Waters established the first anesthesiology residency program at the University of Wisconsin in 1927, and Virginia Apgar was
one of the residents in early 1937. When she became chief of the Division of Anesthesia at Columbia-Presbyterian Hospital
in 1938, she consulted her mentor on several issues. Here, Apgar had asked Waters about the best way to handle relations with
surgeons and other attending physicians. Waters' response reveals much about the challenges faced by physician-anesthesiologists
as part of the operating room team during this period.
Number of Image Pages:
2 (106,745 Bytes)
1938-03-05 (March 5, 1938)
Waters, Ralph M.
University of Wisconsin. State of Wisconsin General Hospital
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
Your letter was both entertaining and instructive and I appreciated a lot your taking the time to write it. Both Miss Hanson
and I are up to our ears in work and this is just to say that I like your way of going at things, and that I have, strangely
enough, only one suggestion to make. It has long been my practice to say as little as possible to either surgeon or internist
involved in a case, of what I expect to do in the way of technic [sic] or the choice of drugs before operation begins. Of
course one does have to admit that he is not going to use block or that he is not going to use inhalation, but further than
that I think it useless to make a statement and actually dangerous. I think I told you of the time that I promised a doctor
friend that I would give him nothing but ethylene while he had his gall bladder removed and did it in a really serious way.
I killed him with ethylene. Since then I have felt justified in saying to any one who asks me, "Doctor, what are you
going to give this patient?" something like the following: "Doctor, no anesthetist can foresee what will happen during
an operation. I should therefore feel very much better if you would let me use my judgment from moment to moment as to what
agents and technic [sic] seem best to fit the needs that confront me." In this way, I have saved harming many patients
in trying to live up to what I had said before. I might say parenthetically that I have also been able to use agents at times
which I know would not have met with the approval of the questioner, and the sum total result has been perfect satisfaction
to that questioner. You're the anesthetist and your best judgment at the moment is what can best be used. Therefore,
why argue with an internist as to whether it is good to use cyclopropane or some other agent. In regard to cyclopropane,
I might say that my answer is to inquiries, cyclopropane is an experimental agent. I never push it, nor argue about it.
If, however, I want to use it, I do so, and try to make sure that I am using it for an honest reason.
Believe me when I say that you will be most welcome here in Madison whenever you can come.
Again, I liked the tone of your letter.
Ralph M. Waters, M. D.
Department of Anesthesia.
RECIPIE FOR MOVING INTO A PLASTIC SURGEON'S OFFICE WITHOUT AN INVITATION - by V.H.
Take 1 green file and move it inside the door.
Use 1 desk, any size, inside the office in time of great need,
Garnish with a punch card machine, any size.
Move in 1 desk in one available corner, mix with 1 typewriter and a lot of noise.
Move in 1 student assistant with desk.
Thoroughly mix the ingredients with apologies and offers to keep one desk cleaned for his honor, the plastic surgeon.