Although quite understandable at the time and, given the aggressive
American habit of striving for immediate results, it is not surprising that the
Mayo brothers took this course. However, declaring anesthesia the practice of
medicine, as the British did, did not really go a long way to solving their
problems until it was understood that several important changes had to occur.
One change was that it really did matter how one educated an anesthesiologist
in order to assure effective patient care and safety. This notion did not
penetrate thoroughly enough until the second decade of the twentieth century,
even in Britain. Anesthesiology needed much more input from the basic
scientific disciplines, especially physiology, pharmacology, and biochemistry.
Scientists working in those areas seemed not to be very much interested in the
problems, in the basic science sense, that anesthetic needs presented. For all
these reasons anesthesiology did not develop sufficiently early and rapidly to a
strong tradition of excellence in the way that internal medicine, surgery,
pediatrics, obstetrics, and gynecology did. The remedy that corrected some of
these difficulties of anesthesia was started in 1927 in the University of
Wisconsin Department led by Ralph Waters and his collaborators in the basic
science departments.

Waters understood the ultimate reliance of anesthesiology on the basic life
sciences. This was really the beginning of making anesthesiology come much
closer to its full potential by the discovering of new information; by applying
the new information to patient welfare; and very important, by providing the
kind of education in science and clinical medicine that was necessary to
position anesthesiology as a major force in dealing with the life and safety of
the surgical anesthetized patient. These disciplines were most important in
improving the collateral clinical and scientific affairs that sprung from the
home base of surgical anesthesia, e.g., intensive care for very sick patients,
resuscitation efficiency, and the management of nonsurgical painful
conditions.

It is urgently hoped that this view of the therapy of pain and suffering, and
of the discovery of America's unique contribution to patient welfare and to the
world of medicine --the invention of anesthesia--was an interesting tale. I
hope it is a modest addition to knowledge and to the virtues of the value of
knowledge about improving the human condition. It is also a statement of the
crucial importance of individuality, subjectivity, and of the democratic state in
development of more effective and more humane therapies to improve the lot
of humankind.

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