. El Etr they each vividly remem-bered Dr. Hornbein’s mountain climbingtalk at that first Midwest residents’ meet-ing. I would add that this first Midwestresidents’ social affair was sponsored byAyerst Laboratories, the distributor ofHalothane. Among the original documentsis a letter from Dr. Hamilton to John Jewell,MD, Ayerst Laboratories, New York, NewYork, thanking Ayerst for supporting thecocktail hour of the gala social affair. Ifind it of interest that the cost for all drinksand the chips and dip was $175.00 for the96 plus attending the affair. The cost forthe dinner was $3.75 each including tipand tax and was collected from each per-son at the dinner table.

The scientific program covered a widerange of topics. There were papers on meth-oxyflurane usage, hypothermia duringneurosurgery, blood gas distribution dur-ing thoracic surgery, and pulmonaryphysiology to name a few. The completelist of papers is included in the meetinginformation mailed out (see above). Of thetwelve papers and one movie submitted,two papers were withdrawn at the lastminute: “Cholinesterases” by Ray Green,MD, University of Kansas, discussantCharles Pittinger, MD, and “Effect of IVUrea on Blood Volume” by ThomasSubitch, MD, University of Wisconsin,discussant John Hanson, MD.

Reading over the list of resident pre-sentations I was curious about what wasthe personal experience by the residentspresenting their papers at that first meet-ing. I was surprised to find that Adel A. ElEtr, MD, who was my Chair during myyears at Loyola, was the third resident pre-senting. Interviewing Adel, he had fondmemories of his experience at that first resi-dents’ meeting. In 1961 he was a first yearanesthesia resident at the University ofChicago. I asked him how he got involved

in research and the methoxyflurane studyon cardiac catheterization. Remember thatnot only were there few anesthesiology resi-dents at that time, but research activitiesby residents was not commonplace. Adelexplained that at the University of Chi-cago they were having difficulty measur-ing shunt fraction in children with con-genital disease. Dr. Holaday got Adel in-terested in the problem and they developeda methoxyflurane and air anesthetic in-sufflation technique that was effective andallowed for accurate shunt measurementin the children. Adel collected data usingthis anesthetic technique and when the “callfor papers” came, Dr. Holaday suggestedhe present his findings at the Midwest resi-dents’ meeting. Although I have not beenable to interview other resident presenters,I would assume that there is a similar ac-count behind each of their studies. Fortu-nately for the specialty in those early daysfaculty and staff took it upon themselvesto mentor some of the residents in researchabout anesthesia. Those early seeds con-tributed to the surge in anesthesia researchfrom the 1960’s to the present that has pro-vided answers to the many questions aboutanesthetic mechanisms and their safe use.Adel remembers being anxious as his timeto speak approached. The discussants andaudience were persistent in their question-ing of the speakers. He remembers well thecomplex questions advanced by his discus-sant, Richard Theye, MD, a faculty at MayoClinic and by Max Sadove, MD, Chair atthe University of Illinois, Chicago. It wasa grilling experience shared by each resi-dent as they stepped to the podium topresent their papers. Slides were occasion-ally used and for the most part they weresimple black and white pictures andgraphs. Some residents even used the old4-inch x 4-inch glass lanternslides. Colorslides, even the blue diazo slides, were notyet in common use. I remember in the1970’s using a reverse black and white slidewith colored transparent film overlaid onthe slide to give an appearance of coloredslides. It seems primitive compared totoday’s vibrant PowerPoint slides, someeven with embedded movie segments. Adelremembers that he and two other residentspiled into a car and drove to Iowa City forthe meeting and staying at campus hous-ing, “the dorm.” He emphasized the colle-gial atmosphere of the meeting and fromthat first meeting the life-long friendshipshe developed with John Michenfelder,MD,Tom Hornbein, MD, and other residentswho presented at that meeting. This tradi-

Continued on


MARC. . . Continued from Page 11

tion continues to this day and it is a majorattribute of the annual MARC meeting. Iam sure that the list of friendships begunat a MARC meeting is longer than onewould care to list. I know that I personallyhave made many friends over the years at-tending the MARC, many who have posi-tively impacted my career in anesthesiaresearch. There is no question that resi-dents, their mentors, and participants ben-efit from the MARC. It is of historic inter-est that among those 11 resident present-ers and their discussants at that first Mid-west residents’ meeting, 4 went on to be-come academic Chairs. They were: ThomasHornbein, MD, Chair at the University ofWashington, Seattle; Richard Theye, MD,Chair at the Mayo Clinic; Adel A. El Etr,MD, Chair at Loyola University StritchSchool of Medicine; and Jack Moyers, MD,Chair at the University of Iowa. In addi-tion, Charles Pittinger, MD, who was adiscussant of one of the scratched papers,became Chair at Vanderbilt University.Several resident attendees also becameChairs. Wendell Stevens, MD, becameChair at Iowa and later at Oregon, ErnestHenschel, MD, became Chair at MarquetteUniversity, and Ramez Salem, MD, becameChair at Illinois Masonic, Chicago. Eightchairs from that first Midwest residents’meeting, quite a record. Many of those at-tending achieved impressive careers inanesthesiology. In particular, JohnMichenfelder, MD, achieved internationalrecognition for his accomplishments inneuroanesthesia and Kai Rehder, MD, be-came a well-known researcher in anesthe-sia.

After that successful first Midwest resi-dents’ meeting, Jack Moyers compiled alist of particulars about the meeting. Whatworked and what didn’t, final expenses andpossible changes that could improve thenext meeting. Clearly, the need for moreresident participation in the paper’s dis-cussion was noted. Having residents’ asthe formal discussants instead of facultyand limiting the amount of questioning byfaculty and staff seemed important for thefuture success of the meeting. That theMidwest Anesthesia Residents’ Meeting bea meeting for the residents and conductedby the residents was an important conclu-sion. Those notes written by Jack Moyersare of unique historical value. All success-ful endeavors require an honest evaluationof whether the objectives were met and ifnot, why. And what changes are necessaryto fully achieve the objectives envisioned.It was true in 1961 and it is true today in

2004. We have Bill Hamilton, Jack Moyersand those initial organizers to thank fortoday’s highly successful MARC.

In addition to the post-meeting analy-sis by Jack Moyers and Bill Hamilton, Billreceived follow-up letters from nearly allof the participating program Chairs ontheir experience at the first annual Mid-west residents’ meeting. I have includedtwo of the letters below (Figures 8 and 9) asexamples of the feedback he received. Ingeneral there were congratulations to Billand his department at Iowa for an out-standingly well-organized meeting. Over-all the Chairs forwarded a sweepinglyunanimous opinion by their residents andfaculty in attendance that the first meet-ing was very educational, enjoyable, anddefinitely worthwhile continuing. Only Dr.Faulconer raised a question about the long-term survivability of such a resident meet-ing. There were comments about having theevent every year or every other year, aboutwhether the high caliber of papers couldbe maintained in succeeding years, andabout the geographic location of futuremeetings. Several considered Iowa the ideallocation and were concerned that a Chi-cago site would be too far East and a longtrip for the residents. Interestingly, by the1980’s the participation by residency pro-grams in Chicago had grown to the pointthat Chicago was preferred as a frequentMARC host site.

Following that 1st Midwest AnesthesiaResidents’ Meeting, Bill Hamilton em-barked on a one-year research sabbaticalin California. Working on a problem incardiovascular research under thementorship of respiratory physiologist,Julius Comroe, Ph.D., Bill’s experiencereinforced his belief on the importance ofresearch for graduate education in Medi-cine. During his career, Bill was a strongproponent of the need to develop researchskills in residents during their residencytraining.

Among the original documents savedby Jack Moyers were the names of the 1961attendees from each participating resi-dency program, along with private prac-tice anesthesiologists attending that firstmeeting.

From an idea to a structured vision byBill Hamilton, the Midwest AnesthesiaResidents’ Meeting had become a reality.Without that first residents’ meeting andthe enthusiasm it generated this new op-portunity in anesthesia resident educationmight not have happened in the Midwest.

Name Change from the “MidwestAnesthesia Residents’ Meeting” to the

“Midwest Anesthesia Residents’Conference”

For some years anesthesiology resi-dents in the East were able to present theirresearch findings at the Post GraduateAssembly in Anesthesia (PGA) held eachyear by the New York Society of Anesthesi-ology. Duncan Holaday, MD, who becameChair at the University of Chicago wasfamiliar with the resident research presen-tations at the PGA when he was on the staffat Columbia University in New York. Hehad been involved in the PGA programwhile there and was instrumental with BillHamilton in promoting a residents’ re-search meeting in the Midwest. Anotherindividual active in the PGA was VinceCollins, MD. In 1961 he was recruited fromNew York University’s Bellevue Hospitalto Chair the anesthesia department atCook County Hospital in Chicago. He wasactive in the Midwest Anesthesia Residents’Meeting in the early 1960’s because of itssimilarities to the resident experience atthe PGA. Historically it is interesting thatat the time the Midwest Anesthesia Resi-dents’ Meeting was created for residenteducation, an annual meeting in Chicagowas being developed for faculty and staffsimilar to the New York PGA. Vince Collinsspearheaded that effort. In 1961 the firstmeeting of what was called the “1st PostGraduate Assembly in Anesthesia” spon-sored by the Illinois Society of Anesthesi-ologists was held in May at the Continen-tal Plaza Hotel in Chicago. In 1962,Edmond I. Eger II, MD, introduced theconcept of Minimum Alveolar Concentra-tion (MAC) into the anesthesia literature.That year Alon Winnie, MD, suggestedthat the name of the Illinois Post Gradu-ate Assembly meeting be changed to Mid-west Anesthesia Conference or “MAC.”Thus the second meeting held in 1962 wascalled “MAC 2” and it has been so namedever sense with only the meeting numberchanged each year. Dr. Winnie told me thatin order to attract well-known anesthesi-ologists to speak at the MAC, a specialaward was created to be given to a distin-guished anesthesiologist each year. Theawardee would be presented the award andgive a talk during the MAC. The awardcreated was to be called “ The Ralph Wa-ters Award” with a $1000 prize. However,when asked for permission to use his name,Ralph Waters, MD, at Wisconsin askedthat the award not be named after him. Dr.Waters thought the award should be namedafter Henry Ruth, MD. Dr. Ruth was aprominent anesthesiologist who was amember of the 1937 American Society ofAnesthesiologists subcommittee on the



hazards of fires and explosions in anes-thesia. In 1940 Dr. Ruth and Paul M. Wood,MD, oversaw the commencement of theASA journal publication, Anesthesiology.The MAC organization committee wantedthe award to honor Ralph Waters and hein the end consented to the use of his namefor the award. To this day The Ralph Wa-ters Award is presented each year at theMAC in Chicago.

From 1961 through 1967, the Midwestresidents’ meeting was called “The Mid-west Anesthesia Residents’ Meeting.” In1968 the Department of Anesthesia, CookCounty Hospital, Chicago, was the hostprogram. At that residents’ meeting thehost program changed the word “Meeting”in the name to “Conference” with the nota-tion “MARC” associated for the first timewith the Midwest residents’ meeting. TheMidwest Anesthesia Residents’ Conference(MARC) has remained the name of theannual Midwest residents’ meeting ever

since.

Evolution in the Format of the MARCPresentations

In the early years of the MARC the fac-ulty/staff attending would be invited to afaculty meeting on Saturday to discuss theorganizational aspects of the meeting. Atthe second 1962 meeting the faculty unani-mously agreed to restrict faculty question-ing of the residents about their research. Itwas established that the meeting was ameeting of residents, for the residents andby the residents. The role of faculty andstaff mentors would be only in support ofthe meeting. This principle has survivedto this day. The faculty and staff serve asmoderators of the sessions, as judges andas meeting organizers. Resident participa-tion in the discussion of papers was and isstrongly encouraged. Formal discussantsof each paper were assigned to residents.The use of formal discussants ended in the

late 1970’s due to the large number of pa-pers submitted to the MARC and the lim-ited time available to present during theday and one-half. Initially, oral presenta-tion was the only format used. The resi-dent had approximately 15 minutes topresent the paper, the discussant had upto 15 minutes and the audience could askquestions for an additional 15 minutes.Later in the MARC the presentations werelimited to 10 minutes with 5 minutes dis-cussion and questions. In the 1980’s posterpresentations became part of the formatalong with the oral presentations. As thenumber of residents participating in theMARC grew the format was changed toinclude multiple simultaneous oral ses-sions and one or more poster sessions. Alimited number of poster-discussion for-mat presentations were used from time totime. The poster-discussion differed fromviewing a poster and directly asking ques-tions to the author to a format where post-ers were viewed for a period at the begin-ning of the session, the audience was thenseated for a short overview of their studyby each resident author. Following theirpresentation, the resident author fieldedquestions from the residents in the audi-ence and from the session faculty/staffmoderators. This format allowed for morepapers to be presented at the MARC thanthe oral only format and provided a betterscientific experience for the resident au-thor compared to the poster-viewing for-mat. Various mixes of these presentationformats were used until the 2000 MARCwhen only the poster-discussion formatwas used. A single poster-viewing sessionwas included for resident’s who submittedtheir paper late, after the formal deadlinedate. This MARC presentation format hascontinued to this date, 2004.

Creation of a Formal Host Site RotationSchedule

The host residency program and site forthe next years’ MARC was decided at theSaturday faculty meeting. Residency pro-grams would volunteer to serve as the nextyears’ host. The MARC had no formal siterotation schedule until at the 1980 facultymeeting Edward Brunner, MD, and SilasGlisson, Ph.D., were appointed by the fac-ulty to construct a draft rotation schedulefor the years 1982 to 1995. Dr. Brunnerwas Chair at Northwestern University,Chicago and Dr. Glisson was an anesthe-siology research faculty at Loyola Univer-sity Medical Center, Maywood, IL. Therewas a genuine need for a formal rotationschedule to facilitate planning for the meet-

Figure 8.


MARC. . . Continued from Page 13


ing. The MARC had grown so large thatcampus housing for attendees was nolonger possible. In 1979 the Departmentof Anesthesiology at Loyola UniversityMedical Center was the first program hostto hold the MARC entirely off campus at ahotel in Oakbrook, IL. After that, theMARC was held more often off campus thanon campus. I have included the originalmap below used by Dr. Brunner and Dr.Glisson to establish the 1982-95 rotationlist. The structure of a star across partici-pating States was drawn. The design wasfor the MARC to rotate back to Chicagoevery third year because of the large num-ber of participating residents enrolled atthat time in anesthesiology residency pro-grams in Chicago. The MARC host rota-tion sites represented the core of all States

involved. There were a limited number ofparticipating residency programs that werenot included as host sites because they weretoo distant from the center or had too fewresidents. Dr. Brunner and Dr. Glissonpresented the draft host rotation scheduleto the faculty at the 1981 MARC held atColumbia, MO, and it was unanimouslyaccepted. Having a formal host rotationschedule allowed residency programs suf-ficient time to plan for hosting the MARCand to make hotel arrangements well inadvance of the meeting. It was also agreedat the faculty meeting that should a resi-dency program desire to be considered as ahost program for the MARC, it would beadded to the end of the rotation list uponacceptance by the MARC faculty. Occasion-ally a substitution of the host site had to be

made by Dr. Brunner and Dr. Glisson dueto an unforeseen problem at a scheduledhost program. Fortunately there have beenfew substitutions needed. In 1994 theMARC faculty again appointed Dr.Brunner and Dr. Glisson to create a newMARC host site rotation list for the years1996-2015. The participating programStates had increased as can be seen belowin the map used by Dr. Brunner and Dr.Glisson. The core rotation concept wasmaintained except for the addition of twoOhio and one Michigan host programs.Unfortunately I have been unable to deter-mine who served as the MARC host dur-ing some of the years 1968 through 1980.That information may become available inthe future, perhaps by a resident of a hostprogram reading this report who partici-pated in the MARC in one of the yearsmissing. The information could be for-warded to the Woods Library at the ASAheadquarters.

The Saturday Night SocialA special time at each of the MARC

meetings was the Saturday night socialaffair and dinner. After a long day of sci-entific papers and discussions, a drink ortwo, a fine dinner with your residentfriends, and entertainment was just whatthe doctor ordered. The social affair was atime to be casual, to meet with old medicalschool friends at other anesthesiology resi-dency programs, and of course to make newfriends. I personally attended MARC meet-ings from 1973 to 2003 only missing three.If there is one thing you can say about an-esthesiology residents and faculty it is thatthey are friendly. At the social affairs youwere never a stranger for very long. It wasalmost like one big residency program.Laughter and fun were the “order of theday,” although those residents presentingtheir papers on Sunday always wished theyhad presented on Saturday, were done withthe ordeal, and could really relax and kickup their heels that Saturday night. But theyall made it through Sunday’s presenta-tions, maybe a little sleepy from Saturdaynights festivities. Each year the Saturdaynight social affair was different often uti-lizing local attractions to make for a veryspecial event. Tom Hornbein spoke abouthis experience climbing the Masherbraummountain at the first social affair in 1961.The “Mutual of Omaha’s Wild KingdomZoo” after the television show of the samename was a special treat in 2002 at Ne-braska. The social affair was held at thezoo with the dinner in the jungle diningroom. There were puffins, penguins, and a

Figure 9.


walk through the center of an ocean withsharks and manta rays swimming over-head. Brightly colored tropical birds andjungle animals were seen on the safari walk.In 1985 Michael Reese Hospital, Chicago,took everyone to the comedy play “SheerMadness” and in 1982, Northwestern tookthe residents to dinner at the 95th restau-rant in the Hancock Building and afterdinner to the Water Tower Theater for aperformance of Neil Simon’s musical play“They’re Playing Our Song.” In 1980 atIndianapolis we enjoyed an Indianapolis500 race night at the Indy 500 speedwaywith the announcer of the Indianapolis 500race reminiscing about the great Indy races.The Saturday nights were all special andenjoyed by all. “Las Vegas Casino Nights”were popular, sports nights with every typeof participation game, comedy routines bylocal comedy club performers, a roaring20’s mystery program held in a real cavein Minneapolis, disco dance lessons in1979, a remember the 50’s night in 1987, atNebraska where the comedian got EdBrunner, Northwestern’s Chair, to dress upin a motorcycle jacket and leather flightcap with goggles in the persona of MarlinBrando and ride around the dining roomwith him on a pretend motorcycle, and amemorable night when a physician at thehost program’s hospital gave one of the alltime funniest talks that I have ever heard.He reviewed published medical researchstudies that were actual hoaxes, but werewritten well enough to slip past the medi-cal journal editors. He showed us how theactual hoax was done with fake data and itwas not only hilarious but also amazingthat the authors got away with it. The listgoes on and on, but I think the examplesabove make my point that the MARC Sat-urday night affair was a fun time enjoyedby one and all. Our hats are off to all thehost programs that provided us such a goodtime.

Prizes for the Best Resident Presenta-tions

There were no awards or prizes for bestscientific paper at the first MARC meet-ing. In fact, there was no discussion of abest paper award in any of the early plan-ning documents. The educational experi-ence gained by the presenting residents wasits own reward. As the MARC grew in sizewith more and more papers presented, theidea of acknowledging those residents pre-senting the best papers became part of theMARC program. By the early 1970’s,awards were presented for the 1st, 2nd, and3rd best resident presentations. Several fac-ulty attending were asked to serve as judges

and they would select the three best papersfrom all presented. Just before the meetingclosed there would be a short awards cer-emony where the best papers would be an-nounced and the residents would receive aspecial MARC certificate of their award.For a time, cash prizes were added to thecertificate usually in the amount of $150,$100 and $50 for each level. Later, anesthe-sia textbooks donated by a vendor wereawarded in place of cash. Each year’s hostwould decide the number of awards andprizes. By the mid- to late 1980’s the prizeswere dropped as more awards were givenout. Currently, over 300 residents presenttheir scientific studies and case reports atmultiple simultaneous scientific sessionscovering a variety of subspecialty topics.

The best paper awards vary from bestpaper per session to the 1st, 2nd, and 3rd bestpaper per session. Approximately 20-30%of residents receive acknowledgement fortheir fine work and presentations each year.Having served as a faculty judge manytimes I know first hand the difficulty inselecting the best three papers in a session.The quality of papers and their presenta-tion by the residents has improved overthe years such that if it weren’t for frac-tions it would be hard to single out the bestthree papers in each session. This speakswell of the quality of medical students whohave entered the field of anesthesiologyand their dedication as residents to thefuture of the specialty. Each resident par-ticipating in the MARC can consider ashis or her award the experience gained atthe MARC.

The MARC in 2004Over the past fifteen years the atten-

dance at the MARC continues to increasefrom 300 to the more than 600 presently.The total cost of hosting the MARC cur-rently is about $115,000.00 not countingtravel or lodging costs borne by the indi-vidual participating residency programs.In 1961 the total cost was approximately$800.00. Support from sponsoring anes-thesia vendors helps to underwrite the costof this educational experience. The MARCis the largest single gathering of anesthe-siology residents in the United States andis said to be the fourth largest annual meet-ing of anesthesiologists behind the ASA,IARS and PGA meetings. From that earlyvision of William Hamilton, MD, and the96 participants at that first Midwest Anes-thesia Residents’ Meeting in Iowa a mightyoak tree has grown. I can only hope thatwhat has become a premier experience foranesthesiology residents and faculty men-tors will continue forever.

Other Resident Research MeetingsIn addition to the PGA and MARC there

are two other annual resident researchmeetings that serve the residents of theGulf Atlantic and Western states. Interest-ingly, both meetings were begun as the re-sult of efforts by two former Iowa residentsand by Stuart Cullen’s direct participa-tion at University of California San Fran-cisco. The Gulf Atlantic Anesthesia Resi-dents’ Research Conference known as“GAARRC” held its 30th annual meetingthis year on March 12-14, 2004, at the RoyalPalm Crowne Plaza Resort South Beach inMiami, FL, hosted by the Department ofAnesthesia, University of Miami School ofMedicine. The GAARRC states “the pur-pose of the conference is to provide a fo-rum for resident presentations in the fieldof anesthesiology, give participants an op-portunity to meet in both an academic andsocial environment and encourage inter-departmental communication and coopera-tion among participating programs”. An-nually the GAARRC has approximately 100scientific presentations by residents. TheWestern Anesthesia Residents’ Conference(WARC) held its 42 annual meeting thisyear on May 7-9, 2004, at the Hyatt Re-gency Hotel in Denver, CO, hosted by theDepartment of Anesthesiology, Universityof Colorado. There were 92 resident pre-sentations at the WARC, 58 poster and 32oral.

The End of My StoryThis project to record the history of the

Midwest Anesthesia Residents’ Conference,I must say, has been truly enjoyable. Thisrecord reflects my personal experience ofthe MARC, informative, educational, col-legial, and fun. And if you participated inthe MARC I hope it was yours too. Forty-three years have passed since that firstMidwest residents’ meeting. Some of thosewho participated have left us and manyothers have scattered across the country.Had it not been for William Hamilton,MD, and Jack Moyers, MD, who savedmany of the original documents, my taskwould have been much more difficult andthe history of the MARC less complete. Thevivid memories of Bill Hamilton, AlonWinnie, and Adel El Etr added so much tomy being able to answer the long list ofquestions I had about the MARC in its ear-lier days. I am forever grateful to each ofthem. I can only hope that on some futureday someone will pick up a pen after read-ing this historical account and begin, “Since 2004 the Midwest Anesthesia Resi-dents’ Conference has ……..”


The Anesthesia History Association (AHA) sponsors an annual Resident EssayContest with the prize presented at the ASA Annual Meeting.

Three typed copies of a 1000-3000 word essay written in English and related to thehistory of anesthesia, pain medicine or critical care should be submitted to:

William D. Hammonds, M.D., M.P.H.Professor of Anesthesia

Director of Pain Outcomes ResearchDepartment of Anesthesia

University of Iowa200 Hawkins Drive, 6JCPIowa City, IA 53342-1079

[email protected]

The entrant must have written the essay either during his/her residency or within oneyear of completion of residency. Residents in any nation are eligible, but the essay MUSTbe submitted in English.

This award, which has a $500.00 honorarium, will be presented at the AHA’s annualdinner meeting to be held in October, 2005, in New Orleans, LA This dinner is always heldduring the annual meeting of the American Society of Anesthesiologists. The paper will bepublished in full in the Bulletin of Anesthesia History.

All entries must be received on or before August 23, 2005.All entries must be received on or before August 23, 2005.All entries must be received on or before August 23, 2005.All entries must be received on or before August 23, 2005.All entries must be received on or before August 23, 2005.

EXCITINGOPPORTUNITY!

THE WLMFELLOWSHIP

The WLM Fellowship willprovide recipients with financialsupport for one to three weeks ofscholarly historical research at theWood Library-Museum.

The Board of Trustees of theWood Library-Museum invitesapplications from anesthesiologists,residents in anesthesiology, physiciansin other disciplines, historians andother individuals with a developedinterest in library and museumresearch in anesthesiology.

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

Complete proposals must bereceived before January 31, 2005,for consideration.

The Wood Library-Museumserves the membership of ASA and theanesthesiology community.

Wood Library-Museumof Anesthesiology

520 N. Northwest HighwayPark Ridge, IL 60068-2573

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

T H E W O O D

LIBRARY-MUSEUM

OF

ANESTHESIOLOGY

Bulletin of Anesthesia History (ISSN 1522-8649) is published four times a year as a jointeffort of the Anesthesia History Association and the Wood-Library Museum of Anesthesi-ology. The Bulletin was published as Anesthesia History Association Newsletter through Vol. 13,No. 3, July 1995.

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

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

2. Journal Articles: Old citations to journals have been moved to PubMed(www.ncbi.nlm.nih.gov/PubMed), NLM's web-based retrieval system, where they may besearched separately along with newly created citations.

3. Integrated History Searches: NLM has online citations to both types of historicalliterature -- journal articles as well as monographs -- again accessible through a single searchlocation, The Gateway (http://gateway.nlm.nih.gov).

C.R. Stephen, MD, Senior EditorDoris K. Cope, MD, EditorDonald Caton, MD, Associate EditorA.J. Wright, MLS, Associate EditorFred Spielman, MD, Associate EditorDouglas Bacon, MD, Associate EditorPeter McDermott, MD, PhD, Book Review EditorDeborah Bloomberg, Editorial Staff

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

EditorBulletin of Anesthesia History200 Delafield Avenue, Suite 2070Pittsburgh, PA 15215 U.S.A.Telephone (412) 784-5343Fax (412) [email protected]

Manuscripts may be submitted on disk using Word for Windows or other PC textprogram. Please save files in RICH TEXT FORMAT (.rtf) if possible and submit a hardcopy printout in addition to the disk. Illustrations/photos may be submitted as original hardcopy or electronically. Photographs should be original glossy prints, NOT photocopies,NOT photocopies,NOT photocopies,NOT photocopies,NOT photocopies,laser prints or slideslaser prints or slideslaser prints or slideslaser prints or slideslaser prints or slides. If submitted electronically, images must be at least 300 dpi andsaved as tif files. Photocopies of line drawings or other artwork are NOTNOTNOTNOTNOT acceptable forpublication.


T H E W O O D

LIBRARY-MUSEUM

OF

ANESTHESIOLOGY

Who was First?Here’s Your Chance

to Cast Your Vote!On March 1842, Dr. Crawford Long

used ether inhalation to anesthetizeJames Venable for the removal of sev-eral sebaceous cysts on his neck. InDecember 1844, Horace Wells used ni-trous oxide to block pain from dentalextractions. On October 16, 1846, Wil-liam Thomas Green Morton used etherto anesthetize Gilbert Abbott for theremoval of a submandibular tumor atthe Massachusetts General Hospital.The answer to the question of who dis-covered surgical anesthesia seems ob-vious, yet Long’s work was not pub-lished until several years afterMorton’s public demonstration. Wellstried to display nitrous oxide anesthe-sia for dental extractions at the Mas-sachusetts General Hospital, failed,and was publicly humiliated. To com-plicate matters even further, Wells andMorton shared a dental practice dur-ing the time nitrous oxide anesthesiawas used as an anesthetic. So, the ques-tion of who was first remains “anenigma wrapped in a mystery.”

“““““Who WWho WWho WWho WWho Was Fas Fas Fas Fas First?” Tirst?” Tirst?” Tirst?” Tirst?” T-Shirts-Shirts-Shirts-Shirts-ShirtsEach depicts one of the three earlydiscoverers of anesthesia: you chooseLong, Morton or Wells!

$15 per T$15 per T$15 per T$15 per T$15 per T-Shirt-Shirt-Shirt-Shirt-Shirt. The following sizesare available (please specify size whenordering): Long (M, XL); Morton (S, M,XL); Wells (S, M, L, XL).

Call the WLM at (847) 825-5586 toplace your credit-card order today!


MedNuggetsby Fred J. Spielman, M.D.Professor of Anesthesiology and Obstetrics and GynecologyDirector of Obstetric AnesthesiaVice Chair, Dept. of AnesthesiologyThe University of North Carolina at Chapel Hill

Anesthesia today is in a sad state fortwo reasons, and this is not my idea butthe anesthesiologist’s idea: Anesthesiolo-gists make anesthesia complicated andtricky instead of simple. Why? Anesthesiahas long been in the hands of nurses andnurse technicians, and like midwifes, theydo a splendid job. Now, in order to justifythe long period of training, anesthesiolo-gists feel they must do something nursescan’t do. All sorts of things, like novocaine,pontocaine, pentothal and curare, are in-jected into the vein while the patientbreathes cyclopropane, nitrous oxide, ether,and so on. When an emergency arises no-body knows what to do, and, of course, thereis trouble.

–William J. PottsAnnals of Surgery 140:627, 1954

The sharp difference between the mor-tality in white and Negro subjects has beennoted by many observers. There are sev-eral explanations. It has been said that theNegro is particularly susceptible to appre-hension, fright, and panic. The physiologicsymptoms which accompany the state ofanxiety interfere with the anesthetic man-agement in these patients.

–Mary Frances PoeAnesthesiology 14:85, 1953

Small, low cost cardiac monitors areappearing in many hospitals throughoutthe country. These are limited in the infor-mation they reveal and may tend to bor-row from the watchful care of the anesthe-siologist. A finger continuously on thepulse is more informative than the cardiacmonitor which only records an electricalactivity.

–Mary KarpSurgical Clinics of North America 39:219,

1959

Contrary to common opinion, the so-called Trendelenburg posture, in realityoriginated by Bardenhauer, of Cologne, isnot the most favorable for the anesthetizedpatient. Trendelenburg, indeed, first de-scribed its danger and advised against itsuse for fat patients.

–Albert H. MillerNew England Journal of Medicine

218:385, 1938

The inseparability of anesthesia fromthe total care of the surgical patient is tous the compelling reason why surgeon andanesthetist, engaged as they are in a com-mon task, cannot with profit pursue sepa-rate goals.

–Henry K. BeecherAnnals of Surgery 140:2, 1954

Occasionally, one meets with patientswho reveal a pathologic fear of the antici-pated ordeal. The seasoned anesthesiolo-gist regards them with caution. There arefew who have not experienced or heard ofthe patient who assured those about herthat she would not recover from the anes-thetic and actually did not. These deathsare believed due to excess secretion ofadrenalin upon a heart sensitized by theanesthetic agent.

–Walter J. ReichAmerican Journal of Surgery 78:231,

1949

Bad subjects for anesthesia are mostgenerally robust, healthy, muscular indi-viduals; the spare, swallow women are moregenerally the ideal patients for anesthesia.

–Frederic W. HewittJournal of the American Medical

Association 40:339, 1903

Since the earliest days in anesthesia,respiration has provided helpful signs forthose who conduct fellow human beings onjourneys through unconsciousness. Wehave no reason to suspect that the last se-cret has been revealed; that no more usefulinformation is forthcoming. Let us thenapply ourselves with renewed vigor to thestudy of respiration, and progress in anes-thesia will surely result.

–H. J. V. MortonAnaesthesia 5:112, 1950

When, during the progress of an opera-tion, symptoms of approaching morphineintoxication present themselves, as hasoccasionally happened, we are in the habitof allowing the patient to drink one or morecups of strong black coffee on the operat-ing table.

–William BartlettSurgery, Gynecology and Obstetrics 33:27,

1921

Even though procedures (regional an-esthesia) are followed exactly and to theletter, one must not be disappointed at oc-casional failures. We must bear in mindthat too often originators of a given blocktechnic become overenthusiastic about theircontribution and overrate its efficiency.

–John AdrianiSouthern Medical Journal 42:923, 1949

The impressions which a child receivesduring his first sojourn in the hospitalusually remain with him for the rest of hislife. Therefore it is necessary that theseimpressions should be as pleasant as pos-sible. We believe that the child should beadmitted to hospital at least 24 hours be-fore operation so that he may become ac-customed to his surroundings.

–C.R. StephenCanadian Medical Association Journal

60:566, 1949

The physician who refers a patient fora surgical operation requiring the use ofan anesthetic, must be as vitally concernedin the kind of anesthesia employed andthe competency of the anesthetist as in thequalifications of the surgeon who is to per-form the operation.

–A.H. WatermanCurrent Researches in Anesthesia and

Analgesia 6:109, 1927


by A.J. Wright, M.L.S.Associate Professor of AnesthesiologyDirector, Section on the History of AnesthesiaUniversity of Alabama at Birmingham

From the Literature

Note: I have examined most of the items listedin this column. Books can be listed in this col-umn more than once as new reviews appear.Older articles are included as I work through alarge backlog of materials. Some listings arenot directly related to anesthesia, pain or criti-cal care but concern individuals important inthe history of the specialty [i.e., Harvey Cushingor William Halsted]. I also include career pro-files of living individuals. Non-English materi-als are so indicated. Columns for the past sev-eral years are available as “Recent Articles onAnesthesia History” in the “Anesthesia HistoryFiles” at www.anes.uab.edu/aneshist/www.anes.uab.edu/aneshist/www.anes.uab.edu/aneshist/www.anes.uab.edu/aneshist/www.anes.uab.edu/aneshist/aneshist.htm.aneshist.htm.aneshist.htm.aneshist.htm.aneshist.htm. I urge readers to send me anycitations, especially those not in English, that Imay otherwise miss!

Continued on page 20

BOOKSFink M, Hayes M, Soni N, eds. Classic

Papers in Critical Care. Oxford: BladonMedical Publishing, 2003. 580pp. [rev. LeeRP. Anaesth Intens Care 32(4):599, August2004]

Gullo A, Rupreht J. World FederationSocieties of Anesthesiologists—50 Years.Springer, 2004. 322pp.

McTavish JR. Pain and Profits: The His-tory of the Headache and Its Remedies inAmerica. Rutgers University Press, 2004.240pp.

Meldrum ML, ed. Opioids and Pain Re-lief: A Historical Perspective. Seattle: IASPPress, 2003. 222pp. [rev. Cramond T.Anaesth Intens Care 32(3):442, June 2004]

Stratmann L. Chloroform: The Questfor Oblivion. Sutton Publishing, 2003.256pp. [rev. Wilkinson DJ. Anaesthesia59:1047-1048, 2004]

Uglow J. The Lunar Men: Five FriendsWhose Curiosity Changed the World. NewYork: Farrar, Straus and Giroux, 2002.512pp. [rev. Stewart L. Chemical Heritage22(2):47, 49, summer 2004]

ARTICLES AND BOOK CHAPTERSBall C, Westhorpe R. Local

anaesthetics—nupercaine and ame-thocaine. Anaesth Intens Care 32(4):457,August 2004 [Cover Note series; 1 illus.; 3refs.]

Ball C, Westhorpe R. Localanaesthetics—procaine (novocaine,ethocaine). Anaesth Intens Care 32(3):303,June 2004 [Cover Note series; 1 illus.; 4

refs.]Ball C, Westhorpe R. Local anaesthe-

sia after cocaine. Anaesth Intens Care32(2):157, April 2004 [Cover Note series; 1illus.; 5 refs.]

Ball C, Westhorpe R. Local anaesthe-sia—the continuing evolution of spinalneedles. Anaesth Intens Care 32(1):3, Feb-ruary 2004 [Cover Note series; 1 illus.; 4refs.]

Bassell GM. In memoriam: Gertie F.Marx, MD (1912-2004). Int J Obstet Anesth13:141-143, 2004 [2 illus.]

Burkle CM, Zepeda FA, Bacon DR, RoseSH. A historical perspective on use of thelaryngoscope as a tool in anesthesiology.Anesthesiology 100(4):1003-1006, April 2004[6 illus., 17 refs.]

Caton D. Medical science and socialvalues. Int J Obstet Anesth 13:167-173, 2004[3 illus., 23 refs.]

Cottrell JE. Robert K. Stoelting, M.D.,to receive 2003 Distinguished ServiceAward. ASA Newsletter 68(8):18, 20, Au-gust 2004 [portrait]

Cottrell JE. H. Thomas Lee, M.D.,Ph.D.—2004 ASA Presidential Scholar.ASA Newsletter 68(8):21, August 2004 [1portrait]

Dagnino J. Coca leaf and local anes-thesia. Anesthesiology 1005:1322-1323, May2004 [5 refs.]

Ellis TA II, Narr BJ, Bacon DR. Devel-oping a specialty: J.S. three major contri-butions to anesthesiology. J Clin Anesth16:226-229, 2004 [13 refs.]

Faust R. Requiem for a heavyweight: inmemory of John D. Michenfelder, M.D. JNeurosurg Anesthesiol 16(3):187-188, July2004 [portrait; 4 refs.]

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Bulletin of Anesthesia HistoryDoris K. Cope, M.D., Editor200 Delafield Road, Suite 2070Pittsburgh, PA 15215U.S.A.

From the Lit. . . Continued from Page 19

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october 2004, vol 22

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