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Douglas R. Bacon, M.D., Editor
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Countdown to the Centennial
s a teenager, I remember clearly my anticipation at
the approach of the year 1976 and the 200th anniversary
of the birth of the United States. There were bicentennial
moments on television, and patriotism was rampant
across the country. Special quarters were minted to
commemorate the event, and America’s only unelected
president, Gerald Ford, was in the White House. Even
today, very occasionally, one of those quarters will
turn up in the change I receive during a transaction,
reminding me of that time in my youth.
ASA is about to enter a similar phase of great anticipation.
October 6, 2004, marks the 99th birthday of our organization.
A yearlong celebration of the 100th anniversary is
being planned even as I write these words. What better
way to begin the festivities than with the September
issue of the ASA NEWSLETTER, with its focus
on the Wood Library-Museum of Anesthesiology? Within
the pages of this issue are articles that delineate
the history of our specialty as influenced and created
by ASA.
Our beginning was not auspicious. Nine physicians
gathered in an auditorium in Brooklyn, New York, at
the Long Island College of Medicine to “promote
the art and science of anesthesia.” A glance
at the current constitution of ASA will show you those
words, and they are seen consistently through our
history. The Long Island Society of Anesthetists began
with physicians teaching physicians and traveling
a road of discovery about the administration of and
science behind anesthetics. In many ways, this remains
the current mission of ASA.
From time to time, I have heard that ASA is only a
political organization concerned with one government
function, increasing the financial remuneration for
services rendered by members to patients. Nothing
could be further from the truth. The Society is and
always has been an educational organization first
and a political one second. The problem is that political
problems are more interesting than education and thus
grab more attention. Think for a moment about the
tremendous effort that goes into planning the ASA
Annual Meeting. Registration for 15,000 to 19,000
people, for instance, can be mind-boggling. Add in
the number of options, the need to properly schedule
and coordinate hundreds of events, and so on, and
the potential for problems is endless.
Over the next year, ASA members should take time to
reflect upon the Society’s roots, which are
steeped in the trials, tribulations and triumphs of
the 20th century. For a small specialty comprising
only 5 percent of all physicians nationwide, we have
overcome tremendous odds many times during our almost
century of existence. What are the odds that nine
physicians gathered to study a clinical problem would
create an organization that has almost 40,000 members
a century later? Who would have believed that in 1938,
when nurse anesthetists outnumbered physicians administering
anesthesia almost 10 to one, the American Board of
Anesthesiology would be created, defining the specialty
on an equal footing with far more established medical
practices such as internal medicine, surgery and ophthalmology?
Are there lessons we can learn from our past that
may help us to navigate through what seem to be the
turbulent times in which we live?
“Over the next year, ASA members should take time
to reflect upon the Society’s roots, which are
steeped in the trials, tribulations and triumphs of
the 20th century.”
Peter L. McDermott, M.D., the 1993 ASA President who
retired from anesthesiology only to embark upon a second
career as a university history professor, has an interesting
theorem based upon George Santayana’s famous quote,
written the same year as the founding of the Long Island
Society: “Those who cannot remember the past are
condemned to repeat it.” Dr. McDermott believes
that if we study the past and learn its lessons correctly,
we are then faced with a future in which all the questions
and problems have never been answered or solved. It
is quite frightening, actually, to contemplate a future
in which the past has been correctly understood, for
there is then nothing to guide us. At least two lessons,
both of which we still struggle with, emerge from the
pages of this NEWSLETTER.
First, the Long Island Society of Anesthetists was created
by a very small number of dedicated physicians interested
in what we might now call “patient safety.”
They wanted to administer a better anesthetic and felt
that the best way to do this was to learn about the
field from each other and from those in related fields.
It was common in the early years of the Society for
physiologists to address the group, most notably Yandell
Henderson, Ph.D., of Yale University. From nine to 40,000
in 100 years — such growth demonstrates the power
that a dedicated group can have in moving something
important forward. In the Society today, we see a dedicated
group of people trying to improve the specialty for
the benefit of all. Has the lesson of dedication come
home to you?
The second lesson is that research into problems that
affect anesthesiology is the backbone of clinical advancement
of the specialty. As opposed to 1905, with none of the
nine original physicians truly attached to academics
and supported by the infrastructure of a university,
the specialty enjoys a robust academic cohort that continues
to study problems affecting anesthetics and their administration.
Yet in the late 1990s, academic anesthesiology was on
the ropes, and it is still recovering. Economics played
a role, and time outside of the operating room became
a precious commodity. The most junior people, the ones
trying to establish themselves as investigators, were
often the first pulled to cover the clinical load. Department
chairs turned over with hospital and university administrations
alike looking for replacement candidates who could keep
the operating rooms running. Critical care and pain
medicine were luxuries within the department —
investigations seemed to be the last priority. As a
specialty, we receive only .5 percent of the funding
available from the National Institutes of Health, which
compares unfavorably with the 5 percent of all physicians
that anesthesiologists comprise. Without scientific
investigation, the specialty will soon lose momentum,
and innovation and the anticipated advances in patient
care in operating rooms, critical care units and pain
clinics may never materialize.
One hundred years is a long time, and we anesthesiologists
have seen many interesting twists and turns on the road
we have traveled. Come celebrate our triumphs and mourn
our losses; but learn from these incidents so that,
together, we can continue to build a specialty of which
the nine physicians of Brooklyn, who met together so
long ago, can be proud.
— D.R.B.
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