E Editorial
Remembering the Famous and Forgotten in Medicine Orlando Hung, MD, FRCPC, and Ronald D. Stewart, MD, FACEP
H
istory has at times been unfair to heroes, particularly the cryptanalysts who worked in secret. Frank Newte worked at the Bletchley Park code-breaking center in the United Kingdom during the Second World War. He analyzed intercepted radio signals that helped to break the Enigma Code, saving thousands of allied lives and shortening the length of the war. He died unknown in 1977, his life and work unacknowledged. Only recently, several decades after his death, have his work and contributions come to light.1 While we generally recognize those who made medical discoveries and contributions, many are forgotten. Recently on our Dalhousie University medical school campus, in an effort to stimulate and determine students’ interest in the history of medicine, our Humanities Program conducted a survey in which participants were asked to list 10 “great Canadian physicians.” A list was narrowed to 7. There were the “usual suspects”: Osler, Bethune, Banting, Best, etc. Strangely enough, many great Canadian clinicians, including Harold Griffith (anesthetist) and Wilder Penfield (neurosurgeon), were forgotten. Not 1 female clinician was mentioned. We do remember historic events, particularly the catastrophic ones. On December 6, 1917, a French ammunition ship, the SS-Mont Blanc, caught fire following a collision with the Norwegian cargo ship, Imo, in the busy wartime port city of Halifax, Nova Scotia. The resultant “man-made” explosion, the greatest in the history of the world at that time, destroyed half of the city of Halifax, including >12,000 buildings, causing 2000 deaths, and injuring another 9000.2 The city was cut off; telegraph services were disrupted, and thousands of injured patients flooded the hospitals. In his book, The Halifax Disaster, Dr. A. M. MacMechan wrote: “Men, women and children of all sorts and classes were literally packed in the ward like sardines in a box, the cots all occupied, and the floors covered so that it was difficult to
From the Departments of Anesthesiology, Surgery, and Pharmacology, Emergency Medicine, Community Health and Epidemiology, and Medical Humanities, Dalhousie University, Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada. Accepted for publication July 22, 2014 Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Orlando Hung, MD, FRCPC, Department of Anesthesia, Dalhousie University, Queen Elizabeth II Health Sciences, 1278 South Park St., Halifax, Nova Scotia, Canada B3H 2Y9. Address e-mail to [email protected]. Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000441
November 2014 • Volume 119 • Number 5
step between them.”2 Help slowly began to filter through. Within 24 hours, and while the citizens of the city were still in shock and disbelief in the aftermath of the explosion, a medical team consisting of 30 doctors and 60 nurses, with supplies, was quickly organized and dispatched from Boston on a relief train. Adding to the misery and death toll, a blizzard struck the hapless city that night, delaying relief trains from Montréal and Boston for almost 2 days. The Boston medical team provided much-appreciated relief. They brought valuable supplies, as well as hope. Thousands of surgical procedures requiring anesthesia were performed. The American relief team tended the wounded for almost a month before returning home to Boston in January 1918. We, in our province, paid tribute to this unselfish dedication to our suffering citizens from our American neighbors when, in 1918, a Christmas tree selected from a Nova Scotia forest was sent as a gift to the people of Boston. The gift became an annual one in 1971.3 Although the tree may be familiar to many Bostonians, even among physicians, few would remember the names of the relief team that represented the collective kindness of neighbors. One of those American friends who helped Halifax so much was Dr. Freeman Allen. His story is told in this issue of the journal by Morris et al.,4 who wrote a welcome and perhaps long-overdue tribute to Dr. Allen, the Boston pioneer in anesthesia. Dr. Allen’s remarkable career was highlighted by his contributions to the early development of anesthesiology as a specialty in Boston and the New England area. These include his investigative curiosity leading to experiments with different inhalational anesthetics including the use of rectal administration of ether; his early adoption of regional anesthesia; and his dedication in teaching anesthesia residents and nurse anesthetists. But, most importantly for the people of Halifax, Dr. Allen is honored as a valuable member of the emergency medical relief team from Boston who came to help in our hour of need. For us, it is fortunate to have the opportunity now to recognize his remarkable career. Canada is grateful, Nova Scotia is grateful, and all who call Halifax home are grateful. The question might well be asked as to why would such a stellar example of “physician greatness,” exemplified by achievement and contribution, be largely forgotten. As painful as it may be to admit, we physicians seldom study our past or celebrate it. Even though we know some of our beginnings that formed the foundation of our vocation and the advancement of our calling, we have not done enough to actively preserve and promote our medical history. For example, to assist librarians in the evaluation of www.anesthesia-analgesia.org 1005
E Editorial medical textbooks for health sciences libraries, Alfred Brandon began to publish a “Selected list of books and journals for the small medical library” in 1965.5 He was later joined in his efforts by Dorothy Hill. Together, they updated the list biannually. The Brandon/Hill list was last updated in 2003,6 but, alas, the category of Medical History has never made the cut. Furthermore, none of the North American medical schools includes the history of medicine as a “core” area of undergraduate medical education curricula. In 1904, Dr. Cordell, an eminent professor and president of the Johns Hopkins Historical Club, revealed in his annual presidential address the results of his survey of medical history courses in the United States’ medical schools.7 He received replies from the Deans of 14 institutions. Only one of those institutions, the University of Pennsylvania, offered a required course. In none of the 14 was an examination required. Harvard, he pointedly commented, had “tried out” a course but discontinued it “due to lack of interest.” Even widely accepted contemporary undergraduate and postgraduate curricula fail to include medical history as a component in the education or professional development of the currentday practitioner.8 What is lost to us without a sense of our history that forms the foundations of our careers and our calling in medicine? Does it matter that many students graduating from medical schools have scant knowledge of the origins of their chosen profession? Have the dawn of the computer age and the subsequent influence of digital technology and social media rendered the knowledge of our history a “frill”? Is educating our trainees in the history of medicine obsolete? On the contrary, the volume of information now available to us does not diminish the need for understanding our past and recognizing the achievement of those upon whose shoulders we stand. In fact, to be ignorant of the past practices increases the likelihood we might not change our practice to improve outcomes and that we might not avoid the pitfalls of that past. The ready access to information provided by modern technology allows us to more easily build a base, both technically and ethically, for the practice of our art. Knowledge of the work of pioneers, such as Dr. Freeman Allen, serves as an inspiration to our life in medicine. Might social media be a useful channel to examine our medical heritage and ensure our professionalism? A recent systematic qualitative review of the impact of social media on medical professionalism suggests that health care professionals “should proactively seize both the challenges and opportunities of social media to foster interprofessional and intergenerational dialogue in modern health care.”9 Our past can instruct and inspire us. Medical students, for example, might well be inspired to express their ideas or research work by learning about Ernest Duchesne. He was a French medical student who, in 1897, published his graduating thesis which demonstrated the antibacterial action of the mold Penicillium glaucum in animals and suggested the use of its extract in treatment of disease.10 This was 20 years in advance of Alexander Fleming’s serendipitous discovery and 30 years before Howard Florey’s and Ernst Chain’s production of the first therapeutic antibiotics.11
1006 www.anesthesia-analgesia.org
Tributes and reminders about the famous and forgotten in medicine, such as presented about Dr. Freeman Allen, should be a regular feature in our journals. Through an acquaintance with medical history early on in their training, physicians can be inspired and encouraged. In 1979, interest groups among our medical students and faculty members founded our Dalhousie campus Society for the History of Medicine that is still going strong and holds monthly meetings. This is not core to our curriculum but is well supported. It should, perhaps, be a goal that modern undergraduate medical education should infuse elements of the history of medicine as a thread woven throughout the curriculum. In short, introducing students to the “famous and forgotten” such as Dr. Allen may help to form the foundation of a life and career in the art called medicine. There is a good reason why few knew of Frank Newte’s seminal code-breaking work. He worked for the Intelligence Service, and secrecy was necessary. When it comes to medical history, we have no need for secrecy. Knowledge of the history of medicine can inspire, add to our understanding of the duties and obligations of our profession, and provide cautionary tales and models for how we can meet the challenges of current and future practice. Whether famous or forgotten, those who came before us, and who set in place the foundations upon which we now build, are worth remembering. E DISCLOSURES
Name: Orlando Hung, MD, FRCPC. Contribution: This author helped in manuscript preparation. Attestation: Orlando Hung approved the final manuscript. Name: Ronald D. Stewart, MD, FACEP. Contribution: This author helped in manuscript preparation. Attestation: Ronald D. Stewart approved the final manuscript. This manuscript was handled by: Steven L. Shafer, MD. REFERENCES 1. Bletchley Park Code Breaker Frank Newte Honoured. BBC News, United Kingdom. July 19, 2013 2. MacMechan A, Metson G. The Halifax Disaster (Explosion). Whitby, Ontario: McGraw-Hill Ryerson, 1978 3. Hanson M. From Nova Scotia, with love: the Boston’s Christmas tree begins its odyssey. The Boston Globe. November 13, 2013 4. Morris SD, Morris AJ, Rockoff MA. Freeman Allen: Boston’s pioneering physician anesthetist. Anesth Analg 2014;119:1186–93 5. Brandon AN. Selected list of books and journals for the small medical library. Bull Med Libr Assoc 1965;53:329–64 6. Hill DR, Stickell HN. Brandon/Hill selected list of print books and journals in allied health. J Med Libr Assoc 2003;91:18–33 7. Cordell EF. The importance of the study of the history of medicine. Med Library Hist J 1904;2:268–82 8. Frank J. Better Standards. Better Physicians. Better Care. The CanMEDS 2005 physician competency framework. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005 9. Gholami-Kordkheili F, Wild V, Strech D. The impact of social media on medical professionalism: a systematic qualitative review of challenges and opportunities. J Med Internet Res 2013;15:e184 10. Duchesne E. Contribution à l’étude de la concurrence vitale chez les microorganisms. Antagonisme entre les moisissures et les microbes: Thèse. Lyon: Faculté de Médicine et de Pharmacie de Lyon, (French) 1897 11. Notter A. The difficulties of industrializing penicillin (1928– 1942) (Alexander Fleming, Howard Florey, Ernst Boris Chain). Hist Sci Med 1991;25:31–8
anesthesia & analgesia
Remembering the Famous and Forgotten in Medicine Orlando Hung, MD, FRCPC, and Ronald D. Stewart, MD, FACEP
H
istory has at times been unfair to heroes, particularly the cryptanalysts who worked in secret. Frank Newte worked at the Bletchley Park code-breaking center in the United Kingdom during the Second World War. He analyzed intercepted radio signals that helped to break the Enigma Code, saving thousands of allied lives and shortening the length of the war. He died unknown in 1977, his life and work unacknowledged. Only recently, several decades after his death, have his work and contributions come to light.1 While we generally recognize those who made medical discoveries and contributions, many are forgotten. Recently on our Dalhousie University medical school campus, in an effort to stimulate and determine students’ interest in the history of medicine, our Humanities Program conducted a survey in which participants were asked to list 10 “great Canadian physicians.” A list was narrowed to 7. There were the “usual suspects”: Osler, Bethune, Banting, Best, etc. Strangely enough, many great Canadian clinicians, including Harold Griffith (anesthetist) and Wilder Penfield (neurosurgeon), were forgotten. Not 1 female clinician was mentioned. We do remember historic events, particularly the catastrophic ones. On December 6, 1917, a French ammunition ship, the SS-Mont Blanc, caught fire following a collision with the Norwegian cargo ship, Imo, in the busy wartime port city of Halifax, Nova Scotia. The resultant “man-made” explosion, the greatest in the history of the world at that time, destroyed half of the city of Halifax, including >12,000 buildings, causing 2000 deaths, and injuring another 9000.2 The city was cut off; telegraph services were disrupted, and thousands of injured patients flooded the hospitals. In his book, The Halifax Disaster, Dr. A. M. MacMechan wrote: “Men, women and children of all sorts and classes were literally packed in the ward like sardines in a box, the cots all occupied, and the floors covered so that it was difficult to
From the Departments of Anesthesiology, Surgery, and Pharmacology, Emergency Medicine, Community Health and Epidemiology, and Medical Humanities, Dalhousie University, Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada. Accepted for publication July 22, 2014 Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Orlando Hung, MD, FRCPC, Department of Anesthesia, Dalhousie University, Queen Elizabeth II Health Sciences, 1278 South Park St., Halifax, Nova Scotia, Canada B3H 2Y9. Address e-mail to [email protected]. Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000441
November 2014 • Volume 119 • Number 5
step between them.”2 Help slowly began to filter through. Within 24 hours, and while the citizens of the city were still in shock and disbelief in the aftermath of the explosion, a medical team consisting of 30 doctors and 60 nurses, with supplies, was quickly organized and dispatched from Boston on a relief train. Adding to the misery and death toll, a blizzard struck the hapless city that night, delaying relief trains from Montréal and Boston for almost 2 days. The Boston medical team provided much-appreciated relief. They brought valuable supplies, as well as hope. Thousands of surgical procedures requiring anesthesia were performed. The American relief team tended the wounded for almost a month before returning home to Boston in January 1918. We, in our province, paid tribute to this unselfish dedication to our suffering citizens from our American neighbors when, in 1918, a Christmas tree selected from a Nova Scotia forest was sent as a gift to the people of Boston. The gift became an annual one in 1971.3 Although the tree may be familiar to many Bostonians, even among physicians, few would remember the names of the relief team that represented the collective kindness of neighbors. One of those American friends who helped Halifax so much was Dr. Freeman Allen. His story is told in this issue of the journal by Morris et al.,4 who wrote a welcome and perhaps long-overdue tribute to Dr. Allen, the Boston pioneer in anesthesia. Dr. Allen’s remarkable career was highlighted by his contributions to the early development of anesthesiology as a specialty in Boston and the New England area. These include his investigative curiosity leading to experiments with different inhalational anesthetics including the use of rectal administration of ether; his early adoption of regional anesthesia; and his dedication in teaching anesthesia residents and nurse anesthetists. But, most importantly for the people of Halifax, Dr. Allen is honored as a valuable member of the emergency medical relief team from Boston who came to help in our hour of need. For us, it is fortunate to have the opportunity now to recognize his remarkable career. Canada is grateful, Nova Scotia is grateful, and all who call Halifax home are grateful. The question might well be asked as to why would such a stellar example of “physician greatness,” exemplified by achievement and contribution, be largely forgotten. As painful as it may be to admit, we physicians seldom study our past or celebrate it. Even though we know some of our beginnings that formed the foundation of our vocation and the advancement of our calling, we have not done enough to actively preserve and promote our medical history. For example, to assist librarians in the evaluation of www.anesthesia-analgesia.org 1005
E Editorial medical textbooks for health sciences libraries, Alfred Brandon began to publish a “Selected list of books and journals for the small medical library” in 1965.5 He was later joined in his efforts by Dorothy Hill. Together, they updated the list biannually. The Brandon/Hill list was last updated in 2003,6 but, alas, the category of Medical History has never made the cut. Furthermore, none of the North American medical schools includes the history of medicine as a “core” area of undergraduate medical education curricula. In 1904, Dr. Cordell, an eminent professor and president of the Johns Hopkins Historical Club, revealed in his annual presidential address the results of his survey of medical history courses in the United States’ medical schools.7 He received replies from the Deans of 14 institutions. Only one of those institutions, the University of Pennsylvania, offered a required course. In none of the 14 was an examination required. Harvard, he pointedly commented, had “tried out” a course but discontinued it “due to lack of interest.” Even widely accepted contemporary undergraduate and postgraduate curricula fail to include medical history as a component in the education or professional development of the currentday practitioner.8 What is lost to us without a sense of our history that forms the foundations of our careers and our calling in medicine? Does it matter that many students graduating from medical schools have scant knowledge of the origins of their chosen profession? Have the dawn of the computer age and the subsequent influence of digital technology and social media rendered the knowledge of our history a “frill”? Is educating our trainees in the history of medicine obsolete? On the contrary, the volume of information now available to us does not diminish the need for understanding our past and recognizing the achievement of those upon whose shoulders we stand. In fact, to be ignorant of the past practices increases the likelihood we might not change our practice to improve outcomes and that we might not avoid the pitfalls of that past. The ready access to information provided by modern technology allows us to more easily build a base, both technically and ethically, for the practice of our art. Knowledge of the work of pioneers, such as Dr. Freeman Allen, serves as an inspiration to our life in medicine. Might social media be a useful channel to examine our medical heritage and ensure our professionalism? A recent systematic qualitative review of the impact of social media on medical professionalism suggests that health care professionals “should proactively seize both the challenges and opportunities of social media to foster interprofessional and intergenerational dialogue in modern health care.”9 Our past can instruct and inspire us. Medical students, for example, might well be inspired to express their ideas or research work by learning about Ernest Duchesne. He was a French medical student who, in 1897, published his graduating thesis which demonstrated the antibacterial action of the mold Penicillium glaucum in animals and suggested the use of its extract in treatment of disease.10 This was 20 years in advance of Alexander Fleming’s serendipitous discovery and 30 years before Howard Florey’s and Ernst Chain’s production of the first therapeutic antibiotics.11
1006 www.anesthesia-analgesia.org
Tributes and reminders about the famous and forgotten in medicine, such as presented about Dr. Freeman Allen, should be a regular feature in our journals. Through an acquaintance with medical history early on in their training, physicians can be inspired and encouraged. In 1979, interest groups among our medical students and faculty members founded our Dalhousie campus Society for the History of Medicine that is still going strong and holds monthly meetings. This is not core to our curriculum but is well supported. It should, perhaps, be a goal that modern undergraduate medical education should infuse elements of the history of medicine as a thread woven throughout the curriculum. In short, introducing students to the “famous and forgotten” such as Dr. Allen may help to form the foundation of a life and career in the art called medicine. There is a good reason why few knew of Frank Newte’s seminal code-breaking work. He worked for the Intelligence Service, and secrecy was necessary. When it comes to medical history, we have no need for secrecy. Knowledge of the history of medicine can inspire, add to our understanding of the duties and obligations of our profession, and provide cautionary tales and models for how we can meet the challenges of current and future practice. Whether famous or forgotten, those who came before us, and who set in place the foundations upon which we now build, are worth remembering. E DISCLOSURES
Name: Orlando Hung, MD, FRCPC. Contribution: This author helped in manuscript preparation. Attestation: Orlando Hung approved the final manuscript. Name: Ronald D. Stewart, MD, FACEP. Contribution: This author helped in manuscript preparation. Attestation: Ronald D. Stewart approved the final manuscript. This manuscript was handled by: Steven L. Shafer, MD. REFERENCES 1. Bletchley Park Code Breaker Frank Newte Honoured. BBC News, United Kingdom. July 19, 2013 2. MacMechan A, Metson G. The Halifax Disaster (Explosion). Whitby, Ontario: McGraw-Hill Ryerson, 1978 3. Hanson M. From Nova Scotia, with love: the Boston’s Christmas tree begins its odyssey. The Boston Globe. November 13, 2013 4. Morris SD, Morris AJ, Rockoff MA. Freeman Allen: Boston’s pioneering physician anesthetist. Anesth Analg 2014;119:1186–93 5. Brandon AN. Selected list of books and journals for the small medical library. Bull Med Libr Assoc 1965;53:329–64 6. Hill DR, Stickell HN. Brandon/Hill selected list of print books and journals in allied health. J Med Libr Assoc 2003;91:18–33 7. Cordell EF. The importance of the study of the history of medicine. Med Library Hist J 1904;2:268–82 8. Frank J. Better Standards. Better Physicians. Better Care. The CanMEDS 2005 physician competency framework. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005 9. Gholami-Kordkheili F, Wild V, Strech D. The impact of social media on medical professionalism: a systematic qualitative review of challenges and opportunities. J Med Internet Res 2013;15:e184 10. Duchesne E. Contribution à l’étude de la concurrence vitale chez les microorganisms. Antagonisme entre les moisissures et les microbes: Thèse. Lyon: Faculté de Médicine et de Pharmacie de Lyon, (French) 1897 11. Notter A. The difficulties of industrializing penicillin (1928– 1942) (Alexander Fleming, Howard Florey, Ernst Boris Chain). Hist Sci Med 1991;25:31–8
anesthesia & analgesia
