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Casebooks, daybooks and diaries were among a number of literary forms commonly used by physicians in the nineteenth century to record the details of their medical cases. Because they constitute primary sources on medical practice in that era they have value to the medical historian. To illustrate this, the writings of three Canadian physicians—John Mackieson, Jonathan Woolverton, and James Langstaff—are discussed, together with a consideration of some of the principles relating to the study of their manuscripts, particularly in relation to the study of the history of practice in rural areas.

Since 1847 anaesthesia in Canada has evolved through six phases. In the first (1847–1898), it was a craft without an academic and professional base. The second (1899–1919) was marked by the first academic appointments and by Canadians’ wartime experiences of anaesthesia. The third phase (1920–1929) evidenced the professional satisfaction of anaesthesia and included the founding of the Canadian Society of Anaesthetists. In the fourth phase (1930–1943) the growth of the Royal College of Physicians and Surgeons of Canada, the introduction of certification and the founding of the definitive professional society — the Canadian Anaesthetists’ Society — fostered the evolution of what was now becoming a recognizable specialty. The fifth phase (1944–1971) was one of resolution of problems affecting the status of anaesthesia: the first autonomous department of anaesthesia in a Canadian university was founded (at McGill in 1945), the Royal College Fellowship was approved for anaesthesia (in 1951), the Canadian Anaesthetists’ Society Journal was launched (in 1954) and a single standard for certification of specialists was finally established (in 1971). In the sixth (1972–1989), the main elements were the assumption of responsibility for residency training by the universities and by the renaming of the journal as the Canadian Journal of Anaesthesia. Through these years of increasing professionalism, it has, however, been the accomplishments of individual Canadian physicians, facing many challenges, that have made the specialty in Canada recognizably Canadian.

In 1931 Saskatchewan became the first jurisdiction in Canada to introduce a province-wide program for the control of cancer. The program was conceived in 1929 by the cancer committee of the Saskatchewan Medical Association. The provincial government promptly took up the committee’s recommendations for centralization of cancer care in two clinics and emphasis on radiotherapy as a mode of treatment. The following year the Saskatchewan Assembly approved The Saskatchewan Cancer Commission Act, as prepared by Health Minister F. D. Munroe, himself a physician. The Regina Cancer Clinic opened at the end of 1931 and the Saskatoon Cancer Clinic at the beginning of 1932. This initial phase of the conception and introduction of cancer control in Saskatchewan is notable for the harmony of agreement among its planners and for the rapidity with which it was introduced. Progress during the remainder of the first decade was much slower, as competing interests and priorities among a larger group of individuals and institutions, together with the Depression, held back the initial momentum. Initially, however, weaknesses accompanied the strengths of the program. Weaknesses included the reluctance of some physicians to cooperate wholeheartedly as they feared the perceived effects of the incursion of a government agency in patient care plus the increasing financial burden placed on the hospitals. The strengths of the program included the existence of the program where none had been present earlier, the availability of a diagnostic and therapeutic service for patients, and a comprehensive system of patient records. In particular, the cancer control program in its first decade was the basis for notable progress in later decades and a model for other jurisdictions.

For the greater part of the past century and a half the hazards and problems of anaesthesia loomed large. They were serious and frequent enough for Dr. Wesley Bourne to suggest that the anaesthetist of that era was "holding his patient over an open grave. "~ However, particularly in the past 25 years, advances have made anaesthesia relatively safe and straightforward and relatively free of hazard and stress. From our perspective today it is therefore difficult to visualize our predecessors' problems and the solutions they applied. A backward look is not entirely academic because some of the basic problems (e.g., control of the airway, preservation of homeostasis and provision of analgesia and muscle relaxation) of their day are not dissimilar to ours, while the keys to solving them, then as now, have always been cut from a continuing commitment to self-education. This is nicely illustrated in the autobiographical review left to us by the late Dr. Nicholas Hill. Besides broadening our perspective through a knowledge of history, his account merits our attention for several other reasons. Dr. N.P. Hill practised in St. Catharines, Ontario, from the mid-1920s to the early 1970s. The title of his narrative, "Fifty Years in Anaesthesia," suggests one reason why his account is of interest. The experience he gained as extraordinary and exciting advances shaped and reshaped the practice of anaesthesia during that time enabled him to write a first-hand summary of what happened. He witnessed the following advances in both drugs and techniques: - the original inhalational agents (ether and chloroform and later ethyl chloride) through cyclopropane and trichlorethylene yielded primacy to halothane, fluroxene, methoxyflurane, which in turn gave way to isoflurane. - the early intravenous barbiturate hypnotics (e.g., sodium amytal) were superseded by hexobarbital, sodium pentothal and methohexital, which were augmented later by a variety of other agents (e.g., the steroid hydroxydione [Althesin], ketamine, Etomidate, benzodiazepines) and then propofol.

A casebook written by Dr. John Mackieson (1795–1885), of Charlottetown, contains the records of 49 surgical cases he managed between 1826 and 1857. In view of the rarity of first-hand accounts of surgical practice in Canada in the mid-19th century, Mackieson’s case records are a significant source of information. These cases are discussed in order to delineate Mackieson’s approach to the surgical problems he faced in his general practice. His case records also illustrate some of the general problems that beset surgeons in that era.

Fundamental Principles and Practice of Anaesthesia is a basic textbook co-edited by anesthesiologists from the United Kingdom and the United States. The book is not really a condensed anesthesia textbook, nor is it a full version textbook, but rather something in between. It is an amalgam of scientific information that can be found in regular anesthesia textbooks as well as in basic science and intensive care texts. The justification for a new textbook in the anesthesiology armamentarium is presented in the foreword and is to provide a novel approach for written information aimed at the early years of training. The book is bulky (1100 pages), and the glossy paper makes it difficult to read due to light reflection. The printing is monotone with the numerous tables and graphics exclusively printed on a purple background. Although the editors claim that contributors come from both sides of the Atlantic, Canadian participation is remarkably absent. This textbook (the first page of which is filled with errata), is divided in four sections.

The purpose of this review is to describe the pathogenesis of pulmonary oedema associated with upper airway obstruction, summarize what is known of its clinical presentation, and reflect upon its implications for the clinical management of airway obstruction. The pathogenesis of pulmonary oedema associated with upper airway obstruction is multifactorial. However, as the phrase "negative pressure pulmonary oedema" suggests, markedly negative intrapleural pressure is the dominant pathophysiological mechanism involved in the genesis of pulmonary oedema associated with upper airway obstruction. The frequency of the event is impossible to ascertain from the literature but paediatric cases requiring airway intervention for croup or epiglottitis and adults requiring airway intervention for emergence laryngospasm or upper airway tumours account for over 50 per cent of the documented cases in each age group, respectively. Individuals at risk should be observed closely while they remain at risk. The majority of cases present within minutes either of the development of acute severe upper airway obstruction or of relief of the obstruction. Resolution is typically rapid, over a period of a few hours. Rarely is anything more required for management than the maintenance of a patent airway, supplemental oxygen, and, in approximately 50 per cent of cases, mechanical ventilation and positive end-expiratory pressure.

John Snow's leadership in epidemiology as well as anaesthesia resulted from his research as much as his clinical practice. In anaesthesia, Snow's research concerned the regulation of concentrations of volatile agents and the development of efficient inhalers; the uptake and elimination of volatile agents; stages of anaesthesia; carbon dioxide metabolism and rebreathing; and metabolism in anaesthesia and the theory of anaesthesia. In epidemiology, Snow investigated the relationship of water supplies to mortality in cholera during the London epidemic in 1854, which led him to formulate an original and valid theory of the transmission of cholera. Snow's research, which has received less attention than anecdotes concerning his career (e.g., his anaesthetizing Queen Victoria and urging removal of the handle of a contaminated water pump), was always directed towards solving specific problems. The significance of his research is evident in its leading not only to improvements in health care but also to the evolution of anaesthesia and epidemiology as professional disciplines.

Harvey Cushmg, the great American neurosurgeon, made four important contributions to the specialty of anaesthesia He was one of the first to introduce anaesthesia records, he was responsible for the introduction of blood-pressure measurement into operating-room practice, he develooed the technique of precordial monitoring of patients undergoing surgery, and he was an authority on local anaesthesia, coming the term “regional anaeshesia ” These aspects of Cushing’s career have been discussed because of their inherent value, and because they lead us to an understanding of the nature of a great physician A mark of his genius was the thoroughness with which he approached his neurosurgical work His desne to understand every aspect of it led to 1 along important contributions to specialties outside his own Not only did Harvey Gushing make neurosurgery safe, but this master surgeon also did much to unprove the conditions of anaesthesia m his day His contributions to anaesthesia are of lasting value, arid the practice of anaesthesia today owes much to him

ALTHOUGH it was the invention of the telephone in 1876 that made Alexander Graham Bell famous, Bell devoted relatively little of his life to the development of the telephone. After 1880, other interests absorbed him. These interests — among which education of the deaf, aviation, eugenics and sheep breeding were four lasting ones — are less well known than the telephone. Particularly unrecognized, even among physicians, is Bell's honorary doctorate of medicine (Heidelberg University, 1886) and Bell's influence on medical practice in the era 1878–1903. Consideration of these aspects of Bell's life adds a new dimension to the understanding of . . .

“Genes are important.” This seemingly simplistic statement was one side of a coin tossed many times during a recent international symposium on genetic hazards to man from environmental agents.* The other side of the coin: many of the myriad chemicals in our environment induce genetic mutations, and mutations, more often than not, are harmful rather than beneficial. Moreover, if, as many geneticists believe, our genes are our most treasured heritage, any deterioration in the quality of our genes can only lead to a deterioration in the quality of our lives. This, in essence, is the price society must pay for convenience living: for convenience foods, convenience domestic and industrial goods, convenience drugs, indeed, for the convenience of our very way of life, so dependant on the whole chemical environment. Is the price worth paying, in view of the risks involved?

A method of anesthesia, essentially amnesia, for patients undergoing cardioversion has been presented. A review of the administration of anesthesia in 150 cases has indicated the safety of the method and the absence of complications in this group of patients presenting with cardiac arrhythmias.