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September 1999
Volume 63 |
Number 9
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| Robert Alvin Berman,
M.D.: Airway Inventor (1914- ) |
Jonathan C. Berman,
M.D.
This year marks the 50th anniversary of the Berman Airway, the
development for which Robert A. Berman, M.D., is best known. I
tell his story today to honor his lifelong interest in airway
management, but more importantly, to honor the spirit of anesthesiology,
which he embodies.
Dr. Berman was born in Brooklyn, New York, in December
1914. He graduated Phi Beta Kappa from the University of North
Carolina at Chapel Hill in 1936, continuing there for his medical
school training. During his first year, while questioning the
anatomy curriculum, he was told by the Dean that it was often
hard to place Jewish students after finishing the two-year curriculum.
Dr. Berman made it easy -- by leaving. This rebellious spirit,
defiant attitude and sharp tongue (for better or worse) would
always be a hallmark of Dr. Berman. He enrolled at the University
of Sheffield, England, in 1938. While home in 1939, World War
II began, visas were revoked and he could not return. He eventually
went to Chicago Medical School, graduating in 1943. He went back
to New York for an internship at Israel Zion. Upon completion,
he returned to Chicago to set up a general medicine practice and
worked as a hotel doctor at the Palmer House. His plans were interrupted
by a two-year hiatus in the U.S. Coast Guard Public Health Service
during World War II.
There is no one mentor or incident that led to his choice
of an anesthesiology residency, but he felt the developing field,
which was based in the basic sciences, had great potential. He
started his residency at Brooklyn Jewish Hospital, Brooklyn, New
York, and left that program due to a difference in ideas with
the department chair. He finished his anesthesiology training
at Mount Sinai Hospital, New York City, in 1949. At this time
in his career, he had worked on mechanical ventilation and airway
development and had thought about making a heart-lung machine.
New York City was one of the anesthesia hubs and he was well aware
of the players. He had tried to gain admittance to the Emery A.
Rovenstine residency and had an unreceptive welcome by Virginia
Apgar, M.D., while showing her his airway. He visited with the
gracious legend Paul M. Wood, M.D., (two of the airways he gave
him are in the WLM collection) and befriended many future heroes
of the Society like Eli Brown, M.D., and Erwin Lear, M.D. It was
at this time that Dr. Berman left the allure of academics and
a larger practice to become Director of Anesthesiology at St.
Joseph's Hospital in Far Rockaway, New York (a position he held
for 35 years).
Despite the rigors of private practice, including every
night call for years, he developed the Berman Airway [Figure
1] and felt the desire to share his ideas by writing articles,
letters and comments for the journals of anesthesiology in each
decade he practiced. He also participated by presenting scientific
exhibits at the New York State Society of Anesthesiologists Postgraduate
Assembly (NYSSA PGA). He presented at the PGA eight times. He
has attended 51 out of the 52 NYSSA PGAs. His files are filled
with carbon-copy letters (just imagine if he had e-mail). He was
redrafted in 1953 and administered anesthesia in Korea and Japan
during the Korean War. In the late 1950s, as more attention was
focused on resuscitation, he developed the Resuscitube® [Figure
2] and a hand bellows for resuscitation, called the Respir-Aider
[Figure 3]. In attempting to popularize the
Resuscitube (he strongly felt that mouth-to-mouth resuscitation
was unsanitary), he met resistance from James O. Elam, M.D., an
anesthesiologist at the forefront of resuscitation research. Drs.
Berman and Elam later became friends and worked on airway management
ideas together. Dr. Berman later helped Dr. Elam sell his idea
for an Ambu Bag. Also during this time, he patented a plastic
blood pressure cuff, Quik Cuff® [Figure 4]
feeling that the blood pressure cuff was easily soiled and not
hygienic to use repetitively from patient to patient. His innovations
with plastic were at the forefront of utilizing this material
in medicine and allowed the era of disposability to begin.
Dr. Berman belonged to all of his professional societies.
He even served as President of the Rockaway Medical Society in
New York. Despite his love of anesthesiology, he was not active
in the politics of either ASA or NYSSA. This was unfortunate for
both Dr. Berman and the societies that would have benefited.
Dr. Berman's interests were varied, and in the late 1960s,
he embarked on the idea of treating cancer pain with total body
hyperthermia. He did this on Saturdays. He presented his findings
at the NYSSA scientific exhibits in 1969. Lack of resources prevented
further promising research.
In the 1970s, Dr. Berman tried to further tackle innovations
in airway management by making a blow-molded endotracheal tube
[Figure 5] and anatomically shaped endotracheal
tubes [Figure 6] and presented a tapered endotracheal
tube [Figure 7] at the 1973 NYSSA PGA. Poor
business acumen often thwarted his progress and career. To highlight
this, when the patents were about to expire from the original
airway, no provisions were made to market his product competitively.
Numerous companies quickly began producing and selling Berman-type
airways. Sales dwindled and eventually ceased, leaving no capital
for further research and development. In 1979, he resurrected
an idea he had in residency, an intubating airway. His new Berman
Intubating Airway led the way for a generation of intubating devices
for blind and fiberoptic intubation.
His operating room was always an environment for learning.
Many young college students spent time there as their first introduction
to medicine, leading the way to careers in medicine. Many drug
and anesthesia equipment representatives spent time there learning
about what they were selling. He would continue to research ideas
and obtain patents. He had other ideas for airways, including
an expandable airway and a balloon airway. He collaborated with
two main plastic engineers throughout his career, Meyer Moch and
William Jordan. With advancing years and lack of a research and
development team, it became harder to develop products. He always
remained innovative. Toward the end of his career, while facing
a Joint Commission on Accreditation of Healthcare Organizations
review, his hospital would not provide for proper scavenger systems.
He quickly went to the hardware store and, with 1/2-inch nipples,
pipes, hose valves and hoses, assembled six Bain manifolds with
scavenging hoses to comply. They passed.
One of the last published communications Dr. Berman made
was a letter to the Editor of the Anesthesia Patient Safety
Foundation Newsletter. He asked what role a retired anesthesiologist
with decades of experience might play in the future and continued
administration of anesthetics; it was a professional and personal
plea still awaiting an adequate answer. Perhaps, if he had picked
a career in academics or stayed involved with professional societies,
he would be as active and prominent today as he was during his
35 years of practice.
Controversial? Always. A hero? I think he was a hero to
the profession of anesthesiology, to the history of airway management
and, like most ASA members, a hero to the patients, hospital and
community in which he practiced. In celebrating the 50th anniversary
of his airway, we celebrate his contributions and career.
Dr. Berman continues to research new ideas from his home
in Far Rockaway, New York, and encourages future generations of
anesthesiologists to do so.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
References available on request from the author.
Jonathan C. Berman, M.D., is Director
of Obstetric Anesthesia, St. Anthony's Central Hospital, and Assistant
Clinical Professor, Department of Anesthesiology, University of
Colorado Health Sciences Center, Denver, Colorado.
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