Historia de la Medicina

Andrea Catherine González Torres*, José Ricardo Navarro Vargas**

* Estudiante de segundo año de Postgrado de Anestesiología. Universidad Nacional de Colombia
** Profesor Asociado de Anestesiología y Reanimación. Universidad Nacional de Colombia

Recibido: mayo 15 de 2010. Enviado para modificaciones: julio 7 de 2010. Aceptado: julio 22 de 2010.

In June 18, 2010 we remembered nine years of the passing of a prominent man for Latin American anesthesiology, Dr. Juan Marín Osorio, a physician who self learned anesthesia and authentically devoted himself to influence others.

He was an atheist for which he had many problems during his anatomy lessons at the National University under professor Bermúdez who was a demanding radical theophilus (1). However, Dr. Marin, a peculiar looking, small built thin man, with long hair with an air of a detached philosopher and sociologist was as human as God's best creature.

He is appropriately considered as the father of anesthesia in Colombia, because he defended its cause and taught the art and science of anesthesia to countless students. In his times, physicians were not interested in anesthesia because it was far of what was expected from this profession; however he still persevered teaching nonmedical personnel and with humility he showed distinguished surgeons of the times, that anesthesiology was a specialty in itself as much as part of internal medicine or surgery, but that it was independent with its own life (2).

The respect with which he cared for his patients and the responsibility with which he practiced his profession including the use of rudimentary monitoring which he promoted (he designed a precordial stethoscope), were later recognized during Latin American congresses, by the admiration and appreciation even of colleagues trained abroad (3).

He was born in Sonsón, a province in the mountains of Antioquia, and was baptized in Aguadas, where he attended school at Colegio HH Cristianos de Villa de Capiro. In Bogotá he finished high school in the Técnico Central y Nuestra Señora del Rosario schools, and then went into medical school at Universidad Nacional in late 20s. In 1933 he won the position of surgical internship at Hospital Infantil de la Misericordia and then became resident physician and then anesthetist for next 13 years (4).

He lived humbly with the detachment of a man who loves his peers and environment, and died of old age for the benefit of Colombian anesthesiology, because his example and strong will helped build the larger and stronger scientific society of Colombia, the Colombian Society of Anesthesia (SCARE).

To be born in the province in the midst of a humble family, in addition to his eccentric looks (his attire made him look like a mental patient) made him an outsider. However, he excelled in all of the areas of knowledge where he ventured, as while he was humble he was also daring and built his own path, and nobody can question his capabilities as physiologist, neurologist, musicologist, philosopher, designer, photographer, tireless traveler, unending reader, dreamer and artist.

His partner, Hilda Uribe, cared and shared with him his life, and together they traveled as lovers many places including Indian Central America, and thereafter he cared for her when she endured a very painful malignant disease, from which he freed her by practicing euthanasia. In many conferences he mentioned that he had made this determination in full use of his mental abilities, but full with love and feelings of human solidarity for which he never regretted and even felt proud of allowing her a good death (3,4).

His first anesthetic was traumatic not because of the outcome, but from the way he was induced to provide for with great ignorance of what he was doing. It happened in 1932 in one of the operating rooms of most recognized medical school of the country at Hospital San Juan de Dios de Bogotá (Hospital de la Hortúa). The professor of surgery, Dr. Juan N. Corpas, assigned him the task, and taught him hastily the anesthetic technique of providing ether with the Ombredanne. Dr. Marin recalled:"You can see on the side of the ball (Ombredanne ) some numbers, with the screw on the end you start moving it indicating from 1,2,.... until 9. Anesthesia is very simple, I tell you: "Marin 1, and you move the dial to 1, Marin 3, you move the dial to 3, Marin 7 you move it to 7, Marin 9 and you move it to 9, very well. Then I say Marin remove the device that the patient is dying! then you remove the apparatus". This was the concept that one of the best surgeons of our republic had: you only needed to know how to count to provide anesthesia". This was his first experience with ether which although successful was full with panic, he himself said:"by pure chance, this patient did not die" (4,5).

In 1933 he started working at Hospital de la Misericordia where he became an expert at administering chloroform (in one of his lectures he said that during his first year of work as anesthetist he did not receive any payment at all, not even a cup of coffee, that was the kind of treatment surgeons bestowed to in him).

Dr. Marin's equipment consisted of a sponge folded twice like a funnel and within, a cotton gauze like a vaporizer, an opaque vessel with an eyedropper for the chloroform and a pair of tongs to pull the tongue, and Vaseline (2,4).

One would wonder: how could he be safe and happy in a high risk profession with minimal reimbursement? The answer is found in his words, ever since he provided his first anesthetic he fell in love with the specialty, which he practiced with mysticism and full commitment in all of his professional acts. In fact, it is known how important cardiac auscultation was for him, with which he prevented many cardiac arrests and thus the death of his patients. In 1933 he designed a monoauricular stethoscope with a wax disk and a pig bladder. Initially he used it in precordial position and thereafter he used it esophagically. He assertively mentioned: "when the intensity of heart sounds decreases, chloroform concentration must be diminished" (5).

One of his anecdotes was that of a mouth bite by a boy when he was suctioning his secretions, after which he developed an infection that determined the definite loss of a fingernail (4,5).

He promoted smooth dosed inductions. In 1943 he started using thiopental using a three way stopcock: one way for thiopental 2.5 %, another one for normal saline or blood if it was necessary. He used thiopental in the hospitals of de la Hortùa, la Misericordia y San José without a case of mortality related to its administration (5).

In 1947 he was designated chief of the Department of Anesthesia at Hospital de San José where he began his dedication to teaching anesthesia, opening the School of Anesthesia, the first one in the country on March 5th, 1947. He graduated three classes (1947, 1948, and 1950) (5).

During his time as a teacher he conceived the idea of creating a seal of the specialty, which is the current official seal of the Colombian Society of Anesthesia and other societies. Only a man interested in Greek and Latin mythology, a poet, an artist and a very sensible human being, could have thought of defining anesthesia as a task for gods, who in the midst of the night under the stresses of surgical pathology, maintain life, provide deep sleep devoid of pain, and with sunrise, awake to reality an already operated individual who gave all his trust. He himself said that when one of his students wanted to design the seal, "after the creative spark was ignited, he fell in the lush field of Latin fantasy, which scrubbing over the romantic myths, could eventually find the precious motif which made into enamel and gold became our seal". He explains his creation: "The upper semicircle with white background depicts the comprehensive life of a human being, and dipping or rising behind the horizon of the unknown, is the sun, the conscience. In the lower semicircle in blue, the unconscious life is represented as striations, and highlighted in this dark background are the two gold twins guarding sleep and death pointing down... so we have to watch the sleep torch closely to prevent it from extinguishing, for which its twin rekindling in the dominion of death in which life continues in a hidden and fugitive way, would make us cry as the poet: "was a candle to the wind, and the wind blew it off"" (5,6).

In December 1948, he created another of his inventions: the panestethoscope. It was composed of three sound chambers connected to a four way stopcock, one connected to the earpiece, another to listen the laryngeal sounds during inspiration and expiration, another to listen to the heart sounds, and the last one to measure blood pressure (5).

This prominent and at the same time simple character, was worthy of all the honors in the specialty, he was honored as the pioneer of anesthesia in Colombia, founder of the first anesthesia school in the country, honorary founder and perpetual secretary of the Colombian Society of Anesthesia, editor of the first Colombian journal sthesia, Sedare, creator of the seal of the Society of Anesthesia of Cundinamarca which was later adopted by SCARE, the Latin American Confederation of Societies of Anesthesia (CLASA) and the Guatemalan Society of Anesthesia, and was used until recently in the Medallion of the President of the World Federation of Societies of Anesthesia (WFSA) (7,8).

He was teacher at the Universidad de Caracas at the Hospital Concepción Palacios and chair of anesthesia at Hospital Militar Central of Bogotá (2,8).

Among his legacies was the anesthesia checklist (a type of minimal standards) which he promoted and urged to use it always with rules as: "Permanently listen to the heart sounds"; "Find the problem and solve it"; "Auscultation is key to be safe"; and "Anesthesia delivery is based on science, wisdom and love" (8).

Dr. Bernardo Ocampo Trujillo, another of the distinguished colleagues of Colombian and Latin-American anesthesia, former president of SCARE and historian of Colombian anesthesia and Critical Care, referred to Dr Juan Marin as a man who felt that a tight bond existed between the anesthesiologist and his patient. Dr Ocampo used to say: "Along with Dr Eduardo Garcia, we used to say that we did not hold hands with our bride, "you take her pulse, as it was mandatory that we take the pulse to everyone who we cared for, like Dr Juan Marin said". [...] With him, the Ombredanne anesthesia with chloroform and ether evolved into anesthetic machines, and back then anesthesia depth was the best way to provide muscle relaxation, but we have to be ready for change as long it represents better safety. That and many more, were ideas of this small man with a giant mind".

One of his dreams was that of having an anesthesia department, which he completely achieved in 1949, when he founded the Colombian Society of Anesthesia on a Friday night, September 23rd, 1949 at Hospital San José where unanimously he was anointed as president of the Colombian Society of Anesthesia, but with his characteristic humbleness he rejected this honor, and instead wanted to be appointed secretary where he felt more useful, a position he held permanently, and which he exercised with a passion of real love. He was also the editor of the Sedare, a bulletin of SCARE published in 1952 (5,9).

In 1957 he traveled to Caracas, Venezuela where he worked for 16 fruitful years. In 1971 during the VI General Assembly of CLASA at Rio de Janeiro, Dr Marin's seal was chosen as CLASA's seal. In 1972 it was accepted as the WFSA's seal at the V World Congress of Anesthesia in Kyoto, Japan (2,8).

In 1979, Dr Marin was homaged as creator of the CLASA / WFSA seal during the XV Latin-American Congress of Anesthesia at Guatemala and during the III International Congress of the History of Anesthesia held in Atlanta, USA in 1992 he was an honorary guest. His seal is the most widely and known anesthesia seal in the world (8).

The last hospital to benefit from his services was Clínica Fray Bartolomé de las Casas. During the XXIII Colombian Congress of Anesthesia held in Cali in August 19th 1995, we had the opportunity to enjoy his company, always youthful among young colleagues and always original (3).

In his honor the resident's research competition is named after him, as well as the main meeting room of the SCARE's headquarters, both well deserved recognitions of this Colombian man who gave shine to anesthesia, clearly a simple charming physician who was well ahead of his times.

ACKNOWLEDGEMENTS

2. Juan Marín, el padre de la anestesiología en Colombia. Rev Col Anest. 2001;29(2):171-2.

3. Herrera J. Juan Marín. Socio fundador honorario único de la Sociedad Colombiana de Anestesiología y Reanimación. Rev Col Anest. 2001. 29(2):89-90.

4. Marín J. Conferencia dictada en el Primer Curso Internacional sobre Monitoría y seguridad en Anestesia y Medicina Crítica. Academia Colombiana de Anestesiología. 17-18 de febrero de 1989.

5. Herrera J. Historia de la anestesia en Colombia. Bogotá: SCARE; 1999.

6. Marín J. Emblema de la Sociedad Colombiana de Anestesiología y Reanimación. Rev Col Anest. 2001;29(2):91-2

7. Marín J. Anestesia de antaño. Boletín informativo de la Cátedra de Anestesiología de la Universidad Central de Venezuela. Caracas. 1971;4(4).

8. Ocampo B. Historia de la Confederación Latinoamericana de Sociedades de Anestesiología (CLASA) durante 50 años. Rev Col Anest. 2007;35(3):247-8.

9. Marín J. La Fundación de la Sociedad Colombiana de Anestesiología. Año de 1949. Rev Col Anest. 1985;13:183-4.