In Reply:—

I thank Dr. Diaz for taking the time to add to our knowledge of anesthesia during World War II, and particularly for bringing to light some of the experiences of the 24th General Hospital. Because I was focusing on the European Theater of Operations, I did not fully comment on operations in North Africa, Italy, and southern France, which the military considered to be in the Mediterranean Theater of Operations. Diaz is particularly correct to honor the extensive contributions of Beecher, who was Consultant in Anesthesia and Resuscitation, Mediterranean Theater of Operations. From those experiences, Beecher authored such seminal works as “Pain in Men Wounded in Battle,” which was originally published in the Medical Bulletin of the Mediterranean Theater of Operations  and subsequently published in the Annals of Surgery . 1 

Dr. Kopp focuses on an interesting and valid question worthy of its own series of articles: to what extent did anesthetic agents used influence the progression of the profession of anesthesiology? He is right, of course, in that different factors affected the growth of medical and nonmedical practice of anesthesia. However, I think to characterize the ether–chloroform element of this discussion as “pharmacologic determinism” unfairly overstates the purported argument to the point of creating a straw man. Although it was far from the sole factor, the pharmacologic agents used were a considerable cause in the substantial rejection of careers in anesthesia by physicians in the United States. The ease of administering ether anesthesia coupled with a more dramatic response in the United States to the reports of chloroform deaths in the late 1800s led to a predominantly ether-based inhalation practice, which was wholly amenable to having the least-skilled individual provide it. This practice, in concert with other factors, encouraged physicians to scorn careers in anesthesia and permitted other professions, such as nursing and dentistry, to fill the void. I thank Dr. Kopp for his insightful letter and I look forward to continuing this most important discussion with him and other interested parties.

Beecher HK: Pain in men wounded in battle. Med Bull Mediterranean Theater of Operations USA 1945; 3: 77–82 [duplicate publication in Ann Surg 1946; 123:96–105]