| |
September 1999
Volume 63 |
Number 9
|
| |
|
| Francis H. McMechan,
M.D.: Internationalist (1879-1939) |
Douglas R. Bacon, M.D.,
Trustee
Wood Library-Museum of Anesthesiology
At the annual dinner of the Forum of Anesthetists on May 17,
1939, at the far end of the head table sits a small, gaunt figure
[Figure 1]. Six weeks later, Francis Hoeffer McMechan, M.D., would
be dead. Obviously ill, looking far more frail than usual, Dr.
McMechan sits, no longer center stage, at a meeting he worked
for decades to organize and keep going [Figure 2]. Why did this
happen in the twilight of his life when he should have been revered?
What happened to make McMechan an almost unnoticed figure at his
own meeting?
McMechan began his career in anesthesiology early in the
20th century. Crippled by rheumatoid arthritis, by 1915, he could
no longer practice [Figure 3]. Rather than turn from the specialty
he loved, McMechan focused his efforts on organizing anesthesia.
Through his friendship with Joseph McDonald, the editor of the
American Journal of Surgery, he was able to secure a supplement
to the journal. The Quarterly Supplement on Anesthesia and
Analgesia was the first time a journal devoted a section solely
to anesthesiology. By 1922, McMechan would launch the specialty's
first journal, Current Researches in Anesthesia and Analgesia.
In addition to publishing, McMechan [Figure 4] was responsible
for putting on the annual national meeting of physician anesthetists.
By the mid-1920s, McMechan had established a national network
of local and regional organizations that fell under the umbrella
of his national Associated Anesthetists of the United States and
Canada. Internationally, McMechan was known through his work with
the International Anesthesia Research Society. He traveled abroad
twice, once to Great Britain and two years later to the Far East,
including Australia, where he helped organize the Australian Society
of Anaesthetists.
Yet despite all of his efforts, McMechan remained controversial
at home. McMechan tried to convince the American Medical Association
(AMA) that the practice of anesthesiology should be restricted
to only physicians. He hoped that the AMA would fail to approve
those hospitals in which physicians did not give anesthetics.
McMechan was equally as aggressive with medical schools. McMechan
was known to write to the dean of a medical school complaining
about the lack of instruction in anesthesia for medical students
and interns. Indeed, one of the reasons McMechan's old friend
Ralph M. Waters, M.D., joined the faculty at the University of
Wisconsin in Madison in 1927 was to "get medical schools right"
on the teaching of anesthesia.
McMechan's greatest controversy, however, centered on
the issue of specialty certification for physicians in anesthesiology.
As the Great Depression deepened across America, the anesthetic
fee clearly became important to general practitioners, surgeons
and hospitals. A surgeon hired a nurse for a fraction of the anesthetic
fee the surgeon charged. General practitioners often gave the
anesthetic for the surgeon to whom they had referred the case.
Hospitals, like surgeons, hired nurses and made a profit by charging
patients a fee for the anesthetic which was in excess of the nurse's
salary. Full-time physician specialists in anesthesiology were
slowly being forced out and the quality of anesthetic care was
suffering. In 1931, McMechan proposed an international college
of anesthetists, based upon the American College of Surgeons,
to define specialists. Always the internationalist, McMechan hoped
the physician anesthetists of the United States, Canada and Great
Britain would join in one great fraternity. In addition, countries
with too few anesthetists to sponsor a certifying body could apply
to the International College of Anaesthetists and establish their
credentials as a specialist in anesthesiology.
Within four years, the International College awarded its
first fellowships. However, as credentials for specialty certification,
the fellowships were weak. In addition to the usual information,
a submission of 10 cases anesthetized with "lessons learned" was
required. Physicians were not above exploiting this weakness for
their own purposes. In one case, an intern who had rotated on
the anesthesia service for less than a month wrote up his cases
and was declared a fellow. In another, a surgeon who rarely administered
anesthesia tried to use his international certification to prove
his qualifications as the chair of a hospital department of anesthesiology.
Thus, McMechan's hopes that the college would elevate the specialty
and eliminate all but physician specialists within the field were
cruelly dashed.
McMechan had another exclusionary criterion built into
the college. Physicians who worked with nurses or other nonphysician
providers could not become fellows. Thus, John S. Lundy, M.D.,
one of the major leaders in anesthesiology in the 1920s and 1930s
was excluded. This criterion almost split anesthesiology in two,
causing a deep rift that was only partially healed after the death
of McMechan. Indeed, it would not be until after McMechan died
that a second American journal could be published in anesthesiology
or a second national meeting organized.
Finally, it was McMechan's poor relationship with the
AMA that caused the American Board of Anesthesiology to be originally
incorporated as a sub-board of the American Board of Surgery.
In July of 1939, less than one month after McMechan's death, Lundy
was exploring with the AMA the possibility of both a new journal
and an independent section on anesthetics. The latter was necessary
for the American Board to gain independence, which occurred in
1940.
Francis Hoeffer McMechan was a strong leader, organizer
and editor when the specialty of anesthesiology needed him most.
His energies were turned to organizing anesthesiology when his
body was so crippled that he could not practice it. Without his
efforts, anesthesiology would not have been in the position to
contemplate a specialty board in the late 1930s. Yet, it was that
same stubborn energy that failed to allow McMechan to make amends
with the AMA at a time when it was critical for the specialty.
Thus, he almost split organized anesthesiology when it was too
weak to survive such a conflict. Controversial and central to
the history of American anesthesiology in the first half of the
20th century, McMechan's work is still visible in the specialty
today.
Douglas R. Bacon, M.D., is Vice-Chair
for Education and Associate Professor of Anesthesiology, State
University of New York at Buffalo, and Manager, Anesthesiology
Service, VA Healthcare Network Upstate New York at Buffalo, Buffalo,
New York.
References:
- Wells CJ. Francis Hoeffer McMechan. Current Research in Anesthesia
and Analgesia 1948;S:iv.vi.
- Ranney O. Francis Hoeffer McMechan: his life and work. Current
Research in Anesthesia and Analgesia S1939.
- Minutes of Meeting of the Faculty and Executive Faculty,
School of Medicine, University at Buffalo, March 2, 1925. State
University of New York at Buffalo Archive, Buffalo, New York.
- Letter from Ralph Waters, M.D., to Emery Rovenstine, M.D.,
July 2, 1935. The Collected Papers of Ralph Waters, M.D., Steenbock
Library Collection, University of Wisconsin, Madison.
- Mendell Z. Recent experiences of anesthetics in America.
Lancet. 1924; II:411.
- Haines FE. Economic Problems in anesthesia: Presidential
address Mid-Western Association of Anesthetists. Current Researches
in Anesthesia and Analgesia. 1927; 6:26.
- Letter from Paul M. Wood to W.W. Dill, M.D., May 27, 1937,
The Collected Papers of Paul Wood, M.D., The Wood Library-Museum
of Anesthesiology, Park Ridge, Illinois.
- Bacon DR. The promise of one great anesthesia society: The
1939-1940 proposed merger of the American Society of Anesthetists
and the International Anesthesia Research Society. Anesthesiology.
1994; 80:929-935.
- Letter from John S. Lundy, M.D. to Ralph M. Water, M.D.,
August 1, 1939. The Collected Papers of Ralph M. Waters, M.D.,
Steenbok Library Collection, University of Wisconsin, Madison.
return to top
|