Thursday, June 19, 2014

Early Anesthesia in Alabama

Anesthesia is one of America's great contributions to medical care. Ironically, some of the earliest users of ether were often medical students, doctors or dentists who inhaled it recreationally. Crawford Long, a doctor in Georgia, after such use in his community realized the practical potential for ether, and he used it on several surgical patients in 1842. In October 1846 dentist William Morton demonstrated ether inhalation at Boston's Massachusetts Hospital, and the news spread quickly. By 1847 ether anesthesia had reached Alabama.

Dr. Albert A. Cary, a dentist in Huntsville made the first known use of anesthesia in Alabama. In a May 12, 1847, advertisement in the Huntsville Weekly Democrat, Dr. Cary proclaimed that he could extract teeth "without pain!" That ad listed a local attorney, C.C. Clay, Jr., as a satisfied patient. Clay also served as a judge, state representative, U.S. Senator, and diplomatic agent for the Confederacy. He died in 1882 and is buried in Maple Hill Cemetery in Huntsville. 

Thomas Hubbard Hobbs, a student at LaGrange College in 1845, wrote in his journal (which is now at the University of Alabama's Gorgas Library) that they discussed the effects of nitrous oxide inhalation in Professor Tutwiler's chemistry class. "It is commonly known as Exhilarating Gas, from its effects when inhaled. After evening prayers, we went down to see it tried upon some of the students." Although its effects were known since the late 18th century, nitrous oxide was not used for surgical pain until about the same time as ether. 

After a long search for an anesthetic without ether's smell and side effects and effects lasting longer than those of nitrous oxide, Dr. James Young Simpson and colleagues in Edinburgh, Scotland, discovered chloroform in November, 1847. The following May, Dr. Andrews of Montevallo reported that he had used chloroform to amputate "a negro boy's leg, immediately below the knee, while under the influence of this powerful agent. He declared he did not feel or know anything of the operation."

In an 1850 publication, Dr. Hardy V. Wooten of Lowndesboro noted that "I have made more or less use of chloroform in those cases [obstetric], pretty constantly, for the last two years." In 1848, S.B. North, a "Surgeon Dentist," placed an ad in the Mobile newspaper, noting that "Chloroform...This chemical preparation has satisfactory [sic] proven itself in several surgical operations in Mobile." North went on to claim that the urging of "many friends" had induced him to offer his services in painless teeth extraction. By the end of 1853, the use of ether and chloroform in the state had been reported in cases ranging from tooth extraction to tumor removals, amputation, and Cesarean section.

A decade later, during the Civil War, the North's naval blockade made drug supplies a constant worry within the Confederate States. Three drugs were in high demand: morphine, quinine, and chloroform. Some evidence of chloroform use in Alabama during the war has survived. Most examples are related to the numerous temporary hospitals and supply depots that operated in the state during the conflict. For instance, a surgeon, Dr. E.H.C. Bailey, reported in October 1864 that his supply of chloroform at the depot in Demopolis was adequate. Chemist Charles T. Mohr is also known to have produced ether in his laboratories in Mobile and Montgomery.

A fascinating case was published in the September 1864 issue of the Confederate States Medical and Surgical Journal. A surgeon in Demopolis, Dr. Hargrove Hinkley, described an arm amputation he performed on August 26, 1863, on J. Cope, a sergeant in the 18th Mississippi Volunteers. Cope was anesthetized with chloroform. Wounded at Gettysburg the previous year, Cope had walked 200 miles to the hospital at Richmond. The arm wound healed, and Cope was sent home to Mississippi on furlough. On that trip he developed a terrible fever since gangrene had developed and ended up in Demopolis in the care of Hinkley. The surgeon noted after the amputation that "Patient recovered from the influence of chloroform without any bad result and with much moral courage, and expressed hope and confidence in the attendants." Hinckley finished his case report by declaring Cope had "entirely recovered by the first week in November."

After the war, twenty years passed before significant changes in anesthesia appeared in Alabama. In September 1884 Carl Koller's use of topical cocaine for eye surgery was reported in Germany. The use of cocaine for local anesthesia reached America before the end of the year, and by April 1885, Dr. William Sanders of Mobile reported at the state medical meeting 19 cases of eye surgery using cocaine. 

The first deliberate spinal anesthetic was performed by August Bier in Germany in August, 1898. At the 1901 state medical meeting, Drs. Samuel Billing of Montgomery and Samuel Gay of Selma reported using spinal anesthesia for toe amputation and labor and gynecological surgeries. Both men were skeptical of the technique because of complications and side effects.

Dr. Barney Rogan, also of Selma, reported yet another anesthesia advance at that same 1901 meeting. "I have recently adopted the ether chart, devised by Dr. Cushing of Johns Hopkins Hospital," he wrote. "I believe that nothing so trains a person to become skilled in the administration of anaesthetics as the routine employment of the charts." How Rogan, a physician in a small Alabama town learned of this as yet unpublished development by Drs. Harvey Cushing and E.A. Codman in Baltimore remains something of a mystery.

In the early 1900s most general anesthetics in the United States were administered by nurses or medical students. Physicians who devoted some of their practice to anesthesia were rare and had to supplement that income with other duties. Yet for several years in Birmingham Dr. James Robertson Dawson [1876-1973] spent many hours administering nitrous oxide/oxygen anesthesia for surgeries performed by Dr. Edward Mortimer Prince. One of the co-founders of South Highlands Hospital in 1910, Prince published numerous articles before World War I about his cases, and in at least one of them acknowledges Dawson's role "at the head of the table." 

James Robertson Dawson, M.D. [Courtesy of Dr. Dawson's family]

Robertson published at least one article as illustrated above. Near the end of that 1906  article he wrote, "My earnest plea is for a greater appreciation and recognition of the anesthetist, and as a result this branch of surgery will soon mount to the height it so justly deserves..." Dr. Robertson was probably the earliest physician-anesthetist in Alabama, but even his practice in that area was not full-time; he was also a general practitioner. He is buried in Birmingham's Elmwood Cemetery.  

Other Alabama physicians known to have administered anesthesia before the Great War include Robert G. McGahey in Birmingham, James Chisolm in Selma, and Edward Sledge in Mobile.

An early nurse anesthetist in Alabama was Selma native Mary Morgan Keipp. She did her medical training in the Northeast, where she developed a second career as a photographer. Keipp returned to Selma in 1904 and worked as an anesthetist at King Memorial and Baptist hospitals as she continued her photography.

Amy Baldwin was another early nurse anesthetist in the state. In 1924 the medical director of TCI Hospital in Fairfield sent this registered nurse to a four-month training course in anesthesia. Verna Rice, a nurse anesthetist at Providence Hospital in Mobile from 1925 until 1957, was involved in the early organization of both the American Association of Nurse Anesthetists and its state component in Alabama.

Surgery and anesthesia were performed under rather primitive conditions in Alabama even into the 1930s. In his 1996 memoir Life of a Country Doctor James Edwards Cameron noted a surgery he performed near Alexander City in the 1930s. "Out in the yard, under the shade of an oak tree, in daylight, I took out the child's appendix while Dr. Nolen gave the anesthetic and shooed the flies away." 

The first male full-time anesthesiologist in Alabama was Dr. Alfred Habeeb, who practiced for many years in Birmingham beginning in the late 1930s. In the early 1950s he and several colleagues founded what became Anesthesia Services of Birmingham, the first private anesthesia practice in Alabama and one of the largest in the South. 

He and several others founded the Alabama State Society of Anesthesiologists in 1948. He was also the first physician in the state to be certified by the American Board of Anesthesiologists and one of the earliest state members of the American Society of Anesthesiologists. Dr. Habeeb died in 2009 at the age of 98.

Alfred Habeeb, M.D. 

The first female full-time anesthesiologist in Alabama was Illinois native Dr. Alice McNeal, who arrived in Birmingham in 1946 after a long career in Chicago and served as Chair of the University of Alabama School of Medicine's Anesthesiology Department from 1948 until 1961. 

                                Alice McNeal, M.D.

She was also one of the founding members of the Alabama State Society of Anesthesiologists in 1948. Dr. McNeal, who died in 1964, was inducted into the Alabama HealthCare Hall of Fame in 2010.

For more information about medicine and anesthesia in Alabama, see

Holley HL. History of Medicine in Alabama. University of Alabama Press, 1982

Wright AJ. Early Use of General Anesthesia in Alabama, 1847-1853. Ala J Med Sci 1986 July; 23(3):333-335

Wright AJ. Regional and Local Anesthesia in Alabama Before World War I. Ala J Med Sci 1988 April; 25(2):204-209

An earlier version of this post appeared in the Birmingham Medical News in December 2011.

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