Maurice S. Albin, M.D.

The annual Lewis H. Wright Memorial Lecture is sponsored by the Wood Library-Museum of Anesthesiology and honors its namesake, a pioneer in American anesthesiology. Dr. Wright was committed to enhancing the stature of anesthesiology as a clinical science and as an advanced medical specialty. He was a founding member of the Board of the Trustees of the Wood Library-Museum and later served as its President-Emeritus. In 1975 the New York State Society of Anesthesiologists endowed this history lectureship to honor Dr. Wright, who died in 1974.

This year’s distinguished speaker is Maurice S. Albin, M.D., neuroanesthesiologist and scholar of Civil War medicine. Dr. Albin began his medical career during World War II as a combat medic in the United States Army, First Infantry Division. He graduated from the National Autonomous University of Mexico School of Medicine in 1957 and completed his anesthesiology residency and fellowship at the Mayo Clinic in 1962. While still a resident, Dr. Albin became interested in clinical problems related to the neurosurgical patient. He demonstrated the feasibility of spinal cord hypothermia by perfusion cooling of the subarachnoid space. During his anesthesiology fellowship, Dr. Albin was a National Institutes of Health trainee and received a Master of Science in Anesthesiology in 1964 from the University of Minnesota in Minneapolis.

Dr. Albin continued his basic neuroanesthesia research at Case Western Reserve University School of Medicine, Cleveland, Ohio, focusing on spinal cord cooling, venous air embolism, transplantation and perfusion of the isolated mammalian brain and cerebral blood flow and metabolism. In 1972 he was appointed Anesthesiologist-in-Chief at Presbyterian University Hospital, Pittsburgh, Pennsylvania. He was recruited in 1978 to develop the neuroanesthesiology division at the University of Texas at San Antonio. In 1981 he published a seminal paper on the use and positioning of a central venous multiorificed catheter for aspiration during venous air embolism.¹ In 2001 Dr. Albin became a Professor in the Department of Anesthesiology at the University of Alabama School of Medicine in Birmingham.

Dr. Albin’s academic interests reach beyond the physiology laboratory. Influenced by his father, who was a bibliophile, Dr. Albin has become an avid collector of medical anesthesiology literature and memorabilia in three significant areas: 1) the discovery and introduction of chloroform anesthesia (1840s and 1850s); 2) the neurosciences and early description of neuroanesthesia, including venous air embolism (mid-1800s); and 3) medicine in the American Civil War (1861-65). In 2001 Dr. Albin was awarded the David M. Little, M.D., Prize for the best historical publication in anesthesiology for his paper, “The Use of Anesthetics During the Civil War (1861-1865).”²

This year’s Wright lecture is titled “They All Didn’t Bite the Bullet! Anesthesia, Analgesia and Substance Abuse During the Civil War, 1861-1865.” Despite ether’s success in the hospital setting, there was resistance to using it on the battlefield. Although the Civil War began 15 years after William T.G. Morton’s public demonstration of the use of sulfuric ether for a surgical procedure in 1846, the Union Army Medical Corps was at first hesitant to employ anesthesia during surgery. What turned the tide was the sheer magnitude of injuries and casualties (250,000 deaths) coupled with the practices of more sophisticated surgeons and the successful use of chloroform during the Crimean War (1854-56).

The Medical and Surgical History of the War of the Rebellion (MSHWR) reported 30,000 amputations, and most of them were accomplished in less than 10 minutes. The MSHWR estimated that at least 80,000 anesthetics were given during the war. In a special study of 8,900 anesthetics, chloroform accounted for 75 percent of the cases; sulfuric ether 15 percent; and a combination of chloroform-ether in the remaining 10 percent. Mortalities never exceeded 0.54 percent. Chloroform was the choice for the battlefield because it was portable, potent and noncombustible. Sulfuric ether was used in large general hospitals and was set up in the rear areas. Surgeons who had never seen or used chloroform or ether prior to the war quickly learned to use these agents.

The primary analgesics during the Civil War were opiates: opium, laudanum, paregoric and morphine salts. These compounds were used to treat pain from trauma, but they also were used in the treatment of enteric diseases “to bind up the bowels.” Opiates were used as therapy for febrile diseases such as malaria, typhoid and typhus. Morphine sulfate was often dusted into wounds, and in the later war years, the Union Army Medical Corps used hypodermic syringes for subcutaneous opiate injection.

After the Civil War, a significant number of soldiers with chronic pain or illnesses remained addicted to opiates — these were the “opium eaters” or “morphinists.” Their pensions were often denied if they were suspected of having the “Soldier’s Disease.” Postwar addiction was a powerful sociological force during the Reconstruction era, and it was only in the early 1900s that opiate use was restricted.

The Wood Library-Museum of Anesthesiology is honored to have Maurice S. Albin, M.D., as the 2004 Lewis H. Wright Memorial Lecturer. The 2004 Lewis H. Wright Memorial Lecture will take place on Tuesday, October 26, from 1 p.m. to 2 p.m. at the Las Vegas Hilton. His basic and applied research in neuroanesthesiology has helped us to recognize clinical problems and face clinical challenges. His analysis of the use of anesthetics in the American Civil War has helped us to better understand the tragedy of postwar addiction. This year marks more than 60 years since Dr. Albin began his medical career. He was caring for the wounded long before he was an anesthesiologist. We thank him for being a physician, a scholar and a soldier.

References:

1. Bunegin L, Albin MS, Helsel PE, et al. Positioning the right atrial catheter: A model for reappraisal. Anesthesiology. 1981; 55:343-348.

2. Albin MS. The use of anesthetics during the Civil War, 1861-1865. Pharmacy in History. 2001; 40:99-114.

Susan A. Vassallo, M.D., is an anesthesiologist at Massachusetts General Hospital, Boston, Massachusetts, and a Trustee of the Wood Library-Museum.