Dr. Jean Henley, author of the first modern German textbook of anaesthesia

Dr. Jean Henley, author of the first modern German textbook of anaesthesia

International Congress Series 1242 (2002) 277 – 281 Dr. Jean Henley, author of the first modern German textbook of anaesthesia Gerald L. Zeitlin*, Mi...

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International Congress Series 1242 (2002) 277 – 281

Dr. Jean Henley, author of the first modern German textbook of anaesthesia Gerald L. Zeitlin*, Michael Goerig Plainfield Street 104, Newton 02468-1636, USA

Abstract Dr. Jean Henley, an American anesthesiologist who was also Board-Certified in Internal Medicine, travelled to Germany shortly after the end of the Second World War, and found that anesthetic practice in that country lagged behind modern standards. She started, on her own initiative, to teach these methods and soon she was invited to many academic centres across Germany. She wrote a practical textbook in German and this is now considered to have been the first modern textbook of anesthesia in that language. Dr. Henley was an accomplished sculptor and linguist. D 2002 Elsevier Science B.V. All rights reserved. Keywords: Modern anesthesia; History; Textbooks

1. Text In 1998, Dr. Michael Goerig became aware of some facts about the life of Dr. Jean Henley, an American anesthesiologist who wrote the first modern textbook of anesthesia in the German language. Her name was Jean Emily Henley. She was born in Chicago in 1910 and died in the lake side town of Shelbume, Vermont, in 1994. She had an extraordinarily varied career. By obtaining a copy of Dr. Henley application for enrollment in the American Social Security system, we discovered that her name at birth was Jean Emily Heller. Later, we were informed that her father Eugene changed the family name to Henley. Jean, who was an only child, also adopted that surname. Her parents, Eugene Henry Henley and Helen Esther Goodman, both practiced lay clinical psychology, but late in life they returned to college and obtained PhDs. Her father Eugene is reputed to have

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Corresponding author. Tel.: +1-6172-444-579; fax: +1-6175-274-248. E-mail address: [email protected] (G.L. Zeitlin).

0531-5131/02 D 2002 Elsevier Science B.V. All rights reserved. PII: S 0 5 3 1 - 5 1 3 1 ( 0 2 ) 0 0 7 6 1 - 6

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been a friend of Carl Jung. When Jean’s mother Helen died, her father became profoundly depressed and tried to kill himself by driving into a tree. Sadly, he only succeeded in paralyzing himself. A nurse, called Adelphia Synaiko, took care of him, and in 1959, at the age of 70, he married her. Eugene died in 1968. We know from a living family member of Eugene Henley’s second wife, Adelphia, that Jean’s parents frequently traveled to Western Europe when she was young, particularly to the German-speaking parts of Switzerland. One may assume they took Jean with them on these trips because she was fluent in German. Jean obtained her BA at Vassar and Bamard Colleges, two leading women’s colleges, between 1928 and 1930 and then from 1934 to 1936, respectively. In the early 1930s, she went to Paris to study sculpture. During that period, she supported herself financially by working as a dentist’s assistant. After she returned to the United States, she went to medical school at Columbia Presbyterian in New York from 1936 to 1940. She did her internship at Santa Barbara Cottage Hospital in California. Between 1941 and early 1944, she underwent training as a specialist in Internal Medicine first at University College in San Francisco, and then at the New York Hospital. But in 1942, for reasons that remain unclear so far, she moved to Boston and completed her Internal Medicine training at the Peter Bent Brigham Hospital, one of the principal teaching hospitals at Harvard Medical School. It is also somewhat unusual for a young doctor to complete her training in Internal Medicine at three different medical schools. Being accepted by Harvard Medical School for resident training as a woman in 1942, was quite an achievement, since Harvard first admitted female medical students in 1945. Cynics might argue that because all the male doctors were away in WW-II Harvard was forced to train women. One of Jean Henley’s contemporaries, who is still alive today, told us that Jean was raised by her parents to completely deny her Jewish heritage. Perhaps that denial might also explain how she got into Harvard. In Professor Henry Beecher’s History of Harvard Medical School, he has little doubt that as far as the admission of Jewish students was concerned there was a strict but secret quota of 10%. The part of her life about which we know the least, so far, is her service in the US army in the South Pacific and Korea from 1944 to 1946. We do know, however, that she served in the military for 27 months and that she served as a ward officer. This would be the equivalent of being the general practitioner for the physically or psychologically injured soldier. In early 1945, there were approximately 48,000 male doctors serving in the US army worldwide, but only 83 women. Women doctors who volunteered to work in the army were discriminated against. Male doctors were automatically given a commission i.e., they became lieutenants on induction and often rose to Colonel or higher. It took a scandal, and then an act of Congress to achieve the equivalent status for women doctors in 1943. One might perhaps speculate that while in the military she became interested in anesthesia. Whether or not this is true, soon after leaving the army on March 1947, she began with the residency training in anesthesiology in Columbia. We have been fortunate enough to obtain from Mr. Patrick Sim, Librarian at the Wood Library Museum, a copy of her application form to be admitted to the American Society of Anesthesiology. The signature of her first sponsor is of particular interest—Virginia Apgar—the obstetric anesthesiologist. Jean finished her anesthesia residency in March

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1949. She rejected an offer of a faculty position at Columbia—at that time, already one of the leading academic anesthesia departments in the USA—and left for Germany. We do not know why she went. We have some indirect evidence but nothing conclusive. We now jump forward in her life in 1980 when she was invited to speak briefly as part of a panel at the W.f.S.A. World Congress in Hamburg in 1980. This was 8 years after she retired from clinical anesthesia. Some of the most distinguished leaders of the specialty sat on that panel including Sir Robert Macintosh and Prof. Frey. Here are some extracts of Dr. Henley’s address at that time: ‘‘. . . My having played a part in bringing modern inhalation anesthesia methods to West Germany began quite by chance and was unofficial.’’ She continues: ‘‘. . . after several trips to the American embassy in Bern, I was allowed to take the train to Wiesbaden. (Dr. Daelen) had made arrangements for me to work with her friend Prof. Bernhard, the chief of surgery, for the 10 days of my visa. That I was needed became clear right away.’’ And later: ‘‘. . . Anesthesia was being administered as it always had been, mostly by a beginning surgical resident intent on learning surgery. When the belly tightened, usually from CO2 retention, the surgeon would bellow, ‘More ether.’ So instead of improving the airway, the fellow at the head of the table would soak the ether mask even more. There often followed what was called ‘postoperative shock’ even when little blood had been shed. Soon, in Giessen, a couple of surgical residents who saw what I was driving at when I discussed physiology as it related to anesthesia, volunteered to work with me and try to learn the basics. I accepted invitations to work in a similar way in other hospitals all over Germany. Before returning to the United States I wrote a little hand book which was published in German. I left with great regret. I had the feeling however, that I had contributed to the beginning of something really worthwhile. Indeed I had!’’ There can be little doubt Dr. Henley was a straightforward, even blunt person. She did not hesitate to tell the truth as she saw it. We should turn our attention to the book itself. On the flyleaf, one reads the initials HCOG, which stand for High Commissioner for Germany. So the book must have been written under the sponsorship of the US Military Government. In the ‘‘forward’’ of her book, we find a blow-by-blow description of how the book came to be written. In the English translation, Jean Henley says: ‘‘I got to know Miss Maria Daelen in New York when she was travelling around the USA. When she heard I was planning to visit Europe, she asked me to come to Germany to work in my profession here. Initially, I wanted to spend 10 days in Giessen, but repeatedly I extended my permission to stay and so I was able to travel from one clinic to another. As I was unable to do this job at ALL the hospitals, Professor Bernhard asked me to write a textbook of anesthesia, written from a practical point of view, as outlined below by the beloved professor. I do hope I did my German colleagues a good turn.’’ Professor Bernhard replies, further in the foreword, ‘‘Dr. Henley is attending my clinic where she worked as an anesthesia specialist.’’ It is due to her that we now know the great progress which has been made in the last century in the USA. We already knew these facts from the literature, but to see them used in daily practice was overwhelming. There is no doubt that modern techniques of anesthesia will be adopted in Germany in the future. Because I was convinced that there was lacking a German textbook describing modern methods and techniques of anesthesia, I asked for one.

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I want particularly to mention that on her own, Dr. Henley came from the USA to Germany to familiarize us with recent developments in anesthesia. It is impossible to praise and thank her for all she has done in the meantime for us to become familiar with modern anesthesia methods. Visitors, as well as various directors of large hospitals, were deeply impressed by her professionalism. In her book, Dr. Henley’s clearly describes, and precisely illustrates endotracheal intubation, positive pressure ventilation, proper and accurate contemporaneous record keeping of the patient’s physiology, and last but not least, modern early postoperative care including airway management of the still unconscious patient. These techniques were almost unheard of in Germany in the early post-War era. What else do we know about Jean Henley as a doctor and as a person? When she returned from Europe to New York in 1951, Prof. Papper appointed her Chief of Anesthesia at the Francis Delafield Hospital, which is the cancer hospital attached to Columbia. Here is a selection of comments we have gathered from some of her former colleagues and chiefs. ‘‘In the operating room she did things that were new and perhaps even ahead of their time. In order to achieve induced hypotension for extensive operations she would give a total spinal anesthetic by introducing a subdural catheter in the cervical area and then anesthetize the patient with Pentothal and nitrous oxide. Although there were no outcome studies, the patients all survived. She always did what she thought was right. She was a determined person. She had the guts to try any technique. In all the years I knew her, she never once mentioned a member of her family. She suffered from psychological problems. I, who was her colleague and initially thought she was rigid and narrow, became her friend.’’ Another colleague said, ‘‘Jean was a loner, I guess. I never saw her at any departmental function that I can remember. She was a confident person who specialized in cervical epidurals for thoracic procedures. It was the only place I (and others I suspect), did them. I can’t recall a complication being reported at out M and M conferences that was ascribed to the technique. Those cases that I did under her direction were all for radical mastectomies which were common in those days. At Columbia Presbyterian especially, several of our surgeons were major proponents of that surgical approach to cancer of the breast.’’ Dr. Papper wrote: ‘‘I knew her well as a member of my Department at Columbia and as one of a small number of ‘inherited’ colleagues, preceding my arrival there in 1949. She was a very competent anesthesiologist clinically and completely reliable in every respect. I asked her to chair the section of anesthesia at the Delafield cancer hospital. She did an excellent job there. I knew very little of her personal life. She was a very private person indeed. She was also a highly accomplished artist. The bronze bust she did of me that she did on behalf of the anesthesia faculty when I left New York to become Dean in Miami as a ‘goodbye’ present is one of my most cherished possessions.’’ Why do we believe that Jean Henley is considered a fundamental figure in the development of modern scientific anesthesia in Gennany? We have already heard what Prof. Bernhard had to say. I have a letter from Madame Vera Joschko who was Prof. Hermann Frey’s secretary for many years. She said, ‘‘Dr. Henley was indeed a remarkable lady. I met her several times at the department of Anesthesiology at the University of Mainz, and once in New York. Prof. Frey considered her as being the first teacher of modern inhalation anesthesia in Germany, and they had a lifelong friendship and exchange of experiences. I also admired Jean

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Henley very much. She was great personality. In 1980 the German Society of Anesthesia wanted her to come to Germany so that they could convey an Honorary Membership on her. She wrote back saying she would be unable to accept the invitation. She retired from clinical practice in 1972 (she was 62 at the time) and lived the rest of her life alternating between her family’s summer home in Connecticut and the lovely Vermont town of Shelburne.’’