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Background Regional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-a-vis physician anesthesiologists and surgeons. Sources Hospital records and interviews with individuals familiar with the case. Findings An otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. Conclusion Spinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.

Evidence of human use of opium dates back as far as the sixth millennium BCE. Ancient societies through the Renaissance period created a variety of opium products, proliferating its common use and subsequent addiction. Because the active moiety was not known at this time, the potency of these opium concoctions could neither be predicted nor controlled. The first step in identifying opium's active ingredient, morphine, was its chemical isolation in the early 1800s by Wilhelm Sertürner. The subsequent elucidation of morphine's chemical formula and Sir Robert Robinson's derivation of morphine's structural formula, which won him the 1947 Nobel Prize in Chemistry, round out 150 years of the incremental advances in our chemical understanding of morphine. Nevertheless, our attempts to synthesize morphine, despite our advanced knowledge in synthetic chemistry, are still no match for the plant-based extraction of morphine from the poppy plant. The status quo remains problematic socially, economically, and politically; the relationships between the countries laboriously growing poppy plants to extract morphine and those countries importing these painkillers are unstable at best. In this study, we contrast the cumulative scientific discoveries that have led to our current chemical knowledge of morphine with the centuries-old natural method of morphine production that still dominates the opioid market today.

Although the development of anesthesia as a specialty and its practice in Rwanda have occurred postindependence, there are several contributing factors that have had an impact on the current state of the delivery of anesthetic care. European colonization of Africa, in general, and Belgium's control, in particular, are primary factors that have had a significant impact on education. The ripple effect has had a long-lasting impact on health care as well as other facets of present-day Rwandan society. Tertiary education did not start until the latter half of the 20th century and has left this country with the belated development of an educated population in sufficient numbers to handle health care problems and provide sufficient care to its population. This article will examine the history of Rwanda and delineate factors that have led to the current state of anesthetic practice.

Background In 1970, Harold James Charles Swan and William Ganz published their work on the pulmonary artery catheter (PAC or Swan-Ganz catheter). They described the successful bedside use of a flow-directed catheter to continuously evaluate the heart, and it was used extensively in the years following to care for critically ill patients. In recent decades, clinicians have reevaluated the risks and benefits of the PAC. Aim We acknowledge the contributions of Swan and Ganz and discuss literature, including randomized controlled trials, and new technology surrounding the rise and fall in use of the PAC. Methods We performed a literature search of retrospective and prospective studies, including randomized controlled trials, and editorials to understand the history and clinical outcomes of the PAC. Results In the 1980s, clinicians began to question the benefits of the PAC. In 1996 and 2003, a large observational study and randomized controlled trial, respectively, showed no clear benefits in outcome. Thereafter, use of PACs began to drop precipitously. New less and noninvasive technology can estimate cardiac output and blood pressure continuously. Conclusions Swan and Ganz contributed to the bedside understanding of the pathophysiology of the heart. The history of the rise and fall in use of the PAC parallels the literature and invention of less-invasive technology. Although the PAC has not been shown to improve clinical outcomes in large randomized controlled trials, it may still be useful in select patients. New less-invasive and noninvasive technology may ultimately replace it if literature supports it.

Background Many forms of art accurately depict physical attributes of their subjects. But how precisely do portraits capture personal, emotional, and behavioral aspects of individuals holding leadership positions in academic departments of anesthesiology? Methods We examined formal portraits of the first three academic chairmen of anesthesiology in our department – Leroy D. Vandam, Benjamin G. Covino, and Simon Gelman and obtained information about the artists (George Augusta and Marc Klionsky) regarding how they conducted research on their subjects, and the methods they used to depict significant character traits into their art. We then correlated the artistic depiction with known biographical and behavioral qualities of these leaders. Results We found that the artists were remarkably astute in their observations and that they successfully captured both physical and emotional aspects of these chairmen in their portraits. Moreover, in one instance, significant early life experiences were added to the composition with subtlety. Individuals familiar with these chairmen and aware of their management style can easily appreciate the techniques employed by the artists. Summary We conclude that art successfully depicted personal and executive attributes of these three academic anesthesia chairmen.

At the conclusion of World War II in Europe, officials and agents of the German Regime were tried for crimes against humanity in the Palace of Justice, Nuremberg, Germany. The main Nuremberg Trial took place before the International Military Tribunal, and 23 political and military leaders were tried between November 20, 1945, and October 1, 1946. Of the subsequent series of 12 trials, we focus our attention on the Doctors' Trial, in which 23 physician and nonphysician defendants were tried for human experimentation and mass murder. Of the 23 defendants, seven were acquitted, seven were executed, and the rest received prison sentences. We were able to identify one individual who remained a conscientious objector and did not participate in the conduct of these experiments. We examine details of their actions, their defense strategies, and their verdicts and offer explanations for how members of the medical profession could possibly participate in such unethical practices. More than 100 countries now have rules and regulations that govern medical experimentation on human subjects.

In 2009, the Japanese Society of Anesthesiologists (JSA) founded the Archives of JSA, which changed into the Japanese Museum of Anesthesiology in 2011. The museum consists of three sections: (1) archives (the collection of historical documents of the JSA), (2) museum (the collection of anesthetic equipment and its related things), and (3) library (the collection of books, journals, leaflets, and related materials). By January 2013, the collections included 2537 Japanese and 1569 foreign language books. JMA collections include 25% of the Japanese anesthesia books published between 1796-2008, making it Japan’s largest collection, with the exception of the National Diet Library of Japan. Most of the Japanese books published from 1796 to 2008 are listed and can be searched through the home page.

It has been suggested that Robert Louis Stevenson's masterpiece Strange Case of Dr. Jekyll and Mr. Hyde derived inspiration from the real-life tragedy of the final days of Connecticut dentist Horace Wells, innovator of the clinical use of the anesthetic properties of nitrous oxide. We examined Stevenson's letters, biographies, and other references in the literature, press, and online to determine whether any factual basis exists for Stevenson to be aware of Wells' life, and also if it played any role in creating the novel's plot. Stevenson was born in Scotland, several years after Wells had committed suicide in New York. Wells' life and death received widespread coverage in the northeastern United States, but there is no evidence that it was printed in newspapers or periodicals in England or Scotland. On the other hand, novelists of the period, psychologists, and the lay public were quite interested in the concept of split personalities and the dual nature of man, so these may have been natural substrates for the novel. There is evidence that Stevenson dreamt about episodes similar to those depicted in his novel. All claims to any relationship between Wells and the novel come from the United States, and none of them are backed by evidence. In the absence of evidence supporting a relationship between the behavior exhibited by Wells during his final days and any inspiration that Stevenson might have derived from it, we conclude that there is insufficient evidence to suggest any relationship between them.

Horace Wells was a Hartford, Connecticut, dentist whose practice flourished because of his clinical skills. He had an imaginative mind that propelled him to the forefront in several aspects of dentistry. Unfortunately, he suffered a recurrent "illness" that began in the winter and resolved in the spring. These symptoms were compatible with both major depressive disorder and seasonal affective disorder as a qualifier. Wells' introduction of nitrous oxide as an anesthetic was also associated with self-inhalation. This led to periods of hypomania, followed by depression. With the progression to ether, then chloroform, there was an episode of mania in January 1848, followed by depression and suicide.

Charles Thomas Jackson claimed to have original ideas that led to the creation of guncotton, the electromagnetic telegraph, and the use of ether as an anesthetic. There was, though, a gap between when the idea was enunciated and when it became reality, with other individuals accomplishing the latter. An examination of Charles Jackson's life reveals a pattern of behavior that is compatible with attention deficit hyperactivity disorder with an associated diagnosis of oppositional defiant disorder. These diagnoses are explored in the context of Jackson's life to explain why he did not carry his initial thoughts to fruition.

News of the successful use of ether anesthesia on October 16, 1846, spread rapidly through the world. Considered one of the greatest medical discoveries, this triumph over man's cardinal symptom, the symptom most likely to persuade patients to seek medical attention, was praised by physicians and patients alike. Incredibly, this option was not accepted by all, and opposition to the use of anesthesia persisted among some sections of society decades after its introduction. We examine the social and medical factors underlying this resistance. At least seven major objections to the newly introduced anesthetic agents were raised by physicians and patients. Complications of anesthesia, including death, were reported in the press, and many avoided anesthesia to minimize the considerable risk associated with surgery. Modesty prevented female patients from seeking unconsciousness during surgery, where many men would be present. Biblical passages stating that women would bear children in pain were used to discourage them from seeking analgesia during labor. Some medical practitioners believed that pain was beneficial to satisfactory progression of labor and recovery from surgery. Others felt that patient advocacy and participation in decision making during surgery would be lost under the influence of anesthesia. Early recreational use of nitrous oxide and ether, commercialization with patenting of Letheon, and the fighting for credit for the discovery of anesthesia suggested unprofessional behavior and smacked of quackery. Lastly, in certain geographical areas, notably Philadelphia, physicians resisted this Boston-based medical advance, citing unprofessional behavior and profit seeking. Although it appears inconceivable that such a major medical advance would face opposition, a historical examination reveals several logical grounds for the initial societal and medical skepticism.

Background We examined publication trends in two major American journals devoted to anesthesia to understand the geographical distribution of authorship and attempt to decipher the factors that influence this distribution. Methods In addition to bibliometric information for all articles published in Anesthesiology between 1941 and 2010 and Anesthesia & Analgesia between 1931 and 2010, we also collected information about the country, continent, and medical school or institution from which the articles were submitted. Results The top five countries that published research in these journals were the United States, Japan, Germany, Canada, and France. More than 50% of the published articles were submitted from the United States. However, US publications have steadily and significantly declined over the decades. Contributions from Europe and Asia (especially China) have shown marked increases. US spending on research, especially biomedical research, has remained essentially unchanged and declined in some areas, whereas it has increased steadily in some of the other countries we discuss. Conclusions There is a significantly increased prominence in publishing from countries other than the United States. The reasons for this include the convenience of Web-based submission, an increased desire by researchers from around the world to publish in journals considered prestigious, English becoming the preferred language of communication amongst academicians in science, the advent of globalization, and a decrease in public research funding in the United States relative to other countries.