Careers in Anesthesiology: Autobiographical Memoirs. Vol. 8 (review)

This series of autobiographies written by noted anesthesiologists was inaugurated in 1996 to mark the sesquicentennial of the first public demonstration of surgical anesthesia. It is published by the Wood Library-Museum, the historical section of the American Society of Anesthesiologists. The present volume comprises the stories of four anesthesia researchers.

A. A. Spence, former president of the Royal College of Anaesthetists and editor of the British Journal of Anaesthesia (BJA), was attracted to anesthesia because it was a developing specialty in 1954, and he could be sure of a job. His exposure to leading British anesthesia researchers led him to a life of research. While BJA editor in 1973, he witnessed developing problems in research, especially the new and powerful role of commercial interests in anesthesia research. He reviews the effect of the National Health Service on research: it did stimulate the expansion of academic departments by funding academic functions, but the only goal was to increase the output of anesthesiologists, not to generate new knowledge to advance the specialty.

Julien F. Biebuyck came to Oxford to work in Hans Krebs's laboratory on the mechanism of action of anesthetics at the cellular level. He would never again find the collaborative experiences of that time; he notes that such collaboration is rare in the United States. When offered the chance to build a brand-new department in 1977, he could position research as a top priority. He predicts that there will be no future rapid growth of academic anesthesia such as occurred during his career: in the 1960s, there were only four high-caliber anesthesia programs in the United States; by the end of the 1970s, there were at least twenty.

Richard J. Kitz's chapter is an example of why Strunk and White's Elements of Style recommends, "Do not affect a breezy manner."¹ Exclamation points and "gee whiz" statements fill the lengthy chapter, and the reader soon loses interest. A prologue notes the current state of academic anesthesia. Kitz's personal story follows, frequently stating how lucky he was at various points in his life. This part vividly captures the personalities of some of the great characters in American anesthesia, such as Virginia Apgar, Henry Beecher, Robert Dripps, and Emanuel Papper.

John W. Severinghaus, who developed the first useful electrode for measuring CO₂ in the blood, magnificently records his life as a basic researcher. Born into a medical family, he announced his scientific destiny at age four when he told his mother, "'lectricity' was the most wonderful thing in the world" (p. 188). In the early 1950s, acid-base equilibrium and respiratory physiology were not well understood, owing to problems in measuring pH, pO₂, and pCO₂. Severinghaus did essential work in solving these problems, and his story of how blood-gas electrodes came to be is unmatched. The electrodes led to much better understanding of acid-base disorders, and blood-gas measurement is an absolutely essential part of patient care today. He also applied his ideas and instruments to other problems, such as noninvasive blood-oxygen measurement and high-altitude physiology. Finally, his report on the development of the Cardiovascular Research Institute at the University of California at San Francisco, his base since 1958, is a useful summary of a vitally important research group.

All four authors make clear the importance of links to basic scientists in other fields, the importance of meetings where those working in an area can interact and discuss problems, and the importance of sabbaticals, when problems can be investigated in other settings. This volume adds useful information about how research made modern anesthesia what it is today.