Some Curious History on Curare
read with interest your comment in the December
2007 “From the Crow’s
Nest” regarding the use of
curare.
A little history might be interesting.
In the 1950s, I was a resident at the Mass General Hospital,
the home of Beecher and Todd. I don’t know how
curare was used in other hospitals, but at MGH, it went
as follows:
We were told that Beecher did not want us to use curare.
We did, of course, along with diethylether, which meant
that a relative “overdose” was given when
compared with the doses used with cyclopropane or N2O.
Secondly, we were told not to reverse curare because
neostigmine was dangerous. Indeed it was because no
atropine was used.
So much for curare “toxicity.”
Incidentally, Beecher also thought that thiopental was
dangerous, and there were surgeons who forbade the use
of either curare or thiopental for their patients.
We residents (and our patients) were lucky to have as
our teachers some good Danes such as Bendixen, Pontoppidan
and Andersen, who taught us to titrate curare and to
reverse with atropine/neostigmine.
I enjoy reading the NEWSLETTER. Keep it coming.
Barbara E. Waud, M.D.
Shrewsbury, Massachusetts
Illuminating the Fog of History
read with great interest Dr. Bacon’s October
2007 editorial concerning anesthesiologist participation
in capital punishment. However, I believe a few corrections
and clarifications need to be made:
1. In 2006, the ASA Board of Directors and House
of Delegates approved an explicit statement concerning
physician participation in capital punishment. Specifically,
that there is no association of capital punishment
with the practice of medicine, particularly anesthesiology,
that capital punishment in any form is not the practice
of medicine, and that it does not require the participation
of any physician. The full statement can be found
on the ASA Web site: www.asahq.org/publicationsAndServices/standards/
41.pdf.
2. The eugenics movement was widely embraced in
the United States, particularly by the elites, during
the first half of the 20th century. Its goal was
to maintain or improve human genetic qualities.
Eugenics was used to justify laws to forcibly sterilize
“undesirables” and to prevent marriages
and immigration. Eugenics was quickly swept under
the rug after World War II after the discovery of
the Nazi death camps.
Finally, the widespread practice of limiting enrollment
of Jews in American medical schools had nothing to
do with the eugenics movement. This was simple racism,
justified by the claim that the policy just kept the
proportion of Jewish students to that of the general
population. Unfortunately, this is one of an almost
endless list of racist policies built upon a foundation
of “the ends justify the means.”
Dr. Bacon is to be commended for shining a light on
these important issues. It is imperative that unsavory
aspects of our history, as Americans and physicians,
do not get lost in the fog of history.
J.P. Abenstein, M.S.E.E., M.D.
ASA Vice-Speaker of the House of Delegates
Reader Executes a History
Lesson on Capital Punishment
was fascinated by reading your statement that the
participation of anesthetists in capital punishment
has come before the anesthesia community in the last
18 months (October
2007 “From the Crow’s Nest”).
After the first execution using anesthetic agents
in 1981 in Huntsville, Texas, M.T. “Pepper”
Jenkins, M.D., the chair of my department at Parkland
Hospital in Dallas, wrote an angry letter decrying
the humorous responses of anesthetists to enquiry
about such use of anesthetics.
In September 1984, A.H. (Buddy) Giesecke, M.D., proposed
to the House of Delegates resolution No.16, concerning
the Execution of Criminals, asking ASA to join the
case Heckler vs. Chaney #83-1878 before the
U.S. Supreme Court as amicus curiae to order the FDA
to formally research the efficacy of anesthetic agents
for the execution of criminals and also to encourage
the FDA to research the fears of our patients who
relate this use of anesthetics to their own anticipated
anesthetic. Buddy made no mention of the possibility
that some of these prisoners on death row were actually
innocent.
I proposed with Edward A. Brunner, M.D., Ph.D., John
J. “Jack” Downes, Jr., M.D., Ronald L.
Katz, M.D., M. Jack Frumin, M.D., and Leonard Bachman,
M.D., that the Association of University Anesthesiologists
(AUA) at the Seattle meeting in 1991 condemn this
use of anesthetics. Stanley Deutsch, M.D., Ph.D.,
formerly the chair at the University of Oklahoma,
who had advised that state about doses and the order
of drugs in 1977, was at that meeting. AUA, after
a motion by Craig Alexander, tabled our motion.
Dear Douglas Bacon, I have great respect for your
writing, but you left some history out of your article
“Descent Into Darkness?” in the October
2007 ASA NEWSLETTER. This subject has received
our attention long before 18 months ago. My opinion?
We should condemn such use of anesthetics categorically
and then condemn executing prisoners by any method.
Lawrence D. Egbert, M.D., M.P.H.
Baltimore, Maryland
Our Stance on Death Penalty
Could Be Impetus for Change
 t
a time when the death penalty system is clearly in
decline, it seems strange that members of ASA should
show such interest in physician presence at executions.1
It is particularly worrisome because the Kentucky
case, Baze v. Rees, is currently before the
Supreme Court and has resulted in a defacto moratorium
on executions. By stepping forward to offer a “humane”
means of execution, anesthesiologists would provide
the Supreme Court a mechanism whereby execution could
be re-instated under a veneer of medically guided
respectability. At this legal moment, would anesthesiologists’
offers to participate in executions be regarded not
as a “humane” gesture but instead a pro-execution
stance?
What if circumstances were different, and instead
of the United States, such policies were proposed
by anesthesiologists in other countries? How would
we regard the ethics of Russian anesthesiologists
if they were to offer terminal anesthesia for those
condemned by Mr. Putin’s courts? Likewise, what
would be our stance concerning anesthesiologists in
China, Egypt or Iran if they were to provide execution
by anesthesia? Would we consider this type of anesthesiologist
participation in this state-directed punishment worthy
of “debate,” or simply wrong?
Now we have a remarkable opportunity to enter the
death penalty debate with a humanity of a more honest
kind. The Supreme Court must be told that anesthesiologists
will never step forward and offer their services as
executioners’ assistants. Our vehement rejection
of such participation could be a step toward an end
to the death penalty.
John C. Sill, M.D.
Rochester, Minnesota
References:
1. Bacon DR. Descent
into darkness? ASA Newsl.
2007; 71(10):1-2,11.
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