Arthur E. Guedel
Arthur E. Guedel (1883–1956) ( Fig.
1-20
) was born in 1883 in Cambridge City, Indiana. Because his family
was
Figure 1-20
Photograph of Arthur Guedel while he was serving in the
American Expeditionary Forces in France during World War I. During the war, he was
responsible for the safe administration of thousands of anesthetics, often delivered
without properly trained personnel. As a guide for teaching nurses and orderlies
to administer ether, he devised a wall chart describing the various stages and planes
of ether anesthesia that eventually resulted in his classic publication on this topic
in 1919. He used a drug sequence of ethyl chloride, chloroform, and ether that prepared
the patient for surgery within 2 minutes.[485]
(Courtesy of the Guedel Memorial Anesthesia Center, San Francisco, CA.)
poor, he had to work as a young man and was unable to attend high school. His early
education was obtained by reading at home, with occasional help from visiting teachers.
Through the intervention of the family doctor, he was allowed to take the entrance
examination for medical school in his home state. He easily gained admission based
on his high scores, and he graduated with honors in 1908.
After a brief trial of general practice, he limited his work solely
to anesthesia. His devotion to the specialty was so complete that during his early
career he provided anesthetics without pay because "there was nothing else to do."
For his first publication, he described the intermittent use of nitrous oxide inhalation
to provide analgesia during labor,[480]
a method
that is still occasionally used.
Guedel served in France during World War I, where he developed
an anesthesia training school at Chaumont. During these years, he began a lifelong
study of anesthetic depth with ether anesthesia. A profoundly curious individual,
he made careful observations on his patients and formulated the various stages and
planes of anesthetic depth that have become known as the Guedel signs.[481]
These observations were refined throughout his career and published in final form
in his book, Inhalation Anesthesia, published in
1937.[449]
His era saw the rise of anesthesiology as a profession, a time
of remarkable change in how anesthetics are delivered. Guedel's letters are full
of ideas, most of which did
not work out. His thoughts, revealed in these letters, uncover several bizarre ideas
scattered in with ones of true brilliance. He carried on frequent discussions with
other members of the Anesthesia Travel Club, which included many of the prominent
figures of the specialty during that time. He tried new techniques offered by others
and was blunt in his criticisms if they proved useless. His many innovations include
the cuffed endotracheal tube, introduction of new anesthetic agents such as divinyl
ether and cyclopropane, construction of a new pharyngeal airway,[400]
and the introduction of controlled ventilation.
For health reasons, Guedel moved to California in 1928, where
he practiced for 12 years before his retirement in 1940. He died of emphysema in
1956 after receiving many awards, including the Henry Hill Hickman Award; he was
the first American anesthesiologist to receive this coveted prize. He also received
the Distinguished Service Award from the American Society of Anesthesiologists.
The Guedel Anesthesia History Center, located in San Francisco, is a repository for
his correspondence and other memorabilia relating to the early 20th century developments
in anesthesiology.
