Reviews of Educational Material  |   June 2003
Holding Court with the Ghost of Gilman Terrace: Selected Writings of Ralph Milton Waters, M.D.
Author Notes
  • Professor, Department of Anesthesia, University of Iowa, Editor-in-Chief, Anesthesiology, 6546 John Colloton Pavilion, 200 Hawkins Drive, Iowa City, Iowa 52242-1009.
Article Information
Reviews of Educational Material
Reviews of Educational Material   |   June 2003
Holding Court with the Ghost of Gilman Terrace: Selected Writings of Ralph Milton Waters, M.D.
Anesthesiology 6 2003, Vol.98, 1525-1526. doi:
Anesthesiology 6 2003, Vol.98, 1525-1526. doi:
Holding Court with the Ghost of Gilman Terrace: Selected Writings of Ralph Milton Waters, M.D.  Edited by David C. Lai M.D. Park Ridge, Illinois, The Wood Library-Museum of Anesthesiology, 2002. Price $30.
My mother always wanted to be a history teacher—and her enthusiasm rubbed off. As members of the history community know, I'm a fan of good historical articles. Such work is not an esoteric luxury—what we know about our origins and forebearers helps define who we are today. Find me a neurosurgical resident who doesn't know Harvey Cushing, or a medicine resident who is unaware of Osler. This book deals with someone who has a place in anesthesia that is akin to these others, not because of a great body of original work, but because he, perhaps more than any other individual, set the stage for anesthesia as a true medical profession and academic discipline. Many of the leaders in our specialty today can directly or indirectly trace their lineage back to this man and his department in Madison, Wisconsin. I was trained by Dr. Richard Kitz, who trained under Dr. Emmanual Papper, who trained under Dr. Emory Rovenstine—who trained under Waters. I work in a department founded by Stuart Cullen, who was trained by Rovenstine, and who in turn trained Ted Eger, John Severinghaus, Bill Hamilton, etc. And the branches of the tree get longer every year.
In one sense, this book is tough to review. It's not a narrative, it's not a story, and it makes no attempt to synthesize or summarize. It's not really about Ralph Waters but rather is a compilation of original papers, book chapters, essays (some on history), and other materials by Waters himself. It's not “history” but rather original historical source material. However, anyone who wants to know “where we came from” owes it to himself or herself to read this book. This is not the first such publication from the Wood Library and Museum—but it's a wonderful example of how the WLM serves our profession by preserving and disseminating material that would otherwise be exceptionally difficult for the average anesthesiologists to find.
Ralph Water's career began at a time when the concept of “anesthesiologist” didn't really exist, and ended it in the 1960s when the concept was well established—in large part through his own efforts. The single factor that struck most me forcefully when reading the various items was Waters’ remarkable wisdom, not about medicine or anesthesia per se  (although that's pretty impressive), but about those aspects of personal and intellectual behavior that are necessary for a person or group of persons to call themselves “professional” or to define themselves as a specialty. He tells us about the time when physicians who wished to “specialize” did little more than hang out a shingle identifying themselves as specialists; there were very few formal residencies and no “specialty fellowships.” Thereafter, it was trial and error—with the patient being the unwitting victim. When Waters started out in general practice in Sioux City, Iowa (in 1913), there were no “anesthesiologists” and almost no one who “unofficially” specialized in the delivery of anesthesia (certainly not in the midwest). Anesthesia was delivered by everyone from office secretaries to nurses, to students—basically anyone who could be instructed in how to pour ether onto a gauze-covered mask. For unclear reasons, Waters was unsatisfied with this situation and decided to become one of these self-taught specialists, practicing medicine himself and also providing anesthesia services to his fellow physicians. Over time, the latter became his sole activity. Perhaps he simply saw an opportunity. To improve his skills, he even spent a few months with Francis McKesson in Cincinnati, the closest he came to any formal training in anesthesia. But as early as 1919, he began speaking out in support of the need for developing anesthesia as a medical specialty. In a 1918 presentation at the South Dakota State Medical Association entitled “Why the Professional Anesthetist” (published in The Lancet  in 1919), he stated, “if by chance, any doctor present can influence a medical-school curriculum one iota toward better instruction in the administration of anesthetic drugs, both general and local, I pray that he may exert all that influence. By that means only can the doctor of medicine of the future be saved the necessity, which must be yours and mine, of digging it out for himself.” In 1927, he had his own opportunity to do just this, when he moved to Madison, Wisconsin, to become the physician in charge of anesthesia at the State Hospital (the predecessor of the University of Wisconsin Hospitals) and soon thereafter to develop what is almost certainly the first academic department of anesthesia in the United States. If judged by his progeny, Waters may be the single most successful department chair ever.
I won't attempt to summarize all of the remaining contents of the book. There are, however, some fascinating items. Consider the following from a paper entitled “A New Intratracheal Cather,” published with Arthur Guedel in Anesthesia and Analgesia  in 1928:“case 3: Dog of about twenty pounds was anesthetized with ethylene…. The catheter was introduced and (the endotracheal tube cuff) inflated. The apparatus was connected and the dog, together with soda lime container, were complete submerged in water and kept there for a period of 1 h (!). During this time there was nothing unusual in the respiration, or pulse or the general conduct of the animal under anes-thesia. …(after removal from the tank and emergence from anesthesia, the dog)…stood up, shook the water off, and lay down for a nap.”
Waters was one of the legitimate pioneers of endotracheal anesthesia—something we take for granted today. There are other examples of areas in which he was a pioneer…. Again, however, the real heart of this book is not Dr. Water's original researches—but rather his thoughts, observations, and recommendations, which are as relevant to our specialty today as they were in 1920, 1930, 1940, 1950, and 1960.
I haven't had this much fun with a book in a long time. I think it belongs on the shelf of every anesthesiologist.