Ralph M. Waters, M.D., and Professionalism in Anesthesiology: A Celebration of 75 Years.

Abstract

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. caton@anest2.anest.ufl.eduRalph M. Waters, M.D., and Professionalism in Anesthesiology: A Celebration of 75 Years. NA Madison, Wisconsin. June 6–8, 2002.On June 6–8, 2002, more than 150 people gathered from all parts of the world to celebrate the 75th anniversary of the arrival of Ralph M. Waters, M.D., in Madison, Wisconsin. The meeting, jointly sponsored by the Anesthesia History Association, the History of Anaesthesia Society of Great Britain, and the Wood Library-Museum and the Department of Anesthesiology of the University of Wisconsin, honored a man recognized worldwide as one who introduced professionalism into the practice of anesthesia.Waters began his career in medicine before World War I as a general practitioner, specializing in anesthesia and obstetrics. Finding the time constraints of such a combination difficult, he abandoned obstetrics in favor of anesthesia. In a paper published in 1918, Waters described the abysmal state of anesthesia practice that he encountered:“A few more or less full time surgeons … employed nurses to administer ether in the mornings at hospitals and act as office nurses in the afternoons. A majority of us … depended upon each other to act as anesthetists as occasions demanded.” He proceeded to call for improvements in training and practice of anesthesiology. Contemporaries of Waters also recognized the problem, as described in a paper delivered by A. J. Wright, 1but it was Waters who showed the way to improvement.In 1927, at the prompting of Erwin W. Schmidt, Professor of Surgery, the University of Wisconsin recruited Waters to Madison. There, Waters established a training program that influenced anesthesia practice throughout the world. Symposium papers by Sir Keith Sykes, M.B., Thomas B. Boulton, M.D., Anthony Aldrete, M.D., Carlos Parsloe, M.D., and many others described Waters’ impact on research, teaching, and practice in various countries. Particularly moving were presentations by former residents of Waters: Lucien Morris, M.D., John Steinhaus, M.D., Ph.D., Jone J. Wu, M.D., and Thorsten Gordh, M.D. (the last two by videotape, as infirmities and distance prevented them from attending). Papers by other participants described Waters’ original research in carbon dioxide adsorption, his studies of the pharmacology of new anesthetic agents such as cyclopropane, and his work to develop anesthesia societies for the encouragement of research and dissemination of information.Distributed to each participant of the symposium was a collection of Waters’ papers, edited by David Lai, M.D. These publications illustrate the breadth of Waters’ research interests. They also define the conditions that Waters’ thought necessary to establish anesthesiology as a profession. For example, Waters never wavered from the idea that anesthesia is the practice of medicine, and that its practitioners must be thoroughly trained—not simply in technical matters but also in principles of physiology, pharmacology, and physics. He made it clear that achieving the status of a professional meant dedication to the education of others, to the support of research, and to the establishment and enforcement of high ethical and technical standards of practice. Various presentations at the symposium described how Waters accomplished this formidable task by personal example, diplomacy, persistence, dedication to public service, and by training a cadre of professionals who themselves would establish programs modeled after the one that he developed in Madison, Wisconsin.Fittingly, this symposium began with an announcement by the University of Wisconsin of the establishment of the Ralph M. Waters’ Chair of Anesthesiology. Preservation of the memory of Ralph Waters and celebration of his work to inculcate professionalism into the practice of anesthesiology is important in these days when so many political, social, and economic forces work to undermine these high standards.