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September 2001
Volume 65 |
Number 9
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| The Political
Career of Ralph M. Waters: ‘This Is Your Society for
the Future’ |
Christopher M. Burkle, M.D.
Ralph M. Waters, M.D., is well remembered for his scientific
contributions and educational achievements. Having joined the
faculty at the University of Wisconsin in 1927 as an assistant
professor of surgery in charge of anesthesia, he was the first
physician to develop a university-based resident training program
in anesthesiology.1 Throughout his years of clinical
practice, he has been noted among others for studies related to
pharmacology of cyclopropane and toxicology of chloroform. What
Ralph Waters is not well known for is the fascinating role he
played in medical politics at the time [Table 1].
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Table 1:
Political Positions
Held by Ralph M. Waters
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| 1928-1932 |
Executive committee member of the
Mid-Western Association of Anesthetists |
| 1928 |
President of the Associated Anesthetists
of the United States and Canada |
| 1929-1937 |
Member of the Council of Teaching
and Hospital Service |
| 1937 |
First Vice-President of the American Society
of Anesthetists |
| 1938 |
Member of the Board of Directors of the
American Society of Anesthetists |
| 1940 |
President of the Board of Anesthesiology |
| 1945 |
President of the American Society of
Anesthetists
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The early 1930s were an interesting and telling time for anesthesiology
and its quest for recognition as a specialty. 2
Physicians who practiced anesthesia were making discoveries into
the complex technology of providing safe and effective anesthesia.
Gas machines were incorporating new and improved agents, regional
anesthesia was gaining in importance, and intravenous methods
were entering into the practice. At the same time, however, the
world was in the midst of a depressed economy. Hospitals were
employing nurses and house staff to provide anesthesia for profit.
3
Physician anesthesiologists were now looking for strong support
from their national organizations to help protect the practice
of anesthesia from being diluted by inadequately trained medical
personnel. 3 Francis H. McMechan, M.D., a friend
of Dr. Waters and member of the American Medical Association (AMA),
had long been attempting to secure physician-only anesthesia in
AMA-approved hospitals. This was a concept that AMA had no interest
in at the time. Frustrated by this impasse, Dr. McMechan sought
to model a certification board based on requirements similar to
the American College of Surgeons and the American College of Physicians.
Through these means he wished to gain independence from AMA.
Requirements for certification were extensive and difficult to
achieve by many physicians, especially in this early stage of
the specialty. Dr. Waters was concerned that such extreme requirements
would stratify physician anesthetists and subsequently limit their
ability to come together to tackle other more pressing topics
in the field of anesthesia. Dr. McMechan did not take kindly to
these criticisms. Although the initial clinical requirements were
lessened, development of the International College of Anesthetists
took place in 1935.
While final plans were being laid out by Dr. McMechan for the
birth of the International College, three physician anesthetists
were coming together to help unite fellow physician anesthetists
by a means different than their more aggressive counterpart McMechan.
In the spring of 1933, Paul M. Wood, M.D., traveled to Wisconsin
to visit Dr. Waters and then onward to Rochester, Minnesota, to
visit John S. Lundy, M.D. Of importance was exploring a means
for gaining specialty status in anesthesia. All three men were
in agreement that before the issue of “technicians”
providing anesthesia could be tackled, certain guidelines related
to organization and representation of physician anesthetists must
first be instilled. Having visited the headquarters of AMA to
discuss criteria for plans leading to specialization, Dr. Waters’
ideas were met favorably but not without fear by AMA that Dr.
McMechan would attempt to gain control of the section.
At the time, Dr. Wood was secretary of the New York Society of
Anesthetists, a New York City-based organization that included
members not only in New York State but also Pennsylvania and New
England. The New York society initiated a plan to create a new
membership class based on strict AMA requirements. Fellows were
required to show evidence of 2,500 performed anesthetics or 500
hours of advanced postgraduate training in anesthesia. The proposal
of Drs. Waters, Wood and Lundy was placed before the AMA board
for approval as an independent specialty board. In February 1936,
the New York society changed its name to the American Society
of Anesthetists. This change in nomenclature was in part to make
it more palatable to AMA but also to reflect its growing national
membership base.
Shortly after the change was made to the American Society, Erwin
Schmidt, M.D., Dr. Waters’ surgical chief from Wisconsin,
came to the three physician anesthetists with a proposal. Rather
than independence from AMA, Dr. Schmidt was offering AMA recognition
as a sub-board of the American Board of Surgery. This proposal
was met with great favor by Drs. Waters, Wood and Lundy, as AMA
was still apprehensive about granting a full, independent board
status given their concerns over Dr. McMechan. It would perhaps
be easier to gain sub-board status under the American Board of
Surgery than attempt independent criteria for an American Board
of Anesthetists under AMA. The finer points of the proposal continued
to be discussed by Dr. Waters and Dr. Schmidt while at the scrub
sinks in Madison. The final preparations were then made and presented
by Dr. Waters and Wood in a speech lasting over two hours before
the American Board of Surgery. In February 1938, the time had
finally come for granting meaningful certification to the practice
of anesthesia.
In June 1939, Dr. McMechan died. Dr. Waters and many others traveled
to pay their respects to a colleague whose politics they may not
always have agreed with but for whom they respected as a person
and physician. With concerns about Dr. McMechan now gone, AMA
was subsequently able to give more independence to the sub-board
of anesthesia. In June 1940, AMA voted to establish a section
on anesthesia, followed by a separation of anesthesia from the
surgical board in 1941. Dr. Waters was at the forefront during
this exciting transition, having been named President of the Board
of Anesthesiology in June 1940.
Waters served in the American Society of Anesthetists from its
inception in 1936. Among other accomplishments, he played an integral
role in establishing an editor for the journal Anesthesiology.
He was rewarded by his fellow physician anesthetists by being
named President of the American Society of Anesthetists in 1945
and recipient of their second Distinguished Service Award in 1946.
4
Dr. Ralph M. Waters was not only an extraordinary scientist and
clinician but also a gifted politician. He was devoted to the
Society that he had helped to develop. There is perhaps no better
means of highlighting this point than to quote from his 1945 Presidential
Address before the Society, “… This is your Society
for the future.” 5
References:
1. Vandam LD. History of anesthetic practice.
In: Miller RD, ed. Anesthesia. Philadelphia, PA: Churchill Livingstone;
2000:1-11.
2. Current Researches in Anesthesia and Analgesia
1928-1937.
3. Bacon DR: John S. Lundy, Ralph Waters, Paul
Wood: The Founding of the American Board of Anesthesiology. Bull
of Anesthesia Hist. 1995; 13(3):1, 4-5,15.
4. Bamforth BJ, Siebecker KL. Ralph M. Waters.
In: Volpitto PP, Vandam LD, eds. The Genesis of Contemporary American
Anesthesiology. Springfield, IL: Charles C. Thomas; 1982:51-68.
5. Waters RM. Presidential address. Anesthesiology.
1945; 6:302-304.
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Christopher M.
Burkle, M.D., is Senior Associate Consultant, Department of
Anesthesiology, Mayo Medical School, Rochester, Minnesota. |
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