In her Anesthesia Division report for the last year of World War II, Apgar's frustration with staffing shortages and increased
workload was very clear. Frequent personnel changes, too little teaching of surgical residents, too much teaching of medical
students without adequate supervision, and an increase in surgery schedules, she said, all helped explain why the anesthesia
service left much to be desired. She proposed that the anesthesia division be expanded, and that its medical student teaching
program be changed radically. Anesthesia instruction for interns had improved to the point where it no longer seemed necessary
to provide practical experience for all medical students, she said.
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6 (477,925 Bytes)
ca. January 1946
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
The year 1945 was marked by frequent changes in personnel, too little teaching of the surgical residents, too much teaching
of the medical students without adequate supervision, and an increase in the operatives schedules, all of which factors tend
to explain why the anesthesia service to the Hospital left much to be desired.
Of the 14,713 anesthesias administered, 10,188 were staffed by or supervised by the physician anesthetists. This total is
an increase of 4,288 cases over 1944, and indicates the main function of the department. In addition, numerous consultations
were requested for problems of pain relief, resuscitation or airway difficulties. In Neurological Institute especially, there
was increased cooperation between the surgeons and anesthetists which resulted in better care of the patients with pneumonia,
intubation of patients in the Respirator, and diagnostic regional anesthesia were functions of the anesthetist.
On April 3, 1945, with the assistance of Dr. Cassius Watson, and Dr. Whipple, a Nerve Block Clinic was opened which meets
on Tuesday afternoons on the third floor. To date, fifty patients have received diagnostic or therapeutic nerve blocks. Most
of the patients have been referred by the Vascular, or the Fracture Clinic.
No new agents were introduced. Our experience with curare as an adjunct to anesthesia was enlarged and its use was begun on
the pediatric service. The number of cyclopropane cases increased to 82, most of whom were seriously ill patients. It is likely
that a combination of cyclpropane and curare will have a wide application in the future. Further attempts to minimize the
explosion hazard of the various inhalation agents, were made. Four more floorings of conductive linoleum have been laid, and
more floors will be changed when the materials are available. In spite of many precautions, a serious fire occurred in the
Neurological Institute on December 23rd, during an operation using ether and oxygen. The patient was fortunately unharmed,
but the anesthetist was quite badly burned.
A new technic for adult tonsillectomies was given a trial with fairly good results. After a pharyngeal topical spray, a nasal
endotracheal tube was inserted and anesthesia was produced by pentothal, while curare was used for relaxation of pharyngeal
reflexes. It was thought that both induction time and recovery time would be expedited by this technic. This was not found
to be the case, for at least 15 items of equipment need to be assembled before anesthesia is begun, likewise the recovery
time was most irregular following pentothal, and was often accompanied by extreme restlessness. This involved more postoperative
nursing care, until it was found that the use of more curare and less pentothal was followed by recovery of consciousness
before the patient was returned to bed. This technic is not recommended unless in the hands of expert anesthetists.
On the pediatric service, the introduction of an operation for arterial anastamonis in patients with congenital heart disease,
has imposed a stimulus to improve anesthesia technics in children. Both absorption and insufflation systems have been used
with endotracheal tubes. Since two of the eight patients have died on the operating table, while the upper mediastinum was
being manipulated it is evident that much more needs to be learned about this region operation, and anesthesia methods. It
is probable that vagus nerve block will protect the patients from reflex disturbances arising in this area.
Changes in Staff
Two residents completed their residencies.
Jean Weil, March 31st . . . Private practice
Mary Jordan, Nov. 1st . . . 2nd year at University of Pennsylvania Hospital.
Two residents were reappointed for a second year.
Lila Gairns, May 1st Spent three months at Wisconsin General Hospital.
Mary Hall, Nov.1st.
One resignation was received.
Kingsley Bishop Ducharme, Instructor in Anesthesia resigned on Oct. 15th.
There were three appointments to the permanent staff.
Fernando Diaz was advanced on Mar.1st. to Assistant Anesthetist.
Elizabeth Conover was appointed Assistant Anesthetist on a part-time basis on June 1st, but resigned on November 19th.
Elmer Sanders was appointed Assistant Anesthetist for a period of five months, beginning November 15th.
Four new residents were appointed for a period of one year.
Charlotte Ewart . . . July 1st. from Harlem Hosp.
Marvella Vanney . . . August 1st. Baltimore City Hosp.
Major Homero Trevino . . . August 15th. Mexican Army
Cap't. Donaled Richter . . . November 1st. U.S. Army
One temporary resident was appointed.
Raquel Santos . . . September 15th. Santiago, Chile. for 6 1/2 months.
Two other physicians spent four to six weeks in the department.
Henry Robbins . . . Portsmouth, N.H. April
Lt. William Hall . . . U.S.N. May 1st to June 15th
Two Oral Surgeons spent two to four weeks in the department.
Fred Morrison . . . Kokomo, Indiana . . . June
Joseph White . . . Portland, Maine . . .Oct. 25th to Nov. 7th.
Besides numerous informal discussions, resident teaching took place at the weekly staff meetings held at 4 p.m. on Thursdays,
and at bimonthly evening meetings. Topics were prepared by the residents and after their presentation, a discussion period
followed. Attendance was required at the American Society of Anesthesiology meetings.
The teaching of surgical residents decreased because of the shortage of surgical residents. Only three men spent the afternoons
of one month working in the department: Herter, Hui and Frick.
Second year: Demonstrations of human anesthesia took place on two days, and were accompanied by much discussion. Dr. Van Dyke
and his staff presented the formal lectures.
Third year: The third year elective course of two months, was dropped after one quarter, and was replaced by a required course.
Each group of three or four students, received an average of 4 1/2 days of instruction.
Fourth year: Fourth year teaching was continued until Oct. 25th when it was dropped because of the resignation of Dr. Bishop.
It was found to be impossible to teach four third year students, the fourth year group as well as new residents, in addition
to other duties, without some able assistance.
The fourth year Dental students received two lectures, but no practical work.
Jan. 3rd . . . The Medical Circle
Jan. 12th . . . 2nd Yr. lecture
Jan. 17th . . . 3nd Yr. lecture
Jan. 19th . . . 2nd Yr. lecture
Jan. 24th . . . 3nd Yr. lecture
Feb.2nd . . . 4th Yr. applied Pharm.
Mar.2nd . . . 4th Yr. lecture
Mar.9th . . . 4th Yr. lecture
Mar.19th . . . 4th Yr. dental lecture
Mar.26th . . . 4th Yr. dental lecture
May 2nd . . . Putnam Co. Medical Society
Nov.21st . . . 3rd Yr. lecture
Nov.28st . . . 3rd Yr. lecture
Oct.10th . . . Baltimore City Med. Society
Dec.7th . . . 4th Yr. lecture
Dec.13th . . . Panel chairman, N.Y. State Section Anesthesiology
Dec.14th . . . 4th Yr. lecture
April 1st weekend . . . Aqualumni, Madison, Wis.
Four New York meetings of American Society Anesthesiologists
Nov. 11th Boston, New England Society Anesthesiologists
Dec. 13th-14th . . . Two day symposium, New York City
Duties as treasurer and member of Board of Directors of the American Society of Aneathesiologists continued.
Meetings of the Committee on Public Relations of the New York County Medical Society were attended.
The yearly statistical report for 1944 was not presented at Surgical Staff Conference, as it had been in previous years. 50
Mimeographed copies were distributed to members of the surgical staff.
The annual newsletter from the department was sent to former residents in December.
Four former residents were commissioned in the Army Medical Corps.
Cap't. Robert Gladstone, stationed in Miami, Fla.
Cap't. Charles Stein, who served in E.T.O.
Capt. Belmont Musicant, who served in Burma, China and India.
Major Herman Levin, who served in the Southwest Pacific, Phillipines
In September, plans were submitted to the Director of Surgery for expansion of the anesthesia department. With the construction
of fourteen more operating rooms in addition to the present twenty three rooms, it is imperative to lay the foundations of
a well-organized and smoothly functioning department apart from teaching responsibilities or research work. It was suggested
that an assistant director be appointed, as well as six well-trained men, on graded salaries, to service the private and semi-private
rooms, and a research director. It was hoped that these positions could be established, if such were thought wise, in the
near future, but apparently it has been thought better to postpone such decisions until the new Director of Surgery is appointed.
We believe the plan for undergraduate teaching should be changed radically. It has always been a question as to the wisdom
of practical instruction for the undergraduate student. This course was pursued only because it was felt the future physician
would receive no training in his internship. The status of anesthesia teaching for interns has improved considerably in the
last seven years, and we feel that it is no longer necessary to afford practical experience to all medical students. We believe,
rather, that the surgical and medical house staff officers would profit much more by a consecutive period of time in the anesthesia
department. Our hospital is far behind many others in this respect. We feel very doubtful of the value of 4 1/2 days spent
in a group of four third year students, in spite of the popularity of the course with the students themselves. It is impossible
to present the proper balance of preoperative and postoperative periods as well as the period of actual operation and anesthesia.
We feel that the two months elective course offered for the last two years, and recently discontinued, was much more profitable
to the student in all respects, and we urge its re-establishment. To summarize the changes suggested,
1. All surgical and medical house officers to spend one month on the anesthesia service.
2. Discontinue the required work in third and fourth year anesthesia.
3. Offer an elective course of one or two months to third year students.
4. Increase the didactic teaching of anesthesia to medical students, preferably by discussion groups, or anesthesia rounds
on the wards, in third year surgery.
The financial status of the department continues to be excellent, with a surplus of $12, 432, after deducting professional
salaries from collections of private fees.
It is with great regret that we submit this report to the Director of Surgery for the last time. Without his patient understanding,
and invaluable assistance we should have made no progress at all. We shall be fortunate if he is succeeded by someone even
half as sympathetic as he, with our anesthesia problems.