In 1938 Apgar became director of the new Division of Anesthesia at Columbia-Presbyterian Hospital. In early 1939, she was
able to give a good report on the division's first year of operation, including the addition of anesthesia residents to
the staff, attending 940 surgeries, teaching medical students, and several research projects. In this first report, Apgar
was optimistic about achieving the goals of the new division.
Number of Image Pages:
3 (2,745,018 Bytes)
ca. January 1939
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
On January 15, 1939, the first year of Medical Anesthesia was completed. Above all, we wish to express our deep appreciation
to the Surgical Staff, and especially to its Director, for their splendid cooperation, without which very little can be accomplished.
The House Staff also have been stimulating in their interest, and eager to act on suggestions with regard to choice of agents
and technics [sic], and pre-medications. Miss Penland and her associates rendered us invaluable assistance which leaves nothing
to be desired, especially with the planning of the teaching schedule. The administration has been most helpful with our demands
for new equipment, and with the numerous problems related to the establishment of residencies.
The general plan for teaching, clinical work, and research has been inaugurated.
A. Clinical Work: 940 cases on 13 services were anesthetized by medical anesthetists. A detailed chart has been kept of preoperation
and postoperation complications as well as operative data for each case. For each chart a Hollerith Punch Card was made according
to the National Anesthesia Code. Data from these cards will be available within a month. Miss Dorothy Kurtz has made many
valuable suggestions and future use of this method of statistical analysis will be under the direction.
B. Residencies: Two residents in anesthesia have been added to replace vacancies on the surse [sic] anesthetist staff. Dr.
Robert Gladstone began service October 15, 1938 and Dr. Charles Stein December 8, 1938. The teaching of the residents has
been individual, to date. Dependent in their past experience. An effort is made to acquaint them thoroughly with inhalational
methods and agents as the basis for their anesthesia training. Intravenous methods have been used in Sloans Hospital and
the Ear Nose and Throat service. The regional technics [sic] have been practiced frequently on cadavers and used at the request
of the various clinics in dealing with intractable pain. Anesthesia staff meetings have not yet been started because of the
small size of the group, but the weekly staff meeting at Bellevue Hospital has been attended regularly.
C. Undergraduate Teaching has proved to be quite time-consuming but this will be remedied as the resident staff is increased.
Since September 1st, over 300 cases have been anesthetized by the fourth year students. Each group in addition has received
an average of 8-10 hours of didactic work during the 8 mornings of anesthesia work, a certain amount of outside reading is
also required. One combined clinic on "Resuscitation" was given in November.
D. Meetings: One short talk on "Neurological Complications of Spinal Anesthesia" was given at a Surgical Conference
At the yearly meeting in April of Dr. Ralph Water's former residents at Madison, Wisconsin, a report on "Oxygen Want
in Spinal Anesthesia" was made.
The first two lectures in the House Staff Graduate Series were on the subject of "Anesthesia".
On October 19, the visiting Congress Of Anesthetists was entertained at the Presbyterian Hospital. About 150 members attended.
Papers were presented by Drs. Humphreys and Moore, Dr. Barach, and Dr. Williams and one paper from this division on "Experience
with Pontocaine Spinal Anesthesia".
Other meetings attended were those of the American Society of Anesthetiests [sic] at New Haven and New York, besides the week
of meetings of the Congress of Anesthetists.
E. Research: Two research problems are under way, one with Dr. George Humphreys on the "Effect of Intrathoracic procedures
on circulation in the human subject" and one with Drs. Drew and Scudder on "The Effect of Avertin on blood specific
gravity". Apparatus is being assembled for work on the "Effect of Avertin anesthesia on pulmonary ventilation".
F. Library: Mr. Firming the Medical Librarian, has obtained all the 200 references suggested as a basis for an anesthesia
library as well as complete bound sets of "Anesthesie et Analgesie", "Schwerz-Narkose" and "Giomale Italiano
de Anestesia e di Analgesia". The British and American Journals will soon be completed. In addition two "Bibliofilms"
of a rare copy of "A Physical Dissertation on Drowning" published in 1747, and of "The Connexion of Life with
Respiration", 1788 have been obtained from the Library of Congress. These are the first Bibliofilms to be requested for
the medical library. The Reprint collection is being enlarged frequently.
G. Miscellaneous: One explosion resulted from the use of nitrous oxids-ether anesthesia in Sloane Hospital. The case was
investigated by Drs. Horatio B. Williams, Kenneth Cole and Karl Connell. The explosion hazard in anesthesia is constantly
being studied and the technic [sic] is being changed to increase the safety margin for both patient and anesthetist.
Many visitors brought us interesting problems from many countries. Among the Anesthetists entertained were some from London,
Vienna, Capetown, South Africa, Santiago, Chile, and Sydney, Australia.
The first part of the examinations for Fellow of the American Board of Anesthesiology was passed in October. The second part
will be taken this year. Work for the degree of Doctor of Medical Science in Anesthesia will begin as soon as time permits.
Plans for 1939: The enlargement of the Anesthesia staff will continue as started -- by replacing vacancies in the nursing
staff with graduate physicians planning to specialize in anesthesiology.
The residents training will be enlarged to include the Eye, Neurological and Obstetrical services as time permits. We have
already been requested to take over all the obstetrical anesthesia but this is obviously impossible at present. Further opportunities
to perform block anesthesias are needed, whether for surgical procedures, treatment of intractable pain due to malignancy,
or for relief of pain in cases with fractured ribs. The intravenous anesthesia clinics will be enlarged especially in Sloan
Anesthesia staff conferences should be held weekly to discuss interesting cases, deaths, and numerous topics related to anesthesia.
It is also planned to have residents present on division rounds, whenever possible.
Miss Kurtz has suggested a solution for the problem of keeping detailed charts, having them incorporated in the patient's
record during the hospital stay, and filed permanently in the anesthesia office for teaching purposes. This will be tried
out in the near future.
It would be desirable in the new plan for training of surgical residents, to include some work in practical anesthesia.
Meetings at Madison, Wisconsin in April, and the A.M.A. meeting in St. Louis, Mo. will be attended, the latter as a demonstrator
of the Anesthesia Exhibit.
Again we express our appreciation of the cooperation given by the Surgical Staff and trust it will continue in 1939. Criticism
of the anesthesia service is invited and any suggestions will be carefully considered.