General Article
E Special Article
Freeman Allen: Boston’s Pioneering Physician Anesthetist Samuel D. Morris, Alina J. Morris, MLIS, and Mark A. Rockoff, MD On October 16, 1846 dentist William T. G. Morton successfully demonstrated at the Massachusetts General Hospital that ether could prevent the pain of surgery. For decades afterwards, the administration of anesthesia in the United States was generally relegated to dentists, medical students, junior surgical trainees, or even nonmedical personnel. It was not until the end of the 19th century that a few pioneering physicians began devoting their careers to administering anesthesia to patients, studying ways to make it safer and more effective, and teaching others about its use. One of these individuals was Freeman Allen, who was appointed the first physician anesthetist to the medical staff at the Massachusetts General Hospital and several other major hospitals in Boston. We describe this remarkable man, his contributions to the early development of anesthesiology as a medical specialty, and the true cause of his untimely death. (Anesth Analg 2014;119:1186–93)
“It is one of the paradoxes of our time that some of its most vital and significant figures live and die virtually unknown.”
F
(Tribute to Freeman Allen, NY Herald Tribune, May 6, 1930)
or its 200th anniversary in 2012, the New England Journal of Medicine conducted a survey of its readers to determine the most important article published in its history. The resounding favorite was a report in 1846 by Boston and Massachusetts General Hospital (MGH) surgeon Henry Jacob Bigelow titled “Insensitivity During Surgical Operations Produced by Inhalation,” describing the recent successful administration of ether anesthesia by dentist and part-time medical student William T. G. Morton.1,2 Although this public demonstration marked a seminal event in the history of medicine, over the ensuing decades few American physicians focused their practice on this aspect of medical care. At the MGH, for example, Dr. Bigelow himself initially provided anesthesia for several patients who subsequently received ether, but generally dentists or inexperienced medical personnel such as medical students or junior surgical house officers were assigned the task of anesthetizing the patient and were referred to as “the etherizer.”3–5 This practice began to change around the beginning of the 20th century when a few pioneering physicians began devoting themselves to administering anesthesia to patients, studying From the Department of Anesthesiology, Perioperative and Pain Medicine and the Archives Program, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts. Accepted for publication June 4, 2014. Funding: Salary support was provided by the Department of Anesthesiology, Perioperative and Pain Medicine (Mark A. Rockoff) and the Archives Program, Boston Children’s Hospital (Alina J. Morris). The authors received no additional compensation for this work. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Mark A. Rockoff, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Bader 3, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115. Address e-mail to mark.rockoff@ childrens.harvard.edu. Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000381
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ways to make it safer and more effective, and training others, including nurses, in its use. Among these was Freeman Allen (1870–1930), the first physician to be appointed as anesthetist to the medical staff of a hospital in Boston, initially at the Free Hospital for Women (a forerunner of the Brigham and Women’s Hospital) in 1901 and then at the MGH in 1902 and Boston Children’s Hospital in 19036–9,a (Fig. 1). Interestingly, Allen was the grandchild of Harriet Beecher Stowe, the author of Uncle Tom’s Cabin, and he married the great-granddaughter of Dr. John Collins Warren, the surgeon who performed the historic first operation under ether at the MGH. This report describes this remarkable man, his contributions to the early development of anesthesiology as a medical specialty, and the true cause of his untimely death.
His Early Years
Freeman Allen was born on September 27, 1870, in Stockbridge, MA, the son of Henry Freeman Allen (1838– 1914), a well-known preacher there, and Georgiana May Stowe (1843–1890), the youngest daughter of Harriet Beecher Stowe (Fig. 2). One of Harriet Beecher Stowe’s brothers, Henry Ward Beecher, was also a distinguished preacher, as was her father, Lyman Beecher, and her husband, Calvin Stowe10,b (Fig. 3). The families were descendants of early immigrants from England to the American colonies. After passage of the Fugitive Slave Act of 1850 that made all citizens responsible for enforcing the institution of slavery, Harriet Beecher Stowe became an activist and published The Freeman’s Dream, a parable in which a farmer fails to help a runaway slave and is condemned by the Lord on Judgment Day.c She then began writing Uncle Tom’s Cabin Allen’s name first appears in the MGH Annual Report in 1903, but Allen notes in one of his Harvard Class Reports that this appointment began in May 1902. Similarly, his name first appears in the Children’s Hospital Annual Report in 1904, but this covered the year 1903.6,8
a
Edwards M. Were Harriet Beecher Stowe’s children as successful as her? http://marsenaedwardsblog.wordpress.com/2013/03/06/were-harrietbeecher-stowes-children-as-successful-as-her/. Accessed January 10, 2014.
b
c Belasco S. Harriet Beecher Stowe. The New York Times, May 6, 2013: http:// topics.nytimes.com/top/reference/timestopics/people/s/harriet_beecher_ stowe/index.html. Accessed January 10, 2014.
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Freeman Allen: Boston’s Pioneering Physician Anesthetist
Figure 1. Portrait of Freeman Allen (courtesy of the Massachusetts General Hospital, Archives and Special Collections; photograph by Sam Riley, Boston, MA).
in installments for an abolitionist newspaper and in 1852 it was published as a book, becoming the first American international best seller.10 This powerful novel focused on the tragic victims of slavery in the South and had a major impact on events that led to the beginning of the Civil War in 1861.d Although freed slaves often assumed the surname “Freeman,” it was unusual for this to be used as a first name, especially by a Caucasian person. However, when Allen’s parents named their only child Freeman, it was not because of any association with the abolitionist movement but in honor of his father, Henry Freeman Allen, and grandfather, Freeman Allen (Fig. 3). Why the Allen family originally adopted the name Freeman is unclear. In 1887, when Allen’s father became pastor of a parish in Boston, he and his parents moved to 200 Beacon Street in the new Back Bay section of Boston where he was raised among that city’s elitee (Fig. 4A). A privileged child, he received his preliminary education at the private Noble and Greenough School where he prepared for Harvard College. Allen graduated from Harvard in 1893 with honorable mention in French, receiving a master’s degree the following year. He was very much involved in college life, a member of many organizations including the Hasty Pudding and Porcelain Clubs, and loved by his friends. Upon graduation, like many affluent Americans of the time, he traveled abroad.11,12 After meeting an inspiring medical student in Germany, Allen decided d In 1862, when Stowe was introduced to President Abraham Lincoln, he allegedly greeted her by saying, “So you’re the little woman who wrote the book that made this great war!”10
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Figure 2. Young Freeman Allen with his grandmother, Harriet Beecher Stowe (courtesy of the Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA).
to take some courses in medicine in Leipzig. When he returned to the United States in the summer of 1894, he enrolled in additional classes at Harvard before traveling again to Europe, this time to Switzerland to pursue his favorite pastime of mountain climbing. In 1895, he entered Harvard Medical School. As was typical for medical students at Harvard at the time, he was required to administer anesthesia to patients at the MGH.3,5 Upon graduation in 1899, he received an appointment as a surgical house officer there.11 The following year Allen began working as a contract physician with the 7th United States Cavalry in Cuba, and he assisted General (and physician) Leonard Wood in his epochal studies that led to the eradication of yellow fever. As part of his assignment, he took on great responsibility as Inspector of Civil Hospitals in the Province of Havana, caring for many orphans and destitute families victimized by the Spanish-American War. He also worked with e 200 Beacon Street. http://www.bosarchitecture.com/backbay/beacon/200. html. Accessed January 10, 2014.
Yellow Fever and the Reed Commission. http://exhibits.hsl.virginia.edu/ yellowfever/. University of Virginia. Accessed January 10, 2014. f
g One of Reed’s other assistants and fellow Commission member, Jesse Lazear, died of yellow fever. Camp Lazear in Cuba, where many of these experiments were conducted, was named after him.
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Figure 3. (Selected) Genealogy of the family of Freeman Allen (courtesy of the Gibson House Museum, Boston, MA).
Dr. Walter Reed (for whom the National Military Medical Center near Washington, DC, would be named) and other young physicians participating in a group known as the United States Yellow Fever Commission, or simply “The Reed Commission.”6,11,13 The American government in Cuba recognized that “yellow fever, malaria and dysentery accounted for far more casualties than bullets… and if Americans were to occupy Cuba until political order was restored, something had to be done to protect them from these deadly diseases.”f Allen traveled to experimental stations located outside of Havana where commission members subjected themselves to a series of attacks of yellow fever for experimental purposes. Allen became very sick and almost died.11,g After more than a year in Cuba, Allen returned to Boston in April 1901 to establish a medical office in his home, a common practice at the time.
Early Interest in Anesthesia
At the instigation of the MGH surgeon Dr. J. Collins Warren, whose grandfather performed the historic operation under ether many years before, Allen decided to study anesthesia.11 In the spring of 1901, he travelled to New York City to work with Dr. Thomas L. Bennett, one of the first and most distinguished physician specialists in anesthesia in the country.6,13 Bennett began his career at St. Margaret’s Hospital in Kansas City where in 1894 he was appointed the institution’s first physician to supervise the administration of anesthesia. His primary responsibility was to teach and train medical students, and increasingly nurses, in delivering anesthesia. During the next 3 years, Bennett also performed experiments with the anesthetic agents then commonly used: ether, chloroform, and mixtures of these with alcohol. He also created several devices for the administration of anesthetic agents known as Bennett Inhalers. In 1898, Bennett moved from Kansas to New York where he One of his contemporaries, Dr. James Tayloe Gwathmey, was also initially interested in dermatology but abandoned this after deciding his skill and reputation in administering anesthesia was much in demand. Gwathmey published one of the early, comprehensive American textbooks of anesthesia in 1914.4 h
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was named the first anesthetist at the New York Hospital and subsequently at several other local hospitals.14,15 After briefly studying with Bennett, Allen traveled to London to obtain additional training in the administration of anesthesia because physicians in Great Britain had been administering anesthesia, especially chloroform, since its introduction. Upon returning home, Allen was “as dedicated to his work as his grandmother has been to the freedom of the slaves and his father to the Church.”11 In November 1901, he was appointed the first anesthetist at Boston’s Free Hospital for Women, and he received a similar appointment at the MGH in 1902 and at Boston Children’s Hospital in 1903. Initially Allen did not devote himself solely to anesthesia but pursued other aspects of medicine as well. Finding the study of anesthesia a somewhat limited field, he endeavored to learn about other medical specialties and spent the winter of 1902 studying dermatology in Berlin, Vienna, and Paris.16,17,h It is not clear why Allen ultimately focused on anesthesia. Perhaps, it was his experience with Bennett or his exposure to the British practice of physicianadministered anesthesia. He may also have been influenced by the fact that his mother, Georgiana May Stowe, suffered from chronic pain following his birth and developed an addiction to morphine, which led to her death at the age of 47.i In any case, in 1908 he traveled to the Bier Clinic in Berlin to obtain further training in regional anesthesia.11,18 In a subsequent Harvard Alumni report, Allen wrote, “I have been practicing my profession in Boston. Although I thought at one time of giving up the administration of anesthetics for Dermatology, since my return from Europe I have resumed the administration of anesthesia and find that … [I] am intensely interested in my work.” He continued, “Since my marriage, on July 20, 1911 to a girl of whom I have always been very fond, I find that Stowe’s Family. Harriet Beecher Stowe Center: http://www.harrietbeecherstowecenter.org/hbs/stowe_family.shtml. Accessed January 10, 2014.
i
Gibson House Museum History. http://www.thegibsonhouse.org/history. html. Gibson House Museum. Accessed September 30, 2013. j
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Freeman Allen: Boston’s Pioneering Physician Anesthetist
Figure 4. The Allen (A) and Gibson (B) residences on Beacon Street in Boston as they appear in 2013. Allen’s house (200 Beacon Street) is now privately owned condominiums. The Gibson house (137 Beacon Street) is a museum preserved with its original furnishings as an outstanding example of the Victorian period in Brahmin Boston.
my interest in my work and in life in general is at least ten times greater than ever before.”17 Allen married Mary Ethel Gibson, the niece of Dr. J. Collins Warren and the great-granddaughter of Dr. John Collins Warren, one of the founders of the MGH and the surgeon responsible for the first ether demonstration there in 1846.19 Her home was located at 137 Beacon Street, very close to Allen’sj (Fig. 4B). The Warren family was one of the most distinguished in Boston, descending also from early English immigrants. Dr. John Collins Warren’s father, Dr. John Warren, was the founder of Harvard Medical School; his uncle, Dr. Joseph Warren, was a leader in the American k The nickname “Ether Allen” is a wordplay of the name “Ethan Allen”, an American Revolutionary War hero from New England (Freeman, MD Portrait. http://www2.massgeneral.org/history/catalogueDetails. asp?catalogueNo=71. Museum at Mass General Hospital. Accessed January 10, 2014.
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Revolution who was killed at the Battle of Bunker Hill20 (Fig. 3). Many later generations of Warrens were also distinguished physicians at the MGH, and the current Warren Building at the MGH is named after them. Thus, by blood or marriage, Allen was related to 2 of the most prominent families in early American history—the Beecher and Warren families!
Contributions to Anesthesia
Throughout his career, Allen personally administered countless anesthetics with few deaths attributed to anesthesia. His superb record began while he was a trainee at the MGH where he gained the nickname “Ether Allen.”k With his appointment to the staff, he became responsible for the administration of anesthesia in difficult cases or when new methods were being tried, and he gave many public
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E Special Article demonstrations on operating days. However his position, like that of other “visiting” physicians at the time, was unsalaried; income was generated from his private practice.3,8 In May 1906, one of Allen’s former college classmates, George Burgess Pierce, underwent an operation for appendicitis at the MGH and reported in the Harvard Alumni Journal that “Dr. Freeman Allen, ‘93, the anesthesia adept, etherized me. The job was so well done have ridden crosscountry since.”21 Allen also studied the various anesthetics available at the time, especially local anesthetics for spinal anesthesia. He used novocaine, stovaine, or tropacocaine, with adrenaline, as alternatives to cocaine, and these proved to be less toxic and more effective. He favored freezing the skin with ethyl chloride to reduce pain and anxiety before inserting the spinal needle. He administered spinal anesthesia to his most severely ill patients having procedures below the umbilicus including for bladder, prostate, and uterine surgery and lower extremity amputations. Allen documented hundreds of cases of spinal anesthesia at the MGH and in his private practice with no fatalities and a minimum of untoward effects.18,22,23 Furthermore, he reported his considerable experience using the various types of inhalation anesthesia available at the time, including nitrous oxide (alone, for very brief procedures, or with room air or oxygen for longer ones), ether, chloroform, ethyl chloride, and combinations of these, such as A.C.E., a mixture of alcohol, chloroform, and ether. Like most American anesthetists, he believed ether was safer than chloroform, though he preferred local or spinal anesthesia over general anesthesia whenever possible because he argued that such regional anesthetics were safer and more efficient.22 Although he reported 85 successful cases using ether administered rectally, by 1911 he had abandoned administering ether by this route.24 Notably, Allen stressed the necessity of a visit from the anesthetist to his patient the day before an operation in order to select the anesthetic that would best fit the patient; Allen felt strongly that this should be determined by the anesthetist, not the surgeon. He was also a proponent of premedication with morphine and either scopolamine or atropine to reduce preoperative anxiety and minimize the subsequent amount and detrimental effects of anesthesia needed.11,24–26 Clearly, Allen was expert in administering both regional and general anesthesia effectively, developing an impressive track record in an entirely new field where complications were prone to occur. During his career, he published several articles in medical journals, including the Journal of the American Medical Association and the Boston Medical and Surgical Journal (now the New England Journal of Medicine), as well as chapters in 2 books, 1 for surgeons and 1 for dentists, and he spoke at meetings of the American Medical Association and the Long Island Society of Anesthetists (which became the New York Society of Anesthetists and eventually the American Society of Anesthesiologists).22–32 He also was a member of several of the early anesthesia organizations including the American Association of Anesthetists (which was absorbed by the International Anesthesia Research New England Society of Anesthesiologists. http://www.nesa.net/NESA/ historyNESA.html. Accessed April 29, 2014.
l
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Society), serving as its Vice President in 1918,33 and the Boston Society of Anesthetists (which became the New England Society of Anesthesiologists), serving as its first President from 1920 to 1922.l His hospital duties included teaching anesthesia to medical students, surgical trainees, and nurses. Many surgeons felt that nurses could be taught to provide anesthesia more regularly and therefore more reliably. He tried to entice young medical students to focus on anesthesia but commented that “only about one man in five takes any real interest in anesthesia. I have found the best system is to use nurses as anesthetists. They are often willing to stay at the hospital one or two years at a moderate salary.”24 In 1908, Allen mentored a nurse at Boston Children’s Hospital who became that institution’s first nurse anesthetist; in 1913 Miss Edna Pryor is listed in the hospital’s annual report as Anesthetist, along with Dr. Allen (though on separate pages), and in 1915 she is listed as Assistant Anesthetist.34,35 In 1916, at his recommendation, a Chief of Nurse Anesthetists was first appointed at the MGH and nurses, instead of less experienced medical students or surgical house officers, subsequently began administering anesthesia there to most surgical patients.8 Interestingly, in 1912 Allen’s title at the MGH was changed to Chief of Anesthesia Services after the surgical staff of the hospital was reorganized, but this reverted back to Anesthetist in 1928 when surgeons convinced the hospital’s leadership that anesthesia was an integral part of surgery and should not have its own department. At Harvard Medical School, he was appointed a Lecturer in Anesthetics in 1912. This was changed to Instructor in Anesthesia in 1916, continuing in this capacity throughout his life.3,6
Allen and the Halifax Explosion
One of Allen’s unusual medical experiences occurred in 1917 in the aftermath of a Canadian tragedy. On the morning of December 6, a catastrophic explosion occurred in the busy port of Halifax, Nova Scotia, devastating the small city. The harbor was crowded at the time with supply ships servicing war-stricken Europe. A Belgian relief vessel, the Imo, collided with the Mont Blanc, a French munitions ship packed with explosives. A fire developed on the Mont Blanc and within minutes an explosion vaporized the entire 3000 ton vessel. The shock wave leveled much of the area. A cloud of smoke traveled more than 2000 feet into the sky and showered the city in thick black soot. A tsunami triggered by the blast engulfed Halifax with frigid ocean water. The explosion was described as the largest in history up to that time. Nearly 2000 people died, and several thousand more were injured. Many children were among them, including hundreds who were watching the ships burn before they exploded, suffering severe eye and facial injuries when windows shattered.36 The surviving leadership in Halifax sent out urgent telegrams appealing for immediate medical assistance, and a team from Boston was among the first responders. Within 24 hours, one of Boston’s most distinguished surgeons, Dr. William E. Ladd, led a group of approximately 30 medical and 70 nursing volunteers, including Allen, who left behind his wife and infant son.13 Unaware of an oncoming storm,
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Freeman Allen: Boston’s Pioneering Physician Anesthetist
Figure 5. Part of the Boston medical team on its way to Halifax in 1917 (courtesy of the Nova Scotia Archives). Ladd appears to be standing in the center. It is not clear whether Allen is third from the left in the back row.
they embarked on a train heading north but soon encountered a massive blizzard that covered the train tracks and isolated Halifax from the entire world (Fig. 5). Nevertheless, the Boston team arrived a day later and began providing care to the numerous casualties, maintaining a hospital of 400 beds in the buildings of St. Mary’s College. Allen and a few medical students administered much of the anesthesia to the victims. Allen returned home on January 5, 1918. The Halifax explosion remained a landmark event in his life and in the lives of all those involved.37–40 Ladd went on to focus his surgical practice on the care of children and to become Surgeon-in-Chief at Boston Children’s Hospital. He established the first training program for pediatric surgeons in the country. To this day, the city of Halifax sends a large Christmas tree each December to the city of Boston in honor of Boston’s citizens who provided medical assistance in its time of great need.
Allen, the Man
Allen had a passionate and daring personality fittingly characterizing a pioneer specialist in anesthesia. Those who knew him described him as instinctive, fearless, and impulsive. His innate courage manifested itself in yearly plunges off the formidable Pulpit Rock at his summer home in Nahant near Boston, a famous dive from a second-story window over a picket fence into the Charles River, and feats of mountain climbing in the Alps. He even once plunged into freezing pond water in February to save a young boy from drowning while a crowd of men had been standing helpless nearby. He was described as a man of honor, bravery, and humility.11,41 He was also a member of many mountaineering clubs, including the Harvard Mountaineering Club, the Alpine Club of America, the Alpine Club of London, and the Swiss Alpine Club. The American Alpine Journal considered him among the foremost climbers in the world, having summited many of the highest peaks in the Alps. In addition, he was a well-known equestrian affiliated with the Norfolk Hunt Club, New Riding Club, and Somerset and Nahant Clubs. He owned a horse named Talk of the Town who
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accompanied him on frequent exhibitions around Boston and won multiple blue ribbons at several riding shows. Allen was described as a presence in and out of the operating room, always driven by his good-natured personality, truly a “thoroughbred in every sense of the word.”41,42 His same spirit of high adventure called him to offer himself repeatedly to the Medical Corps of the Army at the outbreak of World War I, but he was retained at the time as an essential teacher of anesthesia. This was a great personal disappointment to him.11
His Legacy
In 1916, Allen’s wife gave birth to their only child, Henry Freeman Allen. He also went on to attend Harvard College and Harvard Medical School and became Chief of Ophthalmology at the Massachusetts Eye & Ear Infirmary, Chairman of the Department of Ophthalmology at Harvard Medical School, editor of the journal Archives in Ophthalmology, and President of the American Association of Ophthalmologists. Ironically, he, like his father, responded to a mass casualty event when in 1942 he treated victims of Boston’s infamous Cocoanut Grove fire which claimed several hundred lives. Henry Freeman Allen and his wife had 3 children, 1 of whom is also named Freeman Allen (Fig. 3).13,43 During the final years of his life, Allen allegedly suffered from distressingly painful attacks of general neuritis.42 On May 3, 1930, he was reported to have died suddenly from heart disease in his home in Boston at the age of 59.11,44,45 However, he actually committed suicide46 while hospitalized during one of several admissions for treatment of morphine addiction. How this habit developed is unclear. Speculation was that his narcotic use began after he suffered a leg fracture while hiking in the Alps or after he developed pneumonia following his rescue of the drowning child. In addition, he was said to have become very despondent after a pediatric patient died while he was m Personal communication as reported to one of this paper’s authors (MAR) by Dr. Allen’s surviving grandchildren, Roz and Freeman (Towne) Allen, December 26, 2013, based on information told to them by their father.
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E Special Article administering general anesthesia.m Likely, he was also affected by his mother’s addiction. Furthermore, easy access to pain-relieving medications and his personal experiences using these drugs to mitigate the suffering of others may have been risk factors as well. In any case, it appears that this pioneer in anesthesia became one of the specialty’s first casualties of narcotic addiction. Interestingly, Allen was hospitalized at Butler Hospital in Providence, RI, which was founded in 1844 (and is currently the flagship psychiatric hospital affiliated with the medical school at Brown University) and not at the older and also distinguished McLean Hospital, the major psychiatric facility affiliated with Harvard Medical School.46 However, substance abuse and mental health issues were not topics for public acknowledgement at the time, especially in Brahmin Boston, and his illness and the true cause of his death were kept secret. His memorial service was held at the Trinity Church in Boston, and he was buried in the family plot in Mt. Auburn Cemetery.45,46 His passing was noted in papers throughout the country, and his wife received condolence letters and telegrams from around the world. One tribute about him in the New England Journal of Medicine “remarked with surprise that more than half a century had elapsed before a welltrained surgeon pioneered in methods of the administration of anaesthetics in the community from which was broadcast this discovery itself.”11 Allen’s career served as an example for future physicians who began to specialize in the field of anesthesiology. Three years after his death, a surgeon at the MGH, Howard Holt Bradshaw, was appointed his successor as anesthetist there, a position that was finally salaried. In 1936, Bradshaw resigned and Henry Knowles Beecher, another MGH surgeon, took over.3,8 In 1941, Beecher was also appointed the Henry Isaiah Dorr Professor of Research in Anaesthesia at Harvard Medical School, the first endowed Chair of Anesthesia in the United States.47 Beecher would have a significant impact on the development of anesthesiology in Boston and nationwide. Interestingly, his birth name was Harry Knowles Ugangst and he changed his surname to Beecher in his mid-20s, seemingly motivated by his desire to remove all traces of his father’s German heritage. Beecher was the maiden name of his maternal great-grandmother, prompting a misconception that he was related to the famous abolitionists, Lyman Beecher, his son Henry Ward Beecher and daughter Harriet Beecher Stowe (and, therefore, ultimately to Freeman Allen).48 Perhaps Beecher (née Ugangst) also aspired to be associated with the Beecher family, considering that he was instrumental in implementing federal rules on human experimentation and brain death, and members of the Beecher family were widely respected and known for preaching high ethical standards.49 In any case, a separate Department of Anesthesia was not established at the MGH until 1968, and an independent Department of Anaesthesia was finally established at Harvard Medical School the following year. In conclusion, Freeman Allen was one of the first physicians in the country to specialize in anesthesia. He was also the first anesthetist appointed to the medical staff of
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the major Boston hospitals more than 50 years after ether’s ability to eliminate surgical pain was initially demonstrated at the MGH. He and his wife were descendants of 2 of the most famous and distinguished families in New England, and he was one of the pioneers in developing training in anesthesia for both nurses and physicians. He also appears, ironically, to have been one of the first physicians in this new specialty to succumb to narcotic addiction.50 E DISCLOSURES
Name: Samuel D. Morris. Contribution: This author helped with historical research and manuscript preparation. Attestation: Samuel D. Morris approved the final manuscript. Name: Alina J. Morris, MLIS. Contribution: This author helped with historical research and manuscript preparation. Attestation: Alina J. Morris approved the final manuscript. Name: Mark A. Rockoff, MD. Contribution: This author helped with historical research and manuscript preparation. Attestation: Mark A. Rockoff approved the final manuscript and is the archival author. This manuscript was handled by: Steven L. Shafer, MD. ACKNOWLEDGMENTS
The authors would like to thank the following individuals for providing information for this paper: Jack Eckert, Public Services Librarian, Center for the History of Medicine, Francis A. Countway Library of Medicine, Boston, MA; Jeff Mifflin, Archivist, Archives and Special Collections, Massachusetts General Hospital, Boston, MA; Patricia Austen, Head of the Arts and Artifacts Committee, Massachusetts General Hospital, Boston, MA; Gary Boyd Roberts, New England Historic Genealogical Society, Boston, MA; Jessie Barnes Hurley, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA; Karen Bieterman (Director and Head Librarian) and Felicia Reilly (Archivist), Wood Library-Museum of Anesthesiology, Park Ridge, IL; Laura Gresh and Wendy Swanton, Gibson House Museum, Boston, MA; and Rosamond Warren Allen and Freeman (Towne) Allen, grandchildren of Dr. and Mrs. Freeman Allen. REFERENCES 1. Bigelow HJ. Insensibility during surgical operations produced by inhalation. N Eng J Med 1846; 35:309–17 2. Gawande A. Two hundred years of surgery. N Engl J Med 2012;366:1716–23 3. McPeek B. Anesthesia before Beecher. In: Kitz RJ, ed. This Is No Humbug!: Reminiscences from the Department of Anesthesia at the Massachusetts General Hospital. Boston: MGH, 2002:75–92 4. Cope DK. James Tayloe Gwathmey: seeds of a developing specialty. Anesth Analg 1993;76:642–7 5. Bliss M. Harvey Cushing: A Life in Surgery. New York: Oxford University Press, 2007:68–9 6. Harvard College Class of 1893. Third Report: Prepared for the class decennial. Boston, MA: Rockwell and Churchill Press, 1903:36 7. Free Hospital for Women records, 1875–1975, BWH c6. Harvard Medical Library, Francis A. Countway Library of Medicine, Boston, MA 8. Washburn FA. The Massachusetts General Hospital: Its Development, 1900–1935. Boston: Houghton Mifflin, 1939: 351–7 9. Thirty-fifth Annual Report of the Children’s Hospital for the Year 1903. Boston, MA: University Press: John Wilson and Son, 1904:2 10. Armbruster ES. Introduction. In: Stowe HB. Uncle Tom’s Cabin. New York: Sterling Publishing Co., Inc., 2012:xi–xvii
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11. Osgood RB. Freeman Allen, BA, MA, MD: Pioneer in anaesthesia. N Eng J Med 1930; 202:1100–1 12. McCullough D. The Greater Journey: Americans in Paris. New York: Simon & Schuster, 2011 13. Entry of Dr. Freeman Allen in the National Cyclopedia of American Biography. New York: James P. White & Company, 1954:297 14. Liguori EC, Hargett MJ, Liguori GA. Thomas Linwood Bennett, MD: one of New York City’s first prominent physician anesthetists. Anesth Analg 2013;117:1003–9 15. The Society of the New York Hospital. One Hundred and Twenty-seventh Annual Report, for the Year 1897. New York: Press of LH Biglow and Company, 1897 16. Harvard College Class of 1893. Fourth Report. Cambridge, MA: The University Press, 1910:3 17. Harvard College Class of 1893. Secretary’s Fifth Report. Cambridge, MA: Crimson Printing Co., 1911:1–2 18. Allen F. Spinal anesthesia. N Eng J Med 1910;163:715–8 19. Wilson MCC. John Gibson of Cambridge, Massachusetts, and his descendants, 1634–1899. Washington, DC: McGill & Wallace, 1900:98 20. Philbrick N. Bunker Hill: A City, a Siege, a Revolution. New York: Viking Press, 2013 21. Harvard College Class of 1893. Fourth Report. Cambridge, MA: The University Press, 1910:171 22. Allen F. Spinal anesthesia. JAMA 1912; 59:1841–3 23. Smith G, Allen F. Spinal anesthesia in genitourinary surgery. Urologic and Cutaneous Review 1918;22:615–7 24. Allen F. A review of ten years’ work in anesthesia. N Eng J Med 1911;165:976–81 25. Allen F. Anesthesia by nitrous oxide in surgery. The Bulletin of the Free Hospital for Women 1903;1:12–4 26. Allen F. Remarks on the induction of ether anaesthesia. The Bulletin of the Free Hospital for Women 1903;1:11–7 27. Allen F. Special methods of anesthesia. JAMA 1908; 51:1584–6 28. Allen F. Remarks on local, spinal, and general anesthesia. N Eng J Med 1911;165:589–91 29. Allen F. Recent methods in the administration of anesthesia. The International Dental Journal 1904; 25:665–76 30. Allen F. Respiratory complications in relation to the administration of anesthetics. N Eng J Med 1931;204:1288–93 31. Allen F. Anaesthetics and the production of general anaesthesia. In: Bryant JD, Buck AH, ed. American Practice of Surgery. New York: W. Wood and Company, 1908:169–230
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32. Allen F. General anesthesia, its pharmacology and administration. In: Keyes FA, ed. Army Dentistry. New York: D. Appleton and Company, 1918:299–30 33. Officers for 1918. In: American Association of Anesthetists: Sixth Annual Meeting, Chicago, June 10 and 11, 1918. Avon Lake, OH: American Association of Anesthetists, 1918 34. Forty-Fifth Annual Report of The Children’s Hospital for the Year 1913. Boston, MA: University Press: John Wilson and Son, 1914:4–5 35. Forty-Seventh Annual Report of The Children’s Hospital for the Year 1915. Boston, MA: University Press: John Wilson and Son, 1916:4–5 36. MacDonald LM. Curse of the Narrows. New York: Walker & Company, 2009 37. Medical notes. N Eng J Med 1918;179:56 38. Medical relief for Halifax. N Eng J Med 1917;177:884–5 39. Harvard men at the Halifax disaster. Harvard Alumni Bulletin 1917;20:337–8 40. Ratshesky A. Report of the Halifax Relief Expedition, December 6 to 15, 1917. Boston, MA: Wright and Potter Printing Company, 1918:4–20 41. Graves WP. Dr. Freeman Allen. Bulletin of the Harvard Medical School Alumni Association 1930;4:13 42. Recent Deaths, Freeman Allen. N Eng J Med 1930;202:978 43. Jakobiec F. Obituary: Henry Freeman Allen, 1916–1993. Am J Oph 1994;118:133–4 44. Deaths (Freeman Allen). JAMA 1930;94:1780 45. Dr. Freeman Allen’s funeral tomorrow. Daily Boston Globe May 5, 1930:43 46. Death Certificate for Freeman Allen. The Commonwealth of Massachusetts Department of Public Health, Registry of Vital Records and Statistics, 1930 47. Kopp VJ. Henry Knowles Beecher and the development of informed consent in anesthesia research. Anesthesiology 1999; 90:1756–65 48. Gionfriddo M. Henry K. Beecher–his life in part: the Kansas years. Int Anesthesiol Clin 2007;45:135–55 49. Edwards ML. From bench to bedside: Claude Bernard, Henry K. Beecher, MD, and science in anesthesia. Bull Anesth Hist 2013;31:9–11 50. Warner DO, Berge K, Sun H, Harman A, Hanson A, Schroeder DR. Substance use disorder among anesthesiology residents, 1975-2009. JAMA 2013;310:2289–96
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Freeman Allen: Boston’s Pioneering Physician Anesthetist Samuel D. Morris, Alina J. Morris, MLIS, and Mark A. Rockoff, MD On October 16, 1846 dentist William T. G. Morton successfully demonstrated at the Massachusetts General Hospital that ether could prevent the pain of surgery. For decades afterwards, the administration of anesthesia in the United States was generally relegated to dentists, medical students, junior surgical trainees, or even nonmedical personnel. It was not until the end of the 19th century that a few pioneering physicians began devoting their careers to administering anesthesia to patients, studying ways to make it safer and more effective, and teaching others about its use. One of these individuals was Freeman Allen, who was appointed the first physician anesthetist to the medical staff at the Massachusetts General Hospital and several other major hospitals in Boston. We describe this remarkable man, his contributions to the early development of anesthesiology as a medical specialty, and the true cause of his untimely death. (Anesth Analg 2014;119:1186–93)
“It is one of the paradoxes of our time that some of its most vital and significant figures live and die virtually unknown.”
F
(Tribute to Freeman Allen, NY Herald Tribune, May 6, 1930)
or its 200th anniversary in 2012, the New England Journal of Medicine conducted a survey of its readers to determine the most important article published in its history. The resounding favorite was a report in 1846 by Boston and Massachusetts General Hospital (MGH) surgeon Henry Jacob Bigelow titled “Insensitivity During Surgical Operations Produced by Inhalation,” describing the recent successful administration of ether anesthesia by dentist and part-time medical student William T. G. Morton.1,2 Although this public demonstration marked a seminal event in the history of medicine, over the ensuing decades few American physicians focused their practice on this aspect of medical care. At the MGH, for example, Dr. Bigelow himself initially provided anesthesia for several patients who subsequently received ether, but generally dentists or inexperienced medical personnel such as medical students or junior surgical house officers were assigned the task of anesthetizing the patient and were referred to as “the etherizer.”3–5 This practice began to change around the beginning of the 20th century when a few pioneering physicians began devoting themselves to administering anesthesia to patients, studying From the Department of Anesthesiology, Perioperative and Pain Medicine and the Archives Program, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts. Accepted for publication June 4, 2014. Funding: Salary support was provided by the Department of Anesthesiology, Perioperative and Pain Medicine (Mark A. Rockoff) and the Archives Program, Boston Children’s Hospital (Alina J. Morris). The authors received no additional compensation for this work. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Mark A. Rockoff, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Bader 3, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115. Address e-mail to mark.rockoff@ childrens.harvard.edu. Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000381
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ways to make it safer and more effective, and training others, including nurses, in its use. Among these was Freeman Allen (1870–1930), the first physician to be appointed as anesthetist to the medical staff of a hospital in Boston, initially at the Free Hospital for Women (a forerunner of the Brigham and Women’s Hospital) in 1901 and then at the MGH in 1902 and Boston Children’s Hospital in 19036–9,a (Fig. 1). Interestingly, Allen was the grandchild of Harriet Beecher Stowe, the author of Uncle Tom’s Cabin, and he married the great-granddaughter of Dr. John Collins Warren, the surgeon who performed the historic first operation under ether at the MGH. This report describes this remarkable man, his contributions to the early development of anesthesiology as a medical specialty, and the true cause of his untimely death.
His Early Years
Freeman Allen was born on September 27, 1870, in Stockbridge, MA, the son of Henry Freeman Allen (1838– 1914), a well-known preacher there, and Georgiana May Stowe (1843–1890), the youngest daughter of Harriet Beecher Stowe (Fig. 2). One of Harriet Beecher Stowe’s brothers, Henry Ward Beecher, was also a distinguished preacher, as was her father, Lyman Beecher, and her husband, Calvin Stowe10,b (Fig. 3). The families were descendants of early immigrants from England to the American colonies. After passage of the Fugitive Slave Act of 1850 that made all citizens responsible for enforcing the institution of slavery, Harriet Beecher Stowe became an activist and published The Freeman’s Dream, a parable in which a farmer fails to help a runaway slave and is condemned by the Lord on Judgment Day.c She then began writing Uncle Tom’s Cabin Allen’s name first appears in the MGH Annual Report in 1903, but Allen notes in one of his Harvard Class Reports that this appointment began in May 1902. Similarly, his name first appears in the Children’s Hospital Annual Report in 1904, but this covered the year 1903.6,8
a
Edwards M. Were Harriet Beecher Stowe’s children as successful as her? http://marsenaedwardsblog.wordpress.com/2013/03/06/were-harrietbeecher-stowes-children-as-successful-as-her/. Accessed January 10, 2014.
b
c Belasco S. Harriet Beecher Stowe. The New York Times, May 6, 2013: http:// topics.nytimes.com/top/reference/timestopics/people/s/harriet_beecher_ stowe/index.html. Accessed January 10, 2014.
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Freeman Allen: Boston’s Pioneering Physician Anesthetist
Figure 1. Portrait of Freeman Allen (courtesy of the Massachusetts General Hospital, Archives and Special Collections; photograph by Sam Riley, Boston, MA).
in installments for an abolitionist newspaper and in 1852 it was published as a book, becoming the first American international best seller.10 This powerful novel focused on the tragic victims of slavery in the South and had a major impact on events that led to the beginning of the Civil War in 1861.d Although freed slaves often assumed the surname “Freeman,” it was unusual for this to be used as a first name, especially by a Caucasian person. However, when Allen’s parents named their only child Freeman, it was not because of any association with the abolitionist movement but in honor of his father, Henry Freeman Allen, and grandfather, Freeman Allen (Fig. 3). Why the Allen family originally adopted the name Freeman is unclear. In 1887, when Allen’s father became pastor of a parish in Boston, he and his parents moved to 200 Beacon Street in the new Back Bay section of Boston where he was raised among that city’s elitee (Fig. 4A). A privileged child, he received his preliminary education at the private Noble and Greenough School where he prepared for Harvard College. Allen graduated from Harvard in 1893 with honorable mention in French, receiving a master’s degree the following year. He was very much involved in college life, a member of many organizations including the Hasty Pudding and Porcelain Clubs, and loved by his friends. Upon graduation, like many affluent Americans of the time, he traveled abroad.11,12 After meeting an inspiring medical student in Germany, Allen decided d In 1862, when Stowe was introduced to President Abraham Lincoln, he allegedly greeted her by saying, “So you’re the little woman who wrote the book that made this great war!”10
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Figure 2. Young Freeman Allen with his grandmother, Harriet Beecher Stowe (courtesy of the Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA).
to take some courses in medicine in Leipzig. When he returned to the United States in the summer of 1894, he enrolled in additional classes at Harvard before traveling again to Europe, this time to Switzerland to pursue his favorite pastime of mountain climbing. In 1895, he entered Harvard Medical School. As was typical for medical students at Harvard at the time, he was required to administer anesthesia to patients at the MGH.3,5 Upon graduation in 1899, he received an appointment as a surgical house officer there.11 The following year Allen began working as a contract physician with the 7th United States Cavalry in Cuba, and he assisted General (and physician) Leonard Wood in his epochal studies that led to the eradication of yellow fever. As part of his assignment, he took on great responsibility as Inspector of Civil Hospitals in the Province of Havana, caring for many orphans and destitute families victimized by the Spanish-American War. He also worked with e 200 Beacon Street. http://www.bosarchitecture.com/backbay/beacon/200. html. Accessed January 10, 2014.
Yellow Fever and the Reed Commission. http://exhibits.hsl.virginia.edu/ yellowfever/. University of Virginia. Accessed January 10, 2014. f
g One of Reed’s other assistants and fellow Commission member, Jesse Lazear, died of yellow fever. Camp Lazear in Cuba, where many of these experiments were conducted, was named after him.
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Figure 3. (Selected) Genealogy of the family of Freeman Allen (courtesy of the Gibson House Museum, Boston, MA).
Dr. Walter Reed (for whom the National Military Medical Center near Washington, DC, would be named) and other young physicians participating in a group known as the United States Yellow Fever Commission, or simply “The Reed Commission.”6,11,13 The American government in Cuba recognized that “yellow fever, malaria and dysentery accounted for far more casualties than bullets… and if Americans were to occupy Cuba until political order was restored, something had to be done to protect them from these deadly diseases.”f Allen traveled to experimental stations located outside of Havana where commission members subjected themselves to a series of attacks of yellow fever for experimental purposes. Allen became very sick and almost died.11,g After more than a year in Cuba, Allen returned to Boston in April 1901 to establish a medical office in his home, a common practice at the time.
Early Interest in Anesthesia
At the instigation of the MGH surgeon Dr. J. Collins Warren, whose grandfather performed the historic operation under ether many years before, Allen decided to study anesthesia.11 In the spring of 1901, he travelled to New York City to work with Dr. Thomas L. Bennett, one of the first and most distinguished physician specialists in anesthesia in the country.6,13 Bennett began his career at St. Margaret’s Hospital in Kansas City where in 1894 he was appointed the institution’s first physician to supervise the administration of anesthesia. His primary responsibility was to teach and train medical students, and increasingly nurses, in delivering anesthesia. During the next 3 years, Bennett also performed experiments with the anesthetic agents then commonly used: ether, chloroform, and mixtures of these with alcohol. He also created several devices for the administration of anesthetic agents known as Bennett Inhalers. In 1898, Bennett moved from Kansas to New York where he One of his contemporaries, Dr. James Tayloe Gwathmey, was also initially interested in dermatology but abandoned this after deciding his skill and reputation in administering anesthesia was much in demand. Gwathmey published one of the early, comprehensive American textbooks of anesthesia in 1914.4 h
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was named the first anesthetist at the New York Hospital and subsequently at several other local hospitals.14,15 After briefly studying with Bennett, Allen traveled to London to obtain additional training in the administration of anesthesia because physicians in Great Britain had been administering anesthesia, especially chloroform, since its introduction. Upon returning home, Allen was “as dedicated to his work as his grandmother has been to the freedom of the slaves and his father to the Church.”11 In November 1901, he was appointed the first anesthetist at Boston’s Free Hospital for Women, and he received a similar appointment at the MGH in 1902 and at Boston Children’s Hospital in 1903. Initially Allen did not devote himself solely to anesthesia but pursued other aspects of medicine as well. Finding the study of anesthesia a somewhat limited field, he endeavored to learn about other medical specialties and spent the winter of 1902 studying dermatology in Berlin, Vienna, and Paris.16,17,h It is not clear why Allen ultimately focused on anesthesia. Perhaps, it was his experience with Bennett or his exposure to the British practice of physicianadministered anesthesia. He may also have been influenced by the fact that his mother, Georgiana May Stowe, suffered from chronic pain following his birth and developed an addiction to morphine, which led to her death at the age of 47.i In any case, in 1908 he traveled to the Bier Clinic in Berlin to obtain further training in regional anesthesia.11,18 In a subsequent Harvard Alumni report, Allen wrote, “I have been practicing my profession in Boston. Although I thought at one time of giving up the administration of anesthetics for Dermatology, since my return from Europe I have resumed the administration of anesthesia and find that … [I] am intensely interested in my work.” He continued, “Since my marriage, on July 20, 1911 to a girl of whom I have always been very fond, I find that Stowe’s Family. Harriet Beecher Stowe Center: http://www.harrietbeecherstowecenter.org/hbs/stowe_family.shtml. Accessed January 10, 2014.
i
Gibson House Museum History. http://www.thegibsonhouse.org/history. html. Gibson House Museum. Accessed September 30, 2013. j
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Freeman Allen: Boston’s Pioneering Physician Anesthetist
Figure 4. The Allen (A) and Gibson (B) residences on Beacon Street in Boston as they appear in 2013. Allen’s house (200 Beacon Street) is now privately owned condominiums. The Gibson house (137 Beacon Street) is a museum preserved with its original furnishings as an outstanding example of the Victorian period in Brahmin Boston.
my interest in my work and in life in general is at least ten times greater than ever before.”17 Allen married Mary Ethel Gibson, the niece of Dr. J. Collins Warren and the great-granddaughter of Dr. John Collins Warren, one of the founders of the MGH and the surgeon responsible for the first ether demonstration there in 1846.19 Her home was located at 137 Beacon Street, very close to Allen’sj (Fig. 4B). The Warren family was one of the most distinguished in Boston, descending also from early English immigrants. Dr. John Collins Warren’s father, Dr. John Warren, was the founder of Harvard Medical School; his uncle, Dr. Joseph Warren, was a leader in the American k The nickname “Ether Allen” is a wordplay of the name “Ethan Allen”, an American Revolutionary War hero from New England (Freeman, MD Portrait. http://www2.massgeneral.org/history/catalogueDetails. asp?catalogueNo=71. Museum at Mass General Hospital. Accessed January 10, 2014.
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Revolution who was killed at the Battle of Bunker Hill20 (Fig. 3). Many later generations of Warrens were also distinguished physicians at the MGH, and the current Warren Building at the MGH is named after them. Thus, by blood or marriage, Allen was related to 2 of the most prominent families in early American history—the Beecher and Warren families!
Contributions to Anesthesia
Throughout his career, Allen personally administered countless anesthetics with few deaths attributed to anesthesia. His superb record began while he was a trainee at the MGH where he gained the nickname “Ether Allen.”k With his appointment to the staff, he became responsible for the administration of anesthesia in difficult cases or when new methods were being tried, and he gave many public
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E Special Article demonstrations on operating days. However his position, like that of other “visiting” physicians at the time, was unsalaried; income was generated from his private practice.3,8 In May 1906, one of Allen’s former college classmates, George Burgess Pierce, underwent an operation for appendicitis at the MGH and reported in the Harvard Alumni Journal that “Dr. Freeman Allen, ‘93, the anesthesia adept, etherized me. The job was so well done have ridden crosscountry since.”21 Allen also studied the various anesthetics available at the time, especially local anesthetics for spinal anesthesia. He used novocaine, stovaine, or tropacocaine, with adrenaline, as alternatives to cocaine, and these proved to be less toxic and more effective. He favored freezing the skin with ethyl chloride to reduce pain and anxiety before inserting the spinal needle. He administered spinal anesthesia to his most severely ill patients having procedures below the umbilicus including for bladder, prostate, and uterine surgery and lower extremity amputations. Allen documented hundreds of cases of spinal anesthesia at the MGH and in his private practice with no fatalities and a minimum of untoward effects.18,22,23 Furthermore, he reported his considerable experience using the various types of inhalation anesthesia available at the time, including nitrous oxide (alone, for very brief procedures, or with room air or oxygen for longer ones), ether, chloroform, ethyl chloride, and combinations of these, such as A.C.E., a mixture of alcohol, chloroform, and ether. Like most American anesthetists, he believed ether was safer than chloroform, though he preferred local or spinal anesthesia over general anesthesia whenever possible because he argued that such regional anesthetics were safer and more efficient.22 Although he reported 85 successful cases using ether administered rectally, by 1911 he had abandoned administering ether by this route.24 Notably, Allen stressed the necessity of a visit from the anesthetist to his patient the day before an operation in order to select the anesthetic that would best fit the patient; Allen felt strongly that this should be determined by the anesthetist, not the surgeon. He was also a proponent of premedication with morphine and either scopolamine or atropine to reduce preoperative anxiety and minimize the subsequent amount and detrimental effects of anesthesia needed.11,24–26 Clearly, Allen was expert in administering both regional and general anesthesia effectively, developing an impressive track record in an entirely new field where complications were prone to occur. During his career, he published several articles in medical journals, including the Journal of the American Medical Association and the Boston Medical and Surgical Journal (now the New England Journal of Medicine), as well as chapters in 2 books, 1 for surgeons and 1 for dentists, and he spoke at meetings of the American Medical Association and the Long Island Society of Anesthetists (which became the New York Society of Anesthetists and eventually the American Society of Anesthesiologists).22–32 He also was a member of several of the early anesthesia organizations including the American Association of Anesthetists (which was absorbed by the International Anesthesia Research New England Society of Anesthesiologists. http://www.nesa.net/NESA/ historyNESA.html. Accessed April 29, 2014.
l
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Society), serving as its Vice President in 1918,33 and the Boston Society of Anesthetists (which became the New England Society of Anesthesiologists), serving as its first President from 1920 to 1922.l His hospital duties included teaching anesthesia to medical students, surgical trainees, and nurses. Many surgeons felt that nurses could be taught to provide anesthesia more regularly and therefore more reliably. He tried to entice young medical students to focus on anesthesia but commented that “only about one man in five takes any real interest in anesthesia. I have found the best system is to use nurses as anesthetists. They are often willing to stay at the hospital one or two years at a moderate salary.”24 In 1908, Allen mentored a nurse at Boston Children’s Hospital who became that institution’s first nurse anesthetist; in 1913 Miss Edna Pryor is listed in the hospital’s annual report as Anesthetist, along with Dr. Allen (though on separate pages), and in 1915 she is listed as Assistant Anesthetist.34,35 In 1916, at his recommendation, a Chief of Nurse Anesthetists was first appointed at the MGH and nurses, instead of less experienced medical students or surgical house officers, subsequently began administering anesthesia there to most surgical patients.8 Interestingly, in 1912 Allen’s title at the MGH was changed to Chief of Anesthesia Services after the surgical staff of the hospital was reorganized, but this reverted back to Anesthetist in 1928 when surgeons convinced the hospital’s leadership that anesthesia was an integral part of surgery and should not have its own department. At Harvard Medical School, he was appointed a Lecturer in Anesthetics in 1912. This was changed to Instructor in Anesthesia in 1916, continuing in this capacity throughout his life.3,6
Allen and the Halifax Explosion
One of Allen’s unusual medical experiences occurred in 1917 in the aftermath of a Canadian tragedy. On the morning of December 6, a catastrophic explosion occurred in the busy port of Halifax, Nova Scotia, devastating the small city. The harbor was crowded at the time with supply ships servicing war-stricken Europe. A Belgian relief vessel, the Imo, collided with the Mont Blanc, a French munitions ship packed with explosives. A fire developed on the Mont Blanc and within minutes an explosion vaporized the entire 3000 ton vessel. The shock wave leveled much of the area. A cloud of smoke traveled more than 2000 feet into the sky and showered the city in thick black soot. A tsunami triggered by the blast engulfed Halifax with frigid ocean water. The explosion was described as the largest in history up to that time. Nearly 2000 people died, and several thousand more were injured. Many children were among them, including hundreds who were watching the ships burn before they exploded, suffering severe eye and facial injuries when windows shattered.36 The surviving leadership in Halifax sent out urgent telegrams appealing for immediate medical assistance, and a team from Boston was among the first responders. Within 24 hours, one of Boston’s most distinguished surgeons, Dr. William E. Ladd, led a group of approximately 30 medical and 70 nursing volunteers, including Allen, who left behind his wife and infant son.13 Unaware of an oncoming storm,
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Freeman Allen: Boston’s Pioneering Physician Anesthetist
Figure 5. Part of the Boston medical team on its way to Halifax in 1917 (courtesy of the Nova Scotia Archives). Ladd appears to be standing in the center. It is not clear whether Allen is third from the left in the back row.
they embarked on a train heading north but soon encountered a massive blizzard that covered the train tracks and isolated Halifax from the entire world (Fig. 5). Nevertheless, the Boston team arrived a day later and began providing care to the numerous casualties, maintaining a hospital of 400 beds in the buildings of St. Mary’s College. Allen and a few medical students administered much of the anesthesia to the victims. Allen returned home on January 5, 1918. The Halifax explosion remained a landmark event in his life and in the lives of all those involved.37–40 Ladd went on to focus his surgical practice on the care of children and to become Surgeon-in-Chief at Boston Children’s Hospital. He established the first training program for pediatric surgeons in the country. To this day, the city of Halifax sends a large Christmas tree each December to the city of Boston in honor of Boston’s citizens who provided medical assistance in its time of great need.
Allen, the Man
Allen had a passionate and daring personality fittingly characterizing a pioneer specialist in anesthesia. Those who knew him described him as instinctive, fearless, and impulsive. His innate courage manifested itself in yearly plunges off the formidable Pulpit Rock at his summer home in Nahant near Boston, a famous dive from a second-story window over a picket fence into the Charles River, and feats of mountain climbing in the Alps. He even once plunged into freezing pond water in February to save a young boy from drowning while a crowd of men had been standing helpless nearby. He was described as a man of honor, bravery, and humility.11,41 He was also a member of many mountaineering clubs, including the Harvard Mountaineering Club, the Alpine Club of America, the Alpine Club of London, and the Swiss Alpine Club. The American Alpine Journal considered him among the foremost climbers in the world, having summited many of the highest peaks in the Alps. In addition, he was a well-known equestrian affiliated with the Norfolk Hunt Club, New Riding Club, and Somerset and Nahant Clubs. He owned a horse named Talk of the Town who
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accompanied him on frequent exhibitions around Boston and won multiple blue ribbons at several riding shows. Allen was described as a presence in and out of the operating room, always driven by his good-natured personality, truly a “thoroughbred in every sense of the word.”41,42 His same spirit of high adventure called him to offer himself repeatedly to the Medical Corps of the Army at the outbreak of World War I, but he was retained at the time as an essential teacher of anesthesia. This was a great personal disappointment to him.11
His Legacy
In 1916, Allen’s wife gave birth to their only child, Henry Freeman Allen. He also went on to attend Harvard College and Harvard Medical School and became Chief of Ophthalmology at the Massachusetts Eye & Ear Infirmary, Chairman of the Department of Ophthalmology at Harvard Medical School, editor of the journal Archives in Ophthalmology, and President of the American Association of Ophthalmologists. Ironically, he, like his father, responded to a mass casualty event when in 1942 he treated victims of Boston’s infamous Cocoanut Grove fire which claimed several hundred lives. Henry Freeman Allen and his wife had 3 children, 1 of whom is also named Freeman Allen (Fig. 3).13,43 During the final years of his life, Allen allegedly suffered from distressingly painful attacks of general neuritis.42 On May 3, 1930, he was reported to have died suddenly from heart disease in his home in Boston at the age of 59.11,44,45 However, he actually committed suicide46 while hospitalized during one of several admissions for treatment of morphine addiction. How this habit developed is unclear. Speculation was that his narcotic use began after he suffered a leg fracture while hiking in the Alps or after he developed pneumonia following his rescue of the drowning child. In addition, he was said to have become very despondent after a pediatric patient died while he was m Personal communication as reported to one of this paper’s authors (MAR) by Dr. Allen’s surviving grandchildren, Roz and Freeman (Towne) Allen, December 26, 2013, based on information told to them by their father.
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E Special Article administering general anesthesia.m Likely, he was also affected by his mother’s addiction. Furthermore, easy access to pain-relieving medications and his personal experiences using these drugs to mitigate the suffering of others may have been risk factors as well. In any case, it appears that this pioneer in anesthesia became one of the specialty’s first casualties of narcotic addiction. Interestingly, Allen was hospitalized at Butler Hospital in Providence, RI, which was founded in 1844 (and is currently the flagship psychiatric hospital affiliated with the medical school at Brown University) and not at the older and also distinguished McLean Hospital, the major psychiatric facility affiliated with Harvard Medical School.46 However, substance abuse and mental health issues were not topics for public acknowledgement at the time, especially in Brahmin Boston, and his illness and the true cause of his death were kept secret. His memorial service was held at the Trinity Church in Boston, and he was buried in the family plot in Mt. Auburn Cemetery.45,46 His passing was noted in papers throughout the country, and his wife received condolence letters and telegrams from around the world. One tribute about him in the New England Journal of Medicine “remarked with surprise that more than half a century had elapsed before a welltrained surgeon pioneered in methods of the administration of anaesthetics in the community from which was broadcast this discovery itself.”11 Allen’s career served as an example for future physicians who began to specialize in the field of anesthesiology. Three years after his death, a surgeon at the MGH, Howard Holt Bradshaw, was appointed his successor as anesthetist there, a position that was finally salaried. In 1936, Bradshaw resigned and Henry Knowles Beecher, another MGH surgeon, took over.3,8 In 1941, Beecher was also appointed the Henry Isaiah Dorr Professor of Research in Anaesthesia at Harvard Medical School, the first endowed Chair of Anesthesia in the United States.47 Beecher would have a significant impact on the development of anesthesiology in Boston and nationwide. Interestingly, his birth name was Harry Knowles Ugangst and he changed his surname to Beecher in his mid-20s, seemingly motivated by his desire to remove all traces of his father’s German heritage. Beecher was the maiden name of his maternal great-grandmother, prompting a misconception that he was related to the famous abolitionists, Lyman Beecher, his son Henry Ward Beecher and daughter Harriet Beecher Stowe (and, therefore, ultimately to Freeman Allen).48 Perhaps Beecher (née Ugangst) also aspired to be associated with the Beecher family, considering that he was instrumental in implementing federal rules on human experimentation and brain death, and members of the Beecher family were widely respected and known for preaching high ethical standards.49 In any case, a separate Department of Anesthesia was not established at the MGH until 1968, and an independent Department of Anaesthesia was finally established at Harvard Medical School the following year. In conclusion, Freeman Allen was one of the first physicians in the country to specialize in anesthesia. He was also the first anesthetist appointed to the medical staff of
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the major Boston hospitals more than 50 years after ether’s ability to eliminate surgical pain was initially demonstrated at the MGH. He and his wife were descendants of 2 of the most famous and distinguished families in New England, and he was one of the pioneers in developing training in anesthesia for both nurses and physicians. He also appears, ironically, to have been one of the first physicians in this new specialty to succumb to narcotic addiction.50 E DISCLOSURES
Name: Samuel D. Morris. Contribution: This author helped with historical research and manuscript preparation. Attestation: Samuel D. Morris approved the final manuscript. Name: Alina J. Morris, MLIS. Contribution: This author helped with historical research and manuscript preparation. Attestation: Alina J. Morris approved the final manuscript. Name: Mark A. Rockoff, MD. Contribution: This author helped with historical research and manuscript preparation. Attestation: Mark A. Rockoff approved the final manuscript and is the archival author. This manuscript was handled by: Steven L. Shafer, MD. ACKNOWLEDGMENTS
The authors would like to thank the following individuals for providing information for this paper: Jack Eckert, Public Services Librarian, Center for the History of Medicine, Francis A. Countway Library of Medicine, Boston, MA; Jeff Mifflin, Archivist, Archives and Special Collections, Massachusetts General Hospital, Boston, MA; Patricia Austen, Head of the Arts and Artifacts Committee, Massachusetts General Hospital, Boston, MA; Gary Boyd Roberts, New England Historic Genealogical Society, Boston, MA; Jessie Barnes Hurley, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA; Karen Bieterman (Director and Head Librarian) and Felicia Reilly (Archivist), Wood Library-Museum of Anesthesiology, Park Ridge, IL; Laura Gresh and Wendy Swanton, Gibson House Museum, Boston, MA; and Rosamond Warren Allen and Freeman (Towne) Allen, grandchildren of Dr. and Mrs. Freeman Allen. REFERENCES 1. Bigelow HJ. Insensibility during surgical operations produced by inhalation. N Eng J Med 1846; 35:309–17 2. Gawande A. Two hundred years of surgery. N Engl J Med 2012;366:1716–23 3. McPeek B. Anesthesia before Beecher. In: Kitz RJ, ed. This Is No Humbug!: Reminiscences from the Department of Anesthesia at the Massachusetts General Hospital. Boston: MGH, 2002:75–92 4. Cope DK. James Tayloe Gwathmey: seeds of a developing specialty. Anesth Analg 1993;76:642–7 5. Bliss M. Harvey Cushing: A Life in Surgery. New York: Oxford University Press, 2007:68–9 6. Harvard College Class of 1893. Third Report: Prepared for the class decennial. Boston, MA: Rockwell and Churchill Press, 1903:36 7. Free Hospital for Women records, 1875–1975, BWH c6. Harvard Medical Library, Francis A. Countway Library of Medicine, Boston, MA 8. Washburn FA. The Massachusetts General Hospital: Its Development, 1900–1935. Boston: Houghton Mifflin, 1939: 351–7 9. Thirty-fifth Annual Report of the Children’s Hospital for the Year 1903. Boston, MA: University Press: John Wilson and Son, 1904:2 10. Armbruster ES. Introduction. In: Stowe HB. Uncle Tom’s Cabin. New York: Sterling Publishing Co., Inc., 2012:xi–xvii
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