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The World Federation of Societies of Anesthesiologists

1997; Lippincott Williams & Wilkins; Volume: 84; Issue: 5 Linguagem: Inglês

10.1097/00000539-199705000-00033

1526-7598

Douglas R. Bacon,

Medical History and Innovations

Francis Hoeffer McMechan (Figure 1), the tireless, arthritic, wheelchair-bound organizer of anesthesiology, died June 26, 1939. The World Federation of Societies of Anesthesiologists (WFSA) was conceived in September 1951 after a meeting of the International Anesthesia Research Society (IARS) with the Associated Anaesthetists of Great Britain and Ireland, the Societe Francaise d'Etudes sur l'Anesthesie et l'Analgesie, and the International College of Anesthetists [1] in London. How then, could McMechan have anything to do with a federation formed 12 years after his death? What ideals did McMechan espouse that would leave such a lasting impression on his colleagues that he could be regarded as a guiding force in the WFSA founding? What is the real importance of the WFSA?Figure 1: Francis Hoeffer McMechan (photograph courtesy of the Wood Library-Museum of Anesthesiology).Francis Hoeffer McMechan's Achievements Francis Hoeffer McMechan was a unique individual who was driven to advance anesthesiology. When crippling rheumatoid arthritis made working in the operating room impossible, a wheelchair-bound McMechan turned his considerable talents toward advancing the specialty through the use of his pen. McMechan began both the Yearbook of Anesthesia and the Quarterly Supplement of the American Journal of Surgery [2]. Using the latter publication, McMechan created a forum to disseminate information of interest to physician anesthetists1 of both political and scientific interest [3]. The supplement also served as the official publication of the Scottish Society of Anaesthetists [4], beginning McMechan's international connections. (1) Until after the Second World War, a physician who specialized in anesthesiology was referred to as a physician anesthetist. McMechan was also active in establishing societies devoted to anesthesiology. He was a founding member of the New York Society of Anesthetists,2 an out-growth of the Long Island Society of Anesthetists, which was established in 1905 and was the first society dedicated to the specialty in the United States. McMechan was also present at the founding of the first national anesthesia organization in 1912, when the Associated Anesthetists of America (AAA) was formed. He worked as secretary and later as secretary general of that organization and, in 1913, created the first national meeting in anesthesiology called the Congress of Anesthetists.3 At first, the group met during the American Medical Association Annual (AMA) Meeting, but during the 1930s, when the rift4 between McMechan and the AMA widened [5], the meeting was switched to coincide with the American College of Surgeons Meeting. (2) Minutes of Meeting 1911. The Collected Papers and Minutes of the Long Island, New York, and American Society of Anesthetists. The Wood Library-Museum of Anesthesiology Collection. Park Ridge, IL. (3) A program for this meeting may be found among the Collected Papers of Albert Miller, MD. The Wood Library-Museum Collection, Park Ridge, IL. (4) McMechan was opposed to the practice of anesthesia by practitioners other than physicians. On multiple occasions, he petitioned the AMA to ban the practice of lay anesthetists from hospitals they approved. The AMA did not do this and eventually developed a negative view of McMechan. After his death in 1939, John Lundy began to make overtures for a section on anesthesia at the AMA annual meeting-a necessary forerunner to establishment of an independent specialty board. "I called upon Dr. Olin West and Dr. W. D. Cutter at A.M.A. headquarters, and asked their advice about the situation that had arisen since the death of Dr. F. H. McMechan dot bond [who] controlled the organizations of anesthetists very largely up to the time of his death. While he lived, A.M.A. was unwilling to do much for the anesthetists for fear he would come to control it." Letter from John Lundy, MD, to James E. Pallin, MD, October 2, 1939. The Collected Papers of John Lundy, MD. The Wood Library-Museum Collection, Park Ridge, IL. McMechan, the Internationalist The Annual Congress of Anesthetists greatly influenced McMechan's sense of the international community in anesthesiology. Because he married a French woman (Laurette van Varseveld of Paris in 1909) [6], it was almost natural for McMechan to look toward Europe for additional information and ideas to supplement the North American anesthetic experience. In 1925, at a meeting of the Canadian Anaesthetists Society, McMechan was introduced to the Secretary of the British Medical Association, Alfred R. Cox. After several hours of conversation, Cox invited McMechan and the North Americans to a joint meeting in Europe [6]. The following summer, McMechan held the 1926 Congress of Anesthetists in London in a joint meeting with the Section on Anaesthetics of the British Medical Association. The meeting was termed the first All-World Congress of Anesthetists [7]. The meeting led to further contacts. In late 1926, Ralph Waters, who developed the first academic department of anesthesiology in the United States at the University of Wisconsin at Madison [8], wrote to McMechan requesting his help in arranging for Dr. Helmut Schmidt of Hamburg, Germany, to attend the Congress of Anesthetists.5 McMechan was a gracious host to his German guest at the 1927 Congress and was invited to Germany in 1928. McMechan accepted and spoke at the German Medical Congress in Hamburg. During that trip, McMechan also visited Munich, Prague, Glasgow, and Edinburgh [6]. The following September, he attended the Australian Medical Congress of the British Medical Association. The meeting marked the formation of a Section on Anaesthetics. Dr. Gilbert Brown, President of the Section, summed McMechan's contribution in his opening address, stating, "Dr. Frank McMechan has done more than any other man to organize the anaesthetists of the world. In fact, this Section owes its existence largely to his tireless energy in persuading others to ask, and keep on asking, for a Section on Anesthetics. At this meeting he has formed the last link in his chain of groups of organized anaesthetists throughout the English-speaking world" [9]. (5) Letter from Ralph Waters to Francis Hoeffer McMechan, December 30, 1926. The Guedel Center Archives, San Francisco, CA. McMechan also delivered a paper entitled "The Evaluation of Surgical Risk" and met a young Australian anesthetist named Geoffrey Kaye. McMechan persuaded Kaye to visit America and spend a considerable amount of time with Ralph Waters in Madison [9]. Upon his return to America, McMechan's medical condition became worse, and he spent the next 2 yr confined to bed [6]. McMechan would not travel abroad again, but his work as an organizer paid dividends. The IARS, which he founded in 1922 and which published Current Researches in Anesthesia and Analgesia, had members by 1929 from not only the United States and Canada, but also England, Wales, Ireland, Scotland, New Zealand, Australia, Holland, France, Germany, India, Argentina, Sweden, Brazil, Czechoslovakia, and Japan.6 (6) Data from the International Anesthesia Research Society Directory for 1929. Wood Library-Museum of Anesthesiology Collection, Park Ridge, IL. The International College of Anesthetists The 1930s were a difficult decade for McMechan, the internationalist. The worldwide economic depression made travel and the expense of professional society membership difficult for physicians to afford. Yet, in 1931, McMechan conceived of an organization that would certify physicians as specialists around the world in anesthesiology much like the American College of Surgeons. Several more years of committee work were necessary, but in 1935, the International College of Anesthetists (Figure 2) awarded its first fellowships.7Figure 2: Seal of the International College of Anesthetists (courtesy of the Wood Library-Museum of Anesthesiology).(7) Letter from Francis Hoeffer McMechan to the membership of the International Anesthesia Research Society, December 12, 1932. The Collected papers of Ralph M. Waters, MD. Steenbock Library, University of Wisconsin, Madison, WI. The criteria for fellowships were many and varied. The application requested information concerning medical school and the type of anesthetic practice. Of interest also were the number of cases performed over the past 3 yr and anesthetic meetings attended during that time. McMechan was also interested in the anesthetic papers the applicant had published during his career. Finally, McMechan requested 10 complete case records, with a discourse on lessons learned, with special emphasis placed on cases of perioperative mortality.8 (8) Application for Fellowship in the International College of Anesthetists. The Collected Papers of Ralph M. Waters, MD. The Steenbock Library Collection, University of Wisconsin, Madison, WI. While the clinical criteria for fellowship were not strict and abuses of certification occurred,9 McMechan's college was a success. It permitted, for the first time, a physician to be recognized as a specialist in anesthesiology. Since qualifications were universal, a fellow of the college was identified as a specialist in many countries, especially nations that had not organized a national specialty certification. The International College, such as the WFSA, which would be organized in the 1950s, was important because it was the first time that cooperation among nations concerning anesthesiology was possible. Thus, "advanced" countries such as the United States and the United Kingdom could provide leadership, guidance, and educational opportunities for nations that had few physician anesthetists. Thus, across the world, the standards of practice for the specialty were raised, caring for the most important member of the surgical team, the patient. (9) "One clever intern who during his first 30 days of training and who had given the requisite 10 anesthetists wrote his cases up and was certified!" Letter from Paul Wood, MD, to W. W. Dill, MD, May 27, 1937. The Collected Papers of Paul M. Wood, MD. The Wood Library-Museum Collection, Park Ridge, IL. McMechan's Death and International Events As the 1930s drew to a close, McMechan found his leadership more and more questioned in America. The American Society of Anesthetists (ASA) (the name was changed to American Society of Anesthesiologists in 1945) [10] took the lead in American specialty certification by cosponsoring10 a national specialty board [11]. Voices were raised to begin another American anesthesiology journal, and another scientific annual meeting was proposed.11 McMechan's health began to fail. On June 29, 1939, McMechan died, and the leadership of worldwide anesthesiology was forever changed. (10) The American Board of Anesthesiology was formed by the sponsorship of four organizations: The American Society of Anesthetists (ASA), The American Board of Surgery (ABS), The American Society of Regional Anesthesia (ASRA), and the American Medical Association (AMA). The abbreviations of the names of these organizations form a cross in the official seal of the ABA. It is interesting to note that the relationship of the ABA to several of these organizations has dramatically changed since 1938. The original ASRA folded in 1941. The ABS no longer sponsored the ABA as a sub-board after 1940. The ASA and AMA now have a liaison relationship with the ABA. (11) "With you we agreed to make no publication until such time as [Current Researches in] Anesthesia and Analgesia should not be published or some other individual is editor. In the same manner we promise to hold no congresses as long as the International and Associated societies held theirs." Letter from Paul Wood, MD, to F. H. McMechan, February 8, 1937. The Collected Papers of Paul M. Wood, MD. The Wood Library-Museum Collection, Park Ridge, IL. In the years immediately after his death, leaders in American anesthesiology attempted to find someone to replace McMechan. The direction, scope, and involvement of the IARS in both domestic and international affairs in light of the loss of the most respected leader in anesthesiology was difficult for those assuming leading roles. John Henry Evans, President of the Board of Governors of the IARS, shared responsibility for the McMechan organization with Laurette McMechan (Figure 3) and Emmanuel Klaus, the new editor of Current Researches in Anesthesia and Analgesia. Evans, however, was 63 yr old, and engaged in the full-time clinical practice of anesthesia [12]. The ASA was still weak but growing rapidly, and the roles of the IARS and ASA were often confused. There were discussions held about merging the IARS and the ASA [5].Figure 3: Laurette McMechan (photograph courtesy of the Wood Library-Museum of Anesthesiology).On September 1, 1939, Adolf Hitler's armed forces attacked Poland. The world was soon embroiled in a war, one that, 6 yr later, left Europe largely destroyed. New political and world orders emerged in the after-math of the conflict. In organized anesthesiology as well, a new order came to the fore. The role of the IARS was limited, for its leaders now felt that only the ASA spoke for American anesthesiology. The Congress of Anesthetists had competition, for the ASA and its component society, the New York State Society, began in 1945 to hold annual meetings which rivaled the established one. It seemed as if McMechan's dominance in anesthesia circles had come to an end. The Twenty-Sixth Annual Congress of Anesthetists In 1951, the IARS met in joint session with the International College of Anesthetists, the Associated Anaesthetists of Great Britain and Ireland, and the Section on Anaesthetists of the Royal Society of Medicine. The meeting was reminiscent of the 1926 meeting, with the North American anesthesiologists12 meeting their colleagues from across the world. Mrs. Laurette McMechan led the American group; the IARS had made travel arrangements for the IARS physicians to go by steamer from Quebec to London to attend the conference, tour the British Isles, and finish in Paris, where they would attend the International Congress of Anesthesia sponsored by Societe Francaise d'Etudes sur l'Anesthesie et Analgesie [13]. (12) After the Second World War, the term anesthesiologist came to mean a physician in the exclusive practice of anesthesiology. The French meeting also had a direct connection to Dr. McMechan. In 1936, the French society sent two physicians to represent them at the Congress of Anesthetists. McMechan suggested that a European Congress be established under the French society's sponsorship. Plans were made to hold a meeting in Paris in 1940, and there was considerable enthusiasm for the idea among American, British, Italian, and Mexican anesthesiologists. World events, however, caused the cancellation of the congress.13 (13) Mauve M, ed. Episodes from the history of the establishment of the World Federation of Societies of Anaesthesiologists. The Hague, The Netherlands: 10th World Congress of Anaesthesiologists, 1992:6. Robert Monod (Figure 4), a member of the IARS since the mid-1930s and a fellow of the International College since 1938,14 was one of the members of the French society who proposed during the two European meetings that a worldwide society of anesthesiologists be organized. Along with his colleague Marcel Thalheimer, Monod held discussions in London, which continued in Paris. Jean Dalafresnaye, Secretary of the Council for International Organization of Medical Societies of the United Nations Educational, Scientific, and Cultural Organization was brought in, and he suggested that a committee be formed to help establish such an organization and solicit support for it from various countries [14].Figure 4: Robert Monod (photograph courtesy of the Wood Library-Museum of Anesthesiology).(14) International Anesthesia Research Society Directories 1929-1940. Wood Library-Museum of Anesthesiology Collection, Park Ridge, IL. The Organizing Committee met in Brussels in 1952 to report on the progress made toward organizing the federations. The meeting was jointly sponsored by the Council for International Organization of Medical Societies and the IARS, with each organization providing travel money and other support [14]. Many on the committee members were old friends of McMechan, including the chairman, Harold Griffith of Canada (Figure 5). The United States was informally represented by the IARS. In the first session of the committee, an explanation had to be given by the Americans (Drs. Friend, Sheldon, and Whitacre) as to who represented them. The IARS, they explained, was interested in all matters important to the field of anesthesiology. The proper political representative for the United States, however, would be the ASA. The IARS representatives further revealed that there was no animosity between the groups and that all matters would be discussed with the ASA leadership.15Figure 5: Harold Griffith (photograph courtesy of the Wood Library-Museum of Anesthesiology).(15) Minutes of the meeting of the organizing committee of the World Federation of Societies of Anesthesiologists, 18-20 June, 1953. Wood Library-Museum Collection, Park Ridge, IL. The group determined that there was interest in a World Federation. Reports were heard from 20 different countries concerning the activities of the anesthesiology community. A constitution for the Federation was proposed, and an invitation for a congress was extended by the Netherlands for 1955. Another committee meeting was set for 1954 to ensure that progress was being made on all phases of the Federation [14]. The 1954 Organizing Committee meeting was remarkable for the presence of Dr. Clarence Durshordwe of Buffalo, NY (Figure 6). Representing the IARS, Durshordwe as John Evans' partner was a long-time friend and confidant of McMechan16 and served on the Board of Governors after Evans' retirement from the organization. He also was good friends with the Chairman, Harold Griffith, and the Secretary, Geoffry Organe of Britain. Durshordwe had met these men through his association with McMechan, and he had been their host when they visited Buffalo.17 Business at the meeting was little different from previous committee meetings, and plans were finalized for the Federation and the 1955 meeting. The ASA remained indifferent, and despite the lack of commitment and participation of this strong American group, the Federation went ahead as proposed [14].Figure 6: Clarence Durshordwe (photograph courtesy of the Wood Library-Museum).(16) Conversation between Ronald Batt, MD, and Helen Durshordwe, March 30, 1993. (17) Interview hold between Ronald Batt, MD, and Clarence Durshordwe, MD, November 5, 1975. The first World Congress in 1955 was a success. The IARS provided the official American presence, and Mrs. Laurette McMechan once again developed a grand European tour that ended at the conference [15]. The IARS also agreed to edit and publish the proceedings of the meeting. All papers were translated into English, and the 320-page volume was sent to all IARS members and all registrants at the Congress free of charge. This was a considerable financial investment: 10,000 1955 American dollars helped assure the viability of the new Federation [14]. In 1958, the ASA endorsed the principles and objectives of the Federation and was admitted as a member at the 1960 Toronto Congress. Thus, the 1956 publication of the Congress proceedings was also the last official participation of the IARS for the WFSA [16]. The IARS had, however, been true to the international ideals of McMechan. At the critical moment of the formation of the WFSA, the IARS provided money and personnel to ensure both that the organization was established and that Americans had a voice from the beginning. Conclusion The WFSA was firmly established by 1956. Francis Hoeffer McMechan had by then been dead almost 15 years. Yet, the Federation bears his strong imprint. As an internationalist at a time when his country was increasingly isolationist, McMechan truly believed in the international unity of all anesthesiologists. Ties to the profession cut across national boundaries and politics; the sharing of experience and the results of scientific investigation were far more important. McMechan almost succeeded in creating the WFSA in the late 1920s. His editorship of Current Researches in Anesthesia and Analgesia and his leading role in the IARS and the Congress of Anesthetists had made him an international figure. Because of these activities, combined with his travel, he was known in the anesthesiology community worldwide. His proposal to certify all physician specialists in anesthesiology through the International College of Anesthetists almost succeeded. Despite the obstacles of ill health and a major worldwide economic depression, McMechan succeeded in establishing the idea of a worldwide federation in the minds of physicians in France, America, and Great Britain. It is logical, then, that those that who survived McMechan, including his widow, would take an active and leading role in the establishment of the WFSA. Would the French have proposed a world federation at the ill-fated Paris meeting of 1940, the Congress suggested by McMechan in 1936, as they did in 1951? Monod, Griffith, Organe, Durshordwe, and many others evidently internalized McMechan's teachings and incorporated them into a new world order in anesthesiology when the opportunity arose. Always the dreamer, McMechan simply failed to live long enough to see his vision come to fruition. All anesthesiologists owe him a debt of gratitude for realizing that the specialty benefits when all share their experience and that solving our common problems makes the world of anesthesiology comfortably small.