From UWSMPH - Department of Anesthesiology
The arrival of Ralph M. Waters as a faculty member at the new medical school of the University of Wisconsin in 1927 marked the beginning of the modern era in Anesthesiology. Instruction in anesthesia was nonexistent and the field was practiced by only a few self-taught men. Dr. Waters' contributions to the specialty over the ensuing decades are legendary. Foremost, however, was his contribution to anesthesia education. In creating the first academic program of Anesthesiology in the United States here at the University of Wisconsin-Madison, Dr. Waters began a legacy of excellence that lives to this day.
September 2017 marks the 90th anniversary of the arrival of Ralph M. Waters, M.D., in Madison, Wisconsin. From 1927 until 1949, a span of 22 years, Waters was able to revolutionize the practice of anesthesiology. Remembered most often for starting the first university-based residency training program, Waters’ contributions are more extensive than that, but often his work has remained unknown. In a time when anesthesiology was just being defined as a medical specialty, Waters worked to ensure that it was set on an equal footing within the university with surgery, internal medicine and pediatrics as well as the traditional hospital- based specialties of radiology and pathology.
Dr. Waters’ career was an interesting one. He graduated from medical school at Case Western Reserve and established a thriving private practice in Sioux City, Iowa, and later in Kansas City. It was in these two cities where Waters established an ambulatory anesthesia clinic within an outpatient surgical center. 1 Even though his practice was flourishing, Dr. Waters took time to work on some of the problems of anesthesia. He researched and wrote on carbon dioxide absorbance 2 and developed a cuffed endotracheal tube 3 with Arthur Guedel. Dr. Waters looked to increase his skills, and enrolled as a voluntary resident at the Mayo Clinic for three months in 1926 to learn regional anesthesia from John S. Lundy, M.D. Later that year, Dr. Waters injured his back, and while recovering, he sought a less strenuous practice.
The University of Wisconsin afforded him both a different type of practice and an opportunity to “…work toward bringing back anesthesia into the medical profession where it originally was and where it undoubtedly belongs. The only way I could see of really basically helping this movement was through the educational institutions.” 5 The challenge Dr. Waters accepted in 1927 was to design and implement a residency training program in anesthesiology. Dr. Waters chose to make the training three years after the internship, with the first and third clinical and the second laboratory-based research. Dr. Waters preferred residents who had already been in general practice for a few years as these candidates were more mature.
Dr. Waters’ reception at the university was warm. Chauncey Leake, the Chair of Pharmacology and Toxicology, wrote a letter to Waters on February 2, 1927. In it, Leake states, “I want to express to you my great pleasure at the opportunity of cooperating with you. … We should be very happy to have you talk to our students at the 11 o’clock lecture, Thursday, March 8, on the general subject of practical anesthesia…” 7 The anesthesia community at large also was very receptive to what Dr. Waters was doing in Madison. Francis Hoeffer McMechan, M.D., the leader of organized anesthesia at the time and a recognized international figure, was addressing anesthesia meetings and “…talked most enthusiastically of the work you are doing in Madison. He described in considerable detail the organization you have worked out and the plans you have for the future. He also laid great stress on the actual achievement you have made and in general held up your work as an example for the whole country to follow.”
Once established, Dr. Waters’ next greatest challenge was to transplant the residency training program to another site while keeping his program alive. A unique opportunity arose in 1934, and Dr. Waters’ most experienced resident who had remained on the faculty after completing his training, Emery A. Rovenstine, M.D., accepted the position as director of anesthesia at Bellevue Hospital beginning in 1935. While Dr. Rovenstine had a difficult time changing surgical practice in the first few months, his results spoke for themselves. Mortality on the surgical service plummeted. Dr. Rovenstine then developed his own training program, molded after Waters’. Soon the two were sharing residents and looking for universities that wanted to develop academic programs in the specialty in which to place their graduates.
Had establishing an academic department in anesthesia been Dr. Waters’ only contribution to the field, his career would be worthy of study. Yet he was much more involved. In the years before arriving at Madison, he had become enmeshed with the new professional anesthesia societies and had become a close personal friend of Dr. McMechan. He presented numerous papers and published the results of his work long before he became associated with the basic scientists at the University of Wisconsin. Once established in Madison, however, Dr. McMechan relied on Waters to have papers for meetings and to keep a steady flow of young physicians interested in anesthesia coming to the meetings.
It is with pride that the principles Dr. Waters espoused of superior patient care, teaching, and research continue to guide the University of Wisconsin Department of Anesthesiology.
The ASA Newsletter from September 2001 has several articles on Ralph M. Waters.