Donald Caton, M.D., Past President
Wood Library-Museum of Anesthesiology Board of Trustees
Like virtue, professionalism may be easier to identify than to define. Most dictionaries simply equate professionalism with specialization. Serious students of the subject take a different view, however. Among the characteristics of a “profession,” they include formal organization and work that is primarily intellectual in character and based on the theories from some branches of learning. Menke also emphasizes personal characteristics such as a dedication to public service and a relationship between the practitioner and client built on mutual respect.1
As first practiced, anesthesiology had none of these characteristics. Dr. William T.G. Morton, who gave the first successful public demonstration of a surgical anesthetic, saw in his discovery a means to become rich and famous.2 Few early practitioners made any attempt to understand the theoretical basis of the discovery. For many decades, in fact, anesthesiology was not even recognized as a medical specialty. As a technical adjunct to surgery, responsibility for its administration usually fell to the lowest ranking member of the operative team, a medical student, new house officer or nurse.
The Development of Anesthesiology as a Specialty
Technical innovations improved the quality of care, but they did not transform anesthesiology into a specialty. This process began when physicians recognized the necessity of formal training in anesthesia and a practice based on principles of chemistry, physiology and pharmacology. In England, J.F.W. Silk argued for a required course in anesthesia for all graduating students.3 Almost simultaneously, American physicians began their own campaign. In 1901 S.O. Goldan, M.D., called for anesthesia “properly taught by those competent to teach, not by any means the surgeon .... The anesthetist will not be considered a mere satellite of the surgeon but recognized as one of a distinct class.”4 Shortly thereafter a handful of American medical schools appointed the first anesthesiologists to their faculties: Thomas D. Buchanan, M.D., at Flower Medical School in New York; Orville J. Cunningham, M.D., at the University of Kansas; and L.W. Hardy, M.D., at the University of Iowa.
Of the early educators, many believe that Ralph M. Waters, M.D., had the greatest impact. Dr. Waters’ experience as a “self-taught” anesthesiologist in a small Iowa town convinced him of the need for formal training programs. In 1927 he had an opportunity to develop such a program when he was placed in charge of the anesthesia service at the new State Hospital in Madison, Wisconsin. Dr. Waters became actively involved in research, often in collaboration with colleagues in basic science. He developed close ties with other anesthesiologists such as John S. Lundy, M.D., Paul M. Wood, M.D., and Francis H. McMechan, M.D., who also shared his views. They formed “Travel Clubs,” which later evolved into some of the professional organizations that sustain us today. Together they lobbied the Advisory Board of Medical Specialties to develop an examining board for anesthesiology.5,6 In 1940 they won approval from the House of Delegates of the American Medical Association to become a section independent of surgery, thus giving anesthesiologists the opportunity to define the qualifications of a consultant, develop an approved curriculum of study and training and establish a procedure to evaluate the fitness of each candidate.
Most importantly, perhaps, Dr. Waters developed a program that set a standard for training, public service and professional conduct. His trainees, the “Aqualumni” as they called themselves, dispersed all over the world to establish their own programs modeled after the one developed in Madison by Dr. Waters. The 75th Anniversary of Academic Anesthesiology celebration in Madison, Wisconsin, on June 6-8, 2002, celebrated Dr. Waters’ many contributions to the development of professionalism in our specialty.7
The Development of Anesthesiology as a Profession
Leroy D. Vandam, M.D., suggests that “professionalism in any field entails study with consequent progress, the teaching and recruitment of others, integration with the other branches of medicine and devotion to the kind of investigation that solves its own problems.”8 During the past 50 years, many individual anesthesiologists contributed to this professional ideal through their own work. It is noteworthy, however, that the profession as a whole also made such a commitment when members of ASA voted to form and then support its three “foundations.” To the Anesthesia Patient Safety Foundation, the Foundation for Anesthesia Education and Research and the Wood Library-Museum of Anesthesiology, it assigned responsibility for the quality of patient care, improvements in research and education, the dissemination of information and the preservation of the history that makes our profession unique.
Dr. Waters and many others established the standards and traditions that made our specialty a profession. Our institutions preserve and transmit them. Ultimately, however, our specialty achieves and sustains its status as a profession through the work of individuals who accept these values and traditions and practice them. As Menke observes, a professional relationship exists when the physician understands and protects the needs of the patient and when the patient trusts and respects the physician believing in that person’s mastery of the technical and theoretical aspects of practice and adherence to a high standard of personal conduct and public service.1 In the current social and political climate, it is important to remember and to tell others about the core values of our profession.
- Menke WG: Professional values in medical practice. N Engl J Med. 1969; 280:930-936.
- Wolfe RJ: Tarnished Idol: William T. G. Morton and the Introduction of Surgical Anesthesia. San Anselmo, California: Norman Publishing, 2001.
- Silk JFW: Anaesthetics: a necessary part of the curriculum, a plea for more systematic teaching. Lancet. 1892; 1:1178-1180.
- Goldan SO. Anesthetization as a specialty: Its present and future. Am Med. July 1901. Read before the Medical Association of the Greater City of New York, March 11, 1901.
- Bacon DR. John S. Lundy, Ralph Waters, Paul Wood: The Founding of the American Board of Anesthesiology. Bulletin of Anesthesia History. 1995; 13(3):1, 4-5, 15.
- Betcher AM. Historical development of the American Society of Anesthesiologists, Inc. In: Volpitto PP, Vandam LD, eds. The Genesis of Contemporary American Anesthesiology. Springfield, Illinois: Charles C. Thomas; 1982:185-221.
- Lai DC, ed. Holding Court With the Ghost of Gilman Terrace: Selected Writing of Ralph Milton Waters, M.D. Park Ridge, Illinois: Wood Library-Museum of Anesthesiology, 2002.
- Vandam LD: Early American anesthetists: The origins of professionalism in anesthesia. Anesthesiology. 1973; 38:264-274.