Gertrude Mary Gerrard, Chief Anesthetist, Peter Bent Brigham Hospital.

Gertrude Gerrard is a relatively unknown but important early nurse anesthetist in the United Sates in the early part of the 20th century. She was in the first class to graduate from the Peter Bent Brigham Hospital (PBBH) School of Nursing in Boston, Massachusetts. After graduating from nursing school, she participated in anesthesia training with Walter Boothby and became the first nurse anesthetist at the PBBH. In 1917 she was included in a group of medical professionals from the Harvard hospital system to serve in the medical corps in France during World War I. While there she worked with surgeon Harvey Cushing and this professional relationship continued back in Boston. She also was the first nurse anesthetist at Strong Memorial Hospital in Rochester, New York from 1925-1927. She returned to Boston in 1928 and continued as the chief anesthetist at PBBH until leaving in 1946 during a departmental staffing transition after WWII.

The First Cardiac Anesthesiology Fellow, William A. Lell: A Brief History.

Fifty years ago, on August 1, 1971, William A. Lell became the first cardiac anesthesia fellow at Harvard's Massachusetts General Hospital (MGH) Department of Anesthesiology, training with the world's first group of anesthesiologists whose clinical practice, teaching, and research efforts were exclusively devoted to cardiac anesthesia. Lell's early interest in cardiovascular medicine and how mentors, particularly at the MGH, influenced his early career development are recounted. The challenges a young pioneer faced in establishing and maintaining an academic cardiac anesthesia program during the initial and rapid growth of an exciting new subspecialty are described. Dr Lell's experience emphasizes the importance of seizing new opportunities and establishing meaningful working relationships with colleagues based on mutual trust as fundamental to successful career development and research in a new medical subspecialty.

The Origins, Evolution, and Spread of Anesthesia Monitoring Standards: From Boston to Across the World.

In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. Here, we chronicle events that led to the dramatic changes in medical practice that resulted from the activities of a small group of concerned anesthesiologists at Harvard-affiliated hospitals. We place these events in a historical perspective and explore how other specialties followed this example, and end with current strategies that minimize the risk associated with anesthesia. We conducted interviews with principals who formulated original standards of patient monitoring. In addition, we consulted documents in the public domain and primary source material. Efforts of these pioneers resulted in the establishment of the seminal Harvard-based anesthesia monitoring standards for minimal monitoring. What followed was an unprecedented transformation of the entire field. After the implementation of these standards at Harvard-affiliated hospitals, the American Society of Anesthesiologists (ASA) adopted "Standards for Basic Anesthetic Monitoring" for use during the administration of all anesthetics in the United States. Other nations have since adopted similar guidelines and these practices have resulted in significant improvements in patient safety. Currently, we estimate mortality due to anesthesia in healthy patients to be 1:400,000-perhaps as much as 10 times lower since the early 1980s. What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others-the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.

Barbara E. Waud, M.D. (1931-), an early woman clinician scientist and professor of anesthesiology at University of Massachusetts Medical School.

After the first successful public demonstration of modern anesthesia in 1846, most female anesthetists were nurses by trade since none were yet allowed to attend medical school to become physicians. The turn of the twentieth century, however, brought about greater opportunity for female physician-anesthetists. We explore the life and career of Barbara E. Waud (1931-), a pioneering woman physician and researcher in the field of anesthesiology. Waud chose to pursue a career in medicine at a time when most women did not even attend college, and for most of her training and practice, she was the only woman in her department. Personal interviews with Waud, her daughter, and her colleagues highlight her rebellious and resilient nature that helped her overcome the obstacles put forth by male colleagues, and the judgment she received from female acquaintances for being a working mother. Waud's impressive career of dedicated clinical practice and ground-breaking research spanned four decades and inspired generations of physicians.

Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report.

BACKGROUND: Regional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-à-vis physician anesthesiologists and surgeons. SOURCES: Hospital records and interviews with individuals familiar with the case. FINDINGS: An otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. CONCLUSION: Spinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.

Julia Gordon Arrowood (1900 - 1984): A Brilliant Anesthesiologist and a Woman of Many Firsts in Medicine.

After a brief "golden age" in the late 1800s, the patriarchal establishment fought back and women faced increasing restrictions in practicing medicine. In 1900, 18.2% of all physicians in the city of Boston were women, but this number decreased to 8.7% by 1930. The relatively young field of anesthesiology was one of the more welcoming specialties for women during this time. History has been unkind to these early female trailblazers who have often been overlooked in favor of the men in their fields. Julia Gordon Arrowood (1900-1984) was a forerunner for women in medicine and a prominent anesthesiologist in Boston from the 1930s until the 1950s. Her work included not only clinical medicine, but also research and teaching. She attended Boston University School of Medicine, graduating as valedictorian in the class of 1933. She interned at Belmont Hospital in Worcester, MA where she decided on a career in anesthesiology. She was accepted as a resident at Massachusetts General Hospital (MGH) by chief-anesthetist Henry Beecher in 1935, thereby becoming the first woman anesthesiology resident in Massachusetts. She remained at MGH and was named Acting Chief of Anesthesia in 1943. In 1944, she became president of the New England Society of Anesthesiologists, another first for a woman. In 1946, she joined Reginald Smithwick's team as Chief of Anesthesia at Massachusetts Memorial Hospital, Boston, and concurrently held the position of Professor of Anesthesiology at Boston University School of Medicine. Arrowood led many of the earliest studies on spinal anesthesia, muscle relaxants, and spinal headaches. In 1957, she moved to Kentucky and joined the United Mine Workers hospital system where she worked until her retirement in 1970. Women such as Julia Arrowood remain underrepresented in the annals of the history of medicine. Much work is needed to recognize the many contributions made by women physicians and to provide equal opportunities, pay, and status.

Ambition for Self and for Specialty: Emery A. Rovenstine and the Politics of Organized Anesthesia, 1937-1947.

The letters between Emery Andrew Rovenstine, MD (1895-1960), and Arthur Ernest Guedel, MD (1883-1956), are a window into the personalities and politics of the creation of American anesthesiology. The ambition of these men, both personal and professional, lay at the heart of their sacrifices and successes. Their correspondence unmasked common struggles and foibles, humanizing these giants of our field. Notably throughout the letters, Rovenstine, as the junior partner, wrestled with Guedel's advice to temper personal ambition for the collective good. Over time, their relationship matured, and the junior eclipsed the senior. Still, at various points in his career, Rovenstine was censured for self-promotion by leaders in anesthesiology and the general medical community. These moments brought to light issues of continued relevance today: inner tension between individual and group ambition, and professional friction between academic and political priorities in anesthesiology. In the end, it was an unapologetic blend of ambition for self and ambition for the specialty that allowed Emery Rovenstine to make his unique imprint on American anesthesiology.

Why Would the Pope Have A Private Audience with Anesthesiologists? The Origin of the "Doctrine of Double Effect" and Its Application to Pain Control.

Sunday February 24, 1957 was a pivotal day in the history of anesthesiology and pain medicine. The leader of the Roman Catholic Church, Pope Pius XII met with anesthesiologists attending an international symposium sponsored by the Italian Society of Anesthesiologists entitled, "Anesthesia and the Human Personality". The purpose of this audience was to seek clarification about the use of opioids at the end of life to reduce suffering. Three questions had been formulated from the previous year's Italian Congress of Anesthesiologists and sent to the Holy See on this specific issue. The Pope responded during this audience remarking that there was no moral obligation to withhold pain medication that could elevate suffering. He further remarked that the suppression of consciousness that can occur with opioids was consistent with the spirit of the Christian gospels. Finally, he also stated that it was not morally objectionable to administer opioids even if it might shorten life. The moral philosophy behind these answers is the doctrine of double effect. In essence, administering medications to relieve pain, the primary effect, may also hasten death, the unintended secondary effect. In seeking answers to these questions, the Italian anesthesiologists were at the forefront of a larger and ongoing debate. As new therapies are developed that may have unintended consequences, when it is morally permissible to use them?

The seven professorial protégés of John Gillies.

John Gillies was the founding head of the Department of Anaesthetics at the Royal Infirmary of Edinburgh, which began in 1940. An astute educator, he was instrumental in establishing anesthesia as a medical specialty, on equal footing with surgery, from the start of the National Health Service in 1948. Gillies' kudos attracted medical graduates from the UK, USA and Canada to work in his Department. The excellence of his teaching and mentoring may be judged from the fact that no less than seven of his protégés became professors of anesthesia/anesthesiology. This paper identifies these seven professorial protégés and reviews their careers. Reasons for the successful consequences of John Gillies' tutelage are considered.

Eponymous plot of Richard J. Kitz and Irwin B. Wilson in biochemistry.

Irwin B. Wilson and anesthesiologist Richard J. Kitz found the enzyme acetylcholinesterase to be inactivated in two steps by covalently acting molecules resembling acetylcholine in structure. Such molecules rapidly and reversibly bind to the active site of the enzyme. Next, the reversible complex undergoes covalent fixation at a characteristic rate. The Kitz-Wilson phenomenon applies to many cases of time-dependent enzyme inhibition. Experimental data are commonly graphed in linear fashion on "Kitz-Wilson plots". Kitz also contributed to a gas chromatography-mass spectrometry assay for acetylcholine that was suitable for the nonbiological detection of that neurotransmitter in mammalian brain.

Building an International Community of Paediatric Anaesthesiologists: An interview with Dr Edward Sumner.

Dr Edward Sumner (1940) enjoyed a remarkably productive career as consultant pediatric anesthetist at the Great Ormond Street Hospital for Children. His leadership in clinical care helped his department rise to eminence. He trained hundreds of registrars in pediatric anesthesia and educated thousands more through invited lectures and by co-editing leading textbooks of neonatal and pediatric anesthesia. During his long tenure as Editor-in-Chief of Pediatric Anesthesia, he led the growth of the young journal to prominence. Based on an interview and a long-standing professional and personal friendship of forty-four years, this article reviews Ted Sumner's outstanding contributions to the specialty of pediatric anesthesia and to the development of a strong international community of pediatric anesthesiologists.

An Anesthesiologist in the Space Race: The Life and Career of Dr. Cloid D. Green.

The space race began in the summer of 1955 when the United States and the Soviet Union pledged to launch artificial satellites. The race culminated in 1969 when the United States landed the first humans on the moon. After completing his training in anesthesiology, Dr. Cloid Green forged his career as one of the physician-scientists who played an integral role by evaluating the effects of space flight on human physiology. Family members of Dr. Green were interviewed and university and society archives, literature and periodicals were reviewed. Dr. Cloid Green received his medical training at the University of Minnesota. He earned his MD in 1946 before moving to South Dakota and working as a general practitioner. A combination of professional curiosity and the military's request for further service led Dr. Green to complete an anesthesia residency at the University of Iowa. After training, he was assigned as the physician in charge of a bomber wing at a base near Austin, Texas, in 1957. Due to his research on the effects of high altitude on pilots, he was recruited to the Brooks Air Force Base. Dr. Green was the ranking medical official overseeing early space flights involving monkeys. After leaving the USAF, Dr. Green practiced anesthesiology at the University of Virginia before moving to Newfoundland, Canada. He became the first chair of Anesthesiology at the Memorial University of Newfoundland in 1969. Dr. Cloid Green's career grew alongside the specialty of anesthesiology in the 1950s. His training in anesthesiology proved to be a versatile and profoundly useful skill set as the specialty became fully recognized. Dr. Green's long and fruitful career is the perfect example of the diverse opportunities afforded by anesthesiology training.

From Pulling Teeth to Pulling Legs: How Dentist-Anesthetist Samuel J. Hayes Was Mistaken for President Rutherford B. Hayes.

Newspaper editor AH Beitch recorded an anecdote in which a group of barbers gave complimentary treatment to dentist-anesthetist SJ Hayes, whom they had mistaken for US President Rutherford B. Hayes.

Anesthetists and Intensivists Who Defied the Cold War.

The term "Iron Curtain" described the barrier between communist East Europe and the capitalist West from 1945. Next the term "cold war" was introduced for the confrontation between these two sides without open warfare, because of the deterrent of atomic weapons. Restriction in collaboration between those on either side extended to the medical profession, including anesthesia, resuscitation and intensive care. Archives and publications from both sides of the Iron Curtain were perused to reveal the important role of those who defied the Cold War to maintain collaboration between anesthesiologists. From 1956 the British doyen of anesthesia, Sir Robert Macintosh began liaison with personnel in the USSR, which led to reciprocal visits. In this liaison a notable Russian anesthesiologist was Igor Zhorov. Then the WHO Copenhagen Anaesthesiology Centre had an impact. Later liaison from the USA came via Emanuel Papper, followed by Peter Safar. Other notable participants included Vladimir Negovsky from the USSR as well as Hugo Keszler and Jiri Pokorny from Czechoslovakia. These efforts in collaboration helped improvement of standards on both sides of the Iron Curtain.

At the birth of pediatric anesthesia in Mexico: An interview with Dr. Estela Melman, a pioneering woman in medicine.

Dr. Estela Melman (1939-present), Professor in the Department of Anesthesiology, the American British Cowdray Medical Center, Mexico, is an influential pioneer who has shaped the scope and practice of pediatric anesthesia in Mexico and throughout the world. Her early work to reintroduce neural blockade into routine pediatric anesthetic care, particularly the caudal approach to the epidural space, helped to transform current anesthesia practice. Based on a series of interviews held with Dr. Melman between 2016 and 2017, this article reviews the remarkable career of a pioneering pediatric anesthesiologist.