April 2001, Vol 19 - Anesthesia History Association

BULLETIN OF
ANESTHESIA J!ISTORY
AHA
VOLUME 19, NUMBER 2
APRIL, 2001
The Use of Anesthestics during the Civil War, 1861-1865
by Maurice S. Aldin, M.D. *
Professor ofAnesthesiology and NeurosurgelY
Department ofAnesthesiology, University ofTexas Health Science Center
Reprinted with permission from Pharmacy in History [40(3-4); 99-114, 2000].
. .. Faces, varieties beyond description, most in
obscurity, some of them dead, Surgeons operat­
ing, attendants holding lights, the smell of ethel;
the odor of blood, ... (From Walt Whitman's 'Y:!
March in the Ranks Hard-Prest")
The Civil War began
1 5 years after den­
tist W illiam Thomas Green Morton (fig.
1 ) used diethyl ether as an anesthetic for a
surgical procedure at the Massachusetts
1 6 October
1 846. The first reported clinical use of chlo­
roform, by James Young Simpson (fig. 2),
took place in 1 847. However, the routine
General Hospital (MGH) on
use of anesthetics in surgery had not yet
permeated the medical culture in the
United States, and a significant percent­
age of surgical procedures at the MGH were
carried out without anesthetics during the
Figure 1. William I1lOmas Green Morton
Figure 2. James Young Simpson
1 540). They mixed sulfuric
Ether was prepared using the dehydra­
acid with alcohol, distilled the mixture and
tion of alcohol by sulfuric acid. The syn­
(about A.D.
1 849-1 877. It is a popular belief that
discovered "sweet vitriol." However, it was
thesis of ether may result in byproducts
anesthetics were not used to any signifi­
Valezius Cordus who described the syn­
and impurities including peroxides and
cant extent during the Civil War and that
thesis
aldehydes, which produce toxic responses.
pain relief during surgical procedures was
Extractionibus" circa
1 54 1 and in 1 730
Ether is highly inflammable and when
accomplished by imbibing alcoholic spir­
Frobenius named the compound "ether."l
combined with air, forms an explosive mix­
its or "biting the bullet." As we will note,
On
the Civil War, with its hordes of wounded
Long of Jefferson, Georgia, excised a cyst
Since ether has a high vapor tension, the
soldiers, accelerated the acceptance and the
on the back of the neck of James Venable
vapor, being
under the effects of ether, but he did not
flow over the container and fall below the
period
employment of anesthetic agents.
Available Anesthetic Agents
Diethyl ether (C2Hs\0, or "sweet vit­
of
ether
in "De Artificiosis
30 March 1 842, Crawford W illiamson
1 849,
Southern Medical and Surgical Jou/'­
ture, easily ignited with a spark or flame.
2-6 times as heavy as air, can
1 8 53,
publish his findings until December
structures containing it.6 Prior to
in the
ether was manufactured using the hazard­
nal.2
ous open-fire intermittent distillation
3) com­
riol" was known since the time of Ramon
The world-wide spread of the use of
1 200) and Paracelsus
ether occurred only after Morton demon­
pletely changed the manufacturing method
strated its efficacy as an anesthetic agent
by using continuous steam heat through
would like to thank Michael FlannelY,
Curator of the Reynolds Historical Collection,
Lister Hill Library of the Medical Sciences,
University ofAlabama at Birmingham, for his
help in tracking down many of the
bibliographical sources pertinent to this pape/:
I would also like to thank Christina S. Medina
for her help in putting this manuscript togethel:
when the patient Gilbert Abbott was anes­
lead coils.7
Lull (about A.D.
*1
thetized by the eminent surgeon, John
method. Edward R. Squibb (fig.
Chloroform (CHCIl) was discovered in­
1 9 January 1 847,
auly 1 83 1 ), Liebig
1 83 1 ), and Soubeiran (January
1 832).8 In 1 835 Dumas described its chemi­
cal and physical properties and in 1 847,
James Young Simpson first used ether in
Flourens noted its anesthetic effects in ani-
Collins Warren in the amphitheater of the
dependently by Guthrie
MGH in Boston.l W ithin six months ether
(November
was used clinically throughout the world.4
Of interest is that on
his obstetrical practice, so quickly had the
word spread about its efficacy.s
Cantil/lied on Page 4
1""'
BULLETIN OF ANESTHESIA HISTORY
John William "B ill" Pender, M.D., 1912-2001
by Selma Harrison Calmes, M.D.
Bill Pender first appeared in my life
with a crate of oranges, and I have loved
him ever since. This was in the late 1 960s.
I was a lowly resident at the University of
Pennsylvania, and B ill Pender a rrived
from the Palo Alto Clinic for a sabbatical
at Penn. One day, I came into the lunch
room in the OR, and an old-fashioned,
wooden crate of oranges (the kind we used
to make bookcases out of) was on the floor.
Having grown up in Southern California
surrounded by orange groves and having
bought lots of oranges from the local pack­
ing house, it seemed I'd gone to heaven in
the cold, unfriendly city of Philadelphia.
A kindly man dressed in scrubs and with a
gentle Southern accent introduced himself.
It was Bill Pender, and he'd brought the
oranges from California for our lunch. We
became immediate friends, in spite of his
much-more prestigious standing as chair
at the Palo Alto Clinic. Later, Bill and I
worked together on the Wood Libra ry­
Museum CWLM), while he was developing
the WLM's Living History series of video­
tape in terviews of early anesthesiologists,
then on the Guedel B o a rd and, finally,
while founding the Anesthesia History As­
sociation. These interactions all confirmed
his integrity, gentleness, high standards
and dedication to developing and docu­
menting our specialty. S adly, Bill Pender
died in February at his retirement home
in Placerville, C alifornia.
Bill was the son of a country doctor in
Hesterville, Mississippi, so entering medi­
cine was natural for him. He graduated
from the University of Mississippi in 1933
and then from Tulane Medical School in
1935. This was the middle of the Great
Depression, and his medical education was
funded by a Commonwealth Fund of New
York grant. This p rogram was to support
students who would return to p ractice in
rural areas. Internship was at the US Pub­
lic Health Service Hospital in San Fran­
cisco. He then realized he needed more
experience in obstetrics and took 3 more
months training at a hospital in New Or­
leans. From 1 9 37-40, he was a general prac­
titioner in ru ral Missis sippi, fi rst in
Kosciusko and then in C a rthage. Early
on, he took over his sick father's p ractice
in an office in a d rug store, a common lo­
cation for offices then.
Although he enjoyed general practice,
Pender wasn't satisfied with small-town
medical practice. He'd trained with spe­
cialists at Tulane and was frustrated by
John William "Bill" Pendel; M.D.
the limitations of small town medicine and
the lack of a nearby hospital. He sought
something else to do, and anesthesia was
the choice. He had met Coldicutt Pearson
who was just starting anesthesia practice
in Miami. He was the first person Pender
had known who practiced only anesthe­
sia. While in Carthage, Pearson wrote Bill
and said he needed a pa rtner. He sug­
gested the 6 month course with Clement in
Toledo. Bill also considered anesthesia
training in New Orleans, but this position
paid nothing for the first 3 months. A new
Mayo Cinic-trained surgeon arrived about
then in Jackson, Mississippi, where he re­
ferred difficult patients. The surgeon's
wife was a nurse trained in anesthesia at
the Mayo Clinic. Talking with them con­
vinced Pender to go to Mayo Clinic for his
anesthesia training. He began there in
1 940. John Lundy started the anesthesia
program there in 1 924.
Wo rld Wa r II interfe red, and 1 942
found him on active duty with the Navy. A
Mayo Clinic neurosurgeon was stationed
at Bethseda Naval Hospital in Washing­
ton, DC, to establish a mobile neurosurgi­
cal unit which could move to various loca­
tions if the East Coast was bombed. After
realizing they had plenty of surgical help
but no anesthesiologist, Pender was called.
He w a s t h e s o l e a n e s thesiologist a t
Bethseda for much of the war. While there,
Pen d e r gave anesthesia fo r P resident
Franklin Roosevelt, who was then running
for his third term. The operation was to
remove a sebaceous cyst from the back of
the p resident's head. Once again, there was
plenty of surgical help, but no one knew
how to do good infiltration anesthesia.
Pender rose to the occasion, and injected
the President while he was seated in his
wh e e l c h a i r. When Pend e r took the
President's blood pressure for monitoring,
he found severe hypertension-and kept
quiet about it, given the difficult time for
the nation and the continued need for
Roosevelt's leadership. The hypertension
led to the president's fatal stroke in 1945.
Anesthesia at Bethseda was mostly drop
ether with a Yankauer mask. Pender saw
the need for something to "hook onto an
endotracheal tube" so that the mask didn't
have to be held all the time, especially dur­
ing long nuerosurgical cases. He tried to
get dental officers assigned to anesthesia
to help him with his proposed device, but
finally had to have the machinist make
the "Pender Lemon," a clever device that
served its purpose extremely well. He also
experimented with electrical anesthesia
while in the Navy. Because of the war, there
was a great need for a non-explosive, eas­
ily transportable anesthesia technique.
Pender thought of electricity. He was able
to experiment with it at the Naval Research
Institute but then got sent to a hospital
ship overseas, so the project died.
�
The Pender Lemon (Photo from Pender Jw,
Lane IN. An endotrcheal vaporizel: Anes
1945; 6:418-420.)
In 1946, he returned to the Mayo Clinic
as a consultant and then instructor. He was
involved in developing many a re a s o f
anesthesia, especially e a rly open h e a rt
anesthesia. He did anesthesia for the first
open-heart operation at the Mayo Clinic,
a mitral commisurotomy. Aft e r John
Lundy retired in 1 954, Bill left Mayo Clinic
for the Palo Alto Clinic in Califo rnia.
Al though this was a p rivate p ra c ti c e
situation, he knew that Stanford Medical
School would soon be moving from San
Francisco to Palo Alto and an academic tie
BULLETIN OF ANESTHESIA HISTORY
would be possible. The Palo Alto Clinic
also had a sabbatical program (4 months/'
every 6 years), and he was a ble to take sab­
baticals at the University of Pennsylvania
twice and in Cardiff, Wales, with William
Mushin.
Before he left the Mayo Clinic, he be­
gan interviewing older staff to document
the beginning of this important institu­
tion. He joined the Oral History Associa­
tion, and through that, got into the video­
tape interview format, on which the WLM's
Living History program is based. D r. John
Leahey of Philadelphia p rovided critical
technical support for this p rogram and is
considered the co-founder, along with D r.
Pender. This p rogram began in 1 965; there
are now more than 1 50 taped interviews.
This important program documents our
early history and has been an example to
other specialty organizations. The Living
History program is on-going, and the tapes
are widely used.
Pender's many activities in anesthesia
included the Travel Club (founded by John
Lundy), the Academy of Anesthesiology
(serving as president in 1 96 5 ), the AUA,
the WLM Board o f Trustees (from 1 9691 9 7 8 ), the Board of Trustees of the Guedel
Memorial Center, chairman of the Section
on Anesthesia of the Ame rican Medical
Association and associate editor of the jour­
nal Anesthesiology (1956- 1 96 5 ). These ac­
tivities were unusual for someone in pri­
vate practice then-and now. Bill Pender,
with typical modesty, considered himself a
perfectionist and someone of average a bil­
i ty who succeeded by increased e ffort.
People with such characteristics were an
essential component to move anesthesia
forwa rd a s it developed into a true spe­
cialty, in addition to the few brilliant lead­
ers. Bill Pender certainly did his part, and
we'll miss him very, very much. As a final
Wood Library-Museum of Anesthesiology
Duplicate Vintage Books for Sale
April 2001
To order any of the following volumes, please contact:
Karen Bieterman, Assistant Librarian
Wood Library-Museum of Anesthesiology
520 N. Northwest Highway
Pa rk Ridge, IL 60068-2573
phone: (847) 825-5586, ext. 5 8
fax: (847) 825-1 692
C rawford JS. Principles and P ractice
. oJObstetricAnaesthesia. 2 nd edition. Oxford: Blackwell
Scientific; 1 965. $20.00
Eckenhoff JE. Anesthesia from Colonial T imes. - A HistOlY ojAnesthesia at the University oj
Pennsylvania. Philadelphia: JB Lippincott; 1 966. $20.00
Gray JS. PulmonalY Ventilation and its Physiological Regulation. Springfield: Charles C .
Thomas; 1 950. $5.00
Guedel AE. InhalationAnesthesia: A Fundamental Guide. 2nd edition. New York: Macmillan
Company; 1 9 5 8 . $30.00
Heironimus, TW: Mechanical Artificial Ventilation: A Manual Jor Students and P ractitio­
ners. 2 nd edition. Springfield: Charles C. Thomas; 1 97 1 . $5.00
Minnitt RJ, Gillies J. Textbook oj Anaesthetics. 7th edition. B altimore. Williams and
Wilkins; 1 948. $1 5 .00
Mushin WW. Anaesthesia Jor the POOl' Risk and Other Essays. (Oxford: Blackwell Scien­
tific; 1 948. $10.00
Natof HE, Sadove MS. Cardiovascular Collapse in theOperating Room. Philadelphia. JB
Lippincott; 1 9 5 8 . $5.00
Payne JF, Hill VW . A Symposium on Oxygen Measllrements in Blood and Tissues and their
Significance. Boston: Little, B rown and Company; 1966. $5.00
Sherwood-Dunn B. Regional Anesthesia (Victor Pauchet's Technique.) Philadelphia: FA
D avis; 1 920. $20.00
Walton JH, Control ojPain with Saddle Block and Higher SpinalAnesthesia. Summit, New
Jersey: Ciba Pharmaceutical P roducts; 1 948. $5.00
act, before leaving anesthesia forever, he
made a large donation the WLM to sup­
port a room in the museum dedicated to
the Mayo Clinic. The new Mayo Clinic
Room was dedicated at the ASA Board of
Directors meeting March 2, 2001 . It will
be used by the curator of the equipment
collection, Judith Robbins. This will be
another lasting legacy of}ohn "Bill" Pender.
Sources used for this article were my long
friendship' with Dr. Pender, an obituary written
by the family, Dr. Pender's own Living History
interview done in 1983 and a just-released book
on the history of the Mayo Clinic Department,
Art to Science by K. Rehder, P Southonr and A
Sessler.
Bulletill ofAnesthesia HistOlY (ISSN 1522-8649)
is published four times a year as a joint effort of
the Anesthesia History Association and the
Wood-Library Museum of Anesthesiology. The
Bulletin was published as Anesthesia HistOlY Asso­
ciation Newsletter through .Vol. 13, No. 3, July
1995.
The Bulletin is now indexed in HISTLINE
(history of medicine on-line), a database main­
tained by the U.S. National Library of Medi­
cine at <http:igm.nlm.nih.gov>.
C.R. Stephen, MD, Senior Editor
Doris K. Cope, MD, Editor
Donald Caton, MD, Associate Editor
A,J. Wright, MLS, Associate Editor
Fred Spielman, MD,Associate Editor
Douglas Bacon, MD, Associate Editor
Peter McDermott, MD, Book Review Editor
Deborah Bloomberg, Editorial Staff
Editorial, Reprint, and Circulation matters
should be addressed to:
Editor, Bulletill ofAnesthesia HistOlY
200 Medical Arts Building
200 Delafield Avenue, Suite 2070
Pittsburgh, PA 15215 U.S.A.
Telephone (412) 784-5343
Fax (412) 784 -5350
Manuscripts may be submitted on disk us­
ing Word for W indows or other PC text pro­
gram. P lease save files in RICH TEXT FOR­
MAT (.rtf) if possible and submit a hard copy
printout in addition to the disk. All illustra­
tions/photos MUST be submitted as original
hard copy, not electronically. Photographs
should be original glossy prints, NOT pho­
tocopies, laser prints or slides. P hoto­
copies of line drawings or other artwork are
NOT acceptable for publication.
".
BULLETIN OF AN ESTHESIA HISTORY
Civil War... Continlled [rom Page 1
Figure 3. Edward R. Squibb developed a
method of manufacturing ethel' that reduced
the fire-explosion hazard, and supplied large
quantities of anesthetic to the Union armed
forces. Squibb is seen in the uniforlll of a
naval officel:
mal experiments in which he also called
attention to the toxicity of chloro form.9 In
1 847, Simpson used chloro form success­
fully on patients after experimenting on
himself and colleagues. It was a Liverpool
chemist and physician, David Waldie, who
first suggested to Simpson tha t chloroform
might have anesthetic p roperties . 1O Chlo­
roform was originally prepared from ethyl
or methyl alcohol heated with bleaching
powder, then subjected to steam distilla­
tion. Some of the impurities found after
manufacture might include wate r, ethyl
alcohol, ace tone, methyl alcohol, carbon
te tra chloride,
te trachlo re thy lene,
hexachlorethylene, aldehydes, acids, me­
tallic chlorides, e thyl aceta te and oils.
These contaminants could be present in
impure chemicals used in the manufactur­
ing p rocess. Some of the impuri ties also
developed from improper storage.
The Boston firm of William B. Little and
Company (fig. 4 ), manufacturing chem­
ists and druggis ts, decided to enter the
market for chloroform and, as was the cus­
tom, supplied a number of prominent Bos­
ton physicians and surgeons with samples
of their manufacturing e ffort. Among those
supplied were J.C. Wa rren, C . T. Jackson,
J,M. Wa rren, and W. Channing, individu­
als involved in the e a rly use of diethyl
ether. William B. Li ttle and Company also
published a 48-page fascicle containing a
27-page paper by James Young Simpson
entitled "Remarks on the Superinduction
of Anaesthesia in Natural and Morbid Par­
turition with Cases Illustrative of the Use
and Effects of Chloro fo rm in Obste tric
Practice." The publication also included
an appendix of 21 pages containing testi­
monials by p rominent physici ans, all
praising the efficacy of chloroform. ll The
fascicle was dedicated to J.C. Warren who
rema rked tha t the induction of anesthesia
with chloroform was quicker and smoother
than with ether. Other benefits of chloro­
form included the small volume of agent
needed to p roduce "etherisation" and i ts
"absence of inflammability." All in all,
Wa rren (fig. 5) thought chloroform would
take the place of "other e thers," but he cau­
tioned prophetically:
whether chloroform will super­
sede the o ther ethers as an anaes­
thetic, is yet unsettled. The present
impression is in favor of this expec­
tation, but however strongly the bias
may be in this direction, we must wait
a little before we conclude to banish
sulphuric ethel; and receive elusively its
new relation [italics added] . We may
v e n tu re to s ay, p e rh a p s w i th o u t
qualifica tion, tha t the article s o hap­
pily introduced into p ractice by Pro­
fessor Simpson, is the most valuable
improvement on e therisation hith­
e rto made.
S adly, fou r days from the date of publi­
cations of this fascicle, the first death un­
der chloroform anesthesia took place nea r
Newcastle, England, on January 2 8 , 12 The
Figure 4. William B. Little and Company,
Chemists al/d Druggists, housed at 104
Hanovm; cornel' of Salem Street, in Boston,
Massachusetts.
patient, Hannah Greener, was a healthy
1 5-year-old girl who was to have an in­
grown toenail removed. Within two min­
utes after having a teaspoon of chloroform
Figure 5. John Collins Warren, Professor of
Surge/y at Harvard, operated on Gilbert
Abbott on 16 October 1846, at the
Massachusetts General Hospital.
poured on a handkerchief over her nose
and mouth while sea ted in a chair, Hannah
Greener died. Paradoxically, th ree months
before her demise, she had had successful
surgery under ether to remove the corre­
sponding nail on the other foot. In review­
ing this case, John Snow, an early expert
on anesthetics and in reality, the first pro­
fessional anaesthetist, opined tha t she had
suffered an overdose of chloroform. In his
book on chloroform and other anesthetics
published in 1 8 58, John Snow also ana­
lyzed the first fifty recorded deaths from
chloro form, collected from countries the
world over. 13 His findings emphasized an
appreciation of the potency of chloroform.
Thus, by the beginning of the Civil War,
a considerable litera ture on the methods
to deliver e ther and chloroform already
existed as well as the knowledge of the com­
plications caused by each of these agents.
In terms of an anesthetic useful for ba ttle­
field surgery, where lack of inflammabil­
i ty, potency for rapid induction, and a
small volume of drug to p roduce insensi­
bility was important, it appeared tha t chlo­
roform was a more suitable agent w hen
compared to e ther-in spite of the many
reported chloroform deaths. On the other
hand, in a fixed medical installation such
as a gene ral hospital where the environ­
ment could be better controlled in terms
fire haza rds, where the weight factor of the
agent was no t important, and where more
sophisticated anesthetic delivery systems
could be used, then e ther might find its
place.
Manufacturing
Prior to the outbreak of the Civil Wa r,
the anesthetic agents were mainly manu­
factured in the northern states or else im-
BULLETIN OF ANESTHESIA HISTORY
Figure 6. A can of
"Stronger Ethel'''
used in anesthesia
and manufactured
by Edward R.
Squibb, M.D. at his
plant in Brooklyn,
NY.
ported from abroad, mainly the B ritish
Isles. Valentine Mott, a well known sur­
geon wrote in 1 862 that:
In my own practice I have been in
the habit of using the Scotch Chlo­
roform of Duncan, Flockhart, and
Co., of Edinburgh, but have also em­
ployed that of D r. Squibb, of B rook­
lyn, and with pleasure commend the
latter for its purity and reliability. 14
The Union forces had very little prob­
lem in securing adequate supplies of me­
dicinal and surgical material. The major
manufacturing facilities were located in the
northern states and with the Union Navy
in control of the high seas, it could pur-
chase what it wanted overseas. With
firms like E.R. Squibb and Company
manufacturing high quality ether and
chloroform in the North (fig. 6), it is
not di fficult to understand how the
Union fo rces were able to purchase
more than 1 million ounces of chloro­
form and 1 million ounces of diethyl
ether during the Civil Wa rY
The Confederate armed forces, on
the other hand had considerable dif­
ficulties in obtaining medical and sur­
gical supplies. The South lacked the
manufacturing base and found it dif­
ficult to import medical goods because
of the Union naval blockade. Never­
theless, a number of pha rmaceutical
plants and distilleries were built by
the Confederate government and the
plant at Columbia, South C a rolina,
w a s s a i d to have m a nu fa c t u re d
sulphuric ether.16 At one time, the Di­
rector of the Columbia Laboratory was
D r. Julian Chisolm, the author of an
important book on surgery early in the
war and the inventor of a nasal in­
haler for chloroform. 17 Besides manu­
facturing anesthetics within the Con­
fede racy, the C on fede ra t e S t a t e s
gained access t o drugs by blockade­
run n e rs on the s e a s , s m uggling
through the United States and Mexico,
and finally through capturing the
Figure 8. T7ze Chisolm Nasal Inhaler (photo
collrtesy of the Armed Forces Institute of
Pathology, Otis Archives) consists of a rectangular
metal portion with two hollow prongs inserted in
the body, which are placed in the nostrils. A
division in the metal can be seen in the upper
portion of the inhalel; which allows it to be
separated so that the major inferior portion can be
filled with absorbent cotton. A hole in the bottom
end of the inhaler is covered by metal wire mesh
over which a pelforated cap is fitted. A quantity
of chloroforln is poured into the pelforated cap, the
prongs are placed into the nostrils, and the patient
inhales the vapor with the mouth closed.
supplies of the Union Armies. This latter
factor stood the Confedera tes in good stead
almost through midyear of 1 863 because
'
of the enormous amount of medical and
surgical supplies captured in their many
victories. As the Union naval blockade
tightened by the close of 1 864, e ffective
blockade running ended. 18
Anesthesia Techniques
Figure 7. To use the Morton Inhalel; a sponge soaked in ethel' is passed into a two-necked
glass globe through the opening. T7ze opening is then stoppered with a cork that has grooves in it
to freely admit ail' that vaporizes the ethel: T7ze second opening contains the mouthpiece tube
that the patient held between the lips. A rubber-type raised border encircling the tube
compresses the outside of the mOllth, helping to exclude atmospheric ail: A one-way valve is
present in the upper portion of the mOllthpiece through which the exhaled ail' passes. This is a
closed oral system and the nostrils are pinched shut by the anesthetist 01' his assistant. (From
B.M. Duncam, The Development of Inhalation Anaesthesia. London, 1947, p. 640) TIle
vaporization of ethel' is enhanced due to the fact that the inhaler is held in the hand of the
anesthetist with the heat emanating from the palm being sufficient to raise the temperature of
the ethel' in the small glass globe.
Anesthesia during the Civil War re­
quired a simple approach to the delivery
of therapy because of the minimal avail­
ability of transportation and the lack of
expertise in giving anesthesia by surgeons
in the Union and Confederate a rmies.
From 1 846 to the outbreak of the Civil War
in 1 86 1 , more than 30 masks and inhalers
had been developed to deliver chloroform,
ether, or a combination of the twO. 19 With
the possible exceptions of the occasional
use of the Morton Ether Inhaler (fig. 7),
and the Chisolm Nasal Inhaler fo r chloro­
form (fig. 8 ),10 all the anesthetics were de­
livered by pouring the agent on a hand­
kerchief, towel, napkin, sponge, lint, or
special cone (fig. 9, fig. 1 0 ). Valentine
Mott notes that:
It is better to employ no special
apparatus for inhalation. All that is
Cantin lied all Next Page
6
BUllETIN OF ANESTHESIA HISTORY
Civil War
.
.
.
be carried.23
COl/til/ued from Page 5
John Julian Chisolm (fig. 1 2 ) was a
distinguished Southern surgeon and a Pro­
fessor of Surgery at the Medical College of
South Carolina at the beginning of the
Civil War. Earlier he had visited Europe,
studying ophthalmology in Paris with
D e smarres and attending lectures by
Claude Bernard. Chisolm also observed
military medicine in Europe during the
wars for Italian unification, vi sting the
wounded after the Battle of Solferino. Dr.
Chisolm received the first commission
given to a medical officer in the Confeder­
ate States Medical Service in 1 8 6 1 and re­
alizing the importance of military medi­
cine textbooks, he wrote and published ''A
Manual of Military Surgery for the Use of
Surgeons in the Confederate Army."24 Con­
cerning the administration of chloroform
he states that:
Figure 9. Staging of an Amputation: TIle patient lies on a wooden table, head on a pillow,
with the surgeon examining the leg to be amputated. His assistant has taken a cloth or tmoel
and folded it in the shape of a Calle, which is held above, and not pressing on the face. A bulge,
which can be seen in the superior segment of the cone, probably represents the inc01poratioll of a
small piece of sponge soaked with anesthetic. In the background, one can see an Autenrieth
Medicine Wagon, which contained medicines, surgical instruments, and surgical supplies. (Photo
courtesy by the Armed Forces Institute of Pathology, Otis Archives)
needed is a common linen handker­
chief, on which the liquid is poured.
This should be held loosely in the
hands of the opera tor, as in the
folded condition it might interfere
too much with respiration. If aether
is used, little attention is paid to
quantity-from two to four ounces
being commonly required for an
adult; and all the caution necessary
is not to exhibit it so rapidly as to
excite a cough. If chloroform is em­
ployed, less quantity will be re ­
quired-from one to four drachms
being generally sufficient. But care
might be taken to dilute the vapor
sufficiently with atmospheric air.21
Edward Warren, M.D ., Professor of Ma­
teria Medica and Therapeutics at the Uni­
versity of Maryland School of Medicine in
Baltimore, returned to the South at the out­
break of the Civil War. He became Sur­
geon-General of the State of North Caro­
lina and was the author of a textbook of
surgery.22 Like Valentine Mott, Warren did
not believe in the use of inhalers:
ply of Atmospheric Air. The best
mode of administering chloroform
is by means of a cloth folded in the
form of a cone, in the apex of which a
small piece of sponge is placed. This,
impregnated with a drachm of chlo­
roform, should be held over the
mouth and nose, at a distance of
a bout two inches, being gradually ap­
proximated until within one inch of
the face beyond which it should not
The best apparatus is a folded
cloth in the form of a cone, in the
apex of which a small piece of sponge
is placed. This is first held at some
distance from the nose and mouth of
the patient so that the first inhala­
tion may be well diluted with air. As
the exhilarating stage is reached this
cloth should be approached to the
nose so that a more concentrated
ether may be inhaled, which will rap­
idly produce the desired insensibil­
ity.
Ether was found to have a stimulating
effect and according to Turnbull one can
"show that the primary influence of the
drug is to stimulate both vaso-motorcentres
and the heart."25 It was also seen to stimu-
Figure 10. TIze Hospital on the Battlefield of W illiamsburg. TIlis battle took place on 4-5 May
1862, and there were 1866 Union and 1570 Confederate casualties. TIze hospital" is probably
a converted barn or storage shed and a patient is being prepared for amputation of his right leg,
below the knee. Anesthesia is being given using a cloth or towel and is probably just beginning
since the left fist is clenched and the left extremity still retains its tone since it is elevated. TIze
surgeon at the lower left hand of the picture appears to be holding a wound probe in his left
hand, while the surgeon next to him is holding an amputation saw.
«
All the Inhalers which have been
invented are objectionable on ac­
count oftheir inconvenience and the
difficulty of obtaining a proper sup-
BULLETIN OF AN ESTHESIA HISTORY
Figure 11. DI: Edward H. Barton, who
gave the first anesthetic ethel' in a militmy
conflict.
late respiration and cause more excitation
during its initial use in induction. Chlo­
roform, on the other hand, was thought to
be a depressant, affecting both heart and
respiration. There was a p rolonged awak­
ening from ether and a quicker return to
consciousness after chloroform.26 The prob­
lem of flammability with ether was indeed
a problem and Turnbull mentions that: "Dr
Squibb has seen fire at a measured dis­
tance of 15 feet between the source of escap­
ing vapor and the source of fire."27
In order to attenuate the cardio-respi­
ratory effects of chloroform and to utilize
the stimulatory responses to ether, a mix­
ture of chloroform and ether was used. The
mixture also markedly decreased the flam­
mability of ether. Lyman mentions that the
Committee of the London Medical and
Chirurgical Society recommended three
different mixtures:
Mixture A-Alcohol
Chloroform
Ether
Mixture B-Chloroform
Ether
Mixture C-Chloroform
Ether
1 part
2 parts
3 parts
1 part
4 parts
1 part
2 parts28
Adding to the p roblem of the use of an­
esthetics was the paradoxical experience
of the United States Army in the Mexican­
American Wa r of 1 846-1 848. The re were
conflicting views of the usefulness of anes­
thetics. To D r. Edward H. B a rton (fig. 1 1 )
goes the honor o f giving the first anesthetic
in a military conflict: on 29 March 1 847,
he used ether to amputate a leg that was
severely injured by the accidental dis­
charge of a musket.30 Shortly therea fter,
B a rton, assisted by D rs. Harney, Parker,
and Lamb successfully amputated the leg
of a patient under ether who had screamed
and suffered intensely when his other leg
was amputated e a rlier without. At the
Battle of Cerro Gordo, near the town of
Xalapa, on 18 April 1 847, about a dozen
wounded United States soldiers were given
ether for their surgery. Interestingly, a da­
guerreotype taken about the same time also
near Xalapa, appears to show an amputa­
tion by the Mexican Surgeon-General Pedro
Van Derlinden, with the patient anesthe­
tized.31 U nfortuna tely, Army Surgeon John
Porter was not enthusiastic about the use
of anesthetics fo r s u rg e ry on gunshot
wounds. His initial experience left him to
believe that ether can produce uncontrol­
lable hemo rrhage. He noted: "In gunshot
wounds anaesthetic agents are almost uni­
versally necessary, and a re almost univer­
sally injurious. It was for this reason that
they were entirely given up in the hospital
a t Vera C ru z . "32 He a l s o s t a t e d t h a t,
''Anaestheties poison the blood and depress
the nervous system; and in consequence,
hemorrhage is more apt to occur and union
by adhesion is prevented."33 In his remarks
against the use of anesthetics, Porter dis­
cusses the surgical advances gained from
the experiences of the C rimean Wa r (1 8531 866), not realizing that chlorofo rm was
used by the French and B ritish. The French
surgeon, Baudens, reported more than
25,000 operations using chloroform with­
out a death,34 and the B ritish S u rgeon
Macleod described more than 20,000 sur­
gical procedures under chloroform with
but one fatality.35
Porter's reluctance to use anesthesia for
surgical procedures also has an important
psychosocial background. Pernick points
out that it was thought women and chil­
dren were more susceptible to anesthetics
than adult men, which p rovided a safety
factor in terms of overdosage.36 The medi­
cal literature of the mid-century epoch em­
phasizes this point. Lyman stated that be­
cause women a re more sensitive to anes­
thetics, "syncope is less frequently observed
among them than among men," indicating
that "mortality of the male sex is accord­
ingly greater than that of the female."37
This intimated that "strong, rigorous men
were resistant to the effects of anesthesia;
the more manly the more resistant."38
This concept of "manliness" is epito­
mized by the tale of a wounded Union sol­
dier who was captured a fter the battle of
Gaines Mill on 27 June 1 862, and waited
to have h i s a rm a m p u t a t e d . P rivate
Winchell asked the surgeon, Dr. White:
if he had any chloroform or qui­
nine or whisky, to which he replied,
"No, and I have no time to dilly dally
with you."
I finally said it was hard, to go
ahead and take the arm off. He got
hold of my arm, pulled the ban­
dage off, pushed his thumb through
the wound and told me to "Come on,"
and helping me up we walked to the
amputation table where they were
Continued
all
Next Page
}[ANU AL
MlhlTARY SURGERY,
!tultSJlld!\tgo[;tlfoIl50ftlte lUcdio! h1�PJrtn\(nt
Another combination contained one
part of chloroform and two parts of alco­
hol, the rationale being that the alcohol
would act as a stimulant to the heart and
counteract the depressive effect of chloro­
fo rm. A rep o rt by S u rgeon W m . A.
Hammond, U.S.A. [later the Surgeon Gen­
eral] described a death in which the pa­
tient was exposed to the combination o f
alcohol and chloroform.29
Anesthetics and Warfare
CO�FEDER.1.TE .!.RllY
"
J. JULUX ClIIsor,�l, �I.D,
RICH){O:iD,
v_�.
WF.S'l' ,1; JOHNHTON.
1I� �h'; iT""
1881.
Figure 12. John Julian Chisolm, M.D. , was the first commissioned medical officer in the
Confederate States ArIllY, the author of a textbook of militmy surgelY (title page shown above,
left), and the inventor of a nasal inhaler for chioroforlll.
r
t
BULLETIN OF ANESTHESIA HISTORY
Civil War
.
.
.
Continued froll! Page 7
taking off the young man's arm near
the elbow [no anesthesia was avail­
able] . He lay there like a man, and
when they had finished, Surgeon
White asked if I could keep as still
as he did, that "He is a soldiel; evelY
inch of him. "39
Civil War Medical Organization
The outbreak of the Civil War caught
the medical service of the Union Army to­
tally unprepared. Unfortunately, most of
the leaders were veterans of the War of
1 8 1 2 . The Medical Bureau Headquarters
consisted of a general hospital of 40 beds,
and 14 officers. It was headed by an 83year-old dying veteran of the War of 1 8 1 2,
Colonel Thomas Lawson, who was ap­
pointed Surgeon General by dint of his se­
niority. Lawson passed away in June 1 86 1
and was replaced b y Dr. Clement A. Finley,
a Surgeon in his sixties and a veteran of
the Mexican and Indian Wars. Dr. Finley
was also totally inadequate for the incred­
ible medical challenge that lay ahead.40
battle investigation, the Sanitary Com­
mission reported that they could find no
record of a single wounded soldier reach­
ing Wa shington, D . C ., by a mbulance.
Many o f the wounded lay on the battle­
field for days. Although Union medical
supplies were abundant, they were not
available when needed because of a chaotic
medical organization with no plan in place
for contingencies. Plagued by his incom­
petency in organizing the Medical Depart­
ment, Finley was removed from office. On
25 April 1 8 6 2 , William Alexander
Hammond, at the age of 33, was appointed
Surgeon-General (fig. 1 3 ). This brilliant,
impressive and controversial individual
reorganized the Medical Department as an
effective tool of medical care, and helped
to set standards of professionalism for the
huge influx of medical personnel in the
expanding Union armed forces .44
The Confederate States Army Medical
Corps had similar problems and used the
same administrative structure as in the
Union Army. Fortunately for the South,
they had an equivalent to Hammond in
their S urgeon-General S amuel P reston
Moore, who had been in the United States
Army Medical Service prior to the Civil
WarY
Clinical Use of Anesthetics
Figure 13. William Alexander Hammond,
M.D., Surgeon-General, United States
Army, 1862-1864
Fortunately, the e s tablishment o f
United States S anitary Commission was
approved on 13 June 1 86l. The Commis­
sion was a civilian medical advisory board
and consisted of distinguished lay people
and physicians. As a quasi-governmental
agency it played an important role in help­
ing to develop a comprehensive medical­
hospital system on the Union side.41 Tragi­
cally, on 21 July 1 86 1 , the First of Battle of
Bull Run (or First Manassas) occurred,
which was a defeat for the Union army and
a disaster in terms of medical care.42 On
the Union side, about 48 1 were killed, 1 0 1 1
wounded, and 1 2 1 6 missing,43 In a post-
Much of our hard data relating to the
use of anesthetics during the Civil War
came from the landmark publication, the
kIedical and Surgical HistOlY of the War of the
Rebellion (MSHWR).46 Eighteen years in
publication, it consists of two volumes, the
Medical History and the Surgical History,
with each volume divided into three parts,
for a total of more than 6000 pages. The
impetus for this magnum opus came from
the i d e a o f then S urgeon-General
Hammond in 1 862 to publish a medical
and surgical history of the Civil War con­
taining an analysis of all aspects touching
on the delivery of medical care in the Union
forces. The scope of the MSHWR is far
reaching and whenever available included
data and cases from the Confederate Medi­
cal Service as well. When Hammond left
the Union service in 1 864, the new Sur­
geon-General, Joseph R. Barnes, essentially
directed its preparation. Important con­
tributions to this massive work were made
by George Alexander Otis, Charles Smart,
John Hill Brinton, and D . L . Huntington.
Besides containing numerous case stud­
ies of surgical procedures in which anes­
thetics were involved, the MSHWR also
contained a special ch apter on ''Anesthet­
ics" in Volume II, Part lIlY Mention is
made of at least 80,000 instances where
anesthetics were employed. The data were
based almost entirely on records from the
Union Army since a large portion of the
Medical and Hospital records of the Con­
federate Army in Richmond, Virginia, were
destroyed by fire soon after its occupation
in 1 86 5 . Reports on the use of anesthesia
were limited because, "Time and clerical
assistance did not allow of the examina­
tion of this enormous number of 'cases in
detail, and in treating of this subject we
must confine our remarks to the number
of major operations in which the agents used
.
were definitely ascertained."48
The figure of 80,000 anesthetics is most
interesting since no direct supporting data
are presented. We do know, however, that
the MSHWR reported a total of 245,790
projectile wounds with 201,962 surviving
and that 29,980 amputations were carried
out with 20,082 surviving. Accepting it at
face value and relying on the monumental
work by Livermore49 concerning the losses
occurred by both sides in the Civil War, we
could note that approximately 320,000
Union troops were reported wounded. This
would signify that about one in every four
of the wounded received an anesthetic for
his injUlY. Extending this one in four ra­
tio of anesthesia to the 235,000 wounded
on the Confederate side,50 one might ex­
pect that 57,000 troops received anesthe­
sia, for a Union-Confederate total of l30,000
anesthetics. Evidence that the possible
Confederate figure of 57,000 anesthetics
may be true can he gathered from hospital
and field reports and surgeon's diaries.
Hunter Holmes McGuire,s1 the Surgeon to
the " Stonewall" (Jackson) Brigade, men­
tions that chloroform was used more than
28,000 times without a single loss of life
attributed to the agent. Similarly the Con­
federate Surgeon Julian Chisolm (author
of ''A Manual of Military Surgery"S2) men­
tioned that he never had a death from chlo­
roform in more than 1 0,000 casesY Dur­
ing the Civil War, more than 1 50 hospitals
were used to take care of the Confederate
wounded,s4 and it is known that substan­
tial amount of surgery was carried on, es­
pecially in the Chimboraz055 (over 1 2,999
beds) and the Winder Hospitals (over 5,000
beds), both in the Richmond, Virginia, area.
Another problem in calculating the
number of anesthetics delivered relates to
multiple surgeries on the same patient.
Surgeon B . W. Allen describes many of his
c a s e s i n a C o n fe d e r a t e Hospital in
C h a rl o t t e sville, Virginia, from 1 8 62
through a portion of 1 864, including daily
rounds and therapy given. Some of his
patients were operated on many times us­
ing chloroform as an anesthetic.56
BULLETIN OF AN ESTHESIA HISTORY
8,900 CASES
AGENT
CHLOROFORM
ETHER
MIXTURE
# DEATHS
# CASES
%
6784
72.2
1305
811
14.7
9.1
37
4
2
% DEATHS
0.54
0.30
0.24
Table 1. Number of anesthetics according to agents and the subsequent mortality.
In some cases, patients receiving surgi­
cal procedures at front line field hospitals
were hurriedly evacuated to general hos­
pitals in the rear with little or no informa­
tion as to the condition under which sur­
gery was performed or whether an anes­
thetic was given. Thus, the figure of 80,000
anesthetics is likely a conservative esti­
mate. The true number of anesthetics de­
livered probably amounted to at least
125,000 in the Northern and S o u thern
Armies.
The MSHWR focused on 8,900 cases in­
volving "major operations in which agents
used were definitely ascertained."5? Chlo­
roform was used in 6,784 (76.2%), ether in
1,305 (14.7%), and the chloroform-ether
mixture in 811 (9. l %). Deaths thought to
be due to the anesthetic agents were 37 with
chloroform (0.54%), 4 wi th ether (0.30%),
and 2 with the n-mixture (0.24%) (Table
1) .
An examination of the Carver General
Hospi tal (Washington, D . C . ) Surgical
Records from 1864 to 1865 in which 498
patients were admi tted, indica ted tha t
most patients had their primary procedures
performed in field hospitals. The condi­
tion of the injured at the time of surgery
was unknown with many not arriving a t
the General Hospital until days or weeks
after being wounded. Twenty-one proce­
dures were carried out at the hospital, sev­
enteen under sulfuric ether and four un­
der chloroform; one death occurred in eight
hours after ether was given.58
It was also noted tha t 254 cases were
reported in the MSHWR in which no an­
esthetics were given, with no explanation
accompanying this finding. The MSHWR
speculates that perhaps these surgeons
thought tha t " the effects of shot injuries
are deleterious, in as much as they add to
the depression caused by the shock, and
retard union by first intention and predis­
pose to hemorrhage and pyaemia."59 An­
other possible explanation is tha t no anes­
thetic agents were available then.
These data indicate the popularity of
chloroform in the hands of the field sur­
geons . It was n o t flamm able; a small
amount could be used to produce anesthe­
sia; i t was pleasant to inhale, and i ts ef­
fects were very rapid. As mentioned ear­
lier, sulfuric e ther was generally used in
the General Hospitals as can be seen in its
use at the Carver Hospital in Washington,
D.C.
The feelings of the surgeons rela ting to
chloroform are epitomized by Dr. F.E .
Daniel,60 a Confederate Surgeon who after
amputa ting a leg writes:
The form is transferred to a cool
c o t beneath the shade of a wide
spreading tree to cool him and keep
off the flies. He rallies from the sleep
of the merciful anesthetic. He slept
all through the ordeal. A minu te
seems not to have elapsed since He
wakes to find his leg gone.
The MSHWR gives voice to a number
of surgeons abou t the anesthetic agents
used:
in every painful operation, but
did not keep the patients under i ts
influence longer than was absolutely
necessary, withdrawing it as soon as
the cutting was complete.61
Surgeon B.B. Breed,62 U . S . v.:
Chloroform was almost univer­
sally employed as an anaesthetic, and
without bad effect in any case. When­
ever practicable, I employed ether in
preference to chloroform, preferring,
both from personal experience and
observation the delay and discom­
fort in its administration to the pos­
sible danger from the use of the lat­
ter. On the field of ba ttle, however,
chloro form is safe and preferable
agent.
At the Ba ttle of Belmont, Missouri, in
1861, Surgeon John H. Brinton,64 U . S . v.,
reported 48 surgical procedures and:
In all of these operations anaes-
9
the s i a w a s p reviously induced.
Wa shed sulphuric e ther was the
agent generally employed, and in no
case was any untoward result ob­
served.
Considering the terrible battlefield con­
ditions tha t surrounded field care in the
Civil War, the anesthetic mortality was
quite low. It is important to remember that
the majority of operations involved am­
puta tions, which in general was a very
quick procedure. Of interest is that the
Chapter on Anaesthetics65 abstrac ted the
37 chloroform, 4 ether, and the 2 dea ths
from the combination of e ther and chloro­
form. An analysis of the 37 chloro form
deaths using modern anesthetic criteria in­
dicates:
Probable anesthetic overdose
Insufficient data
Hypovolemic and/or septic shock
Respiratory obstruction
Vomiting
Late death
21
9
3
2
1
1
In the four cases where death occurred
involving e ther important contributing
factors were: Hemorrhage and septic shock
(4). In the two deaths from the mixture of
chloroform and e ther: Probable anesthetic
overdose (1); Hemorrhagic shock (1).
If the analysis noted above is correct, it
would probably reduce the number o f
dea ths due to chloroform by three since
hypovolemic and or septic shock in itself
is lethal. The same holds for all 4 cases
where ether was used and in the one case
where the mixture was involved.
Case 1277 as reported in the chapter on
Anesthetics is important,66 since i t indi­
cates use of resuscitative efforts (Marshall
Hall's method of artificial respiration) af­
ter a patient apparently had a cardiac ar­
rest during an e ther anesthetic. It also il­
lustrates the experience of a single surgeon
in anesthetizing a large number of pa­
tients-again indicating tha t the figure of
80,000 anesthetics given in the Civil War
is conservative:
Case 1277 .-Priva te S. R. Green,
C o . A, 5 th New H ampshire, was
wounded in the leg a t Gettysburg,
July 2,1863, by a minie ball, which
fractured the tibia and fibula. Am­
putation at the middle third o f the
leg was ten or fifteen minute s of
Marshall Hall's ready method he
was restored and the operation was
proceeded with. The cause was eviCantil/lied all Next Page
10
BULLETIN OF AN ESTHESIA HISTORY ����
Civil War
.
.
.
Colltillued from Page 9
Staternent oj .Fi"e Hundred and Nind� QzSeJI 01 tM Empl,oyrMnt oj .A�, Mowing Quantitia
wed, 7i1M to induce A�, and Period during which it
maintained.
A:lJJIIIITll.BTlO
ACJDT8 EIO'LOno.
�
r Qu�V....
I
8mall
� QuAD'"
I
I
CbloC"O'fotm ............................... '" .. .. ..
161
Chlot'OtOf'fllllM Ethw ...........
lOS
:B'tl:lc
..... , , .. .... .......... '" .. .. .. ...
.
........... .
I
I
I
1321
�e
QUaJlt..
�
�TDaoW
A;venge
QuAnt..
� .l>nwAm.. �
t
"
u
1
1110
D2
W
&1
"
was
""'... .......,.,
8bortea'
TIme.
LoD� A�
'1'1Die.
TIme.
J( � � Jan"'",
'
l
b--..-...
LoDput A�
Sborteet
Time. �_
TInIe.
M &wtu. JRmdu. lC�
•
81)-
•
1
UItI
U
1.
eo
1'1
1
�
28
1
Ii
18
1
m
".
Table 2, From the MSHWR, Chapter 13,
&atement ahotoing tM Fre<J.'IUMy oj Vomiting, &cilement, and Proal.ralMm in � Hundred and Nindy­
,even CuM oj .A�
I
Vowmo.
A.N'BSTDTIO A.GENT EVPLOYEO.
CblO1'Oform ..........
.. ........................
...... � .............. .... .... .. .. .... "..................... .....
Chloroform and Ether ................................. , ............... ............ .. ......
Ether .........................................................................
Table 3, From the MSHWR, Chapter 13,
dently inattention on the part of the
administrator," The patient subse­
quently died at the Seminary Hos­
p i t a l at Ge ttysburg on July 3 0 ,
1 8 6 3 ,67
A remarkable outcome study also ap­
pears in Chapter 13 of the MSHWR in
which Circular Orders I and 2 from the
Surgeon General's Office (1 876 and 1 878)
attempts to delineate important aspects
relating to the delivery of an anesthetic,
The factors include the: "nature of the an­
esthetic; the quantity used in maintaining
anesthesia, the time required to include
complete insensibility the time the anes­
thetic influence was maintained; the mode
of administration, and whether vomiting,
excitement, or great prostration was ob­
served during or after the administration,"
The study comprised 597 patients, Chlo­
roform was used in 1 5 8 patients, ether in
332, and chloroform-ether in 1 0 8 , Three
deaths were reported, one for each of the
..
fa
fA
�
!
151
114
so
�i
'lG
u
23(
a
I
bazwur.
J
..
! i
I ,
d
A
I---
9
12
�
m
4A
of.
i
I--
us
t3
'1
611
U
10
e
05
u
16
m
85
81
14.
m
H
8
I
PII()dITUTlOlr.
u
�
10
2
11
---_ ..
agents used,68
Table 2 delineates the quantity of an­
esthetics used, the time to induce anesthe­
sia and the duration of anesthesia, Table
3 observes some of the side effects of anes­
thetics including vomiting, excitement and
prostration, In Table 2, average (mean)
quantities and times are used,
Briefly, the data show that c hloroform
was a more potent anesthetic than ether,
with a smaller volume used and a much
quicker induction of anesthesia, Vomiting
appeared to be slightly more frequent with
ether, excitement less prevalent with chlo­
roform, and prostration least with ether,
The rapid action of chloroform in produc­
ing anesthesia and the fact that a small
dose can be used to achieve an anesthetic
effect was important to the Civil War field
surgeon, especially when large numbers of
casualties flooded the field hospitals,
In discussing the use of anesthetics dur­
ing the Civil War, it is only just to relate
the Civil War battlefield j ourneys of the
great pioneer of ether anesthesia, William
Thomas Green Morton, During the period
time in which the Battles of the Wilder­
ness and Spotsylvania Courthouse were
fought (4-1 9 May 1 864), Morton received
permission from both the Surgeon General
and General Grant to work in the field as
well as at the general hospitals, His tal­
ents were greatly needed since the Battles
of the Wilderness and Spotsylvania Court­
house produced more than 34,000 Union
and 1 7,500 Confederate casualties,
Morton states that:
On S aturday mornng, May 14, 1
was awakened by the booming of can­
non and learned that the enemy were
endeavoring to regain their lost po­
sition"" On the arrival of a train of
ambulances at a field hospital the
wounds were hastily examined, and
those who could bear the j ourney
were sent at once to Fredericksburg,
The nature of the operations to be
II
BULLETIN OF ANESTHESIA HISTORY
S urgeon Hunter Holmes McGuire (fig.
14), the Brigade Medical Director, and a
close fri e n d of G e n e r a l J a c k s o n . Dr.
McGuire relates that:
Figure 14. Hunter Holmes McGuire,
M.D., was the Surgeon-ill-Chief of the
famolls "Stonewall" Brigade of the
Confederate States Army.
performed on the others was then
decided on and noted on a bit of pa­
per pinned to the pillow or blanket
under each patient's head. When this
had been done, I prepared the pa­
tients for the knife, producing pelfect
anesthesia in an average time of 3 min­
utes [italics added], and the opera­
tors followed, performing operations
with dexterous skill, while the dress­
ers in their turn bound up the
stumps. It is surprising to see with
what dexterity and rapidity surgi­
cal opera tions were performed by
scores in the same time really taken
up with one case in peaceful regions.
When I had finished my professional
duties at one hospital, I would ride
to another, first arranging at what
hour I would next return.69
There is a clue as to the number of pa­
tients Morton anesthetized when he states:
How little did I think, however,
when originally experimenting with
the properties of sulfuric ether on
my own person, that I should ever
successfully administer it to hun­
dreds in one day, and thus prevent
an amount of agony fearful to con­
template.
The merciful relief of pain that accom­
panies an anesthetic was best expressed by
the famous Confederate Army General,
Thom as J. "Stonewall" Jackson, after be­
ing wounded during The B a ttle of
Chancellorsville on 2 May 1 863, about 9:00
PM. General Jackson had his left arm am­
putated two inches below the shoulder by
At two o'clock Sunday morning,
Surgeons Black, Walls and Coleman
being present, I informed him that
chloroform would be given him, and
his wounds examined. I told him
that amputation would probably be
required, and asked if it was found
necessary, whether it should be done
at once. He replied promptly, "Yes,
certainly; Doctor McGuire, do for me
whatever you think best." Chloro­
form was then administered, and as
he began to feel its effects, and its
relief to the pain he was suffering,
he exclaimed, "What an infinite
blessing," and continued to repeat
the work "blessing," until he became
insensible.70
References
1.
T.E. Keys, The HistDl)' of Surgical Anesthesia (Huntington: Robert E. Krieger Publishing
Company, 1978) p. 193.
2.
C.\V, Long, ''An Account of the First Use
of Sulphuric Ether by Inhalation as an Anesthetic
in Surgical Operations," Southel'll lvIedical and Sur­
gical Jou/'llal 5(1 849) :705-713.
3.
H.J. Bigelow, "Insensibility during Surgical Operations Produced by Inhalation," Boston
Medical and Surgical Journal 35(1 846) :309-317. J.C.
Warren, "Inhalation of Ethereal Vapor for the Pre­
vention of Pain in Surgical Operations,". Boston Medi­
cal and Surgical Joul'llal 3 5 (1 846):375-379. W.T. G .
Morton, Remarks on the Proper Mode ofAdministering
Sulphuric Ether by Inhalation (Boston: Dutton and
Wentworth, Printers, 1 847), p. 44.
4.
R.H. Ellis, "The Introduction of Ether
Anesthesia to G r e a t B ri t a i n," A naesthesia
3 1 (1 967):766-767. ''Anesthesia Centennial Numbel;"
Journal of the HistDl), ofkIedicine and Allied Sciences 1,
October (1 946):505-710. J.A. Robinson, 1}eatise on
the Inhalation of the lilpour of EthelJor the Pre'vention
ofPain in Surgical Operations; Containing A Numerous
Collection of Cases in which -it has been applied ... etc,
etc., (London: Webster and Co., 1 847), p. 63.
5.
J . Y. Simpson, "On the Inhalation of
Sulphuric Ether i n the Practice of Midwifery,"
Edinbu rgh Monthly Jou/'llal of Medical Sciences
3 (1 847) : 7 2 1 -732.
6.
D.W. Buxton, Anaesthetics: Their Use alld
Administration (London: H.K. Lewis, 1 892), p. 222.
\v'H. Archer, "The History of Anesthe7.
sia," Proceedings, Dental Centenary Celebration,
March 1940, p. 333-363.
8.
Keys, TIle HistDl), of Surgical Anesthesia
(n. l ) . J.R. Powling, DI: Samuel Guthrie, Diswverer of
Chloroform (\'V'atertown: Brewster Press, 1 947), p.
123.
9.
M.J.P. Flourens, "Note touch ant l'action
de I'ether sur les centers nerveux," Academie des
Sciences (Paris) 24(1 847):340-344.
Keys, TIle HistDl)' of Surgical Anesthesia
10.
(n.l). B.M. Duncum, The Development of Inhalation
Anaesthesia. with Special Reference to the 1�ars 18461 900 (London: Oxford University Press, 1947), p.
640.
11.
J.Y. Simpson, Remarks on the Superinduction of Anaesthesia in Natural and Morbin Parturition:
With Cases fllustrative of the Use and Effects of Chloro­
form in Obstetric Practice. With an Appendix (\'V'illiam
B . Little and Co., Chemists and Druggists, 104
Hanover, Corner of Salem St, 1848), p. 48.
12.
T.M. Meggison, "Death Produced by
Chloroform," London Medical Gazette 6(1 848):255256.
13.
J. S now, On Chloroform and Other
Anaesthetics; TIleir Action and Administration (Lon­
don: John Churchill, 1 858), p. 443.
1 4.
V. Mott, "Pain and Anaesthetics: An Essay Introductory to A Series of Surgical and Medical
Monographs," in Milital), Medical and Surgical Es­
says. Prepared for the U.S. Sanital), Commission, ed­
ited by William A. Hammond, M.D. (N.Y. : J . B .
Lippincott and Co., 1 864), p. 5 5 2 .
15.
TIle Medical and Surgical HistDl), of the
lfilr of the Rebellion, Prepared under the Direction of
Joseph K. Barnes, Surgeon General United States
Army, by George A Otis, S urgeon, United States
Army, and D.L. Huntington, Surgeon, United States
Army (Surgical Volume, 3 parts); J.J. Woodward,
Surgeon, United States Army and Charles Smart,
Surgeon, United States Army (Medical Volume, 3
parts), Second Issue (Washington, D.C.: Govern­
ment Printing Office, 1883).
16.
N.H. Franke, Pharmaceutical Conditions
and Drug Supply in the Confederacy (Contributions
from the History of Pharmacy Department of the
School of Pharmacy, University of Wisconsin . . . No.
3) (Madison: American Institute of History of the
Pharmacy, 1955), p. 48.
17.
J.J. Chisolm, A Manual of Milital)' Sur-
gel)' for the Use of Surgeolls in the Confederate Army;
with an Appendix of the Rules and Regulations of the
Medical Department of the Confederate Army (Rich­
mond: West a n d Johnson, 1 8 6 1 ) , p. 447. W.C .
Worthington, Jr., "Confederates, Chloroform and
Cataracts: Julian John Chisolm (1830-1903)," So.
Med. J. 79(1 986):748-752.
18.
Franke, Pharmaceutical Conditions and
Dntg Supply in the Confederacy (n. 16).
19.
B.M. Duncum, TIle Development of Inha-
lation Anaesthesia. with Special Reference to the �ars
1846-1 900 (London: Oxford University Press, 1 947)
p. 640.
20.
Medical and Surgical HistDl), of the 1%1' of
the Rebellion (n. 1 5); RT. Hambrecht, M. Rode, A
Hawk, "Dr. Chisolm's Inhaler: A rare confederate
invention," J. South Carolina Med. Assoc.
44(1991):277-580.
Mott, "Pain and Anaesthetics" (n. 14).
21.
22.
E. Warren, An Epitome of Practical SlilC
gel)' for Field and Hospital (Richmond: West and
Johnson, 1 863), p. 401 .
23.
Warren, All Epitome of Practical Surgel),
for Field and Hospital (n. 22).
24.
Chisolm, A Manual of Milita/)' Surgel),
(n. 17). '
25.
L. Turnbull, Artfficial Anesthesia (Philadelphia: Blakeston and Co., 1 878), p. 550.
26.
Turnbull, Artificial Anesthesia (n. 25).
27.
H.H. Cunningham, Field Medical Ser­
vices at the Battles ofManassas (Bull Run), Uriiversity
of Georgia Monographs, No. 16 (Athens: University
of Georgia Press, 1968), p. 1 1 6 .
28.
H . M . Lyman, Artificial Anesthesia alld
Anaesthetics (New York: William Wood and Com­
pany, 1 88 1), p. 33.
29.
\v'A. Hammond, "Death from Inhaling
a Mixture of Chloroform and Alcohol, Alii. J. ivIed.
Sci. 2 5 ( 1 858):4 1 .
30.
J.A. Aldrete, G.A. Marron, A.J. Wright,
"The First Administration of Anesthesia in Military
Surgery. On Occasion of the Mexican-American
War," Anesthesiology 6 1 (1984):585-588.
31.
AJ . Aldrete, "Contribuciones hispanoamericanos a la anestesiologia," Medeco Interamericano
16(1997):396-404. R Fernandez del Castillo, "Cuando
y pOI' Quien se aplico pOI' primera vez en Mexico la
anesthesia pol' inhalacion?" Gaceta lvIedica de Mexico
78(1 954):265-278.
32.
John B . Porter, "Medical and Surgical
Continued
0/1
Page 26
12
BULLETIN OF AN ESTHESIA HISTORY ������
MedNuggets
by Fred J. Spielman, M.D.
Department ofAnesthesiology, University ofNorth Carolina
Probably no other field of medical practice
has been as neglected in yea r's past-even
today probably no other field of medical
practice is less well understood. This lack
of unde rstanding of the importance of
a n e s t h e s iology may be s u ffi cie ntly
widespread that it can constitute a serious
hazard to the advancement of the specialty.
-Editorial
Anesthesiology, 7:668, 1 946
The time upon the operating table has
always been a dramatic hour, with the
surgeon and the patient taking the leading
roles and the instrument nurse and the
anaesthetist granted more or less minor
parts.
-Ralph T. Knight
Canadian MedicalAssociationJou1'llal
5 5 :562, 1 946
The introduction and development of
surgical anesthesia has been, next to the
printing p ress, man's greatest contribution
to the welfare of man.
-John B . Dillon
JAMA 1 90 : 1 23, 1 964
It is a self-evident fact that anaesthetists
united in one l a rge, virile body can do
much to advance the science and p ractice
of anaesthesia, and it behoves those of us
who a re alive to the possibilities of unity to
give the matter attention and thought.
-Editorial
British Journal ofAnaesthesia 1 :3, 1 923
The day has passed when it can be said
that one or two anesthetic procedures will
cover all cases. The development of special
surgical technics not only necessitates the
development of s p e c i a l anesthetic
techniques but depends on t h e i r de­
velopment.
-John B. Dillion
Joumal of theAmerican Medical Association
1 33:829, 1 947
It is not enough that good anesthesia can
be given and that it is given to a fortunate
few. What is of real importance is that all
anesthesia shall be the best that modern
knowledge affords. And this desirable end
can b e reached only when the public
recognizes the need and the importance of
good anesthe s i a . It is only with such
recognition and with such understanding
that the anesthetist will receive that public
rega rd and p ublic support which a re
essential to the fullest development of his
calling.
-Howard W. Haggard
Anesthesiology 1 : 1, 1 940
It now appears possible for an anesthetist
to be sued successfully for damages if he
carries out some act at the request of the
s u rgeon which is followed by s e rious
complications, such as the application of
an Esmarch bandage or tying up a patient's
a rm in a c e rtain p o s ition, or the
maintenance of a steep trendelenburg slope
for a considerable time.
-Editorial
Anaesthesia 7:3, 1952
No d e p a rtment of s u rg e ry h a s shown
g re a tel' development than t h a t of
anesthesia; on the other hand, in perhaps
no other department of medicine has there
been greater diversity of opinion regarding
methods.
-George W. Crile
AmericanJoumal of SurgelY 1 4:288, 193 1
But to our country and century is the world
indebted for the discovery and application
of anaesthetics for the purpose of rendering
p e rsons i n s e nsible u n d e r s u rg i c a l
operations. If Ame rica h a d contributed
nothing more than this to the stock of
human happiness, the world would owe
her an everlasting debt of gratitude.
-J .G. Johnson
Bulletin of the Medico-Legal Society of New
York 4:3, 1 8 8 1
An anesthesia service i s of use outside the
operating room. The evaluation of the
anesthetic risk involved in the patient, the
use of depressant drugs for the nonsurgical
relief of pain, the employment of anesthesia
block to aid in diagnosis as well as in
therapy, and the supervision of oxygen
therapy all fall within the province of a
department of anesthesia.
-Erwin R. Schmidt
SurgelY 6 : 1 77, 1 939
It is the right of the physician or medical
anesthetist, not that of the nurse, to select
the anesthetic and insist on his own choice
of p reoperative sedation and opiate. In the
Continued
011
75th Anniversary of
Academic Anesthesia
The Anesthesia History Association will meet on
June 1 0- 1 3, 2002, in Madison, Wisconsin,
to celebrate the 7yh Anniversary
of Ralph Waters' arrival on the
Faculty of Medicine, University of Wisconsin.
Interested individuals please contact:
Lucien E. Morris, M.D.
1 5 670 Point Monroe • Bainbridge Island, WA 98 1 10
Phone: 206/842-8089 • Fax: 206/842-3521
page 2 7
From the Literature
by A .J. Wright, M.L.S.
Department ofAnesthesiology Librmy, University ofAlabama at Birmingham
Note: In general, I have not examined articles
that do not include a notation for the number of
references, illustrations, etc. I do examine most
books and book chapters. Books can be listed in
this column more than once as new reviews
appeal: Older articles are included as I work
through a large backlog of materials. Some list­
ings are not directly related to anesthesia, pain
or critical care but concern individuals impor­
tant in the histOlY of the specialty [i. e. , Harvey
Cushing]. Non-English articles are so indicated.
Columns for the past several years are avail­
able in the 'Ylnesthesia HistOlY Files" at http:/
/www.anes.uab.edu/aneshist/aneshist.htm as
"Recent Articles all Anesthesia HistOlY. "
esthesia. Allaesth Imens Care 29:3, 2001 [Cover
note. 1 illus., 5 refs.]
Caton D. \fIhat a Blessing She Had Chloro­
Mullins RJ. A historical perspective of trauma
Brody H, Rip MR, Vinten-Johansen P, Paneth
system development in the United States. J
N, Rachman S. Map-making and myth-making
ll'auma Inj Infect Crit Care 4 7(3 suppl):s8-s14,
in Broad Street: the London cholera epidemic,
September 1999 [41 refs.]
1854. Lancet 356 :64-68, 2000 [3 illus., 22 refs.]
Nicholas G. DePiero, M.D., 1915-2000. ASA
Calmes SH. World War II anesthesia and sur­
Newsletter 65(2):37, February 2001 [obituary; I
gery: Bataan and Corregidor. CSA [California So­
portrait]
ciety ofAnesthesiologists} Bulletin 4 9 (1):24-28, Janu­
ary-February 2000 [3 illus., 5 refs.]
thing new [oral airway]. Anesthesiology 92:913-
Caine R. The fllllstrated His!OIY ofSu rgelY. 2nd
ed. Fitzroy Dearborn, 2001 [includes material on
early anesthetics]
Clark RB, Cleland JE. John G.P. Cleland:
Anesth 10:55-57, 2001 [2 illus., 9 refs.]
Anesthesia
Company
[http://
www.uwm.edu/People/foreggerl] Can J Anesth
4 8:99-100, 2001
form: The Medical alld Social Respol/Se to the Pain of
Drury PME. Published anaesthesia history.
Childbirth from 1 800 to the Present. New Haven:
Cu rl' Anaesth Crit Care 11 :338-343, 2000 [38
Yale University Press, 1999 [Rev. Giesecke AH.
refs.]
Anesthesiology 94 :548-549, 2001]
918, 2000 [Correspondence. 11 illus., 24 refs.]
Roy RC. Insights into the American Board of
Am J Anesthesiol 27(1):41-4 4 , January-February
2000 [4 refs.]
Royster RL. An exemplary man and career.
Doyle DJ. New media: web page review: Death
An
Rendell-Baker L. From something old some­
Anesthesiology from its booklets of information.
discoverer of pain pathways in labor. lilt J Obstet
of
Books
2001 [1 portrait]
Gochenour P. Franz Anton Mesmer; 1 733-
[profile of Francis M. James, III, MD] Am J
Anesthesiol 27(1):25, January-February 2000
Still A, Harvey AM. Resident section: from
vision to success. ASRA Newsletter February 2001,
pp 2-3
Teitelbaum GP. A brief history of angiogra­
phy and endovascular therapy. Sem Anesth Pe riop
Med Pain 19:237-240, 2000 [4 0 refs.]
Fink BR, McGoldrick KE, eds. Careers in An­
1815; Swiss physician. In: Schlager N, ed. Science
Thoman CJ. Sir Humphry Davy and Fran­
esthesiology: Two Posthumous lYlemoirs. Park Ridge,
and Its Times: Understanding the Social Significance
kenstein. J Chelll Ed 75:495-496, 1998 [13 refs.]
Ill.: Wood Library-Museum of Anesthesiology,
of Scientific DiscovelY. Volume 4 , 1700-1799. De­
2000 [rev. Cass N. Allaesth lIltellS Care 28:71 2,
2000]
troi t: Gale, 2000, pp 1 71-172
Gochenour P. Mesmerism: a theory of the soul.
Toski JA, Bacon DR, Calverley RK. The his­
tory of anesthesiology. In: Barash PG, et ai, eds.
Clinical Anesthesia. 4 th
ed. Philadelphia:
Fullmer JZ. Thung HumplllY Davy: The Mak­
In: Schlage r N, ed. Science and Its Times: Unde r­
Lippincott W illiams & W ilkins, 2001, pp 3-24.
ing of All Experimental Scientist. Philadelphia:
standing the Social Significance of Scientific Discov­
[8 illus., 83 refs.]
American Philosophical Society, 2000.
ely. Volume 4 , 1 700-1799. Detroit: Gale, 2000,
Lett Z, Joy-Wah RL, eds. Anaesthesia alld In­
pp 1 23-125 [3 refs.]
W idman B, Lisander B. Bertil Lofstrom:
30.6.1922-23.9.2000. Acta Anaesth Scand 45:138-
tensive Care in Hong Kong: Evolution and Present
Goerig M, Agarwal K, Schulte am Esch J. The
Position . Hong Kong: University of Hong Kong
versatile August Bier (1861-1949), father of spi­
Wright AJ. Laughing gas in 1799. In: Schlager
Centre of Asian Studies, 1997 [Rev. Alexander
nal anesthesia.J Clin Anesth 1 2:561-569, 2000 [9
N, ed. Science alld Its Times: Unde rstanding the
JP. E u r J Anaesthesiol 18:127, 2001]
illus., 43 refs.]
Social Significance ofScientific DiscovelY. Volume 4 ,
1700-1799. Detroit: Gale, 2000, p 1 4 5
Livingston W K. Pain and Suffering. IASP Press,
1998. [Rev. Long DM. Bull Hist Med 73:736-
Greene NM. Laureates of the History of An­
esthesia, 2000. Slirv Anesthesiol 45:67, 2001
139, 2001 [obituary; 1 portrait]
Wright AJ. James Watt; 1 736-1819; Scottish
737, 1999; Stewart J. Call J Anaesth 47:604-605,
2000]
Hamilton RC. Sir Harold Ridley, MD, FRCS,
inventor and scientific instrument maker. In:
FRS; inventor of the intraocular lens implant.
Schlagel' N, ed. Science and Its Times: Understand­
Reves JG, Greene NM. Anesthesiology and the
Cu rl' Anaesth Crit Care 11:314-319, 2000 [8 illus.,
ing the Social Significance of Scientific DiscovelY .
13 refs.]
Volume 4 , 1 700-1 799. Detroit: Gale, 2000, pp
Academic Medical Center: Place and Promise at the
Sta r t of the New Millenn iu m . Philadelphia:
Hanson CW III, Marshall BE. Artificial intel­
Lippincott W illiams and W ilkins, 2000 [lil t
ligence applications in the intensive care unit.
Zuck D . Snow, Empson and the Barkers o f
Anesthesiol Clin Volume 38, number 2, spring 2000;
Crit Care Med 29:4 27-435, 2001 [Reviews his­
Bath. Anaesthesia 56:227-230, 2001 [ 3 illus., 8
rev. Friedman R, Krasnor L J , Allesth Analg
91 :1566, 2000]
tory and current applications. 6 illus., 2 tables, 54
refs.]
refs.]
Articles and Book Chapters
War. Plz a r m Hist 4 2: 6 7-86, 2000 [9 illus., 178
AHA David M. Little Prize. Am J Anesthesiol
28: 31, January/February 2001
Albin MS. The use of anesthetics during the
Civil War, 1861-1865. Pharm His! 4 2: 99-114 ,
2000 [14 illus., 3 tables, 70 refs.]
Bacon DR. August Bier's legacy: more than
just a pioneer in regional anesthesia?J Clin Anes!h
12:501-502, 2000. [editorial; 5 refs.]
Ball C, Westhorpe R. Modern developments­
Hasegawa GR. Pharmacy in the American Civil
refs., 2 appendices]
In memoriam: Albert M. Betcher, M.D.
NYSSA [New Thrk State Society ofAnesthesiologists}
Splzere 51 (4):24-25, October-December 1999 [1
portrait]
Kean C. Gertie Mark called the "mother of
obstetric anesthesia." Anesthesiology News 27(1):1,
4 8-49, JanualY 2001 [1 illus., 1 table]
Mackenzie IMJ. The haemodynamics of hu­
plastic cannulas and the Court butterfly needle.
Anaesth Imens Care 28:603, 2000 [Cover note. I
illus., 3 refs.]
man septic shock. Anaesthesia 56:130-1 4 4 , 2001
Ball C, Westhorpe R. Early intravenous ana-
Fink, M.D. (1914 -2000). SIIl'V Anesthesiol 45:1-2,
[2 illus., 1 table, 164 refs.]
McGoldrick KE. In memoriam: B. Raymond
4 3 7-4 3 8
-r­
:$.
Yi'
14
BULLETIN O F ANESTHESIA HISTORY
����
Nineteenth-Century Medical Landscapes : John H. Rauch,
Frederick Law Olmsted, and the Search for Salubrity
by Bonj Szczygiel and Robert Hewitt*
Department ofLandscape Architecture, The Pennsylvania State University
A fascinating period of urban design de­
veloped during the nineteenth century in
America. Its course was relatively short­
lived, but its underlying ideas pervaded the
American mind-set and influenced the built
environment through the development of
what could be called a salubrious urban land­
scape. This new landscape was in large part
the result of medical theories advocating ei­
ther the elimination or the accentuation of
natural and built environments, based on
their disease and health potentials. Those
medical theories postulated that disease­
laden air-often called miasma or malaria­
was produced by particular landforms, cli­
mates, animal waste, and vegetable decom­
position, and was the source of epidemic dis­
ease.1
The impact of the miasmatic theOlY on
the landscape in the United States was felt
most fully from the l 840s into the l 880s-at
which time it was largely discredited by the
medical profession, although it continued to
be embraced by sanitarians and lay persons
well into the l 890s.2 During this period the
medical community had greater influence on
the physical shape of the city than at any
other time in America's history. The impact
of this health/environment dualism was ex­
tensive and has resulted in contemporary
examinations by many historians regarding
its social, economic, political and architec­
tural consequences.3 A brief list of some of
the topics investigated includes the public
health movement, the establishment of ur­
ban sanitalY infrastructure and street im­
provement, the development of antiurban
sentiment in the reform movement, the cre­
ation and modification o f new building
types, the rise of suburban development, and
the rural cemetelY and urban park move­
ments.4 Despite these numerous investiga­
tions, limited attention has been paid to the
interpretation and application of specific
medical theOlY as applied to the design of
cities.s The purpose of this paper is to docu­
ment that correlation through an examina­
tion of the shared vocabularies of place and
*Szczygiel, Bonj and Robert Hewitt. Nine­
teenth-Century Medical Landscapes: John H.
Rauch, Frederick Law Olmsted, and the Search
for Salubrity. Bulletin of the History of Medicine
74:4(2000), 708-734. © The Johns Hopkins Uni­
versity Press. Reprinted with the permission of
the Johns Hopkins University Press.
environmental characteristics developed by
nineteenth-century physicians and urban
designers. We suggest that this shared vo­
cabulary was a result of several factors: the
ascendance of environmentally based theo­
ries in nineteenth-century etiologic thought
and the broad acceptance of miasma theories
by American physicians; the ensuing inter­
pretation and incorporation of those envi­
ronmental characteristics within designs
proposed by physicians and urban design­
ers; and the subsequent general public ac­
ceptance and di ffusion of ideas about
environment's link to health and disease.
We will focus first on nineteenth-century
American theoretical responses-especially
the importance of environment-based theo­
ries at mid-century-and the role of medical
topographies, the U.S. Sanitary Commission,
and sanitary reform in the popularization of
those theories. We will then examine the
writings and ideas of two prominent citizens,
John Henry Rauch and Frederick Law
Olmsted, to determine how medical theOlY
influenced built form. Chicago physician
Rauch was a staunch proponent of mias­
matic theory and a national leader in the
public health movement. His medical re­
ports and environmental analyses of Chi­
cago resulted in specific urban interventions
that ultimately a ffected that city's form.
Olmsted, the preeminent landscape archi­
tect of his centUlY, helped to develop a de­
sign vocabulary that incorporated miasma
theories and shaped urban morphology. The
representative roles of physician as observer,
theoretician, and advocate of environmental
change, and of landscape architect as inter­
preter, advocate, and implementer of medi­
cal theory, are not unique to Rauch and
Olmsted. While the identification of a shared
vocabulary is significant in establishing the
critical linkage between medical theOlY and
its cross-disciplinary application, the par­
ticular significance of our study is the scope
of the theOlY's subsequent effect on urban
landscapes widely accepted then, and now,
as the uniquely American urban condition.
Miasmatic Definitions and Influence
on American Medicine
Inspiration for the miasma-based etiol­
ogy was originally provided by the Hippo­
cratic treatise Airs, Waters, Places. This trea­
tise, in its many interpretations, influenced
Western Europe over the centuries, until mid­
nineteenth-century experiments directed
medical attention toward a germ etiology.6
The Hippocratic environmental inquiry was
also utilized in eighteenth- and nineteenth­
century America. To understand its develop­
ment in America, medical historiography of
nineteenth-century Britain offers valuable
insight regarding miasma's ascendance and
evolution into an adaptable, and therefore
credible, theory. Indeed, John Harley Warner
suggests that American physicians paid par­
ticular attention to medical trends in Brit­
ain during this time because of the similari­
ties they found there to American medical
practices. American physicians, he explains,
"looked to Britain not so much for a source
of therapeutic change as for a voice to second
their own therapeutic positions."? Therefore
a brief look at British etiologic thought re­
garding the role of miasma is warranted.
Of particular interest is Christopher
Hamlin's recent exploration of the complex
dynamic of nineteenth-century British medi­
cal dialectics and etiologic stance. Hamlin
presents an alternative framework to the tra­
ditional contagionists vs. anticontagionists
discussion by suggesting that the medical
dialogue was actually about "predisposing"
causes-elements that act upon the patient
to weaken disease resistance-and "exciting"
causes, which have a direct or immediate ef­
fect on an individual's health. He describes
the development of the British public health
movement as a shift away from a wholistic,
socially based understandirtg of disease
(predispositionists) toward the Chadwickian
concept of public health that focused upon
an environment-based, miasmatic impera­
tive as a single exciting cause. To Hamlin, it
was this dismissal of predisposing factors
that led to an "absurd Chadwickian ortho­
doxy."8 He also describes an important de­
velopment in the miasmatic argument that
helps to explain its presence in public health
policy-namely, Southwood Smith's recon­
stitution of the definition and function of
the exciting cause (exposure to miasma) into
a predisposing role as well, capturing both
arguments in one. It was that transforma­
tion which "effectively emasculated the con­
cept of predisposition by enormously expand­
ing the importance of an hypothetical mor­
bid poison."9 By allowing exposure to mi­
asma to play the role of predisposing the
t
victim to disease, the argument became much
more adaptable to the many manifestations
of illness and helped to explain the degree to
which certain individuals were more suscep­
tible than others.
An example ofthe liberating effect of such
an etiologic modification can be seen in an
1 851 report by an American almshouse phy­
sician, Thomas Hepburn Buckler, on a chol­
era outbreak that had occurred at his insti­
tution, near Baltimore. He described deadly
miasmatic exhalations emanating from over­
flowing privies and decomposing animals
as predisposing the residents to the disease.
The same "morbid poison" was also respon­
sible for diminishing their chances for re­
covelY. While he carefully avoided drawing
a conclusion on the cause of the outbreak,
referring to it as an "indigenous disease" of
"spontaneous origin" in the unhealthful en­
vironment surrounding the almshouse, he
did venture to suggest that "the disease de­
pended on some wide spread influence, which
required in every instance the operation of
miasmatic or malarious exhalations to bring
it into action. It is only at the cross-roads of
the general and local cause ... that the disease
was found."l0 The concept of predisposition
is subsumed within the miasmatic etiology
asutilized by Buckler. His description is in
step with Southwood Smith's mid-1830s con­
tribution to the growing miasma-based pub­
lic health policy in Britain. Buckler, as had
Smith, suggested that the exciting cause (the
miasmic gas) by its very presence acted as a
predisposing element, serving first to weaken
the physical constitution and then to bring
the disease into action. Buckler clearly saw
the impact of miasmatic exposure over
time, for he described a pattern in which
medical students "florid with health"
would soon become sickly, pale, and dull
from exposure to the almshouse.ll During
the cholera outbreak it was determined
that "the malaria acting probably as the
strong predisposing cause of ill health,
exerted its influence by depressing the ner­
vous system and lowering vitality. . . Thus
predisposed, the inma tes were rendered not
only more susceptible to the . . . morbid poi­
sons, or to the action of any other exciting
causes of disease; but. . . their chances of
recovery were greatly diminished."12
With this dual function, miasma could
be considered a plausible explanation for the
seeming vagaries of disease-which does much
to explain its presence in medical theolY and
its eventual adoption in public health policy.
But this alone does not sufficiently explain
the overwhelming acceptance of environ­
ment-based etiology byAmerican physicians.
It would take a perceived crisis within the
profession to complete the transformation.
Warner's work regarding the principle of
specificity charts the tumultuous waters of
the medical profession in the early to mid­
nineteenth centmy as it attempted to rede­
fine its role in society. This was a period in
which the profession became solidly aligned
with an environmental imperative and an
empiricist approach.
In 17ze T71erapeutic Perspective, Warner
describes the change in the American medi­
cal profession's epistemologic approach, be­
ginning in the second quarter of the nine­
teenth centmy, as "among the most impor­
tant and revealing transformations of medi­
cal therapeutics in nineteenth-century
America."13 Citing the level of "desperation"
felt within a profession that believed itself to
be in decline, he documents the critical shift
from rationalistic systems and aggressive
treatment--epitomized by the teachings and
practice of Benjamin Rush-to a reliance on
medical theory that embraced the principle
of specificity, defined by Warner as an "indi­
vidualized match between medical therapy
and the specific characteristics of a particu­
lar patient and of the social and physical
environments."14 From the 1820s to the 1850s
the principle of specificity-and the envi­
ronmental empiricism it heralded-had
come to represent the American medical
profession's quest for professional unity and
public approbation, both of which had seri­
ously deteriorated in the first part of the cen­
tury. Specificity required making observa­
tions both at the bedside and in the locale:
''As long as specificity rather than universal­
ism reigned, much of the wisdom valued by
the profession was necessarily tied to the
place where it was generated and used: it was
in essence local knowledge."15 A great deal of
effort therefore went into meteorologic and
landform observations and the documenta­
tion of disease in a given area, which in turn
were analyzed with a keen eye to etiologic
indications. Miasmatic theOlY was comfort­
ably in step with this new intellectual direc­
tion taken by the medical profession.16 The
constant pressure for urban growth, the at­
tendant threat of epidemic disease, and the
accepted principle of specificity with its
awareness of place and climate suggest an
intellectual climate that supported mias­
matic explanations among American medi­
cal professionals. With the ascendance of
miasmatic theory, and the expanding scope
of environmental inquilY, an attendant shift
in landscape perception followed. Natural­
istic and man-made landscape and urban
conditions were seen increasingly in terms
of their benign and pathogenic characteris­
tics.
Dissemination of miasmatic theories
among the medical profession occurred
through medical journals, physicians' re­
ports, and medical topographies. The last
was an important method for communicat­
ing these ideas to one another, as well as to
interested laypersons. The on-site observa­
tions recorded particular geographic combi­
nations, which, in turn, were linked to physi­
cal health. Salubrity was clearly associated
with landform and atmosphere.
Miasma in Medical Topographies, and
the Development of Salubrious Land­
scapes
It is well known that musquetoes
[sic] and other noxious insects are
most numerous in wet and marshy
places ...where morbific miasmata are
exhaled in greatest quantity and con­
taminate the atmosphere. It may there­
fore be considered an indication of
nature, that wherever those insects are
very numerous, there also unwhole­
some exhalations prevail, inimical and
dangerous to health, and destructive
to human existence.
-Jabez W. Heustis, M.D., 181717
Given the immediate and pressing issues
of urban health, the landscape with its pock­
ets of "unwholesome exhalations" must have
held significant appeal as a topic for investi­
gation. Not only was the landscape compre­
hensible, but it could be manipulated with
immediate results, and the atmosphere could
be measured (temperature, wind direction,
rainfall, etc.), providing clinical data ripe
for interpretation. Very early evidence of this
tendency toward environmental analysis is
seen in the advice tendered by Cadwallader
Colden after a 1741 yellow fever epidemic
hit New York City. Colden, a physician and
lieutenant governor of the state, wrote of the
crucial link between environment and ur­
ban health in a 1743 essay, "Observations on
the Fever which prevailed in the City of NewYork."18 His report in large part consisted of
an abstract of the work of Giovanni Maria
Lancisi (l 654-1nO)-physician to Pope
Clement XI. A contemporary of Colden,
Lancisi wrote of the fevers in Rome caused
by faulty air and soil, suggesting that the
different states of the vapors caused differ­
ent symptoms, and that Rome needed to be
cleaned and its system of disposing of refuse
improved. Then, by way of advice, Colden
cited the success of London in ridding itself
of the plague by adopting improvements in
drainage and street configuration. Before the
great fire in that city, Colden explained, the
streets were narrow, ill-paved, and with few
drains. After the fire, new streets were built
to better standards: they were straight, open,
Contillued
all
Next Page
16
BULLETIN O F ANESTHESIA HISTORY ������
Rauch
.
.
.
Continued from Page 1 5
sufficiently wide for the free flow of air, and
had many drains. As a result, he wrote, the
plague was absent for many years. Proof has
not been found that New York City officials
implemented his suggestions, but past au­
thors have stated that this was likely. 19
Colden was an early harbinger of an
e n s u i n g p e r i o d o f environm e n t a l
investigation i n the nineteenth century.
The popular empirical method for
investigation was the medical topography,
used by Northern European physicians in
the seventeenth and eighteenth centuries
as they chronicled unfamiliar climates,
flora, fauna, and disease. The classical
medical topography adopted by like­
minded American physici a n s in t h e
nineteenth century w a s influenced b y a
growing interest in the development of
statistical data in urban France, and was
theoretically aligned with the Chadwickian
miasmatic theory.2o Widely published, the
new topographies significantly influenced
the exchange of i d e a s , research, and
medical theory in America. Evidence of
such exchange is found in Heustis's 1 8 1 7
medical topography o f Louisiana (cited
above), in which he refers to the work of
Thomas Sydenham and states confidently:
It is a fact confirmed by the gen­
eral experience of mankind, that dis­
eases are essentially influenced and
diversified in their character and
symptoms, by the local circum­
stances of climate and situation. In
all inquiries, therefore, upon the sub­
ject of endemic diseases, the physi­
cal appearance and condition of the
country are entitled to primary con­
sider a tion. 2 1
The condition of the city, in particular,
came under close scrutiny. As early as 1795,
Matthew Davis recognized that the "part
of the town very much crowded by poor
inhabitants, and contain [ing] a great num­
ber of lodging houses . . . is unquestion­
ably the most unhealthy part of the city."22
By the 1 830s, medical topographies had
shown much higher morbidity and mor­
tality rates in the cities than in rural ar­
eas, and it became increasingly accepted
among medical theorists that the locus of
disease was the dirty, crowded industrial
city. In addition, specific landforms-es­
pecially those with water as a component­
were identified and labeled according to
their benign or pathogenic character. Wil­
liam Currie's Historical A ccount of the Cli­
mate and Diseases of the United States of
America (1792), James Lind's Essay on Dis­
eases Incidental to Europeans in Hot Climates
(1 8 1 1 ), and Lionel Chalmers's Account of
the Weather and Disease of SOllth Carolina
(1 8 1 5 ), to name a few, associated disease
with swamps, fens, marshes, and mist. Rep­
resentative of the era, Lind suggested that
"a copious vapor from water, mud, and all
marshy or damp places"23 was long associ­
ates with epidemic disease, and that "the
surface of the ground in many places be­
comes hard, and encrusted with a dry scurf,
which pens up the vapors below, and, by a
continuance of the rains for some time, this
crust is softened, and the long pent up va­
pors set free which thence [also] become
the cause of sickness."24 One of the most
frequently invoked prescriptions (shared
by these authors) for the control of miasma
was to drain damp and saturated lands
and to provide plenty of fresh air. Heustis
also indicated the role of wind direction as
a precipitating cause of scurvy; rainy sea­
sons, he advised, especially render the dis­
ease epidemic and m alignant. D aniel
Drake further refined soil, wetland, tem­
perature, seasons, water-bodies, and settle­
ment characteristics as significant environ­
mental elements in disease causation. In
his exhaustive Systematic 7l'eatise (1 854),
he described soil composition as a critical
factor in autumnal fever, noting that de­
caying organic matter supplied "the mate­
rial o u t of which a p o i s o n o u s g a s i s
formed," and that, "all other circumstances
being equal, autumnal fever prevails most
where the amount of organic matter is
greatest and least where it is least."25 He
suggested that solar heat was a significant
factor in the etiology of yellow fever: it
"impregnate [d] the air with vapor, giving
it a high dew point,"26 and evaporated "the
superfluous water of ponds, swamps,
marshes and lagging streams . . . promot­
ing the extraction of gases" and the as­
sumed undiscovered gas malaria.27 Cata­
racts and rapids were, in his opinion, es­
pecially unhealthy because they liberate
gases by agitation.
Drake's, Currie's, and other physicians'
studies provided a medical basis for the
elimination, remediation, and enhancement
of landscapes associated with specific soil
types, climates, topographies, and settlement
patterns. As the ethnologic evidence
mounted, so did the impulse toward the de­
velopment of a body of landscape and urban
design responses to the threat of disease. In­
dicated as problematic were moving water­
especially if there were a high degree ofwater
agitation-standing water, moisture in the
soil, the presence of wetland conditions, a
lack of air circulation (in streets and dwell-
ings), high population densities, and the
decay of vegetative and animal matter. Con­
sidered remedial were the presence of trees
for oxygenation and mechanical cleansing
ofthe air,wide and well-drained streets, fresh
air, wide open spaces, and the removal of
miasma-generating elements, such as grave­
yards, located near human habitat. Mias­
matic theory incorporated these environmen­
tal characteristics in its rationale of disease
causation, which in turn formed the basis
for the creation of benign environmental
typologies. These typologies include parks
and open spaces; the planting of street trees;
the removal of urban wetlands and cemeter­
ies; the filling of low-lying lands; the
straightening and!or widening ofstreets; and
the design of new boulevards and suburbs.
It was on the basis of these landscape
typologies that a new design vocabulary was
provided to public health officials, environ­
mental designers, and city officials that
would then be translated into a distinct ur­
ban morphology.
Transformation into Urban Morphology
How was this theoretical environmental
framework translated into public informa­
tion, and eventually into the urban land­
scape? How did medical theory turn into built
form? We suggest that this transformation
was the result of a convergence of factors
around mid-century, with emphasis on the
birth of the public health movement. The
Civil War has been described as a watershed
event in the histOlY ofthe public health move­
ment, which, into the twentieth century, still
adopted miasmatic theories as basic to sani­
tary reform. The nudge toward public health
came from the U.S. Sanitary Commission,
which had adopted a miasmatic etiology as
evidenced in their medical reports. These re­
ports were published to disseminate the lat­
est, and most practical, medical knowledge
to physicians in the field. Under the guid­
ance of the general secretary of the Commis­
sion, Frederick Law Olmsted,2s a series of
brief essays or handbooks were printed and
distributed among medical officers in the
army. In one report written in 1 861, entitled
"Military Hygiene and Therapeutics," it was
suggested that when first locating a camp it
was important to avoid marsh lands, or ma­
larious areas. If it was necessary, for strate­
gic purposes, to camp in the vicinity of an
extensive marsh, "the ground should always
. . . be selected on the windward side, so that
the prevailing winds should carry away the
noxious emanations from the soil."29 Regard­
ing the location and design of the regimental
hospital (referring to both pew structures and
the adaptive reuse of churches and school
Continued on Page 20
Wood Library-Museum of Anesthesiology Dedicates the
Mayo Clinic Room Honoring Pioneer Anesthesiologists
Patrick Sim, Librarian
WOod Library-Museum ofAnesthesiology
The Board of Trustees of the Wood Li­
brary-Museum named the office of the
Hon. Curator the MAYO CLINIC ROOM
at its recent meeting held in Park Ridge,
IL, honoring the memory of two promi­
nent Mayo Clinic anesthesiologists, John
Silas Lundy, M . D . , and John William
Pender, M.D. The dedication ceremony
took place immediately after the meeting
adjourned on Friday, March 2, 2001, at
the WLM museum gallery.
The officers of the American Society of
Anesthesiologists, and the trustees of the
Wood Library-Museum j ointly attended
the dedication. A S A P re sident, Neil
Swissman, M.D., acknowledged the con­
tributions of Mayo Clinic anesthesiologists
to the specialty, particularly those of Mayo
anesthesia founder, Dr. John S. Lundy, and
his close associate, Dr. John W. Pender, who
recently passed away. President Swissman
further praised Dr. Pender whose gener­
ous monetary contribution endows the
Mayo Clinic Room. WLM president Dr.
Donald Caton expressed the gratitude and
appreciation of the Board for Dr. Pender's
generosity. He extended his welcome to
the guests attending this event, and intro­
duced other speakers at the dedication. Dr.
Alan D. Sessler, former dean of the Mayo
DI: Alan Sessler signs the MAYO Book
dedication.
From Left to Right, Donald Caton, M.D., Elliott Millel� M.D., Neil Swissman, M.D., Mark
Warnel� M.D. and Alan Sesslel� M.D.
Medical School, and former chair of its
department of anesthesiology, recounted
the development of anesthesiology at
Mayo, describing its leaders who served
and developed the department for more
than seven decades. Dr. Sessler described
the close professional relationship between
Dr. Lundy and his able and valued assis­
tant "Bill" Pender. D r. Elliott V. Miller
described D r. Pender's life and medical
career, in p articular highlighting D r.
Pender's role as an anesthesiologist serv­
ing in the U.S. Navy, providing anesthesia
to President Franklin D. Roosevelt at the
president's major surgery.
Representing the Mayo Clinic Depart­
ment of Anesthesiology, D r. M a rk A.
Warner presented the plaque of the Mayo
Clinic Room, which is affixed to the out­
side wall of the Hon. Curator's office. Dr.
Warner, who chairs the department of an­
esthesiology at Mayo, observed the remark­
able growth of anesthesia at Mayo from
the pioneering days of D r. Lundy to its
present status in academic and clinical
anesthesia. He presented a framed collage
of portraits of distinguished anesthesiolo­
gists in the history of his department who
went on to become national leaders serv­
ing the American Society of Anesthesiolo­
gists. A picture of the Mayo Clinic of the
1990s vintage in Rochester, MN will also
grace the Mayo Clinic Room. Dr. Warner
further presented to participants at the
dedication copies of a new book of biogra­
phies of Mayo anesthesiologists written by
Kai Rehder, Peter Southorn and Alan
Continued
all
Next Page
D,: Charles Tandy shares rare book
acquisitions.
IS
BULLETIN OF ANESTHESIA HISTORY �������
Dedication
.
.
.
COlllilllled ji-Olll Page 1 7
Sessler, titled Art t o Science, [Rochester,
MN, Mayo Clinic, 2000.] Dr. Sessler gra­
ciously obliged autograph seekers at the
Mayo Clinic Room as he presented his
books. Interested individuals for copies
of the book should direct their requests to
Dr. Mark Warner, Chair, Department of
Anesthesiology, Mayo Clinic, 200 First
Street, Sw, Rochester, MN 5 5905.
The dedic ation of the Mayo Clinic
Room was made possible by a very gener­
ous grant from John W. Pender, M.D., a
distinguished Mayo alumnus, trusted resi­
dent of Dr. Lundy, former editor of the jour­
nal, Anesthesiology, and a former trustee
of the Wood Library-Museum. Among his
numerous contributions to anesthesiology,
Dr. Pender co-founded the oral history
program for the Wood Library-Museum
with his friend and fellow-trustee, John J.
Leahy, M.D., in the mid-1960s. At a time
before the advent of the videotaping tech­
nology, Dr. Pender would collaborate with
Dr. Leahy, planning oral history interviews
of prominent anesthesiologists at national
meetings in order to provide quality prod­
ucts for posterity with a very limited bud­
get. Dr. Leahy would haul and operate his
personal movie equipment, while D r.
Pender would conduct his interviews,
which were fondly named "Men of Anes­
thesia," and made into 16-mm films. This
collection has grown to become the "Liv­
ing History of Anesthesiology," with the
original films converted to videocassette
tapes. Drs. Pender and Leahy's project
has evolved to involve the service of a full
committee within the WLM co-chaired by
Dr. Alan S e s sler and D r. M a ry Ellen
Warner. The collection has grown to more
than 150 titles comprising a comprehen­
sive panorama of modern anesthesiology.
Despite its growth in more than three de­
cades, the guiding principles for the pro­
duction of this oral history program re­
main unchanged. It still is produced on a
very austere budget, with easy to under­
stand technical guides written by Dr. Leahy.
The WLM oral history program has been
renamed "The John \YI. Pender Living His­
tOly of Anesthesiology," which has benefited
from Dr. Pender's generous gift for its fu­
ture development and preservation.
The Mayo Clinic Room now perma­
nently honors an outstanding institution
in American anesthesiology. The memo­
rabilia of Mayo and its alumni in the Mayo
Clinic Room display a glimpse of anesthe­
sia history emanated from Midwestern
America to reach to other corners of the
world of medicine.
WLM Board of Trustees' Meeting and
Dinner March 2-3, 200 1
-
Photographs by Jonathan Berman, M.D.
Dl: Donald Caton
and Patrick Sill! at
the Board oj
Ihlstees' Meeting
Mardi Gras at the BOT
lvIeeting: Dl: Doris K. Cope
and D/: Buddy Giesecke
Dl: Selma Calmes and
. Dl: George Bause at
the MAYO Clinic
Room Dedication.
W'LM BOT Dinnel; From Left
to Right: DI: Ted Smith, DI:
Buddy Giesecke, Rani Giesecke,
and DI: Alan Sesslel:
DI: and Mrs. Ted Smith hosted the
WLM BOT dinner at their Frank
Lloyd Wright home in Riverside, fL.
DI: Lydia Conlay and
D,: Elliott Miller
From Left to Right: DI: W illiam
Ham1ll0nds, DI: Charles Tandy,
Cecilia Caton, and D,: Alan
Sessler
20
BULLETIN OF ANESTHESIA HISTORY
Rauch
.
.
.
������
Colltillued ji-Olll Page 1 7
buildings), ventilation was of special impor­
tance: each patient required no less than 800
cubic feet of fresh air; there should be nu­
merous openings in the walls for cross-ven­
tilation; patients should be located only in
above-ground rooms, because these are much
more salubrious than below-ground quarters;
no unnecessary articles should be in the
rooms because, in part, they would absorb
the noxious vapors; and finally, no window
should open onto areas of foul air.
In another report, entitled "Miasmatic
Fevers," the authors acknowledge their ig­
norance of the "intimate nature" of marsh
miasmata.3o Then, having establishing the
absence of solid theOlY on the topic, they con­
tinue with a lengthy, twenty-three-page de­
scription of its general manifestations and
attendant environmental conditions. John
Duffy states that the U.S. Sanitary Commis­
sion taught disease prevention by advocat­
ing the avoidance of miasmatic conditions
and increased sanitary efforts to a large seg­
ment of the American population, affecting
the lives of millions. That the countlY's first
public health department was formed on the
heels of the war in 1 865 and its emphasis was
on cleanliness and improved ventilation­
the same emphasis given in the military
camps-he suggests, is not a coincidence. He
notes that the equation of disease with dirt
was by then firmly entrenched.3l That claim
is supported in another SanitalY Commis­
sion report written by Elisha Harris, one of
the foremost public health physicians of the
day, in which he indicates the pervasiveness
of the knowledge that pure atmosphere and
proper cleanliness were paramount in the
control of infectious diseases: "We need not
enumerate the sources of a vitiated atmo­
sphere and consequent endemic infections
in camps and barracks; they are known to
every soldier.32
Relative to the education received from
the war experience, the city itselfwas an edi­
fying entity. The worsening of the urban con­
dition and the identification of the dense
urban core as a known locus for disease cer­
tainly played a part in the eventual public
adoption of miasma-based etiology. Urban
historians have written about the changes
taking place throughout the centmy as cities
became increasingly affected by manufactur­
ing and industry; as immigrants and coun­
tty-dwellers filled city streets and housing;
and as inexplicable epidemics took thou­
sands of lives. Cholera was particularly dev­
astating, but not altogether unpredictable.
By mid-century a growing number of physi­
cians and laypersons were coming to recog­
nize the unmistakable correlation of the vast
streams of immigrants and disease. These
observers followed tides of immigrant move­
ment inland and saw cholera occur in their
wake. With its improper sanitation and over­
crowding, the specter of "city" must have
loomed large.
To round out the picture of the growing
obviousness of dense populations and ur­
ban filth as being associated with epidem­
ics, there is recent research that explores
the popular acceptance of sanitary reform.
Nancy Tomes states that, for a variety of
reasons, the "sanitarian message gained an
early and wide hearing among the urban
middle and upper classes."33 She suggests
that historians of medicine and public
health have traditionally dismissed the
antebellum commitment to public educa­
tion adopted by public health officials as
being only peripheral to the story of the
American public health movement. In refu­
tation of this attitude, she describes an in­
formed and individually proactive Ameri­
can public who took steps toward informed
and engaged partner with urban sanitary
reformers. Her research points to a public
widely and actively involved in bringing
the latest medical knowledge into their
homes as public health reformers were
working on the larger urban landscape.
Complementing this idea of public accep­
tance of miasmatic theory, James Cassedy
describes a period in the early nineteenth
century in which well-heeled Americans
traveled to more healthful locations, either
to maintain their good health or for cura­
tive reasons-which suggests that there was
a wide, and rather early, acceptance of the
environmental etiology among the general
publicY
The convergence of these factors, espe­
cially when combined with an ever-increas­
ing awareness that clinical intervention
could actually do very little to change the
course of disease or to stay the associated
incidence of death, suggests a receptive
public in need of guidance. Given the inef­
ficacies in medical practice, the best to be
hoped for was the prevention of disease­
which led physicians, lay health reform­
ers, and the public to concentrate on known
(or at least highly suspected) areas of in­
fluence, such as the physical environment,
personal hygiene, and public sanitation.
As will be seen in the writings of both John
Henry Rauch and Frederick Law Olmsted,
improving the physical environment-in­
cluding the elimination of miasmiatic
landscapes and the implementation of ur­
ban forms thought to negate miasma's
harmful effects-was an essential action
toward the protection of public health. The
emergence of both these men as vocal ad-
vocates for an improved urban situation
can be understood as a product of this mid­
century cultural milieu: Rauch, a physi­
cian responding to his profession's rally
around specificity and environmental ex­
amination; and Olmsted, an intelligent
and socially motivated landscape archi­
tect translating this new medical terminol­
ogy into designed form.36 Rauch, in par­
ticular, was immersed in the contemporary
issues regarding public health. He em­
braced a miasmatic etiology and ardently
argued for both the development of benign
landscapes and the remediation of those
considered pathogenic in his adopted city
of Chicago. This is no better evidenced
than in the two following examples: the
removal of Chicago's City Cemetery, and
the development of the city's first park sys­
tem. In addition, Rauch's association with
Olmsted will be seen to further reflect the
causal link between medical theory and the
urban design theory and practice of that
period.
From Medical T heory to Urban Design:
Rauch's Mission of Health in Chicago
Chicago's early situation was consid­
ered to be precarious, and from its begin­
ning the city fought a national reputation
for unhealthfulness.37 The flat topography,
high water table, and clay soils resulted in
serious drainage problems. As early a s
1835 the Chicago Democrat was goading resi­
dents into action: "The atmosphere has
already become poisoned" as a result of
standing water that was "green" and "pu­
trid" from decaying vegetable matter; "Our
town still continues healthy, but we warn
our fellow-citizens that unless something
be done . . . they may expect sickness and
the pestilence for they will surely come."38
The situation was so severe that the city
e s tablished a D r ainage Commission,
which in 1 852 established a new official
grade necessitating the raising of the streets
and buildings. In 1 857 and 1 868 the "damp
and unhealthful" street grades were raised
again.39
John Henry Rauch (1 828-94) returned
to Chicago after the Civil War, while the
city was struggling with its unhealthy
streets, and promptly began to point to
other health concerns. His achievements
were significant: in 1 849 he had graduated
from the University of Pennsylvania medi­
cal school; he was a professor and chair at
Rush Medical College, Chicago; during the
Civil War he served as a medical director
and surgeon; he was one of the first mem­
bers of Chicago's Board of Health, and that
city's sanitary superintendent from 1867
to 1873. In later years, he was president of
the American Public Health Association
(1 876-77), and the first president of the Il­
linois State Board of Health (1 877). There
is no question that Rauch was a firm advo­
cate of the miasmatic theory and employed
Warner 's specificity principles by measur­
ing atmospheric conditions and making
observations of landforms and decaying
matter, which he then evaluated in rela­
tion to the incidence of death and disease
in the city.
Chicago's City Cemetery
Rauch's influence on Chicago's urban
design began in 1 859 with a report on the
dangers of urban burials entitled Intramu­
ral Interments in Populous Cities and Their
Influence upon Health and Epidemics. Infor­
mally circulated at first and then pub­
lished in 1 866, the report was critical to
the final conversion of the cemetery
grounds into Chicago's first large public
park, Lincoln Park,40 With its circulation
and his continued outspoken advocacy,
Rauch established himself as the city's lead­
ing medical authority on environrnent­
based etiology. In the document he ex­
plained that the decay of vegetable and
animal matter transmits "pestiferous ex­
halations" to exposed air and water, which
are capable of spreading infection; that the
presence of such gases, and those created
by humans in an imperfectly ventilated
space, is an exciting cause of disease; and,
that fresh air can do much to dilute mias­
mata.41 Humans, Rauch determined, re­
quire a minimum of 333 cubic feet of fresh
air each day for proper respiration; a lesser
amount renders the body prone to disease
and far less capable of resisting the "bane­
ful agencies" of the poisoned atmosphere.42
His primary target in the report was the
City Cemetery, located just north of the
city along Lake Michigan. Suspecting the
cemetery as a point source for the pollu­
tion of the city's potable water supply, he
documented the direction of shoreline cur­
rents (south, toward the city reservoir) and
charted several years of water-level fluc­
tuation and corresponding rates of putre­
faction in the cemetery, finding a correla­
tion between high water and advanced rates
of decay. The lake, he grimly explained,
with its undulating high-water mark, was
a constant drain upon the c e m et e ry
grounds and their putrefying contents. Was
it surprising, he wrote, that "complaints . . .
[were] made of the character of the water . . .
carrying with it the offensive and deadly
results of the decomposing process into the
common reservoir from which the water is
taken?"43 In addition to this direct source
of contamination, he examined the role of
atmosphere and soil conditions in spread­
ing the volatile emanations being released
into the air.
Having established his case based on
contemporary medical knowledge, and
having shown that the custom of urban
burials was "universally condemned" by
the highest medical authorities in Europe
and America, Rauch presented the alter­
native: the solution would be to stop all
further burial on city grounds and estab­
lish a "rural cemetery" far removed from
the dense population of the city. Rural cem­
eteries had already taken the nation by
storm, the first being built outside Boston
in 1 8 3 1 , with Philadelphia and Brooklyn
soon following. Andrew Jackson D own­
i ng-a noted horticulturist and
aesthetician-claimed in 1 849 that "there
is scarcely a city of note in the whole coun­
try that has not its rural cemetery," the
value of which lay as much in the benefits
for public health as in the elevation of
American taste.44 Indeed, Chicago had
three private rural cemeteries under con­
struction at the time of Rauch's writing;
the best known, Graceland, was designed
by landscape architect H.W. S . ClevelandY
In general, their rise in popularity was the
result of concerns over the inefficient use
of urban land and the capacity limits of
existing city cemeteries, in addition to fears
of endangering public health .46 In the case
of Rauch, however, his proposal to aban­
don the city cemetery arose solely out of
his painstaking environmental observa­
tions that so convinced and alarmed him.
His suggestions for the cemetery's design
and siting were based on a miasmatic eti­
ology; he expressed no concern for either
aesthetics or economics in his report. His
was a purely salubrious solution. The cem­
etery, he explained, should be built on a
hill to take advantage of mitigating breezes,
and should contain abundant vegetation
to absorb the deleterious gases for the ben­
efit of their own growth while maintaining
the surrounding atmosphere in its origi­
nal pure state. And what of the existing
urban burial grounds? "There is no time
for delay," he wrote; "Let immediate steps
be taken to prevent all future interments
within the Corporate limits, and as soon
as practicable let arrangements be made
for the gradual removal, at proper times
and seasons, of the remains already in­
terred, with the ultimate view of convert­
ing these grounds into a public park," the
planting of which would detoxify the se­
verely contaminated soils and contain
gases that, if emitted into the air, would
prove "otherwise injurious."47
The use of medical theory to advoca te a
very specific landscape typology is indica­
tive of the sort of dialogue occurring be­
tween city officials, physicians, and envi­
ronmental designers across the nation at
mid-century in cities large and small. Cer­
tainly Chicago, a disease-weary city that
had already experienced three major chol­
era epidemics in 1 834, 1 849-50, and 1 8 54,
was receptive to the solution. An end note
in Rauch's report, hastily included as the
last page was being printed, shared the
contents of an ominous telegraph message
reporting the appearance of cholera in
Florida-and indeed, cholera hit the city
again in 1 866.
T he Establishment of Chicago's Park
System
Rauch would be given further opportu­
nity to expound on his environmentally
based medical theories and to a ffect
Chicago's built environment. The desig­
nation of Lincoln Park brought with it a
political battle over the proposed estab­
lishment of autonomous park commissions
not only for the North Side (the location of
Lincoln Park), but also for the West and
South Sides of the city-a battle that would
provide Rauch a forum to again address
the city's need for salubrious landscapes.
The debate over the creation of the three
politically powerful park commissioner
positions is a story fraught with behind­
the-scenes in trigue a nd political
maneuverings. The p r o c e s s i nvolved
prominent businessmen and wealthy real
estate speculators jockeying for position
in anticipation of the financial bonanza to
be brought by the development of large
parks, as well as the power and indepen­
dent budget that came with commissioner
positions. In contrast, Rauch's immediate
involvement was without concern for per­
sonal gain and, given his future efforts in
sanitary reform, his was clearly an honest
appeal for the public health benefits of
parks.48 In a letter to Olmsted in 1 869,
Rauch, perhaps naively, explained that his
name was not put forward as candidate for
one of the commissioner positions because
it was felt he could be of most help as an
independent.49 As the political battle over
the creation of the three park commissions
reached its peak, reinforcement was sought
through public advocate Rauch: in Novem­
ber 1 868, the Chicago Academy of Sciences
asked him to prepare a report on public
parks to be read before their assembly.50
One year later, Rauch, then employed as
city sanitary superintendent, published his
second extensive report, entitled Public
Parks: 17zeir Effects upon the Moral, Physical
Con tinued
011
Next Page
IIJ!lI
22
Rauch
BULLETIN OF AN ESTHESIA HISTORY ������
.
.
.
Continued /1'0111 Page 21
and Sanita/)' Conditions of the Inhabitants of
Large Cities; With Special Reference to the
City of Chicago. 5 1 That document provided
historic precedent for urban park devel­
opment and evidenced parks' benefit to
public health.
Public Parks had all the elements of the
first report (a historical overview, citation
of current medical ideas, and extensive
documentation of climate, winds, and tem­
peratures correlated with incidence of epi­
demic and mortality rates) but was more
detailed and specific to Chicago. Of all of
Rauch's convictions, none was more fer­
vently held than the importance of fresh
air: "It is . . . well known, that of all the
circumstances affecting health, none is so
important as the condition of the air we
breathe. On it, more emphatically than on
the food we eat, depends the purity of the
blood and the right exercise of every func­
tion of the system. "52 This conviction, first
expressed in Intramural Interments, was
more fully elaborated in the second report.
Rauch offered many reasons why parks
would improve air quality. Chicago was,
he wrote, for the most part destitute of trees,
and it was obvious that " tree planting
would not only break the force of the wind
[which spreads miasma] , supply warmth
in wintel; and coolness in summer and thus
moderate the extremes of temperature
[which influence miasmic releases and
morbidity rates], but at the same time ab­
sorb to a considerable extent the noxious
gases which are generated in every popu­
lous city,-supplying oxygen, and thus
contributing to the public health"; the
planting of trees and the strategic place­
ment of parks, he summarized, would di­
minish "the mortality of preventable dis­
eases" and improve general health. 53
Rauch's medical mandate swayed park
commission opponents, and it may have
softened public sentiment toward the un­
derlying land speculation attending park
development. Indeed, he called for harmo­
nious action in what he saw as a matter of
general community interest. He explained
that locating a park in one section of the
city would benefit all residents because
miasma does not reside in any one com­
munity: "the subtle and invisible influence
may be wafted to the remotest parts, abated
in virulence, but still pestiferous. "54 In
February 1 869 the Illinois General Assem­
bly passed bills creating the South, West,
and Lincoln Pa rk C o m missions, thus
promising that well-drained park lands
would surround the city. Writing ten years
later, Rauch boasted that "at least one mil-
lion" trees had been planted in the city's
environs, and with the planned construc­
tion of almost 2,500 acres of park land he
determined (after a careful examination of
the meteorologic record) that "the [result­
ant] drainage of the city and of the outside
lands, and this extensive treeplanting, have
already diminished the climate extremes
incident to our particular location," which
resulted in diminished mortality rates and
the improved general health of all city resi­
dents .55
The significant role that Rauch's sec­
ond publication played in the eventual
development of Chicago's park system is
suggested by several factors. First, much
of the success of his work in Chicago ulti­
mately required an informed public and it
is probable that Public Parks was an impor­
tant educational tool for Chicago residents.
Second, the fact that the request for the
report came from the prestigious Academy
of Sciences indicates a certain weight be­
hind the physician and the perceived value
of the report. Yet, given the murky politi­
cal implications, the degree to which Pub­
lic Parks had a direct influence on the park
system is not as clear as is Rauch's influ­
ence in cemetery removal and the subse­
quent development of Lincoln Park. Nev­
ertheless, it was certainly true that he was
a tireless public health promoter and pub­
lic advocate, and it is evident that his medi­
cal theories helped bring about significant
change to Chicago's built environment.
Rauch translated miasmatic medical
theory into a guide for the development of
landscape typologies conducive to health,
including the removal of urban burial sites
and soil remediation through extensive
tree planting; the creation of rural cem­
eteries with very specific characteristics;
the introduction of fresh air and oxygen
throughout the city by the planting of trees;
and the development of an extensive park
system that, in turn, influenced the micro­
climate of the city and the health of its
residents. That Rauch, as a physician,
should have been concerned with the pub­
lic health of Chicago residents is not sur­
prising, and, given the medical theories of
the day, his staunch attachment to an en­
vironmental etiology is easily understood.
But his impact is largely limited to one
city. To what degree his fascination with
this particular etiology was representative
of a larger public understanding of dis­
ease can be better seen through the writ­
ings and d e signs of Frederick L aw
Olmsted, this nation's leading landscape
architect of the post-Civil War generation.
Miasma's National Impact: T he Work
of Frederick Law Olmsted
As Rauch was busy preparing Public
Parks, the suburban village of Riverside,
Illinois, was being planned nine miles
southwest of Chicago's city center. Im­
pressed by the design, Rauch mentioned
Riverside in glowing terms in his report.
Enviously he noted that the situation for
the development was admirable, being a
respectable twenty feet above the river's
e dge, and thereby ensuring healthful
drainage, as was not possible in Chicago.
Along the banks of the river and elsewhere
on the site were groves of trees, making it
"one of the most . . . healthful places of
residence" in and around Chicago.56 Add­
ing to the appeal of this suburban design
was the inclusion of a broad, well-drained,
tree-lined avenue to connect Riverside with
Chicago, which, in addition to its aesthetic
contribution, "will exercise a vast influ­
ence in moderating the extremes of our cli­
mate, ban design was the inclusion of a
broad, well-drained, tree-lined avenue to
connect Riverside with Chicago, which, in
addition to its aesthetic contribution, "will
exercise a vast influence in moderating the
extremes of our climate, and go far to pro­
tect the city from the injurious effects of
the south-west winds at certain seasons of
the year."5? Rauch's enthusiasm for River­
side was virtually uncontained, and per­
haps some of it was generated from the
identity of its designers: the preeminent
landscape architectural firm of Olmsted
and Vaux. But what attracted the attention
of Rauch to Olmsted's work went beyond
admiration of the designer's art: the phy­
sician and the landscape architect were
bonded by a shared vocabulary of health,
founded on landscape typology. Rauch had
been in correspondence with Olmsted­
designer of this country's first public
park-regarding the preparation of his sec­
ond report. Olmsted reviewed the first draft
of Public Parks and offered suggestions for
improvement. When the three park com­
missions were established in Chicago, both
North Park Commissioner Ezra B. McCagg
and Rauch separately contacted Olmsted,
inviting his firm to become involved in the
parks' design.58 Eventually, Olmsted and
Vaux did produce a design for Chicago's
South Park.
Known primarily for their design of
Central Park (18 5 8 ), the firm's interest in
creating healthful environments was not
confined to suburban developments, nor
did it begin with Riverside in 1 8 6 9 .
Olmsted's environmental interest can be
traced through his earlier activities as a
journalist, his design of Central Park, his
affiliation with the U.S. Sanitary Commis-
sion, and his proposals for dozens of ur­
ban schemes throughout the United States.
Olmsted historian Laura Wood Roper de­
scribes young Olmsted as an accurate and
shrewd observer of nineteenth-century
American life in his various roles as park
planner, scientific farmer, and j ournalist.59
His walking tour of England gained him
modest acclaim for his Walks and Talks of
an American Farmer in England in the ThaI's
1850-51 (1852), as did his travels through
the South for the New York Daily Times.
His partnership in Dix and Edwards, pub­
lishers of Putnam's lvlonthly and the Ameri­
can version of Charles Dickens's House­
hold WOrds, brought him influence among
the cultivated, for in his position there he
often came into contact with noted authors
such as Andrew Jackson Downing, and
with the prominent n a turalist Louis
Agassiz and the botanist Asa Grey. His early
knowledge of miasmatic theories may also
have come through the writings of British
author John Claudius Loudon, one of the
more prolific writers in early-nineteenth­
centUlY Britain. While Loudon published
on subjects as diverse as political economy,
natural history, architecture, and land­
scape design, his writings on urban health
provided clear examples of his knowledge
of British miasmatic theories as related to
environmental design.60
Additionally, Olmsted was a friend and
constant correspondent with George E .
Waring Jr., the nationally renowned sani­
tation engineer of the day.6! Olmsted's fa­
miliarity with miasma theory and its de­
sign applications in urban settings deep­
ened as a result of his collaboration with
Waring during his tenure at Central Park.
Waring, in charge of the drainage systems
for the park, was convinced of the environ­
mental characteristics associated with mi­
asma and the resultant effects on health.
He was also well versed in the status of the
public health movement in England, and
had read numerous physicians' reports al­
luding to miasma. In Draining for Profit,
and Draining for Health, he cited the work of
Drs. Bartlett, La Roche, and Chadwick con­
cerning the connections of miasma and wet,
low, and moist places with various fevers
and other diseases.62 Situated within this
intellectual milieu Olmsted would have
had ample reinforcement regarding his
own ideas about the remediation of land­
scapes for healthful purposes.
The official entrance of Olmsted into
the public health arena came with his ap­
pointment as general secretary of the Sani­
talY Commission during the Civil War. The
position brought him into contact with the
country's most devoted practitioners and
advocates for public health-among them
New York's Elisha Harris, as well as Rauch,
then a member of Chicago's branch of the
S anitary Commission. Olmsted worked
closely with these and other nationally rec­
ognized physicians and sanitarians and
was keenly aware of both American and
English medical studies of epidemic dis­
ease. His appointment by the New York
Legislature in 1 870, to a committee of ex­
perts to study, in part, the prevalence of
malaria and the feasibility of development
on Staten Island speaks to his reputation
as environmental designer and health ad­
vocate. The resultant report, dated 1871
with Olmsted as main author, relies heavily
on the expertise of physicians, sanitary
engineers, and geologists, and his own plan­
ning and design theories . 63 The role of
medical theory in his design solutions is
clearly evident here, for his suggestions
were stimulated in large p a rt by the
island's prevalence of malaria, defined in
the report as a poison in the atmosphere.
He explained that houses must be ad­
equately separated to allow for the free flow
of air, which would diffuse any contami­
nants, and that the presence of trees would
also help to purify the air.64 Highlighting
the importance of the environmental cor­
relation to health and, additionally, to
proper planning, Olmsted included a de­
tailed "interview" with Elisha Harris on
t h e topic of m a l a r i a . Responding to
Olmsted's questions, Harris addressed
public health issues as related to the land­
scape characteristics found on Staten Is­
land-an extensive and deliberate discus­
sion that consumed roughly one-third of
the report. Noting that the exact cause for
this poisoned air was not known, physi­
cian Harris nonetheless preferred an envi­
ronmental etiology, one of gases emanat­
ing from certain soil conditions or decay­
ing vegetative matter, exposed to particu­
lar conditions of moisture and tempera­
ture. The design implications were dis­
cussed at length. The poisoned air, he ex­
plained, is largely neutralized in passing
through foliage; trees also serve the im­
portant function of absorbing excessive
moisture from the soil and shading the soil
to prevent rapid heating and the subse­
quent release of gases. Houses surrounded
by trees at a slight distance were preferable
to excessive shading, while belts of trees
were known to be a malarial barrier.65 The
discussion of malaria, trees, drainage, soil
quality, moisture, and pure air was as thor­
ough a dissection of the prevailing envi­
ronmental etiology as could be found in
the reports and medical topograhies writ­
ten by any physician at the time.
Olmsted's understandings of an envi­
ronmentally based etiology regarding den­
sity, ventilation, landscape condition, and
certain characteristics of water and open
space also served as a rationale for a larger
benign urban scheme. In an 1 877 report to
the Board of the Department of Public
Works of New York City concerning the
layout of two new wards, Olmsted as coau­
thor recommended more open space and
less-dense urban patterns, because "in the
middle of all these dark, narrow cubes there
must be a large amount of ill-ventilated
space, which c a n only be imperfectly
lighted through distant skylights, or by
an unwholesome combustion of gas."66
Based on assumptions that industrializ­
ing cities would continue to grow, and that
their growth and economic diversification
were essential components of progress to­
ward a higher level of civilization, he stated
that planning for growth was indispens­
able if conditions of misery, disease, and
other "evils" associated with urban areas
were to be avoided. He suggested incremen­
tal growth while incorporating specific
landscape typologies, in accord with the
prevailing medical etiologies.
In p a r t i c u l a r, t h r e e l a n dscape
typologies stand out in Olmsted's writings:
low-density urban and suburban neighbor­
hoods, large pleasure parks, and smaller
local p a rks-all connected by tree-lined
parkways and promenades. In support of
lower densities, he stated:
we are able to reach the convic­
tion, beyond all reasonable doubt,
that at least, the larger share of the
immunity from the visits of the
plague and other forms of pestilence,
and from sweeping fires, and the
larger part of the improved general
health and increased length of life
which civilized towns have lately
enjoyed is due to the abandonment
of the old-fashioned compact way of
building towns, and the gradual
adoption of the custom of laying
them out with much larger spaces
open to the sun-light and fresh air;
a custom the introduction of which
was due to no intelligent anticipa­
tion of such results.67
His suggestions concerning the estab­
lishment of urban parks also rest, in part,
on the importance of light and air:
the most serious drawback to the
prosperity of town communities has
always been dependent on conditions
Cantin lied on Next Page
..,
24
BULLETIN OF AN ESTHESIA HISTORY
Rauch .
�������
. . COlllinl/ed fivlII Page 23
. . . which have led to stagnation of
air and excessive deprivation of sun­
light.68 Air is disinfected by sunlight
and foliage. Foliage also acts me­
chanically to purify the air by screen­
ing it. Opportunity and inducement
to escape at frequent intervals from
the confined and vitiated air of the
commercial quarter, and to supply
the lungs with air screened and pu­
rified by trees [is necessary for the
protection of health] .69
In defense of his proposals for tree-lined
boulevards, he noted:
If such streets were made still
broader in p a rts, with spacious
malls, the advantage [in scenery and
in air quality] would be increased.
If each of them were given the proper
capacity, and laid out with laterals
and connections in suitable direc­
tions to serve as a convenient trunk
of communication between two large
districts of the town or the business
center and the suburbs, a very great
number of people might thus be
placed every day under influences
counteracting those with which we
desire to contend.7o
These landscape typologies associated
with Olmsted's larger urban scheme are
representative of the kinds of environmen­
tal modification endorsed throughout his
extensive career. The scope and scale of his
projects were far-reaching. One Olmsted
scholar has documented that after his part­
nership with Vaux dissolved, he went on to
carry out an additional 550 commissions
for proj ects such as Mount Royal Park,
Montreal (1 874-8 1 ); Belle Isle Park, De­
troit (1 8 8 1 -84); the U.S. Capitol grounds
(1 874-9 1 ); and S tanford University cam­
pus (1 8 86-9 1 ), as well as park systems for
numerous cities including Buffalo, Bos­
ton, Rochester, and Louisville .7l With
Olmsted's extensive work one can chart the
application of etiologic ideas, from small
designs of neighborhood parks and tree­
lined streets, to the larger application of
great urban parks and suburbs, to con­
nected greenbelts surrounding cities, all
of which provided armature for healthy
cities. The significance of his work, though,
does not rest simply on the scope of his
own professional impact. His successes
were not the result of a forceful personal­
ity and professional zeal; rather, he suc­
ceeded because he was inextricably linked
to the prevalent ideas of the day. He spoke
a language of landscape and health that
provided a foundation for discussion in
each urban community in which he was
employed. His clients were concerned and
active citizens; both parties mutually sup­
ported the perspective of an essential envi­
ronmental connection to health.
Conclusion
This research documents a unique pe­
riod of urban development that owed its
very character to contemporary medical
theory. Beginning with the formulation of
the general understanding of miasma­
developed over time, and shared with phy­
sicians and laypersons alike through the
popular early- to mid-century medical to­
pographies-and the subsequent transla­
tion into benign and pathogenic landscape
typologies, one can document the growing
importance of an environment-based eti­
ology to a resultant urban morphology.
Physicians and concerned laypersons be­
came empiricists of the physical landscape
and atmosphere in an attempt to better
understand issues of health and well-be­
ing. Physicians supplied the essential con­
nection for the development of a salubri­
ous landscape by evaluating specific char­
acteristics of air, land, and water that were
believed to affect human health; in so do­
ing, they contributed to a general public
understanding of the correlation of health
and environment.
The impact on the built urban environ­
ment and its surroundings cannot be ques­
tioned: medical theory, in many ways, di­
rectly informed urban design theory. While
we have focused on the writings of two well­
respected men, we suggest that their belief
in an environmental etiology, with its re­
sultant landscape interventions, was nei­
ther isolated nor an anomaly across the
country. Indeed, the legacy of these public
interventions is still very much a part of
the American experience of place-from
cityscape to suburbia-as the present-day
landscape offers evidence of the nine­
teenth-century search for salubrity.
References
1. For a broader overview of the evolution of
medical ideas, including environmental etiology,
see John Harley Warner, 171e Therapeutic Perspec­
tive: Medical Practice, Knowledge, and Identity in
America, 1820-1885 (Cambridge: Harvard Univer­
sity Press, 1 986); George Rosen, A HistOlY of Pub­
lic Health (New York: MD Publications, 1 9 5 8);
Charles-Edward Amory Winslow, The Conquest of
Epidemic Disease: A Chapter in the HistOlY of Ideas
(Princeton: Princeton University Press, 1944).
2 . Regarding the professionalization of public
health officials and their continued reliance on
the miasma theory, see John Duffy, The Sanitar­
ians: A HistOl)' of American Public Health (Urbana:
University of Illinois Press, 1 992), pp. 1 26-37.
Edwin Chadwick employed the miasmic theory in
his famous report that resulted in Britain's 1 848
Public Health Law. For a fresh look a t Chadwick,
see Sylvia Tesh, "Miasma and 'Social Factors' in
Disease Causality: Lessons from the Nineteenth
Century," J. Health Polito Policy & Law, 1995, 20.
1 001-24; Christopher Hamlin, "Finding a Func­
tion for Public Health: Disease Theory or Political
Philosophy?" ibid., pp. 1024-3 1; John V. Pickstone,
"Dearth, Dirt and Fever Epidemics: Rewriting
the History of British 'Public Health,' 1 780-1 850,"
in Epidemics and Ideas: Essays on the Historical Per­
ception of Pestilence, ed. Terence O. Ranger and
Paul Slack (Cambridge: C ambridge University
Press, 1 992), pp. 1 25-48.
3. While there is tremendous breadth on the
topic of environmental links to health, there is
also considerable variation regarding the topic's
perceived significance. For general urban devel­
opment, see Cities in American Histmy, ed. Ken­
neth T. Jackson and Stanley K. Schultz (New
York: Knopf, 1972); Howard Chudacoff, The Evo­
lution ofAmerican Urban Society (Englewood Cliffs,
NJ: Prentice-Hall, 1 9 8 1 ) . For representative works
concerning the influence of medical thought on
the development of urban social structure, see
David Ward, Poverty, Etil l/icity, and the American
City, 1840-1 925: Changing Conceptions of the Silim
and the Ghetto (Cambridge: Cambridge Univer­
sity Press, 1989); John F. Bodnal; Steeltown: Immi­
gration and Industrialization, 1870-1 940 (Pittsburgh:
University of Pittsburgh Press, 1 990); Elizabeth
H afldn Plecl<, Black Migration and Poverty, Boston,
1 865-1900 (New York: Academic Press, 1 979) .
While often very n arrow in scope, worthwhile
economic and political interpretations concerning
medical influences on urban development include
John S. Garner, TIle Model Company Town: Urban
Design through Private Enterprise in Nineteenth-Cen­
till)' New England (Amherst: University of Massa­
chusetts Press, 1 984); Richard E. Foglesong, Plan­
ning the Capitalist City: TIle Colonial Era to the 1 920s
(Princeton: Princeton University Press, 1 9 8 6) ;
Martin V. Melosi, Pollution and Reform i n American
Cities, 1 8 70-1930 (Austin: University of Texas
Press, 1 980); Roy Lubove, 7718 Progressives and the
Slums: Tenement House Reform in New York City:
1 8 90- 1 9 1 7 (Pittsburgh: University of Pittsburgh
Press, 1 963). For representative offerings concern­
ing the development of medically influenced ar­
chitectural types, see John B urnett, A Social His­
tmy of Housing, 1 8 1 5 - 1 9 8 5 (London: Methuen,
1986); Richard Plunz, A Histol)' of Housing in New
York City: Dwelling Type and Social Change in the
American Metropolis (New York: Columbia Uni­
versity Press, 1990).
4. Works concerning period sanitation and
street engineering necessarily tend to trea t the
influence of medical thought on urban develop­
ment with greater emphasis. Two worthwhile stud­
ies of sanitary infrastructure and street improve­
ment are Ann Durkin Keating, Invisible Networks:
Exploring the Histol), of Local Utilities and Public
Works (Malabar, Fla.: Krieger, 1 994); Stanley Clay
Schultz and C l a y McSh ane, "To Engineer the
Metropolis: Sewers, Sanitation, and City Plan­
ning in L a te-Nineteenth-Century America," J.
Amer. Hist . , 1 9 7 8 , 65 :389-4 1 . While numerous
authors address suburban development, the in­
fluence of medical thought on that development
is consistently of secondary or passing concern;
see Henry C. Binford, TIle First Suburbs: Residen­
tial Communities in the Boston Periphel)" 1815-1860
(Chicago: Universi ty of Chicago Press, 1 985); Sam
Bass Warner, Jr., Streetcar Suburbs: TIle Process of
Growth in Boston, 1870-1 900 (New York: Atheneum,
1 973). Works addressing the various aspects of
the reform movement are more varied in their
consideration of medical issues; representative
examples include Norris A. Magnuson, Salvation
in the Slums: Evangelical Social Woril, 1865-1920
(Metuchen, N.J.: Scarecrow Press, 1977); Sarah
S . Elkind, "Building a Better Jungle: Anti-Urban
Sentiment, Public Works, and Political Reform in
American Cities, 1 880-1930," J. Urban Hist., No­
vember 1997, 24:53-77. Significant studies of the
rural cemetery and urban park movements in­
clud e Blanche Linden-Ward, Silent City on a Hill:
Landscapes of Memol)' alld Boston's Mount Auburn
CemetelY (Columbus: Ohio State University Press,
1 989); Kenneth T. Jackson, Silent Cities: TIle Evo­
lution of t h e American Ce m e t e ry (New Yo rk:
Princeton Architectural P r e s s , 1 9 8 9 ) ; David
Schuyler, TIle New Urban Landscape: T71e Redefini­
tioll of City For/1/ in Nineteellth-Cellllll)' America (Bal­
timore: Johns Hopkins University Press, 1986).
5 . One notable exception is the work of Jon A.
Peterson, who looked a t the general implications
of medical thought on urban built form in "The
Impact of Sanitary Reform upon American Urban
Planning, 1 840-1890," J. Soc. Hist., 1 979, 1 3 :83103.
6. For a history of the Hippocratic connection
of climate and landform to health, see Frederick
Sargent II, Hippocratic Heritage: A Histol)' of Ideas
about Weather and Human Health (New York:
Pergamon Press, 1982).
7. \X'arner, Therapeutic Perspective (n. 1 ) , p.
198.
8 . Christopher Hamlin, "Predisposing Causes
and Public Health in Early Nineteenth-Century
Medical Thought," Bull. Soc. Hist. iVied. , 1992,
5:43-70; quotation on p. 70.
9. Ibid., p. 62.
1 0 . Thomas Hepburn Buckler, A Histol)' of
Epidemic Cholera, as it appeared a t TIle Baltimore
City alld Coullty Alms-house, ill the summer of 1849:
with SO/1/e remarhs all the medical topography alld dis­
eases ofthis regioll (Baltimore: Patent Cylinder Press,
1 85 1).
1 1 . Ibid., p. 36.
12. Ibid., p. 28. Appended to the document
was a meteorologic chart prepared by another
physician documenting the presence of "electric­
ity" in the atmosphere during the outbreak. Buck­
ler makes no reference to these data in his report,
and we do not know to what degree he saw those
atmospheric conditions as contributing to the out­
break.
1 3 . Warner, Therapeutic Perspective (n. 1), p.
37.
14. Ibid., p. 58.
15. Ibid., p. 72.
16. While Warner sets the stage for under­
standing the reasons behind a rise i n environ­
mental etiologic thought, others have suggested
the importance of miasma within this particular
culture. James Cassedy has documented the de­
velopment of American etiologic thought in ante­
bellum America and suggests that in the six to
eight decades prior to the war "a large propor­
tion" of the medical profession endorsed some
form of causal link between the physical environ­
ment and its phenomena-climate, winds, soil,
topography, drainage, etc.-with disease: James
H. Cassedy, Medicille alld Americall Growth 18001860 (Madison: University of Wisconsin Press,
1986), p. 34. Charles E. Rosenberg, in Explaining
Epidemics alld Other Studies ill the HistOl), of iVIedi­
cille (Cambridge: Cambridge University Press,
1992), p. 1 1 7, has written that "almost all" physi­
cians in the 1 830s knew of miasma and under­
stood its essential role in producing disease.
Michael Owen Jones has documented the popu­
larity of "medical geographies" written between
1770 and 1 830 by pioneer settlers (laypersons and
medical professionals alike) as they described the
new environments encountered in their travels
and documented attendant affects o n health:
Michael Owen Jones, "Climate and Disease: The
Traveller Describes America," Bull. Hist. Med. ,
1 967, 4 1 : 2 54"66. Phyllis Allen Richmond
"glanced" a t t h e etiologic sections of books and
journals and reported on the regularity of mias­
m a ti c theories; she wrote: "The atmospheric,
chemical, and miasmatic theories so dominated
etiologic thought in the 1 870's that when alterna-
tive views arose, ... American reviewers were cau­
tious and non-committal" (Phyllis Allen Rich­
mond, "American Attitudes Toward the Germ
Theory of Disease [1 860- 1 8 80]," J. Hist. Med. &
Allied Sci., October 1 9 54, 9:430).
1 7 . Jabez Wiggins Heustis, Physical Obsel'Va­
tiOIlS, and },Jedical v'acts alld Researches on the To­
pography alld Diseases of Louisiana (New York: T &
J Swords, 1 8 1 7), p. 42.
18. Cadwallader Colden, "Observations on the
Fever which prevailed in the City of New-York in
1 7 4 1 and 2," Amer. Med. & Philos. Reg. , 1 8 1 1 ,
1 :3 1 0-30. It can be assumed that Colden's word
carried significant weight. As a member of the
American intelligentsia, he was in frequent corre­
spondence with botanist John Bartram. As well,
Benjamin Franklin sought his j udgment before
going public with his ideas: see preface to T71e
Letters and Papell of Cadwallader Colden (Pennsyl­
vania State University Library; New York: New
York Historical Society, 1 9 1 8) , vol. 1 ( 1 730-42),
microform.
19. Martha J. Lamb, Histol), of the City of New
Yorh, Its Origill, Rise, alld Progress, vol. 1 (New
York: A. S. Barnes, 1 877), p. 589, seems to indi­
cate that part of his advice was indeed adopted by
city officials, but she offers no verification. Saul
Jarcho, i n "Cadwallader Colden as a Student of
Infectious Disease," Bull. Hist. Med. , 1 95 5 , 2 9 : 1 03,
relies on Lamb's evaluation.
20. In Paris, Parent-Duchatelet and Louis­
Rene Villerme, through statistical analysis, main­
tained that disease was a manifestation of pov­
erty. Conversely, C hadwick in England believed
that poverty was not a causative factor but was
rather a manifestation of disease and ill health.
He concluded that the most appropriate inter­
vention was environmental modification, espe­
cially the removal of pathogenic conditions. For
an excellent history of the origins of the British
and French public health movements, see Ann F.
La Berge, Missioll and lvIethod: The Early Nine­
teenth-CelltlllY Frellch Public Health Movemellt (Cam­
bridge: Cambridge University Press, 1992).
2 1 . Heustis, Physical Observations (n. 1 7) , p.
13.
2 2 . Matthew L . Davis, A Brief Accoullt of the
Epidemical Fever Which Lately Prevailed in the City
of New York, With the Different Proclamations, Re­
ports, alld Lellers of Gov. Jay . . . (New York: Mat­
thew L. Davis, 1795), p. 39.
23. James Lind, An Essay on Diseases Incidental
to Europeans in Hot Climates, 1st Amer. ed. from 6 th
London ed. (Philadelphia: W. D u ane, 1 8 1 1) , pp.
1 3-37; quotation on p. 1 3 .
2 4 . Ibid., p. 3 6 .
2 5 . Daniel Drake, A Systematic neatise, His­
torical, Etiological, and Practical, on the Principal
Diseases of the Illterior Tillley of North America, as
TIley Appeal' ill the Caucasiall, Afi'ican, Indian alld
Esquimaux Tilrieties ofIts Poulation, ed. S. Hanbury
Smith and Francis G. Smith, 2d ser. (Philadel­
phia: Lippincott, Brambo, 1 854), pp. 23-30, quo­
tation on p. 23.
26. Ibid., p. 25.
27. Ibid., pp. 29-30.
28. At the time of his appointment to the Com­
mission, Olmsted was a well-known author and
had recently recevied public attention for the de­
sign of Central Park. The park was under con­
struction when he took a leave of absence and
went to Washington, D.C. to begin his war work.
He was especially noted for his organizational
skills in the administration ofiarge projects, which
helps explain his prominence in the Commis­
sion.
29. Alfred C. Post and W.H. Buren, "Military
Hygiene and Therapeutics," in United States Sani­
tal)' Commissioll, lvIilital)" Medical and Surgical Es­
says Prepared for the United States Sanital), Com­
missioll 1862-1864 (Washington, D . C . , 1 865), 2 7
p p . ; quotation on p. 8.
30. John T. Metcalf et aI., "Miasmatic Fevers,"
in ibid., 23 pp.; quotation on p. 1 .
3 1 . Duffy, Sanitarians (n. 2), p p . 1 1 3-29.
32. Elisha Harris, "Hints for the Control and
Prevention of Infectious Diseases in Camps, Trans­
ports and Hospitals," in MilitalY, Medical (n. 29),
28 pp., quotation on p . 23.
33. Nancy Tomes, "The Private Side of Public
Health: Sanitary Science, Domestic Hygiene, and
the Germ Theory, 1 870-1900," Bull. Hist. Med.,
1990, 64:509-39; quotation on p. 5 1 1 .
34. Ibid., p . 5 1 2 .
3 5 . Cassedy, iVIedicine ( n . 1 6), p p . 54-59.
36. Olmsted's work and voluminous writings
have been analyzed thoroughly and aptly by a
number of historians, and most thoroughly by Laura
Wood Roper. For Olmsted's philosophy toward a
changing urban culture, see the excellent discus­
sion in Thomas Bender, Toward all Urban Vision:
Ideas alld Illstitutiolls in Nineteenth-CelltlllY America
(Lexington: University Press of Kentucky, 1975),
chap. 7; Bender also includes a helpful analysis
of additional sources of Olmsted's urban reflec­
tions in the "Biographical Essay," p p . 266-68.
Rauch's involvement as a Civil War physician pre­
ceded his immersion in the public health issues of
Chicago and his eventual leadership role in the
Department of Health for the State of Illinois. It is
obvious that his was a deeply held, personal mis­
sion of public health advocacy.
37. Specifically regarding Chicago, see Isaac
D. Rawlings, T71e Rise and Fall of Disease in Illillois
(Springfield: Illinois State Department of Health,
1 927), 1: 1 0 1 -14; Thomas Neville Bonner, ivIedi­
cine ill Chicago: 1850-1 950, 2d ed. (Urbana: Uni­
versity of Illinois Press, 1 9 9 1 ) , p . 7.
38. Ch icago Democrat, 17 June 1 835, n.p. (Chi­
cago Historical Society).
39. Bessie Louise Pierce, A HistOl), of Chicago
(New York: Knopf, 1 937-57), 2 : 3 1 7. While the
raising of buildings and streets was a n extreme
measure-the Board of Health reported that within
two decades 4,000 acres ofthe city had been "raised
to a grade of 3 to 5 feet above the bottomless quag­
mire which formerly bordered this shore of Lake
Michigan" (quoted in Sophonisba Breckinridge,
"Tenement-house Legislation in Chicago," in TIle
Tellements of Chicago: 1 908-1 935, ed. Edith Abbott
[New York: Arno Press, 1 970; 1 936], p. 40)-it
was an action taken as much for the health of its
residents as for the health of business in the rap­
idly growing city.
40. John H . Rauch, In tramural In terments in
Populous Cities alld Theil' Illf/uence upon Health alld
Epidemics (Chicago: Tribune Co., 1 866), pp. 56-57.
For a description of Rauch's role, see Francis
Eastman, "The Public Parks of Chicago," in Chi­
cago City Manual (Chicago: Bureau of S t a tistics,
1 9 1 4), pp. 7-3 1 , especially p. 1 3; Glen Holt, "Pri­
vate Plans for Public S p a c e s : The Origins of
Chicago's Park System, 1 850-1 875,"in Chicago His­
tDlY (Chicago: Chicago Historical Society, 1979),
pp. 173-84. In addition to Rauch's compelling
medical testimony, pressure was placed on the city
council for the development of a park on the cem­
etery grounds by investors of the North Chicago
Street Railway Company, comprised of prominent
citizens, who, in seeking to obtain the rights to
build a road, argued the potential for future resi­
dential development of the area, as well as the
probable conversion of the cemetery to a public
park.
4 1 . Rauch, Illtramural Illterll/ellts (n. 40), pp.
56-60; quotation on p . 59.
42. Ibid., p . 24.
43. Ibid., pp. 56-57.
44. Andrew Jackson Downing, "Your Leader,
on Cemeteries and Public Gardens," HortiC/ilwrist
& J. Rural Art & Rural Taste [ed. Andrew Jackson
Downing], 1 849, 4 : 1 39.
45. Holt, "Private Plans" (n. 40), pp. 1 75-76.
46. Schuyler, New Urban Lalldscape (n. 4), p.
Cantil/lied
011
Page 27
11"""
,�
26
BULLETIN O F ANESTHESIA HISTORY ������
Civil War
.
.
.
Continued from Page 1 1
Notes o f Campaigns i n the War with Mexico during
the Years 1 845, 1 846, 1 847 and 1 848," Anwl: ]. Med.
Sci. 47(1952):2-30.
33.
Porter, "Medical and Surgical Notes of
Campaigns in the War with Mexico" (n. 32).
34
L. Baudens, La Guerre de Crimee, les
Campements, les Abris, les Ambulances, les Hopitaux.
Germer Balliere (Paris, 1858), p. 305.
35.
George H.B. Macleod, Notes on the SurgelY of the IVaI' in the Crimea with Remarks on the
Treatment of Gunshot IVounds (Philadelphia: J . B .
Lippincott a n d C o , 1 862), p. 403
36.
Martin S. Pernick, A Calculus of Suffering:
Pain, Professionalism and Anesthesia ill Nineteenth-Cen­
tilly America (New York: Columbia University Press,
1985), p. 421.
37.
Lyman,ArtificialAnesthesia andAnaesthetics
(n. 28).
38.
Pernick, A Calculus of Suffering (n. 36).
39.
James Winchell, Private, "Wounded and
a Prison," Civil IVaI' Times Illustrated 4(1 965):20-25,
taken from "Berdans United States Sharpshoooters
in the Army of the Republic," by Captain C.A. Stevens
(St. Paul: Price-McGill Co., 1 892).
40.
S. Bayne-Jones, 1718 Evolution of Preven-
tative Medicine in the United States Army, 1 607-1939
(\Vashington, D.C.: Office of the Surgeon-General,
Department of the Army, 1968), p. 255. M.C. Gillett,
17le Army Medical Department 1818-1865 (\Vashing­
ton, D.C.: Center of Military History, United States
Army, 1 987), p. 371. G.W Adams, Doctors in Blue-
77ze Medical HistOlY of the Union Army in the Civil War
(New York: Collier Books, 1961), p. 224.
41 .
C.J. Stille, HistOl), ofthe United States Sanital)' Commission in the War of the Rebellion (Philadel­
phia: J.B. Lippincott, 1 866), p. 552
42.
Cunningham, Field Medical Services at the
Battles of Manassas (n. 27).
43.
T.L. Livermore, Numbers and Lossess in the
Civil IVaI' in America: 1861-1865, reproduction from
original printed in 1 900, Civil War Centennial Se­
ries (Bloomington: Indiana University Press, 1957),
p. 1 50.
44.
B ayne-Jones, 77ze Evolution of Preventative Medicine in the UnitedStates Army (n. 40). Gillett,
1718 Army Medical Department 1818-1865 (n. 40).
Adams, Doctors in Blue (n. 40). B.E. Blustein, Pre­
sel'Ve lVur Love for Science. Life oflVtlliam A. Hammond,
American Neurologist (New York: Cambridge Univer­
sity Press, 1991), p. 289.
45.
H.H. Cunningham, Doctors in Gray. 77ze
Confederate lvIedical Sel'Vice (Baton Rouge: Louisi­
ana State University Press, 1958), p. 339.
46.
171e Medical and Surgical HistOlY of the
IVaI' of the Rebellion (n. 15).
47.
77ze Medical and Surgical Histol)' of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
48.
77ze Medical and Surgical HistOlY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
49.
Livermore, NUll/bel's and Losses in the Civil
IVaI' (n. 43).
50.
Livermore, Numbers and Losses in the Civil
IVaI' (n. 43).
51.
J.w. Schildt, Hunter Holmes McGuire,
Doctor in Gray (Chewsville, Maryland, 1986), p. 135.
52.
Chisolm, A JHanual of MilitalY SurgelY
(n. 17).
53.
\Vorthington, "Confederates, Chloroform
and Cataracts" (n. 17).
54.
Cunningham, Doctors in Gray (n. 45).
55.
E S . Johns, Ap.P. Johns, "Chimborazo
Hospital and J.B. McCaw, Surgeon-in-Chief," \1,4
Mag. Hospital Biog. 62(1954):190-200.
56.
B.W Allen, Confederate Hospital Reports,
2 volumes, with note dated August 4, 1 880 at Marietta,
OH. Reynolds Historical Collection, Lister Hill Li­
brary, University of Alabama-Birmingham.
57.
17te Medical and Surgical HistolY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
58.
Hospital Records, Carver General Hos-
pital, Washington, D.C., Schoff Civil War Collec­
tion, University of Michigan, p. 218.
59.
1718 Medical and Surgical HistolY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
60.
EE. Daniel, Recollection of a Rebel Surgeon (Austin: Von Boeckmann, Schutze and Co.,
1 899), p. 3 1 5 .
61.
171e Medical and Surgical HistolY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII.
62.
171e Medical and Surgical HistOlY of the
War of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII.
63.
17te Medical and Surgical HistOlY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII.
64.
The Medical and Surgical HistolY of the
War of the Rebellion (n. 15), Volume I, Part I, Ap­
pended Reports.
65.
17le lvIedical and Surgical HistolY of the
War of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
66.
17te Medical and Surgical HistolY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
67.
17ze Medical alld Surgical HistolY of the
IVaI' of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
68.
17te Medical and Surgical HistolY of the
War of the Rebellion (n. 1 5), Volume II, Part III,
Chapter XIII, pp. 887-898.
69.
WT.G. Morton, "The First Use of Ether
as an Anesthetic at the Battle of the Wilderness in
the Civil War," JAMA 42(1904) : 1068-1073. M . S .
Albin, "William Thomas Green Morton a s a Mili­
talY Anesthetist During the Civil War," Bull. Anesth.
Hist. 14(1996):1,23.
70.
H. McGuire, "Last Wound of the Late
Gen. Jackson (Stonewall)-The Amputation of the
Arm-His Last Moments and Death," 17ze Richmond
Medical Jou/'llal, May 1866.
ORA GION DEL ANESTESIOLOGO
ANESTHESIOLOGIST'S PRAYER
Bendice estas manos y esta mente,
SENOR MIO, para que puedan cuidar
can seguridad a los que sean confiados
a ellas en el dia de hoy.
Please bless these hands and
this mind 0' Lord, that they
may safely care for those
entrusted to them this day.
iPermite que mis manos se mantengan
agiles, mi mente alerta y mi vision
clara para que no le ocun'a a mis
pacientes desgracia anestesica al guna!
Keep my hands agile,
my mind acute, and my eyes
shmp, that no anesthetic
misadventure may befall my
patients!
Aunque ellos estan en mis manos, mis
Manos estan en las tuyas, SENOR
MIO; porfavOl, guilas bien.
AMEN
-J. G. Converse, M.D.
Spanish translation
by Miguel Colon-Morales, M.D.
Though they are in my hands,
my hands are in thine, 0' Lord,
please guide them well. Amen.
-J. G. Converse, M.D.
MedNuggets . . .
Continued jimll Page 12
Anesthesia History Association
Sixth Annual Resident Essay Contest
operatin g room, only h e m ay m ake a
minut e-to-minute diagnosis of the
patie nt's condition and prescribe such
treatment as the diagnosis warrants. His
right to diagnose a n d prescribe
distinguishes his function from those of
the nurse anesthetists.
-E. Hayt
Journal of the American NurseAnesthetists
1 5 :26, 1947
The Anesthesia History Association (AHA) sponsors an annual Resident
Essay Contest with the prize presented at the ASA Annual Meeting.
A 1,500-3,000-word essay related to the history of anesthesia, pain man­
agement or critical care should be submitted to:
William D . Hammonds, M . D . , M . P. H .
Chair, AHA Resident Essay Contest
University ofIowa
The reason against the e a rly use of
anaesthesia seems to be that if the patient's
sufferings are relieved in the early part of
labor, she will refuse to go through the
remainder of her labor without help, and
the use of anaesthetics must be continued
until delivery is accomplished.
-Franklin S. Newell
Surgery, Obstetrics and Gynecology 3 : 1 26,
1 906
Anesthesia is the one field in the practice
of medicine in which there has been a
seeming indiffe r e n c e a n d lack of
compensation. With the interest of the
patient, surgeon and hospital in mind, I
do not hesitate to say that I doubt the
wisdom of the present tendency to employ
lay anesthetists, and it is my profound
belief that the system of salaried non­
medical anesthetists is not only contrary
to the medical practice act and professional
ethics but it will surely result in the
degeneration of the art of anesthesia, and
greatly hinder all advancement in this line
of medical research.
-Isabella C. Herb
Current Researches in Anesthesia and
Analgesia 5 : 1 3, 1 926
As I recovered my former state of mind, I
felt an inclination to communicate the
discoveries I had m a d e during the
experiment. I endeavored to recall the ideas,
they were feeble and indistinct.
-Humphrey Davy, 1 799
The past fifteen years have seen
revolutionary advances in anesthesiology.
Perhaps more progress has been made in
these fifteen years than in any of the
p revio u s years since the advent of
anesthesia.
-R.C . Adams
Kansas City Medical Journal 22:11, 1 946
School of Medicine
Dept. of Anesthesia
200 Hawkins Drive, 6 JCP
Iowa City, IA 52242-1079
U.S.A.
The entrant must have written the essay either during his/her residency or
within one year of completion of residency. Residents/Fellows in any nation
are eligible, but the essay MUST be submitted in English. All submissions
must be typewritten.
An honorarium of$500.00 and a certificate will be awarded at the AHA's
annual dinner meeting at the ASA.
The award-winning residents will be invited to present their essays in per­
son at the annual spring meeting of the AHA and their work will be published
in the Bulletin of Anesthesia History.
All entries must be received on or before A ugust 1 5, 200 1 .
Rauch.
. . Con tinued from Page 25
41.
47. Rauch, Intramural Interments (n. 40), p. 66.
The footnote in the text served to warn readers
that no removals should be made from May to
November, known as the most dangerous months
for epidemics.
4 8 . E a s t m a n' s ' P u b l ic Parks" (n. 40) i s a
straightforward account of the birth of the three
park commissions, with observations of the atten­
dant political power plays.
49. Rauch to F. L. Olmsted, 13 April 1 869, in
TIle Papers of Frederick Law Olmsted (Pennsylvania
State University Library; Washington, D .C . : Li­
brary of Congress Photoduplication Service, 1975),
microfilm (hereafter Olmsted Papers).
50. The Academy had previously concerned
itself exclusively with the promotion of scientific
knowledge and investigation. Why, then, would
i t throw its weight into the park debate? One pos­
sible connection is through Ezra B . McCagg, mem­
ber of the Academy and a lawyer specializing in
real estate law (McCagg's law partner, J. Young
Scammon, was one of the founding members of
the Academy). Instrumental in the passage of Lin­
coin Park, McCagg held one of the powerful Lin­
coln Park commissioner positions and was a col­
league of Olmsted. According to E as t m a n , a
gentleman's agreement was made for the support
of park commissions in the West and South dis­
tricts in return for the earlier passage of the Lin­
coln Park Commission. See Eastman, "Public
Parks" (n. 40), p . I S . The park commissioners
were governor-appointed and enj oyed financial
independence from the municipality.
5 1 . John H. Rauch, Public Park: 11!eil' Effects
upon the Moral, Physical and San italY Condition of
the Inhabitants of Large Cities; With Special Refer­
ence to the City of Chicago (Chicago: S.C. Griggs,
1 8 69).
52. Rauch, Intramural Interments (n. 40), p. 23.
Vegetation's role i n purifying "vitiated" air and
producing oxygen was finally becoming common
knowledge in America. For example, the produc­
tion of oxygen by trees was patiently described in
two earlier articles in the scholarly North Ameri­
can Review: "The Chemistry of Vegetation," 1 845,
60 (126) : 1 57-95; "Trees and Their Uses,' 1 857, 85
(176): 1 78-205.
53. Rauch, Public Parks (n. 5 1), p . 79 n. It is
interesting to note that the bulk of his eighty-four­
page report focuses on environmental factors in
preventing disease; only a t the very end does he
briefly mention the psychological and moral ben­
efits of parks, the two arguments that prevail in
historiographic depictions of the era.
54. Ibid., pp. 83-84.
55. John Henry Rauch, TIle SanitalY Problems
Continued
all
Page 28
28
BULLETIN OF ANESTHESIA HISTORY
Rauch .
������
. . Continued from Page 2 7
of Chicago, Past alld Presen t (Cambridge, Mass.:
Riverside Press, 1 879), p . 1 5 .
5 6 . Rauch, Public Parks (n. 5 1), p. 3 1 n .
5 7 . Ibid.
58. Regarding preparation of the report Public
Parks, see Rauch to Olmsted, 1 2, 20, and 21 Janu­
ary 1 8 6 9 , Olmsted Papers (n. 49) . Regarding
Olmsted and Vaux's involvement in the design of
the park, see Rauch to Olmsted, 1 3 , 21, and 22
April 1 869; McCagg to Olmsted, 1 May 1 869, ibid.
59. Laura Wood Roper, FLO., A Biography of
Frederick Law Olmsted (Baltimore: Johns Hopkins
University Press, 1 973).
60. Loudon, in his own Architectural Magazine
and Journal (London: Longman etc., 1 838), 5:619,
references noted phrenologist George Combe's
TIze Constitution of Man: COilS ide red in Relation to
External Objects, 5th ed. (Edinburgh: J . Anderson,
Jnr., 1 8 35), and J o h n Macculloch, Malaria, An
Essay on the Production and Propagation of 771 is Poi­
SOli, and 011 the Nature alld Localities of the Places by
Which It Is Produced . . . (Philadelphia: T. Kite,
1 829); and Sir James Clark, TIze Inj/uellce of Cli­
mate ill the Prevention and Cure ofChronic Diseases .
. . (London: T. a n d G. Underwood, 1 8 30), a s
essential to understanding urban design.
6 1 . There is sustained and at times affection­
ate correspondence from \XTaring to Olmsted i n
Olmsted Papers ( n . 49).
62. George E. Waring, Jr., Draining for Profit,
and Draining for Health, 2d ed. (New York: Or­
ange Judd Company, 1 879).
63. Frederick Law Olmsted et ai., "Report to
the Staten Island Improvement Commission of a
Preliminary Scheme of Improvements" ( 1 8 7 l ) , in
Landscape into Cityscape: Frederick Law Olmsted's
Plans for a Greater New York City, ed. Albert Fein
(Ithaca: Cornell University Press, 1968), pp. 1 73300.
64. Ibid., p . 199.
6 5 . Ibid., pp. 207-37.
66. Frederick Law Olmsted and J. J. R. Croes,
Bulletin of Anesthesia History
Doris K. Cope, M.D., Editor
200 Medical Arts Building
200 Delafield Avenue, Suite 2070
Pittsburgh, PA 15215
"Preliminary Report . . . upon the Laying Out of
the Twe n ty-th i rd and Twe n ty-fourth Wards"
( 1 877), in Civilizing American Cities: A Selection of
Frederick Law Olmsted's lV'i'itings on City Landscapes,
ed. S . B . Sutton (Cambridge: MIT Press, 1 9 7 1 ) ,
p p . 4 1 -5 1 , quotation on p. 49.
67. Olmsted, Vaux & Co., Observation on the
Progress of Improvements in Street Plans, with Spe­
cial Reference to the Park-way Proposed to Be Laid
Out in Brooklyn, 1868 (Brooklyn: 1. van Anden's
68. Ibid., p. 1 8.
69. Frederick Law Olmsted, "Public Parks and
the Enlargement of Towns" ( 1 870), in S u tton,
Civilizing American Cities (n. 66), pp. 52-99, quo­
tation on p. 70.
70. Ibid., p. 72.
7 1 . C ha rles E . Beveridge, 'Frederick Law
Olmsted," in Alllerican Landscape Architecture: De­
signers and Places, ed. William H. Tishler (Wash­
ington, D . C . : Preservation Press, 1989), p. 3 8 .
Print, 1 868), p. 1 7 .
5th INTERNATIONAL SYMPOSIUM
ON THE HISTORY OF ANAESTHESIA
(ISHA )
University of Santiago de Compostela, Spain
1 9 - 2 3 S e p tember, 2 0 0 1
For further information,
please go to the ISHA website at www.usc. es/isha/ or contact:
J. Carlos Diz
Servicio de Anestesio1ogia y Reanimaci6n
Hospital General de Ga1icia-Clinico Universitario
c/Ga1eras sin
1 5705-Santiago
Spain
Tel: 34.98.1540223
Fax: 34.98 . 1 540172
E-mail: < [email protected]>