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. In this letter, Waters wrote to let Apgar know about an upcoming visit
from Dr. Nesbit, an ear, nose, and throat specialist, and discussed the best way to handle the anesthesia for the surgery
he would do while in New York. Waters' reference to "cradle robbing" may refer to the difficulty Apgar experienced
in recruiting anesthesiology residents from the New York area.
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1939-01-06 (January 6, 1939)
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]
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 New 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 activities.
This is to put in a good word for Doctor Wellwood Nesbit, whom you will remember as the head of the E.N.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 institution; namely, Presbyterian, to do a tonsillectomy next Wednesday. Whether
he acts it or not, he will 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 about his predicament.
Whether you ever gave an anesthetic for him for tonsillectomy or not, I do not remember. I should say, therefore, that under
ordinary circumstances he does an extremely rapid and neat Sluder type of operation. It is a distinct advantage for such
an operation to have the patient thoroughly anesthetized 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 thoroughly ready.
Far be it from me to suggest how you should conduct an anesthesia for him if circumstances were to permit you to take care
of it yourself, but I could say that the method which I have found most applicable has been to thoroughly relax the patient
with ether rather rapidly, 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 control of the situation, then
I have cut off the ether, holding it with nitrous oxide-oxygen while a large part of the ether blows off. Conducted in this
way, it has been possible to handle all youngsters very satisfactorily for him without any intubation. The mistake made is
always in, not keeping the closed mask on long enough to get a thorough saturation of the blood. Of course, one does not
aim at a thorough saturation of all the tissues. By such a technic [sic], most of his patients, even though having some light
premedication, are able to spit when they leave the operating room. If the youngster is too old for this technic [sic], he
will have no objection to nasal intubation, taking the tube out for removal of the adenoids if any.
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 I wanted you to know that he would be 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 your 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.