THE UNIYERStTY OF WiSCONSfN
STATE OF WISCONSIN GENERAL HOSPITAL

              YADlaON

January 6, 1939

Dr. Virginia Apgar
617 W. 168th Street
Hew York City, New York

Dear Doctor Apgar:

I understand that you have started in to rob cradles. This is a

grave disappointment to me. There are plenty of eligible bachelors already in
their long trousers, especially in Mer York City. why, then, should you go to the
cradles of Texas for your interest in the opposite sex? It may be, however, that
you are simply helping to train the oncoming generation early. In that case, I
shall have to admit the soundness of your activitie6.

        This is to put in a good word for Doctor Wellwood Nesbit, whom you
will remember as the head of the E.M,T. department at Wisconsin General. YOU as
a native New Yorker probably do not appreciate how scared we of the midwest are
when we go to the great city. Nesbit tells me that he has to come to your insti-
tution; namely, Presbyterian, to do a tonsillectomy next Wednesday. Whether he
acts it or not, he pill be scared to death and it occurs to me that you could
probably make life much easier for him on that day if you were to know ahout his
predicament.

Whether you ever gave an anesthetic for him for tonsillectomy or not,

I do not remember. 1 should say, therefore, that under ordinary ciraumstanoes he
does an extremely rapid and neat Sluder type of operation. It is a distinct ad-
vantage for such an operation to have the patient thoroughly anesthetieed and well
relaxed. He is a very tolerant individual and will not object to waiting a few
minutes for the anesthetist to have the patient thorouphly ready.

Far be it from me to suggest how you should conduct an anesthesis

for him if circumstances were to permit you to take care of it yourself, hut I
could say that the metho& which I have found most spplibablc has been to thoroughly
relax the patient with ether rather repidly, changing to a mouth hook,once I am
ready for him to start,and blowing nitrous oxide-oxygen and ether rapidly through
the mouth hook to maintain deep anesthesia until I am sure that he has oontrol of
the situation, then I have cut off the ether, holding it with nitrous oxide-oxygeu
while a large part of $he ether blows off,
possible to handle ala youngste very satisfactorily for him Pithout any intubation.
The mistake made is always in, + eeping the closed mask on long enough to get a
thorough saturation of the blond. Of course, one does not aim at a thorough saturation
of all the tissues. By such a technic, most of his patients, even thouph having some
light prernedication,.are able to spit when they leave the operating room. If the
youngster is too o16for this technic, he will have no
taking the tube out for removal of the adenoids if any.

Conducted in this way, it has been

objection to nasal intubation,

I hope you will pardon me for any suggestions as to how to handle

him from a technical standpoint. Probably you would do it much better without any
suggestions from me. The main point is that f ranted you to know that he would be

#2 Dr. Virginia Apgar

there so that if you found it convenient, you could sort of welcome him to your
institution. I know it will make him feel much happier about the whole thing.
Anything that you can do to make a fellow physician happier, you will be rewarded for
in the Great Beyond.

           The Waters family greatly appreciated ysur holiday greetings and I
think I need not say that the department looks forward to coming visits from the
whole crowd at Easter time with a great deal of pleasure.

With kindest personal regards, I am,

Yours,

Depar tmen t of  An e8 t he si a.

RMW: vmh