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September 2001
Volume 65 |
Number 9
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| Ralph M. Waters’
Legacy: The Establishment of Academic Anesthesia Centers by
the ‘Aqualumni’ |
Lucien E. Morris, M.D.
Although the discovery and introduction of inhalation anesthesia
is clearly an American contribution to the world history of medicine,
it is astounding how slow the physicians and surgeons in the United
States were to recognize the potential contributions of anesthesia
to medical practice and how reluctant the medical schools were
to include even the basic principles of anesthesia within the
curriculum for medical students! Consequently even in the first
25 years of the 20th century, anesthesia remained a much neglected
area of medical education and medical practice.
There seems to have been a general attitude that perceived the
administration of anesthesia to be a somewhat menial technical
exercise not worthy of attention by serious-minded physicians.
After all, anyone could give open drop ether, although chloroform
required a little more experience. Therefore, administration of
an anesthetic was usually relegated to the least experienced available
physician or often a nurse or technician. Fortunately, surgical
procedures were neither lengthy nor complicated in that era, and
anesthesia was correspondingly of short duration so that patients
usually survived the assault of somewhat asphyxial anesthetic
techniques.
Despite the general attitude of deprecation, there were a few
physicians in various regions of the country who developed a special
interest in anesthesia. Among this group are the notable pioneer
names of Drs. Adolph F. Erdmann, Francis H. McMechan, Louis Harding,
Elmer I. McKesson, Arthur E. Guedel, Dennis E. Jackson and James
T. Gwathmey. Prior to World War I, anesthesia was not only a neglected
area of medical practice but also had been denigrated by a lack
of status accorded by organized medicine: The American Medical
Association in 1911 had rejected a request for an anesthesia section,
ignoring the activities of these and other outstanding physician
anesthetists and the existence of some regional, organized anesthesiology
societies.
An important historical event occurred in Madison, Wisconsin,
75 years ago when Ralph Milton Waters, M.D., after more than 10
years of medical practice limited to clinical anesthesia, accepted
an academic appointment to the medical faculty of the University
of Wisconsin. Dr. Waters came to Wisconsin with not only the obligation
of teaching medical students about the subject of anesthesia but
also with the stated intention of developing a postgraduate program
“to teach doctors who would go out to teach other doctors
the scientific basis for safe practice of clinical anesthesia.”
I believe that his appointment to the medical faculty at the
University of Wisconsin in 1927 was not just a fortuitous happenstance.
Dr. Waters had seen the need for organized specialty education
in anesthesia and set out to do something about it. In retrospect
it seems probable that he was quietly but actively seeking a faculty
position to use as a rostrum to implement some of his innovative
ideas and from which to publicize his concepts about proper professional
care of anesthetized patients. In several ways, the University
of Wisconsin was an ideal place to accommodate his plans. The
School of Medicine there had just expanded from a two-year basic
science course to include the clinical years in a full four-year
medical curriculum, and the basic scientists were eager to cooperate
with the new, young and enthusiastic clinical faculty. The new
hospital was only in its third year, not yet in full stride, and
there were few if any bad precedents to overcome. Senior surgeon
Erwin Schmidt, M.D., who was actually seven years younger than
Dr. Waters, was amenable to physician anesthesia, and Dean Charles
Bardeen, Professor of Anatomy, was receptive to new ideas. It
was fertile ground for the development of professionalism in anesthesiology.
A detailed review of the professional genealogy of anesthesiology
reveals the startling fact that hundreds of academicians throughout
the world and more than 120 departmental chairs in 80 medical
schools of the United States alone have been of the Waters’
lineage. Few of the “Aqualumni” (Waters’ own resident
trainees) had the personal dynamics or the persuasive charm equal
to that of their mentor, but all who had been in the Wisconsin
program left with a sense of purpose and determination to share
with others their knowledge and professional approach to anesthesiology.
Some were fortunate enough to obtain working relationships with
sympathetic basic scientists that were productive in gathering
new knowledge and led to establishment of programs that were successful
in stimulating new individuals who subsequently became leaders
in teaching centers for anesthesiology. Others, perhaps less fortunate
in the environmental situation, had to be content with satisfying
regional needs for providing well-trained physicians in the sophisticated
management of patient care during clinical anesthesia. All of
the Aqualumni made important contributions to the growth and development
of modern anesthesiology; all raised the standards of medical
practice of anesthesiology; and all exhibited either community
or regional leadership, some attained national prominence, and
a few became well-known international figures.
Not all environments to which the Aqualumni went were as receptive
as that of Wisconsin to the new idea of professional medical practice
of anesthesiology. Indeed, some areas were quite resistive. Consequently
in several instances, the initial efforts to establish academic
anesthesia centers comparable to the Wisconsin model failed because
of inadequate support by surgeons or university administrators
(e.g., University of Texas Medical Branch in Galveston, University
of California-San Francisco, University of Cincinnati, Johns Hopkins
University and the University of Washington in Seattle).
When Dr. Rovenstine went to Bellevue Hospital/New York University,
Professor Waters was concerned that insufficient staff to cope
with existing obligations might be a potential detriment to establishment
of the new academic training center for anesthesia. To prevent
this possibility, Dr. Waters effectively split his Wisconsin group,
sending both staff and residents to New York City to ensure the
success of Dr. Rovenstine at New York University. (These transfers
included Drs. Ivan B. Taylor, Perry P. Volpitto, Bert B. Hershenson,
F.A.D. Alexander, Virginia Apgar and Austin Lamont.) For the same
reason, Dr. Waters also referred residency applications by former
Wisconsin students to Dr. Rovenstine (among these was Stuart C.
Cullen, M.D.).
| The Anesthesia
History Association has joined with the History of Anaesthesia
Society (Great Britain) and several other sponsors for “A
Celebration of 75 Years” in honor of Ralph M. Waters,
M.D., on June 6-8, 2002, in Madison, Wisconsin. For more information,
go to: <www.anes.uab.edu/aneshist/watersconf.htm>. |
In the decade before World War II (1933-42), some few Aqualumni
went out into private practice of anesthesiology, but a majority
received appointments at university centers upon leaving Wisconsin
(E.A. Rovenstine, New York University; J.A. Moffitt, University
of Oklahoma; V. Apgar, Columbia; F.A.D. Alexander, Albany University;
A. Lamont, Johns Hopkins; P. Volpitto, University of Georgia;
H. Hathaway, University of California-San Francisco; W.B. Neff,
Stanford; I. Taylor, University of Pennsylvania; R.D. Dripps,
University of Pennsylvania; J. Bennett, University of Texas Medical
Branch at Galveston; I. Taylor, Wayne State in Detroit; J. Bennett,
University of Cincinnati; H. Slocum, University of Texas Medical
Branch at Galveston; W. Cassels, University of Illinois in Chicago;
T. Gordh, in Stockholm; and B. Sircar in Bombay).
The Aqualumni were a cohesive group, remarkably loyal to the
Chief. Beginning at Easter in 1937, the Aqualumni returned to
Madison for a scientific meeting, reunion and re-infusion of the
Waters’ spirit. This became an annual event for the following
decade. Of the original 60 trainees at Wisconsin during the tenure
of Dr. Waters, 40 did go on to teaching positions in academic
centers for a major portion of their careers, and half of these
became chairpersons or directors of academic programs in medical
schools of the United States and elsewhere in the world.
The accompanying centerfold features a large tree-like portrayal
of the Waters professional lineage, depicting only those Aqualumni
who became chairpersons or directors of subsequent academic centers
for education and research in anesthesiology. Literally thousands
of currently practicing anesthesiologists can also claim linkage
to the Ralph Waters’ professional lineage through their own
teachers and those teachers’ teachers.
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Lucien
E. Morris, M.D., is Founding Chair and Professor Emeritus,
Department of Anesthesia, Medical College of Ohio, Toledo,
Ohio. He is retired and resides in Bainbridge Island, Washington. |
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