The Origins of the AUA

Conceived in turbulent times but born in optimism at facing a brave new world, the Association of University Anesthetists (AUA, as it was called at its inception) is an interesting and important manifestation in medicine of the rapid intellectual and societal changes that were taking place in the United States in the immediate post-war (World War II) period. That this new organization was put together in a tumultuous environment is documented by the parting note of the first secretary, who was one of the eight founders of the Association, Austin Lamont. In 1957, he attached two interesting paragraphs to all of the correspondence that he had kept from those who worked to organize the group. On his presentation of the correspondence to the archives of the Wood Library and Museum in Chicago, Lamont wrote (1):

“This folder contains correspondence dealing with the formation of AUA and with the so-called Hingson Report. In both these matters strong personalities were involved. I believe the individuals concerned trusted my discretion, for they would write or tell me things they would not say to each other. There are, therefore, in this folder personal letters not intended for public view.

But someday it may be of interest to a mature organization to look back on these matters. I think it would be a mistake to permit this folder to be opened until 1965 or 1970. By then the persons involved will have mellowed, the controversial issues will have been settled, and the personal references contained in many of their letters will no longer carry the sting they originally had.”

Some consideration, however brief, of the environment in which the AUA first appeared as a structured force in academic anesthesiology is needed to understand the background information important to the story of this new organization’s beginnings.

Academic Anesthesiology

Before World War II, academic anesthesiology was characterized by many healthy accomplishments. The important academic presence in that era begins with and is centered around the first recognized academic department in the United States at the University of Wisconsin chaired and led by Ralph Waters. From the inception of the Wisconsin Department in 1927, Waters and his large coterie of distin- guished followers, including E. A. Rovenstine who brought the academic message from the Midwest to the East at New York University and Bellevue Hos- pital, were engaged in studying the scientific bases of the important clinical problems of that era. Their skillful research in the anesthesiology of that period was a strong beginning. Equally important and interesting was the establishment and subsequent development of an academic arm, with respect to research and teaching at the Mayo Clinic under the leadership of the founder of anesthesiology in that institution, John Lundy. At the same time there were discrete and important burgeonings of interest in intellectual and other scientific matters that dealt with the anes- thetic process. There were individuals who came from other disciplines like surgery, internal medicine, and pharmacology to study the biology of anesthetized humans with great foresight and clarity. Among these people was the young and able Henry K. Beecher who combined a scientific rearing with Professor Krogh in Copenhagen with clinical interest in anesthesia at the Massachusetts General Hospital. Beecher’s book, The Physiology of Anesthesia, pub- lished in 1938, ranks among the landmark develop- ments of the academic strength of anesthesiology. Despite these activities, there was insufficient time and opportunity to develop scientific researchers and teachers in anesthesiology, to say nothing of clinicians, in adequate numbers to have made a major mark upon all academic enterprises in the United States before the War.

The needs of World War II produced a rapid development of marginally educated physicians in anesthesiology to meet the critical exigencies of injury parts of the world.

The Academic Scene in Anesthesiology After World War II

At the end of World War II, the still young but seasoned veterans who had academic interests and talents saw these skills reinforced and greatly ex- tended by the enormous clinical experience brought to them by the unfortunate results of institutionalized killing and wounding that is modern warfare. These young physicians in military anesthesiology were often, and in substantial numbers, attracted to a permanent career in this relatively new discipline; and, as was fortunately the case, a sufficiently strong cohort of this group opted for academic work. The education required for research and teaching careers was, for those days, rigorous. Today, in view of the enormously more complex problems to solve, the adequate clinical and scientific education of the im- mediate post-war era would be viewed charitably as evolutionary in character and accurately as floating on the margin given the problems to be resolved. Between the end of the war and the end of the decade of the forties, there was enough opportunity to accomplish the establishment of new independent departments of anesthesiology devoted to academic purposes of research, teaching, and complex patient care. There were enough individuals with investiga- tive and educational talents devoting their entire career to academic pursuits to become a force mostly of youthful enthusiasm and of raw ability who wished to make anesthesiology the scientifically based discipline that it deserved to be. They worked hard to extend the benefits of those investigations to the care of patients who needed and deserved these attentions. There was a spirit of buoyancy, of pow- erful hope, and of great energy. There was also an important characteristic that marked many of the young leaders of the immediate post-war period. They had courage. Risk taking was known to be necessary and was entered upon with realistic reflec- tions of the possible outcomes. Great success can be gained but equally great failure can ensue if the risk-taking results in an adverse outcome.

Read the Full Article in Anesthesia & Analgesia (March 1992)