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Anesthesia & Analgesia

1997; Lippincott Williams & Wilkins; Volume: 85; Issue: 2 Linguagem: Inglês

10.1213/00000539-199708000-00001

1526-7598

Douglas B. Craig, John T. Martin,

Anesthesia and Sedative Agents

The first issue of Current Researches in Anesthesia and Analgesia appeared in August 1922 as a bimonthly publication of the National Anesthesia Research Society (NARS), the organizational precursor (1919-1925) of the International Anesthesia Research Society (IARS). The linear descendent, Anesthesia & Analgesia, now produced monthly, is the oldest active publication devoted specifically to the specialty of anesthesiology. The 75th anniversary of Anesthesia & Analgesia provides an opportunity to review its history, as well as that of the IARS, and to celebrate the achievements of both. The early history of the Journal and the Society was documented by Dr. T. H. Seldon on the occasion of the 50th anniversary of the Journal, then titled Anesthesia and Analgesia…Current Researchers [1]. Enough of that earlier information is included in this article to provide continuity for the more recent history. Also recalled is the key role played by the IARS in the creation of the World Federation of Societies of Anaesthesiologists (WFSA) and in the first WFSA Congress. Several newer programs of the Journal and Society include the 1983 establishment of the IARS Research Awards Program, affiliations beginning in 1994 between Anesthesia & Analgesia and several subspecialty societies in anesthesiology, and the 1996 development of The Electronic Anesthesiology Library (TEAL) project. A tentative look at the future concludes this historical review. Anesthesia & Analgesia 1922-1997 In the 75 years since 1922, Anesthesia & Analgesia has had only five Editors, plus an interim Editor who was responsible for the final three Journal issues of 1939. It is convenient to examine the history of Anesthesia & Analgesia and of the NARS/IARS within the time periods coinciding with the terms of the five Editors. Francis Hoeffer McMechan, MD (1922-1939) The early years of the NARS/IARS and the Journal were dominated by one man, Francis McMechan. A 1903 graduate of the College of Medicine of the University of Cincinnati, Ohio, he was the third generation of his family to practice medicine in southwestern Ohio. Early in his career, he had shown unusual skill in administering anesthetics, perhaps as the result of assisting his physician father in the care of patients. When the demands of colleagues for McMechan's anesthesia services rapidly engulfed the remainder of his general practice, he became one of the first full-time anesthetists in the country. Less than 2 years after his 1909 marriage to the vivacious and energetic actress, Laurette VanVarsveld, McMechan developed severe rheumatoid arthritis that stiffened and deformed him sufficiently to confine him to a wheelchair, rapidly making him dependent on others for his every need. This skeletal deformity caused McMechan to learn to sleep sitting in a chair, so that his eventually fused body could always be accommodated in the wheelchair that offered him the mobility to travel the world. As a result, his wheelchair was described as a device that contained, but never confined, Francis McMechan. Deprived of the ability to practice medicine, McMechan's boundless energies shifted to managing and promoting the literature of the fledgling specialty of anesthesia and assisting with the development of its organizations. Throughout his life, he was a major catalyst in the evolution of our profession. In 1908, a group of interested anesthetists began to meet regularly with McMechan to discuss current problems and interests. At the 1912 meeting of the American Medical Association (AMA), those present from the discussion groups established the American Association of Anesthetists (AAA), whose first formal meeting held in Minneapolis, Minnesota, at the time of the 1913 meeting of the AMA. After the onset of World War I, McMechan became secretary of the AAA. A dearth of research in anesthesia prompted a group of practitioners of anesthesia, researchers involved with the specialty, and representatives of related industries to meet at the Union Club in Cleveland, Ohio, on December 18, 1919 [1]. There they formed the NARS. As time passed, however, the presence of industry representatives in the NARS provoked such controversy among the membership that the group failed to thrive. Consequently, at a 1925 meeting in Cleveland, Ohio, the NARS was reorganized as the IARS, with a new constitution that excluded industry representatives. McMechan became the Secretary General of the revised organization as well as the Editor of its journal. Before World War I, increasing literature in the field had prompted McMechan to seek assistance from his friend, Dr. Joseph MacDonald, Jr., the Managing Editor of the American Journal of Surgery. Together they developed within the American Journal of Surgery the Quarterly Supplement of Anesthesia and Analgesia, with McMechan as its Editor. The Supplement was first published in October 1914, with a subtitle indicating that it was the American Journal of Anesthesia and Analgesia (Figure 1). Initially, it was the official organ of the American Association of Anesthetists and the Scottish Society of Anesthetists [2]. In time, the society linkages changed and expanded so that by July 1921, the Supplement served as the official organ of the AAA, the NARS, the Inter-State Association of Anesthetists, the New York Society of Anesthetists, and the Providence (RI) Society of Anesthetists. Quarterly publication continued until 1926, when the American Journal of Surgery changed management and the Supplement was discontinued.Figure 1: Cover page from the first issue of the Quarterly Supplement of Anesthesia and Analgesia of the American Journal of Surgery.The death of Dr. MacDonald in 1922 apparently catalyzed McMechan's concerns about existing publications in the new specialty and whetted his desire to establish a major scientific periodical independent of the parental influence of another journal. As a result, he originated Current Researches in Anesthesia and Analgesia, the first issue of which was published in August 1922 (Figure 2) under the sponsorship of the NARS. The Quarterly Supplement of Anesthesia & Analgesia continued with McMechan as Editor but was no longer the official publication of the NARS. The British Journal of Anaesthesia started publication in 1923, making Current Researches in Anesthesia and Analgesia (and its lineage of renamed descendants; Anesthesia and Analgesia…Current Researches and the current Anesthesia & Analgesia) the oldest dedicated publication in the specialty. With the demise of the NARS in 1925, Current Researches in Anesthesia and Analgesia became the official organ of its successor, the current IARS.Figure 2: Cover of the first issue of Current Researches in Anesthesia and Analgesia, August 1922.The cover page of the initial issue of Current Researches in Anesthesia and Analgesia lists the six-man Board of Governors of the NARS and its 30-member Research Committee (Figure 3). Membership was open to physicians, dentists, and researchers holding doctor of philosophy degrees. McMechan was Executive Secretary of the Society, Chairman of its Research Committee, and Editor of its journal.Figure 3: Early organization of the National Anesthesia Research Society with Dr. F. H. McMechan as Executive Secretary, Editor, and Chairman of the Research Committee. From August 1922 issue of Current Researches in Anesthesia and Analgesia.Comments in the editorial foreword of the initial issue of Current Researches in Anesthesia and Analgesia (Figure 4) remain relevant today. From the outset, the mission of the NARS/IARS has been apolitical, with its focus being the advancement of the specialty of anesthesia through the publication of a journal, the support of research, and the conduct of annual Congresses. The new publication was intended to link the many small anesthesia societies that had evolved. The current affiliation of three other societies with the IARS in support of Anesthesia & Analgesia reaffirms that objective. Emphasis on international aspects of the specialty was an important role of the NARS and remains so with the IARS of today, as its early involvement with the WFSA indicates [3,5]. Support by the IARS of ongoing research currently constitutes a major program that is described later in this article.Figure 4: Editorial Foreword of the first issue of Current Researches in Anesthesia & Analgesia, August 1922.Dr. McMechan was very active in establishing and managing a number of anesthesia organizations during the 1920s and 1930s [1,4]. He was the originator and promoter of organized anesthesia. The AAA lasted until 1926, when it became part of the Association of Anesthetists of the United States and Canada, a group that eventually blended into the IARS early in the years during World War II. The Canadian Society of Anaesthetists appeared in 1920. Participating in the evolution of these and other societies despite his uncompromising physical limitations, McMechan and his ever-present wife/nurse/companion, Laurette, traveled the world as enthusiastic, widely respected ambassadors of the specialty. During the 1930s, Dr. McMechan's health deteriorated further. Because of their extensive travels together throughout North America, Europe, and Australia, Laurette McMechan had become a widely known and admired figure. Almost by default, she became an increasingly prominent influence in the affairs of the IARS and the Journal. The death of Dr. McMechan in June 1939 removed from the evolving specialty of anesthesia one of its most forceful and dynamic early leaders. Dr. Emanuel Klaus of Cleveland, Ohio, a member of the IARS Board, was appointed the interim Editor and was responsible for the final three issues of 1939. At a meeting of the IARS Board of Governors on October 16, 1939, the Board voted to "constitute themselves as a Board of Editors of the Publication of this Society Current Researches in Anesthesia and Analgesia reserving to themselves the power to review all manuscripts and copy to be published in the magazine." The Board also confirmed an earlier resolution (July 1, 1939) to appoint Laurette McMechan as Assistant Editor, and they made formal the appointment of the next Editor. Howard Dittrick, MB, MD (1940-1954) Dr. Howard Dittrick, a Cleveland gynecologist with strong interests in medical history and library activities, was appointed Directing Editor of Current Researches in Anesthesia and Analgesia effective with the first issue of 1940. A Canadian who received his medical degree at the University of Toronto in 1900 and his gynecological training in Cleveland, Ohio, and at Johns Hopkins Hospital in Baltimore, Maryland, Dittrick had practiced gynecology in the Cleveland area for several decades. From 1943 to 1947, he served as Head of the Department of Education at the Cleveland Clinic as well as its Director of Publications. Mrs. McMechan remained with the Journal as Assistant Editor and apparently became the major force in the maintenance of the publication. With the rapid maturation of the new journal, Anesthesiology, the official publication of the fledgling American Society of Anesthesiologists (ASA), competition for manuscripts was increasingly difficult for Current Researches in Anesthesia and Analgesia. Under less than vigorous direction from the Editor and the Board of Governors, it languished and lost readership. Dr. Dittrick continued as Directing Editor until his own death in 1954 at age 77. Despite his lack of professional connection to clinical anesthesiology, he frequently opined editorially in the Journal on a variety of subjects. Thomas Harry Seldon, MD (1954-1976) After Dr. Dittrick's death, Dr. Thomas Harry Seldon (always addressed as Harry), an anesthesiologist at the Mayo Clinic and a member of the IARS Board of Trustees since approximately 1949, volunteered for the editorship. Seldon had earned his medical degree from Queen's University in Kingston, Ontario, Canada, in 1929. He was a general practitioner in nearby Sharbot Lake until recruited by his friend, anesthesiologist Ralph Tovell, to Rochester, Minnesota, and a residency in anesthesiology at the Mayo Clinic. He remained a Consultant in Anesthesiology at Mayo until his retirement at age 65. Having been assigned to supervise the new transfusion service at St. Mary's Hospital, his innovative leadership earned him national recognition and leadership positions in blood banking. His editorship of Current Researches in Anesthesia and Analgesia was accomplished in addition to his full-time clinical responsibilities. Never slighting either task, he became known to neighbors as the gentleman whose study lights were on until the wee hours of most mornings. Harry was active in the American Medical Writers' Association, an organization from which he gleaned many new ideas for his meticulous process of rebuilding the Journal. With many innovative features designed to attract articles and readership, the publication gradually recovered its usefulness. To permit more appropriate referencing, in 1957 the IARS Board of Trustees approved the request of the Editor to change the name of the Journal to Anesthesia and Analgesia…Current Researches. Also in 1957, the Journal was enlarged from its historic pocket size to a 7 x 10 inch page that would be more useful for advertising copy and could carry more text. The covers retained their traditional mustard hue, but article titles appeared in color for the first time. While her participation in the affairs of the Society had diminished in the early 1950s, Mrs. McMechan continued as honorary Assistant Editor of the Journal with an annual stipend from the IARS Board of Trustees until her death in 1970. Historically, and throughout Harry Seldon's tenure as Editor, the IARS Trustees had functioned principally as Associate Editors and had comprised the Editorial Board of the journal. In 1975, Dr. Seldon recognized that his advancing age and, by then, 5 years of retirement from clinical practice, might interfere increasingly with his editorial functions. He resigned the following year at age 71, completing an energetic 22-year tenure as Editor. Always modest, Harry shunned center stage in public activities. Nevertheless, his talent, tenacity, friendliness, encouragement of young authors, and innovative devotion to the affairs of the Journal had reversed its march toward oblivion and restored its literary health. Nicholas M. Greene, MD (1976-1990) Dr. Nicholas M. Greene was appointed Editor in 1976 and began a significant new phase for the publication and the Society. Dr. Greene graduated from The College of Physicians & Surgeons of Columbia University, New York, NY, in 1946, began a surgical residency at Columbia-Presbyterian Hospital, and served 2 years as a medical officer at Annapolis Naval Hospital, Annapolis, Maryland. After discharge from the Navy, he trained in anesthesiology with Dr. Henry Beecher at Massachusetts General Hospital, Boston, MA, and then with Dr. John Gillies at the Royal Infirmary, Edinburgh, Scotland. After a brief stay at Harvard, he was appointed Professor and Chairman of Anesthesiology at the University of Rochester, New York, School of Medicine and Dentistry in 1953, with an additional appointment in the Department of Pharmacology. He was charged with the responsibility of creating the residency training program in the Department of Anesthesiology. Two years later, he moved to Yale University to found the Department of Anesthesiology as its Professor and Chairman and also to be Director of the Department of Anesthesiology at the Yale-New Haven Medical Center, New Haven, CT. He remained in that capacity for the next 18 years before stepping down to devote more time to other aspects of anesthesiology. During a distinguished academic career, Greene displayed his excellence as a teacher, clinician, writer, and lecturer. He was, however, particularly outstanding as an editor, having served first on the editorial Board of Anesthesiology from 1965 to 1972 and then as its Editor-in-Chief from 1973 to 1976. When he was appointed Editor-in-Chief of Anesthesia and Analgesia…Current Researches in 1977, Greene brought to the position a wealth of knowledge, experience, and credibility as an editor and as a consummate academician. His gentle, but always very firm and deliberate, hand on the controls of the Journal steered it in new directions and to new heights, assuring its credibility and its future. Designated Editor-in-Chief, Greene declined to become a member of the IARS Board of Trustees. The Editorial Board members were designated Editors, and most were not simultaneously members of the Board of Trustees. As a result of these changes, the Journal became independent of but remained responsible to the IARS Board. In 1979, the Journal underwent a complete cover-to-cover redesign and was renamed Anesthesia & Analgesia. By the following year, the increasing number of quality manuscripts that it received required that it appear monthly. In 1983, responsibility for publication was assumed by Elsevier Science Publishing (New York, NY), replacing the geographically separate activities that had been used traditionally for its production and distribution. Improved management, plus Greene's highly positive influence on the scientific content of Anesthesia & Analgesia, led to expanded circulation and increased profitability. From the added revenue came funds used to develop and expand IARS research support for the specialty. Dr. Greene remained Editor-in-Chief until his retirement in 1991, leaving behind a highly competitive and well regarded publication. Dr. Greene's honors for outstanding academic achievements have been many, including the ASA Distinguished Service Award in 1989, the T. H. Seldon Distinguished Lectureship at the 65th IARS Congress in 1991, the Emery A. Rovenstine Memorial Lecture at the 1992 annual meeting of the ASA, and appointment as an Honourary Fellow of the Royal College of Anaesthetists (London, UK). Ronald D. Miller, MD (1991 to date) The current Editor-in-Chief, Dr. Ronald Miller, was appointed in 1991 at a time of rapid expansion of subspecialty societies in anesthesiology, as well as increasing numbers of anesthesia journals, both specialty and subspecialty. Addressing these forces of change, Miller developed the concept of a subspecialty having its own identity within the context of a large general journal of anesthesiology. As a result, subspecialty sections of Anesthesia & Analgesia were developed, with separate Section Editors for each. This allowed subspecialties to have control over the scientific output of their discipline and to have a "journal within a journal." Important new relationships were established between several of the subspecialty societies and the Journal. New international editors were added from Japan, England, Belgium (the Editor later relocated to Germany), and Sweden. Under Miller's leadership, Anesthesia & Analgesia is aggressively adapting to the international influence of anesthesiology. In 1993, publishing responsibilities were assumed by Williams & Wilkins in Baltimore, Maryland. Anesthesia & Analgesia is attempting to be progressive in the examination of other forms of communication. Accordingly, an important new CD-ROM project, TEAL, in collaboration with The British Journal of Anaesthesia, Anesthesiology, and the Canadian Journal of Anaesthesia, was launched in 1996. Dr. Miller is a 1964 graduate of the Indiana University School of Medicine, Indianapolis, IN. His anesthesia training and a subsequent Fellowship in Pharmacology were completed at the University of California, San Francisco, in 1968. After 2 years in the United States Navy, during which he earned a Bronze Star with a combat V for service in Viet Nam, he returned to San Francisco, where he has had a very distinguished academic career. In 1980, he became Professor of Cellular and Molecular Biology and in 1984 was appointed Professor and Chairman of the Department of Anesthesiology. He served on the Editorial Board of Anesthesiology from 1978 to 1988 and was appointed Editor-in-Chief of Anesthesia & Analgesia in 1991. Since 1993, he has been a member of the Editorial Board of the British Journal of Anaesthesia. Dr. Miller has been the recipient of many honors, awards, and distinguished lectureships, including appointments as an Honourary Fellow of the Royal College of Anaesthetists of the United Kingdom and of the Faculty of Anaesthetists of the Royal College of Surgeons of Ireland. Widely published, he is the Editor of Anesthesia, the leading multivolume textbook of anesthesia. The Role of the IARS in the Formation of the WFSA In an effort to promote anesthesiology internationally, the IARS held its 1951 Congress jointly with the Association of Anaesthetists of Great Britain and Ireland in London, UK [1,3,5]. There, and 2 weeks later at an anesthesia meeting in Paris organized by French surgeons, discussions took place about the advisability of forming a worldwide organization to assist countries in which anesthesia was not yet reasonably advanced [3]. The idea received support, an organizing committee was formed, and Dr. Harold Griffith of Montreal, Quebec, Canada, then also the Chairman of the IARS Board of Trustees, was made its Chairman. The IARS underwrote the expenses of an expanded committee meeting in 1953, during which it was decided to proceed with the establishment of the WFSA. When invited to join the WFSA, the apolitical IARS declined in favor of the ASA as the United States representative. However, the ASA refused the invitation. The first WFSA Congress was held in Scheveningen, in the Netherlands, in September, 1955, with Dr. Griffith as Congress Chairman. Forty societies were represented by approximately 2000 delegates. The IARS underwrote the publication of the proceedings of the meeting and provided a copy to each attendee. Harry Seldon arranged translation of the papers and provided the extensive editorial effort required. With the leadership of Dr. Griffith, the editorial expertise of Dr. Seldon, and considerable financial support, the IARS played a major role in the success of the First World Congress of Anaesthesiologists. Without the involvement of the IARS, the United States would have had no part in the initial development of the WFSA [1,3]. The ASA did not accept WFSA membership as the United States representative until 6 years later. On several subsequent occasions, the IARS provided financial support for WFSA programs or World Congress events. Although the apolitical nature of the IARS has precluded its full participation as a WFSA member, it played a unique supportive role in the development of the organization. IARS Congresses The first Congress of the NARS after the birth of its Journal, Current Researches in Anesthesia and Analgesia, was held at the Deshler Hotel in Columbus, Ohio, from October 30 to November 1, 1922. Its 71st successor, now the Clinical and Scientific Congress of the IARS, was held March 14-17, 1997, at the San Francisco Hilton Hotel in San Francisco, California. The numerical discrepancy occurs because World War II caused the suspension of the IARS Congresses from 1942 to 1945, and the 1955 Congress was omitted in favor of the first WFSA meeting. All but four of the IARS Congresses have been held in the United States; in 1926 it was held in Nottingham, UK; in 1948 in Montreal, Quebec, Canada; 1951 in London, UK; and 1953 in Quebec City, Quebec, Canada. The size and comprehensiveness of IARS Congresses have increased in the past decade. The 71st Congress encompassed 25 review courses, 33 tutorial workshops, 12 case conferences, an eponymous lecture, and the communication of 598 scientific abstracts as posters and poster discussions. Also featured were a large commercial exhibition and 20 scientific exhibits. The Congresses and the Journal are the two major educational programs of the Society, and they, along with the Research Awards Program, continue to fulfill the mission of the IARS to promote advancement in the specialty. IARS Research Awards Program From the outset, the mission of the NARS/IARS included promotion and support of research in anesthesia (Figure 4). It was not until 1983 that the carefully husbanded funds of the Society became sufficient to honor that commitment by offering direct financial support to peer-reviewed, competitive investigators. Table 1 summarizes the history of the IARS Research Awards Program that began with a single grant in 1983.Table 1: IARS Research Awards ProgramSince 1994, three IARS Clinical Scholar Awards (each $75,000 over 2 years) have been presented annually to support clinical research by qualified young investigators. Also in 1994, the IARS established the Frontiers in Anesthesia Research Award, consisting of $500,000 paid over 5 years and intended to foster innovation and creativity by an individual researcher in the field of anesthesiology. The first Frontiers Award was presented in 1995 to Dr. Beverly Orser of the University of Toronto, Toronto, Ontario, Canada; the second was presented in 1997 to Dr. Rona Gifford of Stanford University School of Medicine, Palo Alto, CA. With this award, the IARS has committed almost $3,000,000 to the support of anesthesia research since 1983. Society Linkages The McMechan era included many links between the NARS/IARS and other societies [1,4]. During the 1930s, those involvements lapsed, and with the exception of the unofficial relationship with the WFSA summarized above, the IARS continued on its own independent course until the 1980s. Several important new relationships then developed between the IARS and the Canadian Anaesthetists' Society (CAS); the IARS and the Japan Society for Clinical Anesthesia (JSCA); then between Anesthesia & Analgesia and the British Journal of Anaesthesia, and, most significantly, recent affiliations with three subspecialty societies. - The IARS and the CAS had a long-standing informal relationship that was formalized by a written agreement in 1991 that provides for IARS joint sponsorship of the CAS Annual Meeting for Category 1 CME Credit under the AMA Physician's Recognition Award, for journal subscription exchange, for exhibit booth exchange at each other's annual meetings, and for journal advertising exchange, among many other less formal but strong ties between the two groups. - Representatives of the IARS and the Japan Society for Clinical Anesthesia met at the 1988 Washington, DC, Congress of the WFSA to plan a joint meeting that would strengthen ties between anesthesiologists in America and the Far East. The result was creation of the America-Japan Anesthesia Congress, which first met in Omiya, Japan, in 1990 and has since held meetings alternately in the host countries. The fourth American Japan Anesthesia Congress convened in San Francisco, California, for 2 days just before the 71st IARS Congress. - The British Journal of Anaesthesia is the journal of the Royal College of Anaesthetists. Anesthesia & Analgesia and the British Journal of Anaesthesia have cooperatively arranged favorable subscription rates for each other's subscribers and work jointly on promotional campaigns. Dr. Ronald D. Miller, Editor-in-Chief of Anesthesia & Analgesia is a member of the Editorial Board of the British Journal of Anaesthesia. - In January 1994, the Society of Cardiovascular Anesthesiologists joined with the IARS in sponsoring Anesthesia & Analgesia, and the Journal became the official publication of both societies [6]. This arrangement was joined in January 1996 by the Society for Pediatric Anesthesia and by the Society for Ambulatory Anesthesia. Thus, Anesthesia & Analgesia is now the official publication of the IARS, Society of Cardiovascular Anesthesiologists, Society for Pediatric Anesthesia, and Society for Ambulatory Anesthesia. The Editorial Board of the Journal includes representation from each of the sponsoring societies, but it remains functionally independent from each. The end result of these important relationships is a greatly strengthened Journal that is published monthly (plus annual meeting Supplements) and distributed to approximately 22,000 members and subscribers worldwide. In addition to the foregoing, the IARS has supported a series of less complex interactions with other organizations. - Annually, the WFSA provides the IARS with a list of anesthesiologists or societies in developing nations whose library access is limited or nonexistent. As many as possible of these addresses are provided with a free copy of the IARS Review Course Lecture Booklet. - Project ORBIS International, based in New York, New York, is a mobile endeavor that flies teams to developing countries to bring ophthalmologic care to underserved patient populations. Training in advanced sight-saving skills for local doctors at the treatment sites is one of their fundamental contributions. Recently, permanent land-based programs have been established in several relatively remote locations. Since 1995, the IARS has supported ORBIS activities with multiple copies of Anesthesia & Analgesia, Congress Review Course Booklets, and Supplements. - The Canadian Anaesthetists' Society International Fund in Toronto, Ontario, Canada, has accepted the task of helping to reestablish the Library of the Department of Anaesthesiology at the University of Addis Ababa in Ethiopia. In support of that goal, the IARS contributed funds to the Canadian Anaesthetists' Society International Fund in 1996 that are being used to purchase textbooks, a CD-ROM drive for the departmental computer, and a subscription to the TEAL project. TEAL TEAL is an exciting new electronic product that combines 5 years of content from four of the leading anesthesia journals worldwide-Anesthesia & Analgesia, Anesthesiology, the British Journal of Anaesthesia, and the Canadian Journal of Anaesthesia-on a single CD-ROM. It contains full text and graphics supplemented by MEDLINE abstracts for reference. Available in single-user, multiple-user, and network versions, TEAL will be updated annually to include the most recent 5 years of publication from each of its journals. This new vehicle compliments the electronic on-line version of Anesthesia & Analgesia that has been available for a number of years from the BRS Colleague and Information Access. The Future Like most things in North American medicine at this time, future directions for the IARS are better defined in broad outline than in minute detail. The combined effects of managed care, a real or perceived surplus of physicians and hospitals, and continued governmental restrictions on health care budgets make predicting events of the next quarter difficult, to say nothing of the next 1 to 5 years. With that proviso, the IARS will continue its search for new and more innovative ways to support research and education in anesthesiology. As traditional funding sources for research become more and more penurious, continued support of the IARS Frontiers in Anesthesia Research Award will be increasingly important. There will be an emphasis on continuing education in anesthesiology. The new Anesthesiology Teaching Recognition Award, first presented at the 1997 IARS Congress, is one example. Another is increased emphasis on electronic means of recording and transmitting information. Translastion of Anesthesia & Analgesia into various languages, while adding locally pertinent articles, is yet a third. The educational and research ties with the societies that are currently affiliated with the Journal will be strengthened, and the IARS will remain open to similar ties with other specialty or national organizations. At the same time, the Society will remain financially sound and apolitical. As always, the challenges are immense, intriguing, and provocative. The authors acknowledge with thanks the assistance of Anne F. Maggiore, Executive Director, IARS; Stephen J. Thomas, MD, Chairman of the IARS Board of Trustees, and James M. Edmonson, PhD, Curator, Dittrick Museum of Medical History, Cleveland Health Sciences Library, Cleveland, Ohio.