2009 Abstracts

Closed System and Low Flow Anesthesia Began at the University of Wisconsin and Matured at the University of Alabama at Birmingham
Presented by J.A. Aldrete & AJ Wright, University of Alabama at Birmingham, Birmingham, AL

From 1846, anesthetics were administered openly, requiring that patients breathe to take-in or let-out the anesthetics. By inserting lime water in the circuit, D. Jackson in 1915 found a way to remove CO2 from the circuit. R. Waters designed the “To-and-Fro” system in 1927 with a soda lime absorber; and also formed the first academic anesthesia group at the University of Wisconsin. By using this “closed system” explosive gases (cyclopropane and ethylene) and flammable liquids (ether and fluoroxene) were used safely. In 1952, L. Morris built a vaporizer (copper kettle) that delivered precise concentration of vapors; the uptake of N2O was first measured by J. Severinghaus in 1957, followed by Eger, who determined the uptake and distribution of halothane, enflurane and other vaporized agents and establishing the concept of minimal alveolar concentration (MAC).

The first meeting on LFCS was held in Denver, in 1978; the lectures were published as Low Flow and Closed System Anesthesia (1979) by Aldrete, Lowe and Virtue. Using a water model, H. Lowe tirelessly demonstrated the advantages of closed circuit anesthesia everywhere. In 1981, Ed Ernst recruited to the University of Alabama enthusiasts of LFCS including H. Lowe, T Mackrell, J Spain, D Gould, S Gelman, B Lampert and JA Aldrete. Birmingham became the center where this technique was advanced. In 1982, a 2nd Congress was held, a Newsletter, “The Circular”, appeared quarterly. The impetus culminated in a masterpiece book by Lowe and Ernst entitled Quantitative Anesthesia (1982). At a meeting with equipment manufacturers in 1988, consensus was reached on how to build the current safe anesthetic machines used today.

Physicians, Alcoholic Women and The Sophia Little Home
Presented by Simone Caron, Wake Forest University, Winston-Salem, NC

Scholarly works on male alcoholics in the late nineteenth-century United States abound, but the same cannot be said for women. Available scholarship usually deals with treatments for upper and middle-class women with private doctors or in comfortable sanitariums. Articles on working-class or indigent women tend to focus on incarceration in state institutions. What is missing is a scholarly analysis of working-class and indigent women’s treatments in private facilities. This paper seeks to fill this gap by exploring national debates in medical journal on alcoholic women and offering a microanalysis of the treatment of alcoholic women at the Sophie Little Home (SLH) in Cranston, Rhode Island. In the late nineteenth century, two views of alcoholism prevailed: the “physicalistic view” defined it as a disease in need of treatment while the “moralistic view” identified it as a lack of individual self control that called for religious conversion, punishment and often jail for the indigent. The Sophie Little Home does not fit neatly into either category. The staff in this independent facility was aware of physicians’ discourse on alcoholism, but they did not see alcoholism as a disease per se; they also did not believe women should be forced to convert, be punished or spend time in jail for their behavior. They offered the SLH as an alternative that emphasized hard work to strengthen the body and mind, and to reclaim womanhood. This paper is based on the debate on alcoholic women found in medical journals in the late nineteenth century, and on the records of the Sophie Little Home.

Evolution of the Doctor-Patient Relationship
Presented by John Erlen, University of Pittsburgh, Pittsburgh, PA

The doctor-patient relationship has been the focus of clinical medicine dating back to the beginning of time. This power point presentation examines the doctor-patient relationship during American history, from the colonial period up into the present time, focusing on the factors that either promoted or hindered this relationship.

Beginning with the colonial period this presentation describes the treatments offered by the well meaning physician, as well as the alternatives of domestic medicine, health alternatives, and blatant quackery which the potential patients might choose to avoid going to the physician because of his painful, often futile therapies.

With the advent of the age of magic bullets beginning in the last quarter of the 19th century this presentation will explain how medicine and the American physician gained an incredibly high level of respect from the American public. Special attention is paid to some of the major clinical breakthroughs against specific diseases, including yellow fever, pellagra, and tuberculosis. Discussion also focuses on the advent of seemingly miraculous new remedies, including the sulfa drugs, penicillin, and antibiotics.

These successes ushered in the mythical “golden age” of the doctor-patient relationship, circa 1945-1960. Images depict how the doctor was perceived by the American public during this era and why the physicians gained such a level of seemingly supreme trust from his patients.

The majority of this talk focuses on the wide variety of factors that have ended this mythical “golden era” in the doctor-patient relationship. Emphasis is placed on how physicians have been impacted by societal factors outside their control, such as the Civil Rights movement and the Women’s Rights movement. Special attention is paid to the changing image of the doctor on television, from Dr. Kildare to Dr. House.

Past Influences on Present Work: Understanding the History of Maternal and Child Health Work for American Indian & Alaskan Natives (AI/AN) Women and Children
Presented by Laurel Hitchcock & Lorie Chestnut, University of Alabama at Birmingham, Birmingham, AL

The creation of the Indian Health Services (IHS) in 1954 changed health care for American Indians/Alaskan Natives (AI/AN) in the US. Maternal and child health (MCH) programs were quickly integrated into the IHS during the 1960s. But what was done for AI/AN women and children prior to the 1950s? This presentation investigates MCH programs and policies during the first half of the 20th century, to understand the accomplishments and struggles of current MCH efforts for AI/AN women and children. Specifically, we will trace and describe the connection between federal and national MCH and AI/AN health care programs prior to the development of IHS, focusing on the influences of key leaders, relevant legislation and important federal agencies.

Primary sources include: 1) records from federal agencies such as the US Children’s Bureau and the Bureau of Indian Affairs, 2) influential reports and legislation such as the Meriam Report of 1928 and an 1929 report on Indian Boarding Schools by American Red Cross; 3) collections from the Eskind Biomedical Library Special Collections at Vanderbilt University; and 4) periodicals and conference proceedings such as JAMA, The Child, the National Conference on Social Welfare and The Survey.

Findings suggest that early federal MCH programs tended to force assimilation of AI/AN women and children into mainstream culture while doing little to address health needs. Those federal programs and policies that did find some success were often the result of collaborations among different federal departments. Later reform efforts of the 1930s may account for the early adoption of MCH programs by the IHS in 1954. However, long-term consequences of this early U.S. policy directly impact the current health outcomes of AI/AN women, infants and children.

Constituting the Syphilitic Collector
Presented by Elizabeth Lee, Dickinson College, Carlisle, PA

Since its opening in 1923, the Freer Gallery in Washington, D.C. has housed the collection of Charles Lang Freer, the late nineteenth-century Detroit industrialist who amassed a fortune from the manufacture of railroad cars and the purchase of pharmaceutical stocks. Freer invested his profits in East Asian artifacts—including Korean pottery, Japanese folding screens and Chinese scroll painting—along with works by several contemporary American painters. Scholars have understood his collecting interests as part of the period’s cosmopolitanism, including ‘Japonisme’ and a more general fascination with Asian cultures, the Arts and Crafts movement, Aestheticism and, even, post-Darwinian agnosticism. Yet none of these interpretations has adequately addressed Freer’s tastes in light of a profoundly affecting fact: the collector inherited syphilis from his father and, as a result, lived his life in a physically weakened, fragile state. Although asymptomatic at any given point, Freer was constantly at risk of experiencing chancres, skin rashes and, at an advanced stage, degenerate joints, corroded organs and mental insanity (which he suffered from late in life). So disturbing were the effects of this disease at the time that doctors issued dire warnings cautioning syphilitic men against marriage—not only in the interest of protecting “innocent women” from infection, but also with an eye on the future of the (Anglo-Saxon) race. With this in mind, it is perhaps not surprising both that Freer remained a life-long bachelor and that he collected paintings which emphasized the theme of pure young womanhood by American artists James McNeil Whistler, Thomas Dewing and Abbott Thayer. In fact, he once described Thayer’s painting, Virgin Enthroned (1891), as an “emblem of purity” and “a protest against sin,” declaring that he would have mortgaged his personal possessions to own it (although he lost this particular work to another collector, he soon purchased a similar painting by Thayer, The Virgin). Through this example and others, this paper demonstrates how Freer’s health and collecting interests not only informed one another but were inextricably linked.

The Early History of Anesthesia in Alabama
Presented by Mark G. Mandabach, University of Alabama at Birmingham, Birmingham, AL

I. Introduction
The objective of this talk is to explore the development of physician practiced anesthesia in the state of Alabama.

II. Background and Narrative
a.) Previously, there was no organized history of the practice of anesthesia in the state of Alabama. In 1982, Howard Holley published his book The History of Medicine in Alabama. It is the only book of its kind dealing with the history of medicine in the state. Chloroform and ether anesthesia were discussed in Dr. Holley’s book, but only two concrete references exist: Dr. E.H.C. Bailey was reported to have confirmed an adequate supply of chloroform at his Confederate supply depot in Demopolis, Alabama; and Dr. Lister L. Hill’s landmark heart surgery was performed using chloroform anesthesia in 1902.
b.) Dr. Ben Carraway and Dr. Alfred Habeeb practiced anesthesiology in Birmingham in the early days. Dr. Carraway introduced sodium pentathol into the practice of anesthesia in Alabama in the 1930’s. Dr. Habeeb was the first resident in anesthesia in the state of Alabama and is the first physician in Alabama to be certified by the American Board of Anesthesiologists. Ms. Anita Smith has documented their careers in her excellent written histories of Carraway and Lloyd Noland Hospitals. W.H. McDonald also chronicled Dr. Habeeb’s personal and professional life in the touching article entitled “A long way from Bishmizzin”.
c.) Mr. A. J. Wright has published several articles on the early days of anesthesia in Alabama. Most of his work focused on the period prior to World War II, with the exception of his research on Dr. Alice McNeal, the first chair at the first academic department of anesthesiology in the state of Alabama, UAB. Wright discovered that the Selma physician B.B. Rogan was utilizing the Cushing-Codman anesthesia record in the spring of 1901. The Cushing-Codman chart was developed seven years earlier but was not published by Cushing until 1902. Prior to World War I, at least three physicians had practiced anesthesiology in the state of Alabama: in Birmingham, Dr. James R. Dawson [1876-1973] and Dr. Robert G. McGahey [1877-1959]; and in Selma, Dr. James S. Chisolm [1880-19??].

III. Summary
a.) This talk will focus on the early years of the development of physician anesthesia in the state of Alabama and the call for professionalism. This is in the period between 1882 and 1906.
b.) I will discuss the practice of anesthesia in this era before the call to professionalism was answered and explore the use of the limited number of drugs available, such as ether first used by Crawford Long on March 30th, 1842 and first demonstrated to the public by W.T.G. Morton on "Ether Day " October 16, 1846 and chloroform, first used by Sir James Young Simpson in Edinburgh, Scotland on November 4, 1847. The only available local anesthetic was cocaine, used first by Karl Koller in Vienna, Austria. His findings were published on September 11, 1884.
c.) I will link the international developments in anesthesia to the practice of anesthesia in Alabama in this early era. Surprisingly, the use of ether, chloroform and cocaine were in use in Alabama soon after their introduction in major centers in Europe and North America.
d.) I will discuss the development of physician based anesthesia in Alabama and the origination of the UAB Department of Anesthesiology and its first chair, Dr. Alice McNeal and the formation of the Alabama State Society of Anesthesiologists.

Be Not Their Death in Vain: A Treatise for the Use of German Basic and Clinical Research (1933-1945)
Presented by Mikaela Poling, Freeman-Sheldon Research Group, Buckhannon, WV

The National Socialist, or commonly the Nazi, Party (NSDAP) theory actually promoted medicine and research, from which society has benefited greatly. This statement is not to attempt a rehabilitation of Nazi policy but to address a practical question: should present researchers, medical historians, and clinicians use this data? At the centre of the debate, lies the indefilable truth of active participation of ‘men of science’ in the conception, design, and execution of the euthanasia, sterilisation, and ‘Final Solution’ programs.

To consider the present problem, a fundamental understanding of the medical information is required, with understanding of political, intellectual, economic, and military history inherent to the situation. I focus on Dachau studies of human physiological (body function) responses to hypoxic (little oxygen) and hypothermic states and Eduard Pernkopf’s Anatomy Atlas, drawing extensively upon primary and secondary sources, as well as original interviews. I also examine multiple conflicting arguments.

I conclude, in acknowledgement of their collective and unique sufferings, we must ensure that the victims’ scientific legacy not be lost to the ages in continuing to use Nazi-generated medical information. I derived specific recommendations: (1) creation of a citation stipulate to be adopted by the editorial boards marking unethical research; and (2) direction of a portion of sales’ profits of reprinted Nazi-generated medical information to organisations that work for remembrance and prevention of such atrocities in the future.

Winning Women’s Votes in the Anti-Vivisection Campaigns of the 1920s and 30s
Presented by Karen Ross, Troy University, Troy, AL

American antivivisectionists in the early twentieth century campaigned unremittingly against animal cruelty in medical research, particularly, as Susan Lederer has noted, at the Rockefeller Institute for Medical Research. The Institute had, from its origins, battled antivivisection legislation at both the state and federal level. Simon Flexner, the Institute’s director from 1901-1935, helped coordinate the “antivivisection war” as Rockefeller scientists, and medical researchers throughout the United States, resisted government regulation of animal experiments. In the years leading up to World War I, Flexner journeyed to Albany nearly annually to speak before the New York State Assembly in opposition to antivivisection bills.

This was typical of the Rockefeller approach. The antivivisection organizations and their members, mostly women, were rarely directly engaged. Instead, Flexner and his colleagues relied on an informal network of predominantly male scientists, businessmen, and influential politicians who prevented the passage of these bills locally and with little public exposure.
However, as I argue in this paper, the ratification of the nineteenth amendment in 1920 and the prospect of millions of new women voters prompted Rockefeller scientists and allies to change their tactics. In the interwar period Flexner and company engaged in open debates, formed a lay organization in defense of medical research, and actively solicited the support women’s organizations in a public campaign against antivivisection. They successfully stressed the benefits of scientific medicine and the necessity of animal experiments. This episode in medical history demonstrates the influence of women’s suffrage, as well as the relevance of American perceptions of medical research and its value versus possible dangers even before the advent of significant federal funding.

My sources for this paper primarily come from the Rockefeller Archive Center and the Simon Flexner, Peyton Rous, Florence Sabin, and Walter B. Cannon Papers of the American Philosophical Society.

Melancholy as a Late Medieval & Early Modern Condition
Presented by Wendy Turner, Augusta State University, Augusta, GA

In fifteenth-century England, the medical condition of melancholia had not yet become the vogue term of mental affliction that it would in later centuries, but it was beginning to be used. The mentally ill were most often referred to in administrative documents as being freneticus or furiosus; while, those persons who were mentally incompetent were labeled quite differently as idiota, fatuus, or non compos mentis. There might be two reasons for the shift from an "idiotic" or "fatuus" person to a "melancholic" one. First, idiota became a negative term and a reason to disinherit. This congenital condition was categorically different from the mild disorders of many with mental incapacity, and a distinction needed to be made. Second, being mentally unhealthy (insania) did not mean complete dysfunction. Being temporarily freneticus, lunaticus, or other such condition did not adequately describe forms of stress, depression, or despair. These fell into this newer, third category of “melancholy” toward the end of the fifteenth century.

Emerging Infectious Diseases and Bioterrorism
Presented by Peter Washer, Imperial College, London, England

Since the appearance of AIDS in the 1980s, infectious diseases have made a resurgence both medically, and as socio-cultural and political phenomena. Since the 1990s, a new concept has become widely adopted: newly emerging or re-emerging infectious diseases. Infectious diseases are no longer thought of as a ‘thing of the past’, they are now said to pose a risk to our future. My earlier research shows how the threat from ‘new’ infectious diseases is mapped onto wider preoccupations about globalisation, with its attendant mass migration, environmental changes and the shift of economic power to the East.

Post 9/11 and the anthrax letters scare, the issue of emerging infectious diseases has become connected with that of the potential threat of bioterrorism. A future bioterrorism attack is often spoken of in both medical and political arenas as inevitable: Government policies such as the National Security Strategy of the USA have argued that strengthening emergency management systems would not only make the country better able to manage the threat of bioterrorism, but also outbreaks of infectious disease. At the same time, medical journals devote much attention to the threat of bioterrorism. Thus the very different issues of emerging infectious diseases and bioterrorism are elided and used to try to restrict the movement of people and goods, and more generally to try stem the tide of globalisation.

My paper will examine the roots of the emerging disease paradigm and the bioterrorism debate, and describe how and why these two very separate issues have been elided and politicised.

Gesundheit! - A Nietzschean Perspective on Sickness and Health
Presented by Steven Weiss, Augusta State University, Augusta, GA

This paper explores Nietzsche’s philosophical and psychological reevaluation of our traditional ideas about sickness and health. Typically, we regard health and sickness as polar opposites—both in terms of how we explain these states and how we evaluate them, positively and negatively. My paper lays out several of Nietzsche’s provocative claims about sickness and health and their interdependency. First, I try to make sense of his revisionary idea of “great health” which for those who are “dangerously healthy” must be acquired continually since it must be constantly given up. Here health and sickness are not opposed to one another but function as integrated elements of a new paradigm or ideal for living in the world that elevates daring, exuberance, and the courageous testing of one’s strengths and abilities over a life of comfort and the prudent avoidance of pain and dis-ease. Second, my paper critically examines Nietzsche’s recommendation that medicine should abandon the concept of “normal health” along with the idea of “the normal course of illness.” Is it possible to re-conceive the practice of medicine in the way he suggests? Nietzsche proposes a radically individualistic concept of health that attends closely to each person’s unique set of goals, energies, impulses, ideals and phantasms of the psyche; I attempt to follow out the implications of his suggestion that there are “innumerable healths of the body” where health for one person would look like its opposite for another person. I conclude by arguing that Nietzsche’s ideas on health and sickness should compel us to rethink our ordinary valuation of these states—viz., health/good and sickness/bad. Also, I contend that while medicine should not jettison its general diagnostic schemes and standard protocols for treating patients there is room for accommodating Nietzsche’s idea of “innumerable healths of the body” and individual disease trajectories.

Dr. Alice McNeal: Alabama's First Female Anesthesiologist
Presented by AJ Wright, University of Alabama at Birmingham, Birmingham, AL

General Thesis
This paper examines the professional career of Dr. Alice McNeal (1897-1964), the first female anesthesiologist in Alabama and the first female chair of an academic anesthesiology department in the U.S. The second phase of her career in Birmingham, Alabama, will be emphasized.

Sources Used
Sources include surviving departmental correspondence 1946-1964 in the UAB Archives and the secondary literature on women in anesthesia.

Research Findings
Dr. McNeal’s professional career had two phases. At Presbyterian Hospital in Chicago, she worked under Isabella Herb and with two other female anesthesiologists. By the time she arrived in Alabama, she already had 21 years experience in anesthesia. In her new home, she found herself to be not only one of the few female physicians but one of the few physician-anesthesiologists in the state. She coordinated anesthesia administration at the university's busy hospital (formerly the county hospital in the state's most populous county) with help from a few nurse anesthetists, an occasional resident, and sometimes a dental student doing an anesthesia rotation. By 1950 her department coordinated 9700 anesthetics a year at the hospital. She is remembered fondly by those who knew her; former UAB President Charles McCallum's comment that she was "a great teacher, well-liked, and worked hard" is typical.

General Conclusions
Although she published only a few research papers, Dr. McNeal laid the foundation for academic anesthesia in the state by chairing the first department for so long, providing excellent patient care and many clinical improvements, and training so many anesthesiologists, dentists, and nurses. Dr. McNeal is thus an important figure both in the history of the state's medical education and its female physicians. By World War II several women such as Drs. Mary Botsford and Isabella Herb had become chiefs of the anesthesia services in various U.S. hospitals, but Dr. McNeal was the first female chair of an academic anesthesia department.