t the turn of the last century, transforming technologies reshaped the world and altered how people lived, worked and played. A clear example can be found in electricity, which had been understood since Thomas A. Edison developed the filament light in 1879. But it was not until giant dynamos illuminated the streets of Paris with hundreds of thousands of electric lights at the 1900 World’s Fair that the death knell sounded for gas lighting.

So, too, the discovery of anesthesia — beginning with the painless removal of a neck tumor by Crawford W. Long, M.D., in Georgia on March 30, 1842, and later the public demonstration of ether anesthesia by W.T.G. Morton, on October 16, 1846 — heralded a major transforming technology. Yet the world of medicine was not revolutionized until decades later when anesthesia became the standard of care for surgery, allowing a host of procedures, once complex beyond imagination, to become commonplace.

In 1905 a Dr. Thomas Bennett of New York City was described by James Tayloe Gwathmey, M.D., as the first American “practicing anesthetics” exclusively. At that time, the administration of anesthetics as a specialty was recognized in only a few of the larger cities. Dr. Gwathmey was one of the earliest private-practice anesthesiologists. He followed various surgeons from hospital to hospital to care for their patients, submitting his own bill and demanding to be treated as any other physician specialist.

James T. Gwathmey, M.D., was an avid gymnast before embarking on a career in anesthesiology. He was Director of the Gymnasium and Instructor in Physical Exercise at Vanderbilt University, Nashville, Tennessee, where he also was awarded an M.D. in 1899. Image courtesy of Bradley E. Smith, M.D.

Open ether anesthesia in the early 20th century.

These were the last days of “red-blooded, full-throated, get out of my way or I will run you down” capitalism, and medicine, like business in general, was ripe for entrepreneurship. Dr. Gwathmey, an intern at the New York Skin and Cancer Center, had decided that anesthesiology offered better practice opportunities than dermatology. In 1902 he described his portable “anaesthetic outfit,” which consisted of an “18-inch dress suit case” containing the whole of all he would carry to each hospital to perform anesthesia (see box below).

In 1903 he published his own anesthetic chart with a graphic display of pulse to be taken every five minutes, rate of the mixture he used, often administering “A.C.E.” (one part alcohol, two parts chloroform and three parts ether) using an inhaler he modified. He reported its use “in over 50 very difficult cases, most of them over three hours and two of them over four hours in duration. Several of these cases were athletic alcoholics, such as give most trouble to the anaesthetist, but it has never failed to give satisfaction.”² In 1904 he anesthetized cats² in a series of experiments, concluding that the four general anesthetics then in common use should be listed in the following order of safety:

• Nitrous oxide gas and oxygen;

• Nitrous oxide gas and air;

• Ethyl chloride and oxygen;

• Ethyl chloride and air;

• Ether and oxygen;

• Chloroform and oxygen;

• Ether and air;

• Chloroform and ether and air (two parts chloroform, three of ether);

• Chloroform and air.³

In 1905 his preference was to sequence agents gas (N₂O) followed by ether and then chloroform, all warmed and preferably administered with oxygen rather than room air.

From his extensive private practice and experimentation, he went on to explore this new specialty, publishing the first comprehensive American textbook of anesthesiology in 1914⁴ and becoming a key founding member and the first president of the New York Society of Anesthetists, a precursor of the American Society of Anesthesiologists.

Dr. Gwathmey’s early advice to Richard von Foregger, M.D., was to “seize opportunities as they arise,” and this he did with vigor — the face of medicine, and in particular anesthesiology and surgery, was changed forever.

References:
1. Gwathmey JT. Remarks on gas-æther anaesthesia. Med Rev Reviews, October 25, 1902;976-979. [Collected in Pittinger CB. James Tayloe Gwathmey, M.D. American Pioneer Anesthesiologist. Vanderbilt University School of Medicine Department of Anesthesiology, 1989].
2. Gwathmey JT. Improvements in anaesthetic apparatus and technique. Med Rec. 1903; 69:92-94.
3. Gwathmey JT. The selection and administration of the anesthetic. NY State J Med. 1905; 5:252-257.
4. Gwathmey JT. Anesthesia. New York: D. Appleton and Co; 1914:945.

Doris K. Cope, M.D., is Director, University of Pittsburgh Medical Center (UPMC) Pain Medicine Program, and Professor of Anesthesiology, UPMC, Pittsburgh, Pennsylvania.

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