Chapter 1. The Evolution of Anesthesiology as a Clinical Discipline: A Lesson in Developing Professionalism

Douglas R. Bacon

The history of anesthesiology is an interesting and complicated story of professionals seeking to understand the anesthetic state and to anesthetize patients safely.
Shortly after the first public demonstration of ether anesthesia on October 16, 1846, the news spread across the world. At first anesthetics were given based on written accounts, often in the lay press.
John Snow, a London physician, worked out the physics of vaporization of volatile agents by observation off ether and chloroform and used this information to design vaporizers and anesthetic techniques that were safer for the patient.
The first professional organization devoted to anesthesia was the London Society of Anaesthetists founded on May 30, 1893. The first similar group in the United States was the Long Island Society organized by Adolph Frederick Erdmann in 1905. The Long Island Society eventually became the American Society of Anesthesiologists.
Francis Hoffer McMechan organized professional anesthesia. He helped create the first national organization, the Associated Anesthetists of America in 1912, and went on to found several national and international organizations, of which the International Anesthesia Research Society (IARS) remains active. He was the founding editor of the first journal in the world devoted to the specialty, Current Researches in Anesthesia and Analgesia, which is currently published as Anesthesia and Analgesia.
Ralph Water is credited with the first department of anesthesia within an academic setting at the University of Wisconsin in 1927. Much of the current residency structure comes from this seminal department that helped establish the specialty on an equal footing with other medical specialties and created a method to train physicians in the art and science of anesthesia.
John Lundy, working at the Mayo Clinic, organized the Anaesthetists Travel Club, whose members were the leading young anesthetists of the United States and Canada. These individuals helped create, by 1938, the American Board of Anesthesiology, which defined what it meant to be an anesthesiologist in the United States.
The need for physician specialists in World War II exposed a large number of young men to anesthesiology who would not have otherwise considered the specialty. After the hostilities ceased, these physicians returned and helped create the tremendous growth in the 1950s and 1960s that the specialty enjoyed.
In the mid-1950s, the World Federation of Societies of Anesthesiologists (WFSA) was formed. It was the culmination of a dream that dated to the late 1930s. The WFSA made it possible for nations with a long tradition of physician specialization in anesthesia to help train and create the specialty in countries where it did not or does not exist.
In the 1980s, the Anesthesia Patient Safety Foundation (APSF) and the Foundation for Anesthesia Education and Research (FAER) were created. They are additional examples of the professionalism demonstrated throughout the history of anesthesiology. These two organizations work to create a safe anesthetic environment. In addition, they support educational and research efforts in the specialty.