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September 1999
Volume 63 |
Number 9
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| Robert Andrew
Hingson, M.D.: OB Analgesia Pioneer (1913-1996) |
Henry Rosenberg, M.D.
Robert Andrew Hingson, M.D., was not only a pioneer in anesthesiology,
renowned for his introduction of peridural analgesia during labor
and delivery, but was also recognized for his contributions to
humanity outside his specialized field. In the field of public
health, he enabled millions of people to be immunized against
a wide variety of diseases in a relatively painless and efficient
manner because of his development of the jet injector. Hingson
also established the Brother's Brother Foundation, a volunteer,
interfaith group dedicated to linking America's vast resources
to global health care needs.
Early Medical Training
Born in 1913 in Anniston, Alabama, Hingson's interest
in studying medicine grew as he witnessed the plight of poor African
Americans and their disproportionate number of deaths by disease.
After graduating from Emory University School of Medicine in Atlanta,
Georgia, in 1938, Hingson interned at the U.S. Marine Hospital
on Staten Island, New York, and then joined the Coast Guard as
a Public Health Officer. While serving in the North Atlantic before
America entered World War II, he ministered to then Treasury Secretary
Henry Morganthau returning from a secret mission to Europe. When
Morganthau sought to reward Hingson for his services, he helped
him obtain a one-year fellowship under John S. Lundy, M.D., at
the Mayo Clinic.
Still assigned to the Public Health Service, after two
years at Mayo, he returned to Staten Island in 1941 to become
Chief of the Department of Anesthesia at the U.S. Marine Hospital.
Because a large number of wives of enlisted men were served by
this facility and since his own wife was pregnant at the time,
he became interested in solving the problem of pain in childbirth
at the newly converted obstetric hospital.
Development of Continuous Caudal Anesthesiology
Having observed the analgesia produced by a single peridural
injection of a short-acting agent into the lumbar area when the
cervix was fully dilated, Hingson and an obstetrician colleague,
Waldo B. Edwards, M.D., realized the need to develop methods of
pain relief throughout prolonged or difficult labor. They decided
to combine the advantages of continuous spinal anesthesia with
the safety, simplicity and effectiveness of extradural nerve block
by using the sacral hiatus approach to the peridural space. Securing
the hub of the malleable needle to rigid rubber tubing, the anesthetic
agent could be introduced with the patient in her hospital room,
uninterrupted during transfer to the delivery site and easily
maneuvered for preparation, delivery and, if necessary, episiotomy.
Of course, the needle was left in the caudal canal, and the patient
labored in the decubitus position.
Because of the impressive results, Hingson suggested continuous
caudal block for traumatic surgery, including at the battlefront,
and his techniques were later extended to the upper abdomen by
increasing the amounts of the injected solution.
Hingson was encouraged to publish his findings by Morris
Fishbein, M.D., then Editor of the Journal of the American
Medical Association. Eventually, an extensive body of writing
evolved and Hingson received invitations to hold clinics in obstetric
analgesia throughout Europe, Canada and the United States.
Still in the Public Health Service, he transferred to
the Philadelphia Lying-In Hospital, a unit of the Pennsylvania
Hospital, where he established an obstetric analgesia service.
He was next assigned to the University of Tennessee School of
Medicine to investigate the 13-percent infant mortality rate in
Memphis. He established the university's first department of anesthesiology,
while reversing the trend of newborn deaths.
Hingson was next assigned to the Johns Hopkins University,
Baltimore, Maryland, where he promoted the replacement of general
anesthesia with regional anesthesia for deliveries. Retiring as
a public health officer in 1951, he became the first professor
of anesthesiology at Western Reserve University School of Medicine,
and director of anesthesia at the University Hospital of Cleveland,
both in Cleveland, Ohio. There he developed a portable anesthesia
machine, nicknamed the Western Reserve Midget, capable of providing
instantaneous anesthesia for dentistry, obstetrics and surgery.
His machine was also adapted as a ventilator for resuscitation
by firemen, military personnel and rescue workers.
Development of the Jet Injector
During his time at Staten Island, Hingson cared for a
merchant seaman whose hand was exposed to high-pressure trauma.
The pressure had forced oil into the man's hand without a visible
surface wound. Hingson was determined to utilize the phenomenon
to develop a technique of injection. Working with an engineer,
he designed the "hypospray," a two-cell-flashlight-size instrument
constructed so that 125 pounds of spring pressure was projected
against a plunger within a metal container. Pressures built up
to approximately 3,900 pounds per square inch and projected a
column of liquid through the orifice of the ampule at a velocity
of 600 miles per hour. Because of the minute size of the orifice,
only 11 g of pressure was developed by the jet. The high pressure
forced fluid into the subcutaneous tissue without a break in the
epidermis.
This high-velocity, microjet, injectable apparatus was
first used clinically with local anesthetics, ephedrine, insulin
and penicillin. The original hypospray underwent extensive experimentation
in anesthetic administration and later for vaccination, evolving
as an important public health instrument. For Hingson, the most
important benefit of the hypospray was that it did not frighten
children undergoing vaccination nearly as much as did a syringe
and needle.
Production-line immunization began in 1956 when Hingson
and his team inoculated children with the Salk vaccine in Cleveland,
Ohio. Eventually more than 300,000 patients were immunized via
jet injection, primarily against polio and influenza.
Brother's Brother Foundation
In 1958, in association with the Baptist World Alliance,
Hingson and his team, with gifts of vaccines and transportation
facilities from pharmaceutical firms, inoculated some 90,000 people
throughout Asia and Africa against typhoid, cholera and polio.
These large-scale medical missions were the impetus for his establishing
the Brother's Brother Foundation (BBF), an agency now directed
by his son, Luke. Robert Hingson left academic anesthesia in l973
to devote his full time to BBF.
Today, along with medical and agricultural supplies, BBF
receives yearly donations of millions of educational materials
to be distributed to schools and medical institutions, and BBF's
Intraocular Lens Program distributes and implants lenses to help
restore vision to cataract sufferers.
Honors for Robert Hingson
Nearly every country in which Hingson served awarded him
their highest humanitarian honors. He was nominated for a Nobel
Peace Prize. He was a guest faculty member in anesthesia throughout
clinics in Europe, South and Central America and in the United
States. He was also honored by the American Society of Regional
Anesthesia and was one of 19 recipients of the President's (Reagan)
Volunteer Action Award.
Hingson's monumental achievements were never officially
recognized by ASA, probably because his major development was
in the field of public health and the intensity of his effort
took him out of the mainstream of ASA activities. He preferred
the recognition that he received from the people who benefited
from his efforts. ASA missed an opportunity to encourage and recognize
one of its most innovative members.
Hingson and his wife, Gussie, had five children, all of
whom accompanied him on overseas missions. He and Gussie retired
to a farm in Ocilla, Georgia, where he died in 1996.
Henry Rosenberg, M.D., is Professor of
Anesthesiology, Residency Director, and Vice Chair for Academic
Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania.
Reference:
- Hingson RA, Edwards WB. Comprehensive review of continuous
caudal analgesia for anesthetists. Anesthesiology. 1943; 4:181-196.
This is one example of the many articles Hingson wrote on the
subject in a variety of journals and monographs.
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