Cocaine Comes to Alabama in 1884

In an earlier post on this blog I wrote about early anesthesia in the state. I noted that Dr. William Sanders of Mobile had reported the use of cocaine for local anesthesia in 19 eye surgeries in April 1885. Apparently that drug had been used for a similar purpose several months earlier in Montgomery.

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 in a matter of weeks, and surgeons in New York and elsewhere used the method both on patients and in self-experiments. Several of these doctors, including the great William Halsted, became addicted. At the time of his discovery Koller was a surgeon in Vienna and a colleague of Sigmund Freud. 

By the end of 1884 more than 180 articles had appeared in the world medical literature describing cocaine use for local anesthesia in eye, nose, throat and other areas. A newspaper article in the Montgomery Advertiser in late November 1884 noted use by a local doctor named B.J. Baldwin.

That article is reproduced in full below from its reprinting in the Huntsville Weekly Democrat of November 26, 1884. Baldwin was apparently Benjamin James Baldwin. He appears in the listing of Montgomery County physicians in the 1889 Transactions of the Medical Association of the State of Alabama. He is identified as a medical school graduate of "Bellevue" in 1877. That apparently means Bellevue Hospital Medical College, which operated in New York City until 1898 when it merged with New York University. Baldwin was certified via exam by the Montgomery County medical board of examiners in 1883. 

Baldwin was born in Montgomery on February 6, 1864. He became a prominent figure in state medical circles. In 1892 he served as President of the Medical Association of the State of Alabama. His presidential address at the annual meeting in Montgomery in April of that year can be found here. Baldwin died on June 9, 1936, in Chilton County. 

Here is the entire Montgomery newspaper article as reprinted by the Huntsville Weekly Democrat. The author has the chronology of ether and chloroform anesthesia development reversed. Efforts to use nitrous oxide and ether as surgical anesthetics culminated in October 1846 in Boston when William Morton provided ether inhalation for a patient of surgeon John Collins Warren. Simpson and colleagues did not establish the anesthetic properties of chloroform until November 1847.

The article notes about cocaine, "Its discovery marks a new era in surgery" and that is very true. Koller's work with that drug inaugurated decades of clinical use and research into various other drugs for local and regional anesthesia; and the techniques enjoy wide medical application today. The many wounded Civil War soldiers who became addicted to morphine and then the quick spread of cocaine into the non-medical population in the late 1880's also created the kinds of addiction issues society deals with to this day.

The "poet Cowley" who is quoted in the article is Abraham Cowley [1618-1667], an English poet and essayist. His 1662 poem "A Legend of Coca" is one of the earliest mentions of the coca plant in English literature. The entire poem can found in Mortimer's 1901 book Peru.History of coca on pages 26-27 here. And now the article:


The science of medicine has made another step towards the relief of pain, and this time it comes through an humble medical student of Vienna. England can boast of the discovery of chloroform, and, through it, the relief of millions of sufferers. The name of Sir James Y. Simpson, it discoverer, will live through eternity and the statue erected to his memory in Westminister Abbey tells the thousands of visitors who walk through its sacred halls in what esteem the mother land holds this great benefactor. America can claim the discovery of ether a few years later, and while its discoverers have not been rewarded as was Sir James Y. Simpson, yet our people bow in reverence and gratitude to Wells, Long and Morton. 

It does not detract from the great blessings which ether and chloroform bestow upon human race, for they both have their special places, to say that the new German anesthetic for certain purposes has entirely supplanted them. About one month ago Dr. Koller, a student in a Vienna hospital, gave the startling news to the medical world that, by dropping a few drops of the Hydrochorate [SIC] of Cocaine in the eye any operation could be performed without pain and that the same was true of other parts of the body. 

American surgeons at once cabled to Germany for a supply of this marvelous drug, but only succeeded in getting a small amount. Last week, Dr. B.J. Baldwin, of this city, received a few grains from New York and under its influence performed eleven operations on the eye with entire satisfaction and absolutely without pain. 

The Cocaine is dissolved and dropped into the eye at intervals of five minutes until it has been used four times. It produces no pain, and leaves no unpleasant after effects. It seems to act by destroying the sensibility of the parts to which it is applied, but it does not, like chloroform, produce unconsciousness. Its discovery marks a new era in surgery and its action is the marvel of the medical age.

A short history of Cocaine in this connection will prove interesting. Cocaine is obtained from the leaves of the ordinary coco plant which is found wild in the mountains of Peru and Bolivia. The natives of the Western countries of South America chew these leaves as a stimulant when fatigued. So much vaunted is the coco as a stimulant that the poet Cowley represents an Indian chief as addressing Venus thus:

"Our Varichoca first this coco sent,
Endowed with leaves of wondrous nourishment,
Whose juice suck'd in, and to the stomach taken,
Long Hunger and long Labor can sustain,
From which our faint and weary bodies find
More succor, more to cheer the dropping mind
Than can your Bacchus and your Cerea joined.
The Quitoitla with this provision stored,
Can pass the vast and cloudy Andes."

It was used by the Indians of Peru in ancient times as an offering to the sun, and it is still held in veneration by the miners, who believe it has a softening effect upon the veins of one when chewed and thrown upon it. The cost of ordinary coco is very little, but he hydrochlorate of cocaine is very expensive. At present it is only manufactured by one firm, in Germany, and it costs two hundred and forty dollars an ounce or three thousand eight hundred dollars a pound. 

It will probably become cheaper when other chemists begin to manufacture it. The discovery of the action of cocaine is regarded by the medical profession as more wonderful than chloroform. Let suffering humanity build a mountain of gratitude to this humble medical student of Vienna. Though scarcely out of his teens Dr. Koller is now famous over the civilized world, and the good he has done is a greater glory than the crown of his own Imperial Land.  

Alice McNeal, M.D.: Alabama's First Female Anesthesiologist

          On May 8, 2010, in a ceremony in Montgomery, Alice McNeal, M.D., was inducted into the Alabama Healthcare Hall of Fame along with other members of the 2010 class of honorees. Dr. McNeal became the second anesthesiologist inducted; Robert A. Hingson, M.D., in 1999, was the first. 

       The Hall of Fame was established in 1997 “to recognize those persons, living or deceased, who have made outstanding contributions to, or rendered exemplary service for healthcare in the State of Alabama.” Past honorees have included such well-known medical figures as Peter Bryce, William Crawford Gorgas, James D. Hardy,  Seale Harris, Tinsley R. Harrison, Sr., Luther Leonidas Hill, Basil I. Hirschowitz, John W. Kirklin, Josiah C. Nott, Lloyd Noland, David Satcher, and J. Marion Sims. 

In September 1945, the first class of students began their studies at the Medical College of Alabama in Birmingham. This four-year school had replaced a two-year program in Tuscaloosa, and thus students no longer needed to leave Alabama to obtain a medical degree. The demands of creating this school quickly and almost from scratch led DeanRoy Kracke to open a few opportunities for female physicians. When the school opened, Dr. Melson Barfield-Carter, an Alabama native who had practiced radiology in the city since 1929, was named Professor and Chair of the school's Radiology Department. Three years later, Dr. Alice McNeal became the second female department chair at the Medical College.

            Alice McNeal was born in 1897 in Hinsdale, Illinois. She graduated from Rush Medical College in Chicago in 1921, and during the next two years completed internships at Women's Hospital in Philadelphia and Durand Hospital in Chicago. In 1925 she began a stretch of twenty-one years as Anesthesiologist and Instructor in Anesthesia at Presbyterian Hospital in Chicago. During this period she completed a residency in anesthesia under Huberta Livingstone in 1926 and a second residency under Ralph Tovell in Hartford, Connecticut, in 1938 and 1939. Dr. McNeal was certified by the American Board of Anesthesiology in 1941.

McNeal in 1921, at the time she received her Rush MC certificate

She received her M.D. the following year, one of 5 women among 129 total graduates

Source: Rush-Presbyterian-St. Luke’s Medical Center Archives [Chicago]


 

            During World War II McNeal was active in the effort to bring female physicians into the U.S. armed forces. Women doctors had not been allowed to enlist in World War I; they could not yet vote and thus were not "citizens". A few were allowed to be "contract" physcians during that conflict. McNeal and Dr. Virginia Apgar led the effort in World War II; in April 1943 the Sparkman-Johnson Bill passed Congress, and women were allowed to enlist. 

            By early 1946, Dean Roy Kracke needed a Chief of Anesthesia for the hospital of the new medical school. Apparently John Adriani, a prominent anesthesiologist at Charity Hospital in New Orleans, was offered the position but declined. By May of that year Dean Kracke had persuaded Dr. McNeal to accept the post, and she arrived in Birmingham to become an Assistant Professor of Surgery and Chief of the Surgery Department's Anesthesia Division. In August 1948, Dr. McNeal was named Chair of the newly created Department of Anesthesiology and remained in that position until stepping  down in 1961. She retired the following year. Dr. McNeal died on December 31, 1964.

            In October 1946 Dr. McNeal began organizing a School of Nurse Anesthetists at the hospital. In the spring of 1948 she was one of four founding members--and the only female--of the Alabama State Society of Anesthesiologists. As a result of her efforts, the department's residency program was certified by the American Board of Anesthesiology in February 1949. In that same year, under the auspices of the International Refugee Organization, Dr. McNeal made a nine-week trip to Munich, Germany, and lectured to some 150 local physicians on modern medical practices. She served as President of the Southern Society of Anesthesiologists for 1956-57.

            Dr. McNeal’s professional career had two phases. At Presbyterian Hospital in Chicago, she worked under Dr. Isabella Herb and two other female anesthesiologists, Drs. Nora Brandenburgh and Mary Lyons. By the time she arrived in Alabama, she already had 21 years experience in anesthesia. In her new home, she found herself to be not only one of the few female physicians but one of the few physician-anesthesiologists in the state. In the early years, she coordinated anesthesia administration at the university's busy hospital (formerly the county hospital in the state's most populous county) with help from a few nurse anesthetists, an occasional resident, and sometimes a dental student doing an anesthesia rotation. By 1950 her department coordinated 9700 anesthetics a year at the hospital.

Dr. McNeal presents the Chief Resident’s Chair to Patricia F. Norman, M.D. in 1959. This tradition continued in the department into the early 1990s. 

Source: UAB Archives

She is remembered fondly by those who knew her; former UAB President Dr. Charles McCallum's comment that she was "a great teacher, well-liked, and worked hard" is typical. Dr. McCallum also said “She loved to dance.”  [Source: my interview with Dr. McCallum in 1992] Jim Jones, M.D., a faculty member in her department from 1958 until 1960, remarked that “She dearly loved fine conversation, classical music and well-written books…and good scotch!” Dr. Jones also noted, "Alice in an interview shortly before her demise, denied being a pioneer but did admit to being perhaps a veteran in the field of anesthesiology." [Sources: written tribute by Dr. Jones, December 1971 and my interview with him in March 1996] 

          Former UAB President S. Richardson Hill, Jr., told me in a letter in June 1993 that "I liked her very much and thoroughly enjoyed her company...my wife was also very fond of her, and occasionally on special occasions they exchanged presents. At one time Alice gave my wife a beautiful pocketbook which she had made."

           Unfortunately, Dr. McNeal committed suicide on New Year's Eve 1964. She had stepped down as Chair of the department in 1961, although she remained on the faculty for a year or so after that. McNeal was an only child; her parents were long dead, and apparently she had no reason to return to Illinois. Her body was cremated, but a gravestone for her can be found in Birmingham's Elmwood Cemetery. There the spirit of this stranger in a strange land rests along with many other individuals prominent in Alabama history.

Although she published only two research papers, Dr. McNeal created the foundation for academic anesthesia in the state by chairing the first department for so long, providing excellent patient care and many clinical improvements, and training so many anesthesiologists, dentists, and nurses. Dr. McNeal is thus an important figure both in the history of the state's medical education and its female physicians as well. She was the first female anesthesiologist in Alabama, and one of the first females to chair of an academic anesthesia department in the United States. In 1998 the University of Alabama Board of Trustees established the Alice McNeal, M.D., Endowed Chair in Anesthesiology in her honor.

Dr. McNeal and others in the Hill Heart Suite, Medical College of Alabama, Birmingham in the early 1960s.

Source: Alvin Bearman, M.D. [one of her last residents]

Two photos of Dr. McNeal during her time at UAB. 

•Ca. 1922

•Graduated MC Phi Beta Kappa and AOA

•Woman on right may be her mother

•Photo taken in back yard of family home?

Source: Fran Watkins, long-time CRNA at UASOM

Anesthesia Staff, Presbyterian Hospital, 1936

•Nora Brandenburgh, M.D.

•Alice McNeal, M.D.

•Mary Lyons, M.D.

•Isabella Herb, M.D.

•Spring 1936

      Source: Bulletin, Presbyterian Hospital, April 1936

Anesthesiology 11: 96, 1950 [Department’s first publication]

Julie Cole Miller has written a very nice profile of Dr. McNeal with some additional photos that is available here.

 

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.