Douglas R. Bacon, M.D., Editor

Who We Are at 100 — Reflections of a Historian

t begins somewhere deep in the soul, welling up through the mind until it comes out with the loudest possible sound and a force that reveals its origin. Moments before this gut-wrenching clamor is heard, a surgeon has put knife to skin in an effort to cure the patient. No matter how or when we have encountered this cry, and perhaps witnessed the events of surgery without anesthesia, most likely in the movies, but rarely, and under extreme conditions in real life, it tears the very fabric of our being. For we are anesthesiologists; we have dedicated our lives to stopping this horror and allowing the surgeon’s knife to be an instrument of healing rather than an instrument of torture. And this is why the “awareness crisis” of the last several years, in all of its manifestations, evokes such a personal response in all anesthesiologists.

The decade of the 1840s in the United States was the time when the scream was first stilled. The best extant account of that “first” administration, in January 1842, was in Rochester, New York, a scant 60 miles from my hometown. A medical student, William E. Clark, gave ether to the sister of a classmate from medical school in order that a molar might be painlessly extracted. Two months later, Crawford W. Long, in rural Jefferson, Georgia, gave ether to his friend, James Venable, so that masses could be removed from his neck. In 1844, Horace Wells used nitrous oxide to eliminate pain from dental practice. On October 16, 1846, a brash young man, William Thomas Green Morton, stood in front of the American surgical establishment in a room that would come to be known as the “Ether Dome” and silenced the sound for the first time publicly. Word spread around the world from that day in Boston, Massachusetts, and people across the world, regardless of nationality, race, creed, politics or religion, benefited from the first great medical advance from the fledgling United States.

Flash forward almost 60 years. A small group of eight physicians and a medical student gather in an auditorium at the Long Island College of Medicine in Brooklyn, New York. October 6, 1905, almost 59 years to the day after Morton’s demonstration, these men hope to form a society that is dedicated to the “art and science” of anesthesia. It was felt that a forum was needed, a place to discuss who could best care for surgical patients and advance the specialty, to continue to silence that awful sound. They succeeded in a way that Adolph Frederick Erdmann, M.D., could not even begin to envision. Consider for a moment how the Society and the specialty have changed. No longer meeting quarterly, for an evening, to do both business and education, the Society works year-round to produce our Annual Meeting, and our dedication to education is such that the Society has moved, on very short notice, the 2005 Annual Meeting from devastated New Orleans to Atlanta to ensure that all anesthesiologists have the opportunity to continue their education in the specialty. Our meeting this year will be historic, and while we concentrate on education and to some extent the business of anesthesiology, our thoughts will remain on those whose lives have been forever changed.

On that October day, I wonder if “Fred” Erdmann and his colleagues had a vision of what they were creating. ASA is the oldest independent society devoted to the specialty in the world.¹ Fred and several of the founders did live long enough to see the birth of the American Society of Anesthesiologists on April 12, 1945.² They watched as the Society struggled for recognition of anesthesia as a specialty within the house of medicine in the 1930s and understood the gargantuan efforts by ASA members and officers that made the American Board of Anesthesiology possible, catapulting ASA into national leadership. The Long Island Society, as it came of age, created an offshoot that defined, and to a large extent continues to define, what it means to be an anesthesiologist through the knowledge required to become a board-certified specialist. Furthermore ASA worked with the American Medical Association (AMA) to ensure that this certification process would be recognized in the United States and that anesthesiology would have a seat at the table in any further decisions concerning specialized practice in the United States.

As I write these words, I am 2,000 miles from home, at 33,000 feet, returning from the Sixth International Symposium on the History of Anesthesia, which was held at Queen’s College, Cambridge, England. At this meeting, ASA’s birthday was of such import that one-sixth of the meeting was devoted to our anniversary. Walking the grounds at Queen’s — 100 years is of less significance when compared to buildings and traditions four or more times that age — I was gratified as an American that our anniversary was so important to the worldwide anesthesia history community. I also was struck by how similar our histories are: the struggle for recognition in the 1930s, sending in a qualifying examination for specialist practice, a post-World War II boom and a current set of circumstances that does not seem to resemble anything in the past 100 years was commonly heard throughout the symposium.

Yet perhaps the coming days most resemble the days of our founding. As an eminent British historian of anesthesiology, Dr. Jean Horton described her research into the techniques employed at the hospital in which she had spent her entire career, and the two physicians who were appointed as specialists in anesthetics, it became clear that the effort and dedication of a few people changed the face of surgical practice at the hospital. Today we continue to face issues about how we define ourselves. Are we chained to the operating room and the anesthesia machine, or are we evolving into a new type of specialist? What is our proper role in the critical care unit? Should we be the invasive pain specialist, as we have the greatest experience in this area? Are anesthesiologists the natural hospitalist — taking a patient from admission through the surgical experience to discharge, however long that takes?

The past 100 years have been filled with triumphs and, to a lesser extent, tragedies. Our history is full of physicians willing to take a chance, to stand up and be counted as believing in something. In creating our specialty, they made it possible for us to have a proper place within the house of medicine. There are many challenges ahead of us in the coming years. How we respond to those trials is what is important. Our history is replete with examples of leadership — and dogged determination. Now more than ever, it is time to follow those examples and to give the anesthesia historians of the 22nd century something to write about and to recognize our contribution to patient care.

We stand on the shoulders of physicians whose grasp exceeded all expectations. To honor them, we must mold our future, centering as they did on the most important facet of anesthesiology — the patient. To do any less would be an abdication of our professional responsibilities.

— D.R.B.

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