Arthur E. Guedel Anesthesia Collection

UCSF Archives and Special Collections is pleased to announce that the Arthur E. Guedel Anesthesia Collection is now processed. The collection’s finding aid is available publicly on the Online Archive of California. Collection processing made possible through support from the Arthur E. Guedel Memorial Anesthesia Center Board of Trustees.

Arthur E Guedel, M.D., was an anesthesiologist and clinical professor of anesthesia at the University of Southern California. The collection documents Dr. Guedel’s long career as an anesthesiologist. The collection includes a variety of material related to his research and his professional service. The collection also includes material from Dr. A.E. Bennett, Dr. William Neff, Dr. Leonard Ramsay Thompson, and Dr. Richard C. Gill’s Ecuadorian curare expedition. The collection also includes material from the Guedel Memorial Anesthesia Center and includes administration files, photographs, and correspondence.

Material in this collection relates to Guedel’s work and others in the anesthesia field, including files regarding anesthesia, anesthesia machines and equipment, ether, chloroform, curare, and other related topics. Material includes correspondence, reports and publications, files related to conferences and meetings, photographs, audiovisual recordings, artifacts, computer media, and other material.

You can view the collection finding aid on the Online Archive of California. If you would like to visit the UCSF Archives and Special Collections and work with the complete physical collection, please make an appointment with us.

The Flying Death and Other Adventures in Anesthesia

It is amazing to think that curare, a poison sometimes known as “The Flying Death” and used on the tips of darts and arrows by indigenous people of South America, could prove to be an important stepping stone in the path to modern anesthesia. But then again, curare is not a simple poison, but actually a powerful muscle relaxant; after injection, an animal that has been shot with a curare-tipped dart can actually be kept alive through artificial respiration. More importantly to the native tribes—as they would not have needed to resuscitate their dinners—curare brings about paralysis and asphyxiation when injected (either by dart, arrow, or needle), but is not poisonous if ingested.

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A native tribesman demonstrating his prowess with a blowgun typically used with curare darts. Clip taken from Richard Gill’s film “White Water and Black Magic”.

Curare was first brought to the United States by Richard Gill, an American living in Ecuador, in 1938. Gill had become interested in the medicinal uses of curare after falling off his horse and developing neurological symptoms including spasticity. After being told about curare by his neurologist, Gill sought out and befriended a tribe who used the arrow poison. The indigenous people then showed him how to procure and use it, and Gill eventually returned to the US with approximately 25 pounds of curare paste.

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Richard Gill sitting with a native tribesman while watching another tribesman cook down curare. Clip also taken from “White Water and Black Magic”.

Medical experiments with curare began as early as the 19th century, but its use in anesthesia didn’t start until the mid-20th century, after Gill had introduced it in the US. One of its first uses was to prevent bone fractures brought about by spasms during electro-convulsive therapy. Since it is such a powerful muscle relaxant, curare proved helpful for tracheal intubation, and in keeping the patients’ muscles relaxed during operative procedures. It also lessened the need for the use of deep general anesthesia during highly invasive operations, like abdominal or thoracic surgeries.

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1943 cartoon by Clark Haas depicting Richard Gill visiting native peoples to obtain more curare. Arthur Guedel collection, MSS 2016-03.

Despite its usefulness in relaxing patients, curare has no analgesic (painkilling) or anesthetic qualities. This was proven in the 1940s, after curare was given to some infants and children as the sole anesthetic agent during operative procedures. The patients who were old enough to communicate complained that they had felt everything during the surgery but were unable to move or cry out about the excruciating pain they were feeling. Upon hear this, anesthesiologist Dr. Scott Smith volunteered to take the drug in order to test whether curare did have any pain-relieving qualities. He became paralyzed but reported that the reduction of painful sensations was not impacted. Like the young patients before him, Smith had felt everything, but had not been able to move to stop it.

Who was Dr.Arthur Guedel?

This is a guest post by Dr. Selma Calmes

Arthur Guedel, MD (1883-1956), was an early anesthesiologist who made many important contributions to the development of anesthesiology.  His papers are now available at UCSF Archives & Special Collections.  Who was Dr. Guedel and why is he important?

Guedel’s early life was difficult.  He was born in Cambridge City, Indiana, and had to leave school at age 13 to help support his family.  A work accident led to the loss of the first three fingers of his right hand—and he was right-handed.  Guedel dreamed of practicing medicine even though he had no high school diploma and no financial resources.  American medical schools had few admission requirements then, and his family physician helped him get into the University of Indiana Medical School.  He graduated in 1908.
Guedel administered his first anesthetics while an intern at Indianapolis City Hospital.  This was a common duty for interns of the time because there were then few physicians interested in anesthesia.  Guedel started a general practice in Indianapolis in 1909 and earned additional income by giving anesthesia in hospitals and dental offices.  He was an exceptional observer, analyzing carefully what might be going on with his anesthetized patients and thinking of possible solutions to the problems.

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First version of Guedel’s signs of anesthesia

One example of his contributions is his work on the signs of anesthesia.  The various devices that tell us how an anesthetized patients are doing today, such as EKGs, blood pressure devices and pulse oximeters, weren’t available when Guedel began to do anesthesia.   Four stages of anesthesia were accepted:
Stage I: Induction, the start of administration until loss of consciousness
Stage II: Struggling, breath-holding, delirium, from loss of consciousness to onset of surgical anesthesia
Stage III: Surgical anesthesia, characterized by deep, regular, automatic breathing
Stage IV: Bulbar paralysis, irregular breathing, pupils no longer respond to light

Guedel’s contributions were to expand these observations and to look for other physical signs.  He better defined Stage III, the level at which surgery could be done, by further dividing it into four planes and by adding eye signs. This improved patient safety by making clear when the patient was too “deep” and might possibly die from overdose of anesthesia.

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Dr. Arthur Guedel during World War I

The setting for these developments was Guedel’s service with the US Army in WW I in France.  The Army had no anesthesiologists when the US entered the war, and casualties were overwhelming.  After working 72 hours straight along with three other physicians and one dentist, and needing to run as many as 40 operating room tables at a time, Guedel decided additional staff had to be trained.  He developed a school that taught physicians, nurses and orderlies to give anesthesia.  But, how could he help his trainees do safe anesthesia once they left the school?  He prepared a little chart of his version of the signs and stages of ether anesthesia, the most common agent in use at the time and one with a wide margin of safety.  This chart was a visual version of the concepts he had been developing before his Army service.  Armed with their charts, the trainees went out to nearby hospitals to work on their own.  Guedel acquired a motorcycle so he could make weekly rounds of the six hospitals for which he was responsible.  He would roar from hospital to hospital through the deep mud that characterized WW I battlefields, checking on his trainees.  He was known as “the motorcycle anesthetist” of WW I.
After his return to the US in 1919, he presented his chart at meetings.  In 1920, he wrote an article on his signs for the first anesthesia journal. Additional articles appeared in 1935 and 1936 and also in Guedel’s notable book, Inhalation Anesthesia: A Fundamental Guide, published in 1937.

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Dr. Guedel (under the operating room table) and his anesthesia machine in the Zakheim mural. Chauncey Leake is standing above him

In 1929, Dr. Guedel moved from Indianapolis to Los Angeles.  He continued his careful observations and worked to solve important problems.  He collaborated with others, most importantly Dr. Ralph Waters of Madison-Wisconsin (considered the father of academic anesthesiology) and pharmacologist Dr. Chauncey Leake, then UCSF’s chairman of pharmacology.  Guedel would travel from Los Angeles to San Francisco for various research projects at UCSF. He even appears in the Bernard Zakheim murals at UCSF!   The papers now available in the UCSF Archives document many other contributions made by this important anesthesiologist.

Selma Harrison Calmes, MD is a retired anesthesiologist interested in history. A 1965 graduate of Baylor College of Medicine, she trained in anesthesiology at the University of Pennsylvania. She came to UCLA in 1976 as their first pediatric anesthesiologist. In 1988, she became chair of anesthesiology at Olive View-UCLA Medical Center. She retired from clinical work in 2007 and now is the Anesthesiology Consultant to the Los Angeles County Coroner.
In 1980, she took a National Endowment for the Humanities Summer Fellowship in Medical History at the University of Cincinnati under noted medical historian Dr. Sol Benison. She writes on various aspects of anesthesia history, especially in California, and on the many women who were early leaders in anesthesiology, especially Dr. Virginia Apgar. She co-founded the Anesthesia History Association with Dr. Rod Calverley in 1982 and served as the first editor of their publication, now the Journal of Anesthesia History. She is on the Board of Trustees of the American Society of Anesthesiologists’ Wood Library-Museum and is president of the Guedel Memorial Anesthesia Center Board of Trustees. She appeared in the National Library of Medicine’s 2003-2005 exhibit on women in medicine, “Changing the Face of Medicine” and is listed in their biographic dictionary.