he Emery A. Rovenstine Memorial Lecture at the ASA 2005 Annual Meeting will be the 44th in the series that began in 1962, soon after the untimely death of Emery A. Rovenstine, M.D. The E.R. Squibb Company endowed the first three years of the Lectureship to commemorate Dr. Rovenstine’s lasting contributions to the specialty. What today’s generation of anesthesiologists knows about his iconic stature is gleaned largely from the brief biography included annually either during the introduction of the Rovenstine Lecturer or by the lecturer him/herself.

Emery A. Rovenstine, M.D.

Emery Rovenstine was born in 1895 in Atwood, Indiana, attended Wabash College and obtained his medical degree at Indiana University. As a young man, Dr. Rovenstine had been a teacher, a coach and an athletic director at La Porte High School. The discipline and focus required by such activities may well have tempered him for the difficult tasks he later chose for himself. Following medical school and a one-year rotating internship, he was one of the first two residents to train with Ralph M. Waters, M.D., in Wisconsin. After completing his training, he was invited to join the faculty of the New York University College of Medicine and, additionally, undertook the enormously challenging task of organizing an anesthesiology department at New York’s Bellevue Hospital, one of the largest in the nation.

During his 25-year tenure at Bellevue, his clinical skills, research interests and vitality as a teacher were legendary. His proudest legacy, however, would have been the achievements of the physicians who trained with him, including, among others, John Adriani, M.D., E.M. Papper, M.D., S.G. Hershey, M.D., Virginia Apgar, M.D., Stuart Cullen, M.D., Martin Helrich, M.D., Louis Orkin, M.D., Louis H. Wright, M.D., and for a portion of his training, Robert D. Dripps, M.D. These and other Rovenstine trainees were destined to play a major role in the growth and maturation of the specialty.

Dr. Rovenstine, middle row center, poses with his staff at Bellevue Hospital in 1958.

There have been 43 Rovenstine Lecturers to date. (A complete list of Rovenstine lecturers and titles is available at: <www.ASAhq.org/wlm>). Initially the lecturers were chosen by the Annual Sessions Chair, and soon after, by that year’s ASA President. It was decided early on, perhaps not as a written “rule,” to exclude anesthesiologists as lecturers, thereby avoiding the perception of a popularity contest. In a still young specialty, it also was reasoned that few anesthesiologists had attained the prominence deserving of the recognition that such an invitation would confer. Additionally there were any number of eminent physicians/scientists who, as Rovenstine Lecturers, could impart their own prestige to this new lecture series and further address topics complementary to anesthesiology.

Conforming to this objective, seven of the first eight lecturers included Francis D. Moore, M.D., Surgeon in Chief of the Massachusetts General Hospital, who delivered the first lecture in 1962. His topic was “Hemorrhage.” In 1963 Julius Comroe, M.D., addressed the “Regulation of Respiration,” and almost in physiological lockstep, Eugene Braunwald, M.D., delivered the 1964 lecture titled “The Control of Cardiac Function.” William K. Hamilton, M.D., remembers his participation in proposing the 1965 lecturer. The subject of Louis Lasagna, M.D., “The Principles and Pitfalls in Evaluation of New Drugs,” was well-suited for an audience of anesthesiologists.

In 1966 the selection of Dr. Papper, a prominent former resident of Dr. Rovenstine, interrupted the chain of “nonanesthesiologist” lecturers. Dr. Papper paid special tribute to his teacher by choosing one of Dr. Rovenstine’s special areas of interest and expertise, regional anesthesia, and more specifically, a critical assessment in its place in therapeutics.

In the following three years, renowned investigators continued the series: Arthur C. Guyton, M.D. (“Regulation of Cardiac Output”); Hermann Rahn, M.D. (“Evolution of Gas Transport Mechanisms from Fish to Man”); and Niels A. Lassen, M.D. (“Cerebral Circulation and the Anesthetist: An Appraisal of Practical Consequences of Present Knowledge”).

While no record of refusal to accept an invitation as a Rovenstine Lecturer could be found, an unfortunate episode occurred in the early 1970s. After Linus Pauling, M.D., an eminent Nobel Laureate, had accepted the invitation, it was withdrawn for reasons that remain unclear (personal communications).

In 1984 Eugene A. Stead, Jr., M.D., Emeritus Professor of Medicine at Duke University, titled his lecture “Anesthesiologists Come of Age.” This reality had been recognized years earlier, though, and in 1970, the era of the anesthesiologist as Rovenstine Lecturer began. The lecture by Robert D. Dripps, M.D., “The Physician and Society,” was largely a philosophical treatise and represented a sea change in the direction of lecture subjects. Dr. Dripps served notice that a change in tone had, indeed, occurred by observing that “there is nothing quite so dull as a doctors’ party with the practitioners off in a corner reviewing their interesting cases.” More seriously he also was prescient in challenging the adequacy of education for both primary and professional school students. A brief return to pure science followed Dr. Dripps’ talk the following year with an esoteric presentation by Nobel Laureate Julius Axelrod, M.D., who addressed “Biochemical Factors in the Inactivation and Activation of Drugs.”

In his lecture in 1972, Dr. Cullen challenged some basic precepts in anesthesiology residency training programs with “Factors Influencing Education in Anesthesiology.” One of the most controversial lectures in the series was delivered in 1973 by William W. Mushin, M.D., who suggested in “The Decline and Fall of the Anesthesiologist” that it was time for the anesthesiologist to get back into the operating room. His concerns would probably have been more strident if the term “perioperative physician” had existed at the time. There were now four anesthesiologists who had delivered the Rovenstine Lecture, and it seemed appropriate to invite Drs. Dripps, Cullen and Papper to join Dr. Mushin in a separate Rovenstine panel at the 1973 meeting.

In 1978, the lecture by William K. Hamilton, M.D., “Stress and Anesthesia,” challenged the concept, championed by Hans Selye, M.D., that anesthesia was a stress-inducing event, arguing that “anesthesia was not as much a stress as an anti-stress.”

Of the remaining lectures, seven dealt with clinical facets of our specialty: Arthur S. Keats, M.D. (anesthesia for cardiac surgery); John F. Nunn, M.D. (risks with newer inhalational agents); Ellison C. Pierce, Jr., M.D. (anesthesia safety); Michael J. Cousins, M.D. (pain: past, present and future); Burton S. Epstein, M.D. (sedation and analgesia for nonanesthesiologists); and Terri G. Monk, M.D. (postoperative cognitive dysfunction). Thomas F. Hornbein, M.D., one of the first Americans to reach Mt. Everest’s crest, combined an exciting report of his adventure with, appropriately, oxygen transport and carrying capacity.

Lawrence J. Saidman, M.D., in his “What I Have Learned After Nine Years and 9,000 Papers,” reviewed how publications in the journal Anesthesiology had evolved during his stewardship as editor.

Twelve of the most recent lectures, while including references to clinical practice, were more devoted to an eclectic list of issues: education, ethics, responsibility, challenges, leadership and manpower, etc. Edward R. Annis, M.D., a past president of the American Medical Association, spoke of new challenges and opportunities in medicine. Glenn W. Johnson reminisced about education, science and advocacy from the vantage point of his years as ASA’s Executive Director.

Lectures addressing concerns about the status of the specialty included “Anesthesiology: The Search for Identity” by John Lansdale, Esq., longtime legal counsel for ASA. In “Neuroanesthesia and the Achievement of Professional Respect,” John D. Mitchenfelder, M.D., expressed concern about the lack of respect and understanding from our peers in other medical disciplines, emphasizing the need for anesthesiology to be recognized as a clinical discipline as well as a source of valuable contributions to medical science. In his lecture “The Changing Horizons in Anesthesiology,” Nicholas M. Greene, M.D., cited our failure as a specialty to communicate what it is that we do, not only to the laity, but also to our colleagues in other specialties. This was echoed in my 1981 lecture “A Measure of Worth,” which explored how we, as anesthesiologists, viewed our own worth. In 1979, LeRoy D. Vandam, M.D., explored “Anesthesiologists as Clinicians” and ruminated over how other specialties managed to be seen as clinicians while anesthesiologists were identified, pejoratively, as “hospital-based.”

In 1996 David E. Longnecker, M.D., cited the dichotomy between an expanding specialty and the decrease in medical student interest in “Navigation in Unchartered Waters: Is Anesthesiology on Course for the 21st Century?” He also lamented an apparent practitioners’ preference for efficiency over image.

Thomas F. Hornbein, M.D., far right, in white coat, demonstrates the use of plastic sleeping masks to Sherpas who worked with the American climbing expedition on Mt. Everest in 1963. Dr. Hornbein’s Rovenstine lecture in 1989 was titled “Lessons From on High.”

In 1999 Carl C. Hug, Jr., M.D., Ph.D., reconciled disparate and sometimes opposing forces in our approach to clinical practice in “Patient Values, Hippocrates, Science and Technology.” In “Clinical Challenges for the Anesthesiologist,” Robert K. Stoelting, M.D., stressed that learning and education never end and that anesthesiologists should become eternal and vigilant students for the duration of their careers. In 1980 M.T. “Pepper” Jenkins, M.D., spoke about “Responsibility for the Future,” and Francis M. James III, M.D., asked in 1998, “Who Will Lead Us? In 2004 Jerome H. Modell, M.D., extolled the advances in clinical anesthesia but worried about the impact of federal bureaucratic rulings in his “Assessing the Past and Shaping the Future.”

A number of lecturers were asked to respond to questions about their participation in the Rovenstine series. Questions included: How long in advance of your lecture was your invitation tendered? What factors influenced your decision in selecting a topic or title? What message did you hope to leave with the audience? Did you intend your subject, or any of your remarks, to be controversial? In retrospect would you have altered any portion of your presentation? All of the respondents commented that the honor conferred was also an awesome challenge. All lecturers received their invitation at least one year in advance.

Some responses follow: Lawrence J. Saidman, M.D., wished the audience to understand the relevance of ASA in their professional lives and proposed that perioperative medicine should be the direction of our specialty. In choosing his topic, Dr. Epstein was guided (driven?) by 20 frustrating years developing guidelines for sedation and analgesia for nonanesthesiologists. Dr. Modell reminded the audience that anesthesiologists continue to be major contributors to medical science. James F. Arens, M.D., expressed concern in 2000 about inadequate attention to practitioners who had lost their clinical skills. Dr. Stoelting’s choice of topic was based on an opportunity to relate clinical care to continuing education. Dr. Hug’s choice of subject was based upon his passion for end-of life issues and perceptions of the need for change in the way we care for patients, especially those facing high-risk interventions near the end of life.

Twenty-nine of the 33 most recent Rovenstine Lectures have been presented by anesthesiologists or by nonphysicians closely aligned with ASA (Mr. Johnson and Mr. Lansdale). This has been a fortuitous transition rather than a provincial exclusion of “outside” expertise. Attending the lectures or reading them following publication has provided us with an opportunity to witness the continuing growth and maturity of anesthesiology as seen through the eyes of the specialty’s leaders. The content of the talks, filled with wisdom and wit, is a living history of where we began, where we are and the directions ahead. The Emery A. Rovenstine Memorial Lecture remains, and will continue to be, one of the highlights of the ASA Annual Meeting.

E.S. Siker, M.D., is Chair Emeritus, Department of Anesthesiology, The Mercy Hospital of Pittsburgh, Pittsburgh, Pennsylvania. He was ASA President in 1973.

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