sir ralph water Millers 7e 1 History of Anesthetic Practice Ralph M.

. Waters was born in North Bloomfield, Ohio, and obtained his medical degree from Western Reserve University in Cleveland. He began his career in general practice in Sioux City, Iowa, and specialized in delivering anesthesia in 1916. Waters established the first academic program of anesthesiology in Madison, Wisconsin, in 1927. His contributions were many and included the carbon dioxide absorption method, endobronchial anesthesia for thoracic surgery, and introduction of cyclopropane. His chief legacy is the many residents he trained who then became leaders within the specialty in the following generation.

In 1923, Ralph Waters (1884-1979), then working as an anesthesia practitioner in Sioux City, Iowa, contacted Jackson and devised a soda lime canister for clinical use.The canister was attached to a breathing hose close to the face, and although it was cumbersome to use, the device was widely distributed. The in-line soda lime canister launched the academic career of Waters, who later became one of the most prominent figures in anesthesiology during the first half of the 20th century

The cuffed endotracheal tube was promoted by Arthur Guedel (18831956) and Ralph M. Waters (1883-1979) in 1928,and this refinement allowed the use of intermittent, controlled, positive-pressure ventilation and the potential for one-lung ventilation, introduced by Gale and Waters in 1932.

The cuffed endotracheal tube was one solution to the problem of acid aspiration. Authur Guedel and Ralph Waters were motivated to devise a truly closed system of anesthetic administration with carbon dioxide absorption that would conserve anesthetic gases and body heat. Their 1928 report of the cuffed endotracheal tube achieved these goals with the added benefit of protection of the tracheobronchial tree from aspiration. Others had devised cuffed endotracheal tubes before them, but Guedel and Waters used a novel method to demonstrate and promote the safety features of the cuffed tube. Guedel anesthetized and then intubated his pet dog, appropriately named Airway, with a cuffed endotracheal tube. The dog was submerged in a water tank for several minutes and then removed and awakened unharmed. The demonstration was repeated at several meetings, and this publicity enhanced rapid acceptance of the new endotracheal tube. The cuffed tube is regarded today as an effective measure for preventing acid aspiration. Most anesthetic deaths were not attributed to the agent or the method of administration but resulted simply from the patient not taking the anesthetic well. A frequent diagnosis after death during anesthesia was the vague syndrome of status lymphaticus. Although this phrase was convenient for the anesthesiologist to use, it thwarted a review of causes that might help prevent future disasters. A major change occurred in anesthetic practice with the introduction of morbidity and mortality conferences to examine causes of anesthetic accidents. Originally introduced by Ralph Waters in Madison, Wisconsin, these meetings sought to carefully scrutinize anesthetic complications, thereby shifting the focus of investigation from the patient to the provider and the equipment used to deliver the anesthetic.