lbert Heircy Miller, M.D., a largely unsung pioneer of anesthesiology, was born in Lewiston, Maine, on April 3, 1872. Young Albert proved to be an excellent student and developed an early talent for drawing and photography, which helped finance his education and opened many important doors for him. After graduation from Bates College in Lewiston, he began his medical studies at the newly opened Bowdoin co-educational School of Science but, after one year, transferred to the College of Physicians and Surgeons at Columbia. While a student at “P. and S.” (as Dr. Miller refers to it in his papers), Albert Miller was asked to do photographs of surgical procedures for Charles McBurney, M.D. Dr. McBurney was one of the leading surgeons of his time and was in the process of writing his surgical textbook. Albert devised a camera and tracking system that could make photographs at different stages of a procedure without interrupting or distracting Dr. McBurney.

After graduation from P. and S. in June 1898, Dr. Miller had several opportunities, including at the Central Maine General Hospital in Lewiston, Maine, and as an intern at the Rhode Island Hospital in Providence. In Dr. Miller’s own words, “First, I took the appointment at the Lewiston Hospital. It was a wise choice, for the hospital was new. Dr. Oakes was the surgeon … I got experience in anaesthetics and worked out a plan for sterilizing sutures. Later, I had two assistants, Dr. Barrows and Dr. Burrell, so I could safely leave to go on to my Rhode Island Hospital appointment in March 1899.”

Albert H. Miller, M.D. Photograph courtesy of the Wood Library-Museum of Anesthesiology.

Dr. McBurney had offered Dr. Miller a position but had advised him that, if he went to Providence, he should take up anesthesia. He introduced the young Dr. Miller to Thomas L. Bennett, M.D., who gave him many pointers about the latter’s successful method of anesthesia in New York. (Dr. Bennett is thought to be the first American physician to limit his practice to anesthesia.) During his tenure as an intern at the Rhode Island Hospital, Dr. Miller continued giving anesthetics, and he graduated from the hospital on January 1, 1901, with an appointment as anesthetist, which had been promised by the trustees a long time back. In those days, all operations in private practice were done in homes or small private hospitals. Dr. Miller was engaged to give an anesthetic for a spina bifida operation at a house in East Providence on his first day!

Dr. Miller’s mentor, Thomas Linwood Bennett, M.D., of Kansas. Photograph courtesy of the Wood Library-Museum of Anesthesiology.

The famous Bennett Inhaler. Photograph courtesy of the Wood Library-Museum of Anesthesiology.

He soon had a busy and lucrative practice doing general medicine, obstetrics, orthopedics and anesthesia; however, after a life-threatening illness, he limited his practice to anesthesia. By this time, he had trained some assistants and soon established anesthesiology departments in several Rhode Island hospitals, perhaps the first departments of anesthesiology in the United States. In 1935, Leo V. Hand, M.D., was appointed as the first resident in anesthesia in the newly formalized department at Rhode Island Hospital. (Dr. Hand was ASA President in 1960. Later, Meyer Saklad, M.D., another very prominent ASA member, was one of Dr. Miller’s residents.)

Dr. Miller put his incredible observational skills, meticulous attention to detail, compassion for patients, thirst for knowledge and love of the profession to good use. Early in his practice, he promoted the use of careful and detailed anesthesia records, and although not the first to use anesthesia records, it is likely that Rhode Island Hospital was the first hospital in the United States to routinely use such records and to use those records to improve patient outcomes. Dr. Miller studied the records of thousands of consecutive patients and developed a classification of operative risk. He recognized the importance of the anesthesiologist in performing a complete history and physical examination. He insisted it be done in spite of resistance from surgeons who resented what they perceived as an intrusion on their practices. He also recognized that patients with concomitant medical disease should be medically optimized to improve their outcomes from the surgical procedure. Dr. Miller was one of the first anesthesiologists to understand the importance of giving adequate oxygen to patients receiving nitrous oxide, and he made many contributions to the development of safer anesthesia delivery systems and machines (Elmer I. McKesson, M.D., was a frequent guest in the Miller house).

Dr. Miller’s other important mentor, surgeon Charles McBurney, M.D., around 1897 in New York.  Dr. Miller described Dr. McBurney as a short but very proud man who always insisted on standing on a stool during surgery.  This photo was taken during the first operation for appendicitis by Dr. McBurney with Dr. Miller as his anesthetist.  The ether cone seen in the hand of the anesthetist was the forerunner of the first open-ether method developed by Dr. Miller.  The Miller open-ether method was first used at the Rhode Island Hospital in 1900.

Dr. Miller at one of his Friday Night Club meetings in 1948, a forum for doctors which he had instituted to discuss clinical matters every week. Photograph courtesy of the Wood Library-Museum of Anesthesiology.

A surgeon, Philemon E. Truesdale, had devised a method to surgically correct diaphragmatic hernia, which was successful on animals, but he hesitated to try it on patients because of the difficulty of anesthesia and a published mortality rate of greater than 50 percent. At a meeting of the Providence “Friday Night Club,” he suggested that Dr. Miller develop a method of anesthesia for intrathoracic surgery. Dr. Miller called his method “Constant Pressure Nitrous Oxide Oxygen Anesthesia.” It was so successful that he and Dr. Truesdale did a series of 12 operations for diaphragmatic hernia without a death. Dr. Miller also devised a technic of pharyngeal anesthesia for surgical procedures on the upper airway.

Dr. Miller early on recognized the effects of surgical position on the physiology of oxygen delivery. He may have been the first to use symbols for the patient’s position on the anesthetic record. He also was one of the first to note the effects of surgical traction on the gall bladder on the cardiovascular system. A student of history, Dr. Miller was especially interested in the contributions of Horace Wells and William T.G. Morton and the work of British physician Thomas Beddoes.

Perhaps his greatest contribution to our specialty was his description of the ascending intercostal muscle paralysis that develops as the depth of anesthesia increases. Arthur E. Guedel, M.D., used this observation when he developed his classification of the planes and stages of anesthesia. Dr. Miller recognized that the abdominal movement so often complained about by surgeons was actually caused by deep anesthesia, intercostal muscle paralysis and diaphragmatic breathing, and should not be treated by deepening the anesthetic further but rather by lightening the depth.

Dr. Miller also recognized the importance of organizations in the development of a profession. He was present for the founding of the Providence Society of Anesthetists and the Boston Society of Anesthetists. He also attended the founding of the American Association of Anesthetists (AAA) in Atlantic City in June 1912. AAA later amalgamated the International Anesthesia Research Society. James T. Gwathmey, M.D., first president of AAA, also was a frequent guest in the Miller home. Dr. Miller was president of AAA from 1918-20 and was a frequent participant in the scientific sessions. He also was an early member of the American Society of Anesthetists, which later was renamed the American Society of Anesthesiologists (member number 81). His contributions to the specialty of anesthesiology include 74 publications.

All of the material used in developing this article is contained in the extensive Albert H. Miller collection in the Wood Library-Museum of Anesthesiology (WLM). This collection was made possible by the generosity of Dr. Miller, his widow the late Ada Miller, and his oldest daughter, Mrs. Jonathan B. Richards, of Red Oak, Iowa. Included in the collection are personal reminisces, photographs and papers, including programs and notes from many of the early meetings of AAA. These materials are available for study at the WLM and make for fascinating reading. The programs give an insight into the development of our specialty and the genius of the giants on whose shoulders we stand.

R. Dennis Bastron, M.D., is Clinical Director of Anesthesiology, Tucson VA Hospital, and Professor of Clinical Anesthesiology, University of Arizona, Tucson, Arizona.