University of Miami Miller School of Medicine
MEDICINE AND LITERATURE: THE ROMANTIC CONNECTION
Origins of Anesthesia
It's not easy to know exactly where to begin this particular story, but I think when all else fails it is better to begin at the beginning and try to see where we go. The introduction that Henry gave about my curiosity about the beginnings of anesthesia is a correct one, but it is only a partial one. The story is really a very complex one, in some respects, and I will do my best to make it simple. But it has always worried me that all of the histories of anesthesia and all of the commentaries about the early stages seem not to address a very crucial and central question: anesthesia, if it is anything at all, is the method of medicine, par excellence, that deals with the prevention of pain and suffering, and for reasons that have, up to recently at least, escaped most of us, it seemed rather peculiar that it took nearly eighteen hundred and fifty years after the birth of Jesus for this simple in concept idea to materialize.
Why it took so long, I thought may be a reflection of many other things that would be of great and central interest to both medicine and to other parts of our cultivated life, and particularly of interest in medicine, because it happens by chance that around the time of the discovery of anesthesia, or just before it really, is the time when clinical medicine begins to emerge as something that is beyond the wearing of wigs and the using of gold-headed canes by the doctors of that period, whose fees were enormous and whose accomplishments were minuscule. They purged, they bled, and they caused people to vomit for all illnesses, and, in fact, one of the great Romantic poets wrote a desperate letter to one of his friends -- this was Byron -- to please be free of the physician who was killing him by bleeding him and purging him. Malaria killed Byron before the doctor could, but that was the level which medicine was at at that time.
So one had to go beyond, I thought, the historians to search for where the truth might be in this -- a notion of pain and suffering, which all of us and probably all of you in this room take for granted as being the object of medical/scientific relief, that was not really so until, as medicine goes and as culture goes, really very recently. It is, in my view, a quite recent accomplishment, and I would like to give you at least my views of the possible explanation for how it may have begun.
I will get back to some documentation of what went on before this period, but in Western civilization there really was a placid period in which essentially a few people were in charge. They were called kings or dukes or princes and, in the later years, became wealthy business types, and everybody else was oppressed and deprived of even the simplest kinds of amenities. This was viewed as normal as we will see when we look at some of the documentation. It wasn't until the American Revolution, which was the application of some of the 18th Century ideas of equality and democracy, although a war between cousins really. But these ideas of freedom, of liberty and the pursuit of happiness, which is in our Declaration, didn't actually materialize in an important way until the French Revolution of 1789, which was a major upheaval of all of Western civilization, and for the first time democracy really occurs. Many of us, and I was one of them, thought democracy began with the Greeks, but one could hardly cherish a Greek civilization in which a few people controlled everything, and many were slaves, and women didn't count for anything -- they were somewhere between slaves and zero. It wasn't really until the French Revolution that the rights of man -- the economic rights, the absence of titles, and the absence of oppression -- became an established goal for human welfare. This, like so many other good things in the world's activities, was ended in 1793 with the Reign of Terror, in which most of the gains of the French Revolution were either obstructed or actually terminated. The solidification of the return of tyranny and the end of the French Revolution occurred when Napoleon ascended the throne, and a dark period for Europe and the rest of the world, in terms of these human freedoms, actually ensued.
How does all this pertain to what we are talking about? At the time that the 18th Century turned into the 19th, a modest number of British intellectuals, literary artists, visual artists, and others decided that they wanted the benefits of the French Revolution, that they were healthy and that they needed to be gained. And they believed that they could not be obtained by violence -- that was shown because of the failure of the French Revolution. They didn't think it would be a gift of God -- many of them were atheists or deists, which are similar to each other. They felt that it had to be the accomplishments of each individual person, and that the logical development of this kind of thinking, in Britain especially and in Germany to a lesser degree, was that there was a notion of worth. Each individual male, female, child or adult had an intrinsic value and worth. The subjectivity of that kind of thinking led them to believe that these rights could be obtained.
Now when you start to think of the worth of the individual, this is the prelude in medicine to thinking that it is worthwhile to do something for someone who is sick. Otherwise there is no point in trying to help anyone who is sick -- if he doesn't matter, why bother? No one bothered with the slaves. And the medicine, good though it was in some respects, over the many centuries really catered only to nobility and to heroes and to the rich and to royalty. So the democratic process sets the stage, as I view it, for an interest in patient welfare. One of the important consequences of that is an interest in alleviating pain and suffering, however it originates. Eventually, and this is where anesthesia's discovery becomes possible, society accepts this as a good, and then it is possible to develop means of preventing pain, even though induced for people's welfare by surgical intervention.
Now I want to take a little time with you to document some of these ideas and to expand them a bit. I am going use some slides for this purpose, and I want to explain in part -- not to our medical audience. Medical audiences think that they are deprived if they don't see slides, that the speaker hasn't prepared it, so, as a gesture to my medical friends so you don't have to worry: I did think about it; I worked on it; I prepared it. For the rest of you, it will be a way in which you can reinforce what you hear with what you see, because there will be some sections of interesting poetry and some prose selections, that with two senses instead of only one operating, you have a 40% chance of, I hope, enjoying what the facts are, instead of just a 20%.
This is a statement taken from a play that Shelley wrote about himself and Byron. He was Julian, who doesn't appear in this quote, and Maddalo was Byron. Byron was the matinee idol of his time, and Shelley was the very serious young man, who was an atheist and people hated. But this is the concept of how literature and pain and suffering come together. Shelley said, and I remember one remark which then Maddalo made, namely Byron. He said, "Most wretched men are cradled into poetry (lovely phrase) by wrong; (Something wrong makes poetry possible)/ They learn in suffering what they teach in song." Song is the word for poetry of that period. So suffering is an important adjunct arising from something wrong and results in poetry. That's part of the mood.
In order to tell you about the Romantics, I want to define the Romantics at the moment. The Romantic Period is defined arbitrarily. It is a technical term in British Literature from 1789, the beginning of the French Revolution, to 1830. It's got nothing to do with moon or love or June or any of those things. This is a literary/technical term. The Germans think it lasted until 1848 because that is when their revolutions occurred. But whatever it is, it is the turn of the Century into the early 19th. Now the Romantic mood was anything goes; everything was all right to try. Experience was the greatest thing in the world. And this made it possible, for among other cultures, for medicine to change to modern things, for us to be interested in pain and suffering, both as virtues and as things to be avoided. When I said anything goes, I really meant that. Byron, for instance, had a long-term incestuous affair with his half-sister, Augusta, which was viewed as okay by everyone except Lady Byron, and that was understandable. There were other things of this kind.
Wordsworth, who was the first and greatest poet of the Romantic period after Blake, made this comment. This, I think, some of you will recognize. It comes from his Lyrical Ballads, and he says:
"My heart leaps up when I behold
"The Child is father of the Man" was not Shakespeare. It was Wordsworth, and it was a key note of the attitude of the Romantics.
This is what they sought, but how did they come that way? Well, from the mainstreams of Western culture and civilization, which are Greek, Roman, Classic, and Judeo-Christian in the religious and moral areas. I would like to, and I have time only to show you, briefly, that these two great cultures, of major importance to us, gave us nothing of interest or importance for dealing with pain and suffering of the common man. This is a statement taken from Galen's book. Young was a great person in the Middle Ages in medicine, and Roy Porter is the current distinguished British historian of things medical, and what he says is really the way it was. Traditional history of medicine simply ignored the individual patient. That was true in Greek and Roman civilization, and although it is controversial and not completely easy to document, in my view, it was largely true in Judeo-Christian tradition as well. The word pain, for instance, comes from the Latin poena, which means punishment.
These are some examples of the attitudes of the Jewish and Christian traditions about pain and suffering. The essential point to remember is that pain and suffering were inflicted by God for sin, and this was the result of Original Sin in the Garden of Eden. The wicked man in Job: "The wicked man travaileth with pain all his days." And this in the New Testament: "Fear none of those things which thou shall suffer. Be thou faithful until death, and I will give you the crown of life". If you are a good Christian and devout, you will get eternal salvation. And the Christians went one step further than the Jews in cherishing martyrdom as a way to eternal salvation and to eternal life, because this is a replica of the agony and the crucifixion of Jesus. From Peter: "Yet if any man suffers as a Christian, let him not be ashamed, but let him glorify God on his behalf."
Now we skip many centuries, but the attitude about pain and suffering didn't change as late as the 17th Century. This statement of Samuel Heron is taken from a book in which he advises women what to do when they are in labor with the pain of labor. As you may remember in the Bible, it says to women that they will always bear their children in pain because of the sin of Eve. This is the way that he puts it: "The smart of the punishment which thou God laidst upon me, being in the loins of my grandmother Eve for my disobedience toward thee. Thou has greatly increased the sour of our sex, and our bearing of children is full of pain." This is again punishment for sin, Original Sin, which is inherited by all women according to this doctrine.
In the same century, and taken by the statement of a person who wrote in his diary, this man suffered the death of his seventh consecutive child as an infant, which was common in those days. This is what he wrote. "I was at ease, but thou, oh God, has broken me asunder and shaken me to pieces. Though my children died, the lord liveth and they exchange but a temporal life for an eternal one." He gives ground to the omnipotence of God, and even though he has lost seven children in a row, they are saved because they have eternal life as a result of it. So there is the combination of punishment for sin and martyrdom for faithfulness that occurs in the Judeo-Christian traditions that we inherit. And therefore it is a contribution to why we weren't, at least in my opinion, interested in dealing with the individual pain and suffering of the average person.
Now things begin to change with the Romantics because of the notion that they were interested in subjectivity, and in people, and in the democratic process. And one of the people that led the charge, as it were, both in poetry and literature and medicine, was Thomas Beddoes, Sr. This is a picture of him. He started a remarkable institute in Bristol in England -- we will say more about that in a moment -- which he called the Pneumatic Institute. And I will tell you a little bit about the people that worked with him in a moment. But this is the first time that anyone measured a medicine given to people. It was by inhalation of gases and fractions of air, but at that time nobody knew what the concentration of anything was that they took by mouth, and subcutaneous or parenteral injections were still to come in the future. So Beddoes introduced quantitation in medication. He introduced therapy via the lungs, he introduced oxygen therapy as well, and in his organization was the first experience with inhalation anesthesia under his direction. I will try to elaborate on how that happened in a few minutes.
This was the director of his Institute, a young man named Humphry Davy, who was nineteen when he was chosen to direct it. Sir Humphry Davy was later the greatest chemist of his age in Britain and became President of the Royal Society. A most distinguished individual, but he did run a health spa of the time, and it was a spa and it was in a suburb of Bristol, which had hot springs and large fees for physicians. This is a plaque on the original Institute in Bristol, England, where the building is, talking about Sir Humphry Davy's contribution. This is that building in Bristol. They didn't have autos and this is how it looked last year. These slides were given to my by Dr. Zora, who is an anesthesiologist in Bristol and President of the World Federation of Societies of Anesthesiologists. It is inhabited by very nice people who twice a week allow visitors to come in to look at the interior of Beddoes' famous Pneumatic Institute, which by the way lasted only three years.
Now why Bristol? I thought you should see on the map how it relates both to London and to the sea. This part is the opening to the sea. This is the English Channel, and one goes west this way to the New World. Bristol was the second most important city in Britain at the time, and it was the main focus of the slave trade in the United Kingdom. Slaves were brought from Africa to the New World, sometimes via Bristol because they had lots of experience with them. They did all this exchange as the Industrial Revolution began just north of Bristol -- cotton, molasses, money, slaves and such. Bristol was the economic center of that activity.
When I talk about the environment of the Pneumatic Institute. This is mind boggling. You may recall, those of you that are old enough to do so, that President Kennedy once had a dinner party at the White House in which he invited all of the Nobel Laureates to dine with him and his comment was that, "Never has this house (the White House) had so much brain power together, except when Thomas Jefferson dined alone." Now, this is the gang of seven at Beddoes' Institute. Beddoes was a most distinguished physician of his time. Wordsworth, the great English Romantic poet and the co-author with Coleridge of Lyrical Ballads. Coleridge was a person of very many skills, and among them was not only his collaboration with Wordsworth, but he was a medical student for a short time. He persuaded Wordsworth to have Davy, whose is the last name, edit the second edition of the Lyrical Ballads, which is the great British Romantic collection of poems. Probably one of the three most important epic poems in the English language was also written by Coleridge. It is called Dejection: An Ode. Southey became the Poet Laureate of England later, and Southey and Coleridge married sisters and they had planned to immigrate to Pennsylvania to set up an ideal communal life where there would be no prejudice and total democracy. And Coleridge called this place Pant isocracy, two Greek words which means everybody was equal. They didn't get to Pennsylvania to do this, and Coleridge was stuck with one of the sisters with whom he didn't stay in love very long. Though Southey -- apparently that marriage did all right. Roget was a Swiss-French doctor who wrote the thesaurus later. This is the same man that you know who did the thesaurus. James Watt invented the steam engine, and in the time of the Pneumatic Institute he designed all of the inhalation equipment for Beddoes and his people. Davy, we've talked about, was a great chemist. Now all of these people did experiments in preventive medicine by inhalational therapy for Beddoes, and they also were experimental subjects. We will look at some of this in a moment, but this was probably one of the greatest collections of British brains in one place for three years.
Beddoes did many things. He disapproved of a common practice in those days in England of giving fermented liquor to children. Children were put to bed and kept quiet by giving them whiskey. That he opposed. He opposed all sorts of other things. He invented practical toys. He said that children should get acquainted with the real life and work with tools in order to prepare them, as he put it, for overcoming minor failures. You will recognize this as what is called Progressive Education. It is thought to be, by many of you, new in the Montessori school system, but Beddoes wrote about all of these things at that time. He didn't like sports, and this is what he said about cricket: "It's the misfortune of school sports that they must be dropped as soon as boys quit school. The benefit of this game (cricket) seems more than counter-balanced by the carousel (drinking) which commonly follows it in the evening." He was a teetotaler and he thought that sports were a waste of time.
I am going to show you a few things that Beddoes did that were extraordinary. He thought that it was a good idea to keep the young men, not girls but males, virtuous, by taking them to hospitals where patients with tertiary, cerebral syphilis, which then existed, who were insane. He said that he would take the young boys without explanation. As he put it, " I took an opportunity of showing him a debaucher whose organs were half consumed by corroding ulcers. The sight, the smell and perhaps the flood of light suddenly reflected upon his own mind rendering him immediately faint." He thought this was good preventive medicine that they shouldn't indulge in illicit sex.
Here he shows what would today be looked upon as a bias. He says in females, and probably in some feminine males, application to music and other sedentary accomplishments -- he disapproved of those -- and he said that, "Concurring with the simultaneous perusal of light books (which he also didn't approve of), it injured the perceptive and associating faculties and by consequence it spread havoc through the nervous system." So he thought reading novels, listening to music and being sedentary was not good for you. He also thought being in warm closed rooms was no good. He didn't disapprove, for moral reasons, of the clothing of women, but for those of you that know the styles of women's clothes, they were really half naked for formal occasions. He said half-nakedness in women or too thin clothing in men is unhealthy, and he thought it led to tuberculosis.
This is one of the classic observations in relationship to anesthesiology and the whole idea of preventing pain and surgical suffering. Humphry Davy, as an experimenter in the Institute, made this statement in passing: "As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage in surgical operation in which no great effusion of blood takes place." He wrote this in 1800 and the first -- depends on where you sit on the argument about anesthesia -- but the first one, let's say, was 1842 in a little town in Georgia. So it took forty-two years before this percolated. One of the very interesting observations of the distinguished cultural historian who I value as a close friend -- Jacques Barzun wrote in an article in the JAMA in 1972 -- is that the medical profession was so stupid that it didn't take this observation of Davy's seriously and introduce anesthesia earlier. He blamed it on the medical profession, rather than on the applications of the Institute.
Roget, who did the thesaurus, describes what it felt like. He was a subject for these experiments with nitrous oxide. He said:
"I then felt a drowsiness gradually steal upon me and a disinclination to motion. Even the actions of inspiring and expiring were not performed without effort, and it also required some attention of mine to keep my nostrils closed with my fingers. I was gradually roused from this torpor by a kind of delirium which came on so rapidly that the air bag dropped from my hands and I suddenly lost sight of all the objects around me, they being apparently obscured by clouds in which were many luminous points. I felt myself totally incapable of speaking. My whole frame felt as violently agitated. I thought I panted violently. My heart seemed to palpitate and every artery to throb with violence. I felt a ringing in my ears. All the vital motions seemed to be irresistibly hurried on, as if their equilibrium had been destroyed and everything was running headlong into confusion. My ideas succeeded one another with extreme rapidity. Thoughts rushed like a tyrant through my mind as if their velocity had been suddenly accelerated by the bursting of a barrier, which had before restrained them in their natural and equitable chorus. I cannot remember that I experienced the least pleasure from these sensations."
Why was nitrous oxide used in the Pneumatic Institute? It was used because people to whom it was given behaved in what we have subsequently described as the excitement stage of inhalation anesthesia. And Beddoes believed because they carried on, were excited and, in fact, a lady ran nude down the street in Bristol which in those days wasn't exactly normal to have happened, that it was useful for the treatment of depressive illnesses in both neurology and psychiatry. Not a bad idea from what he saw, but of course he didn't understand that the reason for the excitement was the release of cortical brain inhibitions by this particular agent. And by the way, if you think we have a drug scene now is nothing compared to then. Everybody took something. Nitrous oxide -- Davy was an addict of it. Ether was commonly used for social purposes, including parties, and wealthy ladies would invite, on behalf of their daughters, nice young gentlemen and other ladies to attend their ether frolics. So, the notion of mind changing drugs is not a new one.
All of this carrying on of the Romantics and their willingness to try anything has suggested to many observers, mostly Victorians and people who followed them, that these were wild passionate people who didn't follow reason and had no respect for science. Nothing could be further from the truth. What the Romantics did was to add passion to reason. And passion did encompass the ability to love and to do something about pain and suffering. Wordsworth, a great poet of this period, said: "The knowledge, both of the poet and the man of science, is pleasure, and they join when poetry is the breath and finest spirit of all knowledge. It is the passioned expression which is the countenance of all science." He looked forward -- that is Wordsworth looked forward -- to a time when the discoveries of the scientist would be proper objects of the poets' art. There is no clearer statement that the literary people really were interested in the collaboration with science. And again, Wordsworth about science. This he wrote in his preface to the Lyrical Ballads. "If the time should ever come when what is now called science best familiarized to men shall be ready to put on, as it were, a form of flesh and blood, the poet will lend his divine spirit to aid the transfiguration and will welcome the being thus produced as a dear and genuine inmate of the household of man."
Now I will go from that consideration to some things of Coleridge, the most remarkable mind of the century in many ways. Now here is a direct statement in a letter to Humphry Davy about his attitudes about pain. "I want to read something by somebody expressly on pain, if only to give an arrangement to my own thoughts, though if it were well treated, I have little doubt it would revolutionize them." This is a major statement of interest in pain and doing something about it directly -- no equivocation, no reading into the lines. And Coleridge again in a poem. He was both the real sufferer of pain physical and a sufferer emotionally. He, in fact, was the man who coined the word 'psychosomatic' for those of you interested in these words. He understood the relationship of body to spirit. In one of his poems he says, "And seas of Pain seem waving through each limb --/Ah what can all Life's gilded scenes avail?" Pain isn't good. "And gaily sported on the Muse's Lyre", he says, "Ere Tyrant Pain had chas'd away delight/Ere the vile pulse throbb'd anguish Thro' the night!" Pain isn't good. It's a tyrant.
This was the young Coleridge, almost as an adolescent. It is written in heroic couplets. This is the favorite verse form of Alexander Pope in the 18th Century:
"On thee with harpy fangs they seize
Further about pain, in a letter to Southey -- Coleridge seemed to write about every ten minutes to somebody; he had an enormous volume of correspondence - he says, "Oh God, when a man blesses the loud screams of agony that awake him night after night, night after night, and when a man's repeated night screams have made him a nuisance in his own house, it is better to die than to live."
This is a very cryptic comment. I think most of you, or maybe all of you, know the story of Achilles, whose mother dipped him in the river Styx to make him immortal, but held him by the heels so he could be killed through his heels. The words 'Achilles heels' have become standard English cliché almost. Coleridge said that he opposed vulnerability -- I think is what he means here -- "And were I Achilles I would have had my leg cut off to have got rid of my vulnerable heel."
This is the first version of his great dejection ode, which he really wrote as a love poem to Wordsworth's sister-in-law. Sarah Hutchinson was the sister of Mary Hutchinson. Mary is the one who Wordsworth married. Coleridge published a different version of this poem on the anniversary of his own wedding date and on the day that Wordsworth and Mary Hutchinson got married. I think this is one of the more hostile acts of an otherwise very kind person to do to his friend. But he says, "O Lady! we receive but what we give,/And in our life alone does Nature live:/Ours is her wedding garment, ours her shroud!/Ah! From the soul itself must issue forth/A light, a glory, a fair illuminous cloud/Enveloping the earth--".
Now we go to Shelley, who had a different kind of pain and suffering. Shelley was one of the most intellectual of the Romantics. He was an atheist; he was an aristocrat. He did all kinds of things for experience. He died at the age of thirty. Keats died at twenty-six. These people did a lot of their great work when they were very young. But Shelley was an idealistic democrat, despite being born an aristocrat. He wanted everybody to have all of the wonderful good things. When he found out that society wasn't responsive to him, this is one of the things he wrote: "For I am one who men love not."
That in his great poem Prometheus Unbound. He makes it very clear that he wants no living thing to suffer pain, but he has an interesting solution to how to do that, which we will come to in a moment. Then in one of his great essays, which was written as a response to his friend Peacock's criticism of poetry. This he called In Defense of Poetry: "Poets are the unacknowledged legislatures of the world." I think there is a lot to be said for this point of view. Again in Prometheus Unbound, he describes the intensity of pain and the intensity of joy. The Romantics looked at contraries, at polar things. Opposites were important to them, and joy and pain could be considered polar contraries. And Shelley said, "So sweet that joy is almost pain." Shakespeare said earlier that "Parting is such sweet sorrow." So this is a theme that isn't unique to the Romantics, but is an important one to them.
Now Shelley actually, without having seen anything in anesthesia or in medicine, described the induction of anesthesia and the apparatus that was used by Morton in Boston. This was an incredible kind of intuitive prophecy. He could not have known any of this, but the descriptions are very accurate. And for what you think of intuition I don't know, but I have to tell you that explanations are very difficult to make unless you think in some way that the poets have prophetic, not religious, but prophetic qualities. "Look, sister" (this is Asia in Prometheus Unbound), "ere the vapor dim thy brain:/". She says: "……my brain/Grows dizzy; I see shapes within the mist."
Shelley's idea for how you dealt with pain and suffering was to provide for uncritical love and the removal of hate. He felt that one must love without criticism. Two examples I want to cite to you. One is when he was married the first time; he was married twice. The first time was a lady who committed suicide later, but Shelley's best friend attempted to seduce her during their honeymoon. And in letters to others, not to his friend Hogg (interesting name for a seducer) he forgives Hogg for all this and he loves him dearly. This is hard for most people to understand, including me, but Shelley believed that love of that kind was the answer to the human problem. In his great play, which doesn't get performed because it is hard to do, called The Cenci, the heroin, a lady named Beatrice, is sexually assaulted by her father in an incestuous relationship by rape and force, and after it she is brutalized enormously by this monster, who is just not monstrous in that one respect but in every other. And she decides to have him killed. Shelley doesn't forgive her for deciding to murder her father and has her convicted of murder and executed. His view was she should have been able to overcome the horror of the rape and to forgive her father and to love him. Demogorgan goes on in a summary of Shelley's view, which he attributes to Prometheus. The last line is what we need, "This is a lone Life; Joy, Empire, and Victory!" And that is 'love' for Shelly.
This is an interesting small tale that I think I will stop to tell you about. There was a television show on public television about Allen J. Lerner's work with Fritz Lowe. Among other things, of course, were My Fair Lady, Gigi and such. But Lerner had an interesting life; among other things he married eight times. Apparently successful each time, because the wives liked each other and all of his friends liked each of the wives. Lerner also became a drug addict, but a respectable one, as was true of the Romantics. Walter Cronkite was the Master of Ceremonies of this program, which was most interesting. At the conclusion was the typical Cronkite word of a combination of pontification and music. He said this, "Whenever I sat down to write a song of love I wrote of pain, and when I wrote of pain it became a song of love." And he said, "This was written by Shubert." This is a classic summary of the Romantic attitude about pain and suffering and love. The only problem was that Shubert never wrote this. And one of the bright young men who wrote the script for Walter Cronkite must have been carried away. And so it shows you sometimes how very great poets and essayists never are recognized. I have no idea what this young man or woman's name was, but not Shubert and not Cronkite, it was some unknown scriptwriter.
I want to try to summarize some of the things that I have tried to tell you. I think that the attitudes toward pain and suffering changed remarkably at the turn of the 18th into the 19th Century largely because of the Romantics' attitudes and their interest in subjectivity - their value of the individual ordinary person, man, woman and child. I view this as a markedly important, democratic influence upon the development of our Western civilization, and I think it is not an accident, that with the introduction of compassion, love and an interest in individuals, came such things as the modernization of clinical medicine and the concern with the welfare of the individual, of which the discovery and development of anesthesia is the single, solo, best example for the prevention of pain and suffering that we have in clinical medicine. All these are made possible by the change in attitudes for the first time in Western culture of the great Romantics. Thank you.
Emanuel M. Papper, M.D., Ph.D.
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