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The Virginia Apgar Papers

Fourth Annual Report of Division of Anesthesia pdf (356,811 Bytes) transcript of pdf
Fourth Annual Report of Division of Anesthesia
Here Apgar reported on the teaching, clinical, and research activities of 1941 in the new Division of Anesthesia at Columbia-Presbyterian Hospital, emphasizing staffing shortages (especially with many medical personnel enlisting for military duty after the attack on Pearl Harbor in December 1941) and the Anesthesia Division budget as major concerns.
Number of Image Pages:
7 (356,811 Bytes)
1942-01 (January 1942)
[Apgar, Virginia]
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
Reproduced with permission of Peter A. Apgar.
Medical Subject Headings (MeSH):
Exhibit Category:
Establishing a New Specialty, 1938-1949
Box Number: 10
Folder Number: 9
Unique Identifier:
Document Type:
Physical Condition:
Series: Columbia-Presbyterian Medical Center Division of Anesthesia Reports, 1939-1946, 1948
Folder: 1941-1943
The 4th year of the Medical Anesthesia Department was marked by an increase in teaching and a change in organization.
Four thousand cases were anesthetized by the group. No new anesthetic agents nor technics [sic] were introduced, though the work begun in 1940 on continuous spinal anesthesia was increased. By December 31st, 430 cases had been so anesthetized, and a favorable impression is created by the results. Twice during the year, research work was begun on determination of Procaine in spinal fluid, with the help of Dr. Hans Clark, but changes in staff and an increase in clinical work, as well as difficulties in the chemical technic [sic] prevented completion of this problem.
The use of Pentothal by the intravenous route has been increased, for short operations, as well as for induction of inhalation anesthesia, and supplementation of spinal anesthesia. Its cautious use in obstetrics has begun. It has not proved feasible for clinic patients who are to be discharged the same day, because of its uncertain recovery period.
The absence of cyclopropane from the list of available agents is still a serious one, both from the point of view of the patients, and from the resident teaching program.
Four residents completed their two year training:
Dr. Charles Stein is Director of Anesthesia at Michael Reese Hospital, Chicago.
Dr. Margaret Galotta is in charge of anesthesia at Hackensack Hospital, Hackensack, New Jersey.
Dr. Olga Schweizer is in charge of anesthesia at Memorial Hospital; with part-time work at New York Hospital.
Dr. Ellen Foot was appointed Instructor in Anesthesia at Columbia University, and Assistant Attending Anesthetist at Presbyterian Hospital.
Two new residents joined the staff:
Dr. Kingsley Bishop -- February 15th
Dr. Mary Ward -- August 1st
Dr. Samuel Rochberg is still in training, with leave of absence of six months to be spent at Welfare Hospital.
Two third year students, Allen Wheelis and Sidney Scudder worked in the department four and six weeks respectively during the summer. Both did very good work, considering their preparation, and Dr. Wheelis especially, showed a real aptitude for the field.
Alden Boyd, of the fourth year class, spent the afternoons of one month, as a student assistant in July.
Besides the weekly staff meeting at 4 P.M. on Thursdays, a monthly Journal Club was held. In December, it was decided by the staff that more would be gained if the residents prepared selected topics and presented one every two weeks, to take the place of the monthly Journal Club. A list was prepared for one year which included all material needed for the American Board of Anesthesiology examinations. It is hoped that the medical students and intern staff may also benefit by these presentations on alternate Thursday evenings, in "N" amphitheater at 7:00 P.M.
The actual number of patients anesthetized by the students was less than the previous year. This was due to a 50% decrease in the number of tonsillectomies performed in Babies Hospital. It is especially unfortunate that this decreases the number of open drop ether anesthesias.
The greatest advance in teaching has been the result of obtaining Dr. Foot as a part-time member of the staff. Three days a week Dr. Foot meets the 3rd year surgical students on their own wards, for an hour's discussion of preoperative and postoperative complications, and choice of anesthesia agents and technics [sic]. Each ward group is met three times during the surgical quarter. It is felt that this fundamental background, third year, will improve greatly the quality of work done during the fourth year.
After much consideration, and with the help especially of Drs. Whipple and St. John, a salary budget was provided, and a source of income established, in an attempt to make the anesthesia department self-supporting. The salary of the Director was adjusted satisfactorily, a part-time assistant and a full-time secretary were added to the permanent staff. Bills were submitted to private and semi-private patients, at the discretion of the surgeons, and the fees were collected by the Hospital. A brief statement follows for the seven months period:
Fees Submitted: $11,485.00; Actually Used: $7,085.00
Income Collected: $11,061.80; Budget Allowance: $8,400.00; Profit: $3,976.80
In time, if this income is maintained, the nurses' salaries and cost of gases and equipment should be added to the budget.
For the present, immediate addition to the budget of two items is needed:
1) Salary for Dr. Foot at $200.00 monthly. At present, she is being paid two resident's salaries.
2) An item for "supplies" to cover the cost of such items as Record Room charges for the punch card study, lantern slides, a skeleton sold to us by the Anatomy Department, etc. $1,000.00 for the year should be adequate.
Efforts to decrease the explosion hazard of anesthetic gases have continued during the year. Mr. Bush has been instrumental in persuading the manufacturers of anesthesia rubber equipment to adopt the methods of the large rubber concerns in the production of really conductive rubber. Many varieties of masks and tubing have been used clinically, and Dr. H.B. Williams and the Hospital Electrical Engineers, have followed the conductivity factors closely, and advised the adoption of such equipment accordingly.
The shoe manufacturers, again at the instigation of Mr. Bush, have produced a more comfortable and more conductive shoe, which is being used by 20 persons on the operating floor.
February, 1941: Second year Lecture in Pharmacology
Two Third year Lectures in Surgery
March: One Fourth year Lecture in Surgery
April: Two lectures to the "Refresher" group of nurses.
Annual Report at Surgical Conference
June: Two lectures to graduate Oral Surgeons in a course given by Dr. D.B. Parker
October: E.N.T. residents on Choice of Agents and Technics [sic] in E.M.T. Surgery
March: Madison, Wisconsin -- Aqualumni, where two short reports were made on Dr. McAllister's and Dr. Scudder's work
April: Buffalo New York State Medical Society -- Paper of Dr. George Burford's on "Fractional Spinal Anesthesia" discussed
June: Cleveland -- A.M.A. meetings
October: Montreal meeting of American Society of Anesthetists
During trip west, several clinics were visited at Cleveland, Cincinnati, Santa Fe, Los Angeles, San Francisco, and Denver.
1) Rochberg, S., and Apgar, R. -- The combined Use of Ephedrin and Epinephrine in Spinal Anesthesia" -- a preliminary report. Anesthesiology January, 1942
2) Apgar, V. "The treatment of conditions resulting from Nitrogen" In Press-Anesthesiology
Dr. F.F. McAllister, at our request, presented a paper to the American Society of Anesthetists in December on "The Effects of Sympathectomy on Dogs under Ether Anesthesia". It will be published in Anesthesiology.
Duties as Attending Anesthetist at Triboro Hospital, as Associate Attending Anesthetist at Welfare Hospital and Treasurer of the American Society of Anesthetists continued.
It is almost impossible to make plans for the coming year. Our main responsibility will be to supply anesthesia for the clinical work, which will be more difficult in view of the shortage on our regular staff, and the scarcity of good residents. Three nurses are leaving with Base Hospital # 2 Unit, and one is resigning. Two new residents were added in January, one on February 1st and one August 1st. There may be other vacancies but these are unpredictable. Dr. Watson informs us that it will be necessary for us to take over most of the obstetrical anesthesia shortly, because of the many residents in Sloane Hospital who have left for active duty. At least two additional anesthetists should be available for this purpose, and an effort is being made to find acceptable applicants.
The second responsibility is to enlarge the teaching program to include the Resident Surgical Staff, and possibly the Medical Staff to provide anesthetists in time of real emergency.
Much more emphasis on principles and practice of resuscitation is being made throughout the teaching program.
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