OHSU APOM Grand Rounds
May 19, 2014
Angela Kendrick , MD
Associate Professor of APOM
Why a history talk?
Jeff asked
 I have a unique perspective on the
department’s history
 “Contrary to the quoted aphorism of
Santayana, he who forgets the past is
often Not necessarily doomed to relive
it” – Norman Bergman , MD

Learning Objectives
1. Review key developments in science that led to the
“discovery” of anesthesia during the 19th century.
2. 20th century refinements:
equipment - delivery systems
inhaled vapors
monitoring
anesthesia training
will be presented as background for understanding 21st
century developments.
3. Oregon’s anesthesia history from Fort Vancouver through
Oregon Health & Sciences University will be the context for
modeling the historical changes in anesthesia care.
1846
1867
1875
Hospitals
built in
Portland
1950s
polio
epidemic
Halothane
1938 –
Dr.
Hutton
Early
1900s
1919 –
post
WWI ,
Marquam
Hill
1948 Dr.
Haugen
2002 Dr.
Kirsch NIH
funded
scientists
1980s
isoflurane
Dr.Steven
s
1960s
1970s
concept
of MAC
,bup Dr.
Bergman
1990s Dr.
Kingston
rapid
growth
OHSU
Timeline of Anesthesiology Progress in
Oregon
Pre Industrial revolution



16th century
development of
experimental
approach to scientific
problems
Robert Boyle: 1650
pressure volume
relationship of gases
Robert Hooke:
essential requirement
for respiration is a
constant supply of
fresh air
Joseph Black: 1756
Discoverer of carbon
dioxide
 Cavendish 1766:
Described hydrogen
 Joseph Priestley
:1772-discovered and
characterized 10
gases –including
oxygen and nitrous
oxide

Industrial Revolution





1760 (in England) to
1840
Began in England,
Scotland spread to US
Opium was the
“miracle drug”
TB was a deadly
disease with
urbanization
Little progress in
surgery from dark
ages till middle of the
18th century




Scientific inquiry –
Royal Society
Pneumatic Institute (
1798) ; Watt, Davy ,
Beddoes
Davy was a self
experimenter
Ether Frolics in 1830s
Harnessing of steam 1780-1830
Electricity
Manufacturing of goods
Transportation of goods
Urbanization of populations
Demonstration of anesthesia

Demonstration of
Nitrous oxide for
tooth removal –
Wells and Colton
1844, “failed demo”
at Mass General
1845

1846 – Morton
demonstrated
effectiveness of
ether at Mass
General ( 4 times)
Rapid transmission of this
knowledge : It went viral !


Dr. Bigelow reported it
in Nov
Oliver Wendell Holms
proposed calling it
“anesthesia”



American surgeon
demonstrated it in
France in Dec
John Snow began
administering it in
England in Dec, first
used in labor
analgesia in Jan ( Dr.
Simpson)
Chloroform
“discovered” in March
of 1847- clinical use
starts Nov 1847
What was going on in the PNW ?

The Oregon Territory
encompassed a
huge area and was
disputed territory
between the US and
England

Map of territory in
1843
Ft Vancouver established in
1825




The chief “factor” was Dr.
John McLoughlin
Hudson’s Bay Co sent well
trained European doctors
out to the fort beginning in
1831
Oregon Trail began in
1841
Treaty of 1846 established
Canada –US Boundary
First recorded use of anesthesia
in Oregon Territory




Forbes Barclay –
trained in Edinburgh
arrived in 1840 to be
the physician at Ft.
Vancouver
Decided to become
US citizen after 1846
Moved to Oregon City
in 1850
Wrote a letter to
Oregonian describing
his experiences giving
chloroform in 1855

“I have used it (chloroform)
since 1848 in many capitol
and minor operations of
surgery and physic and
rejoice to have a drug that
can alleviate the suffering
patient.”
Civil War 1861-1865
Chloroform and ether, used by both
armies
 Estimated use : 125,000 cases
 650,000 injuries
 Chloroform more popular: slightly
quicker induction 9 min vs 16 min

Establishment of PNW Hospitals



1856 – St Joseph’s
in Vancouver
1875 ( post US civil
war) both St Vincent
and Good
Samaritan were
established in
Portland
Interns or nurses
gave the anesthetics
First Medical School in Oregon
Willamette Medical
School – est 1867
 Moved to Portland in
1877, then back to
Salem in 1895
 A competing School :
a two year Medical
Department of
University of Oregon
opened in 1887 , this
is the start of what
became OHSU


Description of course
in Willamette
University catalogue
of 1886 “ “A surgical
clinic will be given
every Saturday by Dr.
Bevan : The students
will be instructed in
the use of anesthetics,
surgical appliances,
bandaging”
Development of anesthesia
record


Cushing and Codman
were interns together
at Mass General in
1895, co-developed
the anesthesia record
Cushing also became
interested in the
measurement of BP
after a trip to Europe
1901, he already
advocated using a
stethoscope to listen
to breath sounds and
heart tones
1905 description from
Willamette catalogue

“The subject of anesthesia so often
neglected , and yet of vital importance ,
both to the patient and the surgeon, will be
taken up at length and the essential
features explained. Members of the senior
class will be given an opportunity to
administer these agents under competent
supervision, thereby by gaining practical
experience so necessary to their use.”
First Nurse Anesthesia training
program
RNs trained at Good Sam nursing
school since 1890
 Interns passed resolution in 1908-09
“not going to spend internship giving
anesthetics”
 First school of Nurse Anesthesia in US
founded at St. Vincent hospital in 1909director was Agnes McGee ( graduate
RN from Chicago)

School for Nurse Anesthetists at
St Vincent





Not known how many trained per year in
early years
Initial duration of study was 4 months,
expanded to one year in 1939
By 1949 , 142 students had graduated
School closed in 1956
Much of the anesthesia administered in
Oregon was by non specialty trained docs
or by RNs through the years prior to WW 2
Course description from
University of Oregon’s catalogue
in 1915
4 students who have been trained in strict asepsis enter
the amphitheater with the operating surgeon: two of them
assist the operator and take part in the operation, the
other two students are stationed at the head of the bed
under an expert anesthetist who studies anesthesia with
them and instructs them in all methods of administration.
While one student is engaged in giving the anesthetic, the
other is being taught how to make observations with the
sphygmomanometer studying the reaction of the patient
to the various operative procedures.
6 hours per week entire 4th year , Dr. Mackenzie


Dr. Browning is the instructor from 1916-18.
WWI 1914-1918




Face mask delivery
systems
Nitrous-oxygenether popularized
Resuscitation and
fluids
Beginning use of
endotracheal tubes
Eur J Anaesthesiol. 2007 Aug;24(8):649-57.
Dr. Guedel served in American
Expeditionary Forces in France
as an anesthesiologist training
orderlies and nurses to
administer anesthesia.
1919 move to Marquam Hill
50 students in the first class
 County Hospital opened in 1923 –state
board now requires one year post
graduate training
 Doernbecher Children’s Hospital in 1926

Early version of tram ?
1924 Student Shuttle
1930s Development of IV
inductions and anesthetic agents



Dr. Lundy at Mayo
Clinic
Busy clinic
practice;advocate of
care team practice
Barbiturates and
regional anesthesia



Dr. Ralph Waters at
the University of
Wisconsin
Advocate of training
physician scientists
Barbiturates, inhaled
agents, carbon
dioxide absorber in
circle system
Call for data aggregation

From the Mayo clinic
in the 1930s

First look at
morbidity and
mortality in 1954 by
Beecher and Todd
John Hutton, MD
Division Head 1938-1948
Fellowship year at
Mayo
 Chief of U of O
Surgery was Mayo
Alum : Tom Joyce, MD
 Began anesthesia
residency, one
resident per year
 Restarted Nurse
Anesthesia training
 Maintained a private
practice at Good Sam

WW II (1939 Europe, 1941 US
entry ---1945 )



Service for Docs
and RNs in both
Europe and Pacific
Interruption of
training to provide
war time service
Pentothal, regional,
tracheal intubations
Anesthesiology. 2001
May;94(5):907-14.


Link to film
https://archive.org/d
etails/Nitrousoxideoxygenetheranaesthesia3wellcome
1948 Dr. Fred Haugen



Undergrad and
medical School at the
U of O, internship at
Emanuel,
anesthesiology
Training at Bellvue
beginning in 1936
Finished training ,
went to Philadelphia ,
established residency
training program at
Presbyterian Hospital
Recruited back to
Oregon in 1948
1950s




Expansion of
monitoring
EKG in OR
Development of
Halothane, clinical
use in 1956
Polio epidemic 1952
, Denmark led to
positive pressure
ventilation, US
epidemic : Iron lung
Heart Surgery 1950s-1960s





Thoracic surgery – TB
Congenital work
initially extracardiac
BT shunts
Starr co-invents
Implantable
mechanical valve
1960
First Open heart at
OHSU 1957
Hospital South
Construction 1955
1970s
Dr.Norman Bergman
Medical School Oregon
1951,residency
Columbia Presbyterian ,
joined faculty there, then
Utah VA for 12 years,
recruited to become
Chairman of newly
created department of
anesthesiology ( trained
93 residents here)
 Early career :
Respiratory Physiology ,
later career : anesthesia
history
 Became ASA History
Laureate in 2000

Vietnam Era 1965-1973



1965 : Bupivicaine
developed
Ketamine , more use
of “balanced
anesthesia” with
barbiturate induction,
muscle relaxant , ETT,
plus narcotic
75% of general
anesthetics used ETT
in Vietnam
Military increased its
training of both MD
and CRNA personnel
to meet the service
demands

Concept of continuous
resuscitation and rapid
evacuation led to marked
decreased in mortality in
injured servicemen in
Viet Nam war
1980s Dr. Wendell Stevens



1980 ; isoflurane
Archie Brain in
England begins
work on Laryngeal
Mask – avail UK
1988
First clinical use of
pulse oximetry ,
quickly became a
standard as did
capnography



Dr. Stevens was
born in Iowa
Residency at Iowa,
then 12 years at
UCSF, back to Iowa
as Chair, then to
OHSU as chair in
1982
Served as President
of ABA 1987-1988
Equipment in 1980s
VS
Additional year of anesthesia training started in 1988 , so now internship plus 3
Departmental sub-specialization begun and with advent of statewide trauma
system, staff required to stay in house ( 1987)
1990s Dr. H.G.G.Kingston




Originally from SA, trained in
Liverpool
Returned to SA , cardiac
anesthesia
Additional training at Toronto
Sick Children Hospital 1980
Came to OHSU first as visitor
1980, but returned in 1982 ,
became chairman in 1993
Clinical expansion
Emphasis on Quality
management
 Further growth of
subspecialty care: Pain
Center , Peds , OB and
Cardiac



CEI, Free standing DCH
Department in 2000
Remember it has been done before

Child life : Ice
Cream and movies

Trips to radiology
Popular in early 20th century –
resurgence in 21st?
1846
1867
1875
Hospitals
built in
Portland
1950s
polio
epidemic
Halothane
1938 –
Dr.
Hutton
Early
1900s
1919 –
post
WWI ,
Marquam
Hill
1948 Dr.
Haugen
2002 Dr.
Kirsch NIH
funded
scientists
1980s
isoflurane
Dr.Steven
s
1960s
1970s
concept
of MAC
,bup Dr.
Bergman
1990s Dr.
Kingston
rapid
growth
OHSU
Timeline of Anesthesiology Progress in
Oregon
2002 Dr. Jeffrey Kirsch




University of Michigan
Medical school,
residency and
fellowship at Johns
Hopkins University
Medical center
Joined faculty 1987
Vice Chair of Training
and Education
Recruited to expand
our academic
research mission

Brought significant NIH
funding through the
research team who
came with him including
Richard J. Traystman,
PhD, Patricia D. Hurn,
PhD and joined by Nabil
J Alkayed MD, PhD
Modern Era of Department





Growth in clinical
mission: CHH, KPV
Educational
leadership within
Department,
University and
Specialty
Multiple fellowships
Specialized tracks
ICU leadership
Critical inventions of late 20st
century


Human Genome
Project
Begun in 1990 –
declared complete in
2003
Research combining
these tools is the next
revolution, a critical
mass of inventions




Personal computer
1970s
As of 2008, the
number of personal
computers
worldwide in use hit
one billion.
Hand held devices
Current research prize to invent
a hand held Star Trek ‘tricorder”


Qualcomm is
offering 10 million
dollars
Announced at 2012
Consumer
Electronics Show in
Las Vegas.
Next big
discovery
OHSU
Collaborative Life
Sciences Building
Cardiovascular
and Cancer
Center
Intel collaboration
Knight dollars
OR Equipment for 21st century
Software Features
• Single click buttons
• Critical system alarms:
- Displayed on all screens
- E-mailed to key personnel
• Individual sensor fault reporting
• Remote locking and unlocking
• Programmable lighting
• Detailed maintenance reports
• Historical room sales and statistics
• Reports can be exported, E-mailed, or
PDF’d
• Automatic perpetual inventory
• Windows Network ready
• Interface TCP IP / RS232
• Automatic daily backup to separate hard
drive
• Online manual
• 24 / 7 in-house technical support
• Free upgrades
OMNICELL ?
Nope
That was a description
of the electronic hotel
minibar !
University of Oregon Department of Medicine - 1887
University of Oregon Medical School - about 1919
University of Oregon Health Sciences Center -1974
Oregon Health Sciences University – 1981
Oregon Health & Science University – 2001
References

The History of Anesthesia in Oregon
Klein and Kendrick eds 2004

The Genesis of Surgical Anesthesia
Norman Bergman WLM 2008
The Wood Library Museum Digital archives
 The OHSU History of Medicine Archives
 The Wellcome archives
