Dr. Freeman Allen: an anesthesiology pioneer

Although Morton demonstrated the anesthetizing properties of ether in 1846, it was not until late 19^th century that a few physicians began devoting their careers exclusively to administering anesthesia to patients, educating others about its use, and studying ways to administer it in a more safe and effective manner. One such physician was Dr. Freeman Allen. Dr. Allen was the first physician appointed as Anesthetist to the medical staff at Boston’s Free Hospital for Women in 1901 (a predecessor of the Brigham & Women’s Hospital). He subsequently received similar appointments at the Massachusetts General Hospital (MGH) in 1902, and Boston Children’s Hospital in 1903.

Dr. Allen was the grandchild of Harriet Beecher Stowe (the author of Uncle Tom’s Cabin) and married the great-granddaughter of Dr. John Collins Warren, the surgeon who performed the first operation under ether at MGH. His career in anesthesiology is chronicled by Dr. Mark A. Rockoff, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, and colleagues in the article titled “Freeman Allen: Boston’s Pioneering Physician Anesthetist,” and published in this month’s issue of Anesthesia & Analgesia.

Dr. Allen attended Harvard College and Harvard Medical School. Like other medical students at the time, he administered anesthesia to patients at the MGH. After medical school he worked with the United States Cavalry in Cuba, and he assisted General (and physician) Leonard Wood in his historic studies on yellow fever. He returned to Boston in 1901, whereupon the MGH surgeon Dr. J. Collins Warren, whose grandfather had performed the first operation under ether at the MGH, encouraged him to consider anesthesia. He travelled to New York to work with Dr. Thomas L. Bennett, a distinguished specialist in anesthesia. He subsequently studied anesthesia in London in order to obtain additional training in its administration because physicians in Great Britain had been administering anesthesia (e.g., chloroform) since its introduction. He returned to Boston in 1901, assuming his position at the Free Hospital for Women. He also studied dermatology the following year. However, Allen ultimately focused exclusively on anesthesia. It is not clear why he transiently pursued studies in dermatology, and nor why he abandoned such studies to return to anesthesia.

His appointment to the MGH staff, like other “visiting” physicians at the time, was not a salaried position. His income was generated through his private practice. He felt ether was safer than chloroform, but that spinal or local anesthesia was safer than general anesthesia. He published articles in the Journal of the American Medical Association and the Boston Medical and Surgical Journal (now the New England Journal of Medicine). At the time, many surgeons felt that nurses could provide anesthesia more reliably than physicians. It was difficult enticing physicians to focus on anesthesia, and he felt the best system was to train nurses as anesthetists.

Later in his life, Dr. Allen suffered from general neuritis, and at the age of 59, he died suddenly. He reportedly died from heart disease, but Dr. Rockoff and colleagues documented that he apparently committed suicide during one of his admissions for treatment of morphine addiction.

This is a superior historical paper about an important physician anesthesiologist whose life has not yet been well documented in the anesthesia literature. The authors use a good mix of primary and secondary sources to reveal his life’s story, especially his work in anesthesia. The authors successfully frame the historical context of Allen’s significant life events and the interplay between the two.

As Drs. Orlando Hung and Ronald D. Stewart, Departments of Anesthesiology, Surgery, and Pharmacology, Emergency Medicine, Community Health and Epidemiology, and Medical Humanities, Dalhousie University, Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada, write in their accompanying editorial titled “Remembering the Famous and Forgotten in Medicine,” “introducing students to the ‘famous and forgotten’ such as Dr. Allen may help to form the foundation of a life and career in the art called medicine. They cite the example of Frank Newte’s seminal code-breaking work. Frank who? Frank Neute worked for the British Intelligence Service; secrecy was necessary, and nobody knows of his work as a result.

When it comes to medical history, we have no need for secrecy. Knowledge of the history of medicine can inspire, add to our understanding of the duties and obligations of our profession, and provide cautionary tales and models for how we can meet the challenges of current and future practice. Whether famous or forgotten, those who came before us, and who set in place the foundations upon which we now build, are worth remembering.”

The article is also accompanied by an editorial from Dr. Gabriel Schonwald and colleagues from the Department of Anesthesiology, Perioperative and Pain Medicine, at Stanford University, Stanford, California, HELP Pain Medical Network, San Mateo, California, Promises Professionals Treatment Program, Los Angeles, California, Department of Institute for Health & Aging, University of California San Francisco, San Francisco, California, and Georgia Professionals Health Program, Inc. in Atlanta, Georgia. This editorial, “Anesthesiologists and Substance Use Disorders,” notes that Freeman Allen may have been the first anesthesiologist addicted to opiates, but was certainly not the last. Dr. Allen’s story provides a cautionary tale about the risks anesthesiologists face from opioid addiction, and discussed the advances in understanding and treating addiction that might have saved Allen, and could potentially rescue colleagues suffering from addiction disorders.