Douglas R. Bacon, M.D., Editor

have had the pleasure of knowing one person well who reached the age of 100. My maternal grandmother was born in 1890 and died in 1994, two months short of 104 years of age. She was the grandmother portrayed in stories, always there for my sister and me, never condescending and always loving. She had a perspective on life that I came to admire, giving advice to me in my youth that I still use today. Her life was a fascinating study of the growth of the United States in the early 20th century. Growing up in Buffalo, New York, the stories of her childhood remember a time passed that will no longer be. Perhaps my favorite is the time her uncle came to pick her up in his horse and buggy to take her to a family party. She asked him how the horse knew the way to go, and her uncle replied, “I’ve whispered it in his ear.” As a young girl (and quite a tomboy, if the family legends are to be believed), she would hitch a ride on the back of a sled and slide down the snow-covered streets, not unlike catching the back bumper of a car and sliding behind it, only a bit slower and perhaps a lot safer.

Growing Pains
ASA, in its youth, was a bit like my grandmother, a little naive perhaps but growing and changing as the 20th century demanded. Our Society’s history reflects a time that cannot be recreated yet may hint at solutions to future challenges. Formed at the Long Island College of Medicine (now part of the State University of New York Downstate Medical Center) by eight physicians and a medical student, the Society was dedicated to enhancing the art and science of medicine. The early meetings were small, almost private affairs — for the giving of anesthetics was neither as glorious nor as rewarded as the operation itself. The Long Island Society of Anesthetists, as it was called, was a group of men trying to learn about the mysteries of anesthesia to better care for their patients. Meeting three or four times a year, sharing a meal and listening to a lecture or two and a practical demonstration harkens back to a similar and perhaps more naive time in the history of our specialty. Yet the dual focuses of the Society, patient care and education, are the roots of our organization, and we have never, ever abandoned them.

In 1901, Buffalo, the burgeoning industrial city on the shores of Lake Erie, hosted the world at the Pan-American Exposition. As an elementary student, grandma went to the exposition on a streetcar with her class. William McKinley, then President of the United States, came and was assassinated at the fair. Grandma remembered the newsboys on the street corner yelling, “Extra! Extra! McKinley shot in the stomach.”

When my grandmother was 13, my great-grandfather died early in the school year. As an eighth-grader, grandma finished the year and won the gold medal for the highest grade point average of all the children in her grade in the city of Buffalo. So, too, did the Long Island Society go through some growing pains. The group had grown, and many members came from across the river.

The Society moved uptown and became the New York Society of Anesthetists. The organization petitioned the American Medical Association (AMA) for a section on anesthesia, ostensibly for the study of problems within the field, especially with nonphysicians who provided anesthetic services. The request was reasonable as the ophthalmologists had made a similar one that was granted. Unfortunately this 1912 petition was denied, but that denial spurred the leadership of the New York Society to create the first national anesthetic society, the Associated Anesthetists of America. Like my grandmother’s marriage to my grandfather a scant three years later, the creation of a national society demonstrated a new phase in the Society’s growth, a maturation.

In 1920 my grandmother voted for Warren G. Harding for president, the first time in her life that she ever voted, and she never missed an election thereafter. Why wait until the age of 30 to vote? A constitutional amendment had been ratified in time for her to vote — for women in the United States did not have that right and honor until 1920. It is that simple act of voting, of participating in the determination of the future, which my grandmother instilled in me. The roaring 1920s were a time of growth and maturation for the New York Society as well; the group started to represent all of the state, not just the city, and began to expand into the surrounding states. New York Society President (1920-21) J.J. Buettner, M.D., of Syracuse, played an active role, although he was hours by train from the center of the action. Dedication to the Society’s principles and the need to further the specialty were critical to Dr. Buettner, the New York Society and anesthesiology.

Francis H. McMechan, M.D.

Hard Times and a New Beginning
The Great Depression challenged my grandmother and her family. Money was hard to come by, and meals often consisted of lima bean casseroles. These were dark days indeed for my family and for the nation as a whole. Yet out of the Depression came the desire to certify physicians as specialists in anesthesia, confirming that the specialty was the equal of surgery or internal medicine. The 1930s saw the creation of the American Society of Anesthetists, taking the New York Society national over this issue. The Associated Anesthetists had become a North American organization, the Associated Anesthetists of the United States and Canada, and its Secretary-General, Francis H. McMechan, M.D., refused to join any certification process that had AMA involvement. The American Society felt differently, and in creating the American Board of Anesthesiology, was transformed from a greater New York City and New York State Society into one that looked out for the interests of the entire country. In 1939 Dr. McMechan died, and the American Society became, by default, the national organization when the Associated Anesthetists folded into the International Anesthesia Research Society.

The War Years
World War II was difficult for my grandmother. Many of her friends lost sons in the conflict. Her husband served on the draft board, being too old for active service. His work was often criticized, and this took a toll on her. ASA was no different as it helped to organize an effort to teach anesthesia to physicians in the Armed Forces in 90-day courses held throughout the United States. At the outset, when looking for sites to establish these educational areas, every known ASA member was rated on his/her clinical ability, and special qualifications in administration and teaching were noted. A curriculum was established and modified through feedback from graduate officers now practicing at the front. While it was difficult for Society members to get together on a national basis due to gasoline rationing and travel restrictions, the sacrifice of the members who established and taught in the 90-day courses was repaid in the immediate post-war period as requests for residency training and establishment of departments of anesthesiology skyrocketed. As the war ended, the Society changed its name to the American Society of Anesthesiologists to better serve its members, who were felt to study the anesthetic state, striving to make anesthesia safer for the patient.

World War II found the U.S. medical corps critically understaffed for surgical anesthesia. Emergency training in this field led many physicians to specialize in anesthesiology after the war. This picture was taken in Percy, France, and shows a mobile surgical unit caring for the wounded during an Allied bombing run in August 1944. Photo courtesy of the Norman Kornfield Collection, Wood Library-Museum of Anesthesiology.

After the War
The post-war years were kind to my grandmother. She found time to be active as a volunteer, and her husband’s business thrived. In the mid-1950s, there was yet another life change for her as her grandchildren appeared. I can still taste her chocolate chip cookies, and despite using her recipe, I cannot replicate them myself. The 1950s and ’60s were similar for ASA. In the late 1950s, it became clear that ASA was the voice of American anesthesiology. By joining the World Federation of Societies of Anaesthesiologists, ASA assumed an active role in international organized medicine and in advancing the specialty across the globe, looking to help establish physicians in the practice of anesthesiology and supporting growth and development of societies of anesthesiologists everywhere in the world. Domestically ASA in general and the California Society of Anesthesiologists in particular were critical in the establishment of a new method of payment for services. The Relative Value Guide (RVG) helped anesthesiologists across the United States to create a universal system of billing that was adaptable to regional differences in payment. Several other specialties adopted the system. The federal government, however, in the form of the Federal Trade Commission, felt that the system was monopolistic and put pressure on all groups to stop using the RVG. ASA eventually stood alone in a lawsuit brought by the government in 1975. ASA’s eventual victory clearly demonstrated the maturation the Society had reached.

In her last days, my grandmother awaited the birth of my sister’s third child. A great-granddaughter was born and shared her middle name. Grandma felt her time was done, and she slowly faded, dying two months short of her 104th birthday.

Do I think that ASA will die four years hence, worn out, mourned by friends and generations of anesthesiologists? No! Just as grandmother’s life lessons were instilled in her progeny, ASA moves on with each generation. As a Society, we must continue to grow, encourage participation at all levels of the organization, consider new options and opportunities and not rest on our laurels. For each generation, there are highlights and the feeling that these are the best of times. If there is one universal lesson that ASA’s history teaches us, it is that each one of us must continue to strive to make anesthesiology the best that we can, for the anesthesiologists 100 years hence must be willing to look back on a glorious 200-year history with confidence that the best the specialty has to offer lies in the future, as those of us looking forward to the second 100 years certainly do.

— D.R.B.

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