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History of Anesthesia at Johns Hopkins

The Early Days

An intern administers ether anesthesia in 1892
An intern administers ether anesthesia in 1892. Over the course of the 20th century, specialized programs were introduced for the training of nurse anesthetists and physicians for certification in anesthesiology.
Photo credit: The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions

1901-1912: Etherizing patients is viewed by many surgeons as unchallenging. At Hopkins, surgical housestaff and nurses were the anesthetists. Surgeon Harvey Williams Cushing, the father of American neurosurgery, prefers a physician to anesthetize his patients. At Harvard, Cushing had advanced the idea of keeping an anesthetic record. This record first tracked the patient's pulse and respiratory rates, then the continuous blood pressure. Cushing advocated for a physician anesthetist keeping this kind of record. Cushing arranges for Samuel Griffith Davis of Church Home Hospital to be his physician-anesthetist. After Cushing leaves Hopkins, the previous model of anesthesia returns.

1913: Margaret Boise and Hugh Young, a urologist, develop a gas-ether anesthesia machine later known as the Boise-Young apparatus. It is first used at Johns Hopkins Hospital and over the next nine years they continue to perfect it. After assisting Dr. Halsted with a difficult thyroid operation Boise is soon employed by the Johns Hopkins Hospital as the head anesthetist for the surgical department. She continues to give anesthetics to most of Halsted's patients until his death in 1922. [1]

1917: Hopkins nurse, Margaret Boise, founds the "Johns Hopkins School of Nurse Anesthesia" where she trains other nurses to administer anesthesia. Boise works clinically with Dr. William Stewart Halsted, a pioneering surgeon, and one of the "Big Four" founding professors at the Johns Hopkins Hospital. Dr. Halsted is the first chairman of surgery, and he pioneers the use of local anesthesia.

It is important to note that this program to train nurses to administer anesthesia takes place long before the formation of the physician specialty of anesthesia.

1922 Graduates of The Johns Hopkins Hospital School of Anesthesia for Nurses
1922: These graduates of The Johns Hopkins Hospital School of Anesthesia for Nurses were some of the first nurses to receive "continuing education" at Hopkins. This training program for registered nurses continued within the Johns Hopkins Hospital until about 1985. (From left to right: Mary Swisher, Mary Laird, Margaret G. Boise, Ruth Bacon, Olive Berger)
Photo credit: The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions

1931: Olive Louise Berger becomes chief nurse anesthetist and director of the anesthesia school for nurses at the Johns Hopkins Hospital until her retirement in 1969.

1940s

Alfred Blalock, MD
Alfred Blalock, MD
  Austin Lamont, MD
Austin Lamont, MD

1941: Alfred Blalock, MD, Professor of Surgery at Hopkins, asks Instructor in Surgery Austin Lamont, MD, "whether he would be interested in teaching the principles of anesthesia to surgical housestaff and developing a "more professional" level of anesthetic expertise within the Department of Surgery at Hopkins." [2]

Merel H. Harmel, MD
Merel H. Harmel, MD
  Olive Berger, CRNA
Olive L. Berger, CRNA

1943: "As the new Director of Anesthesia at Johns Hopkins, Dr. Austin Lamont, now an Associate in Surgery, was also busy planning a residency program in anesthesiology and a parallel course of instruction to upgrade the training of nurse-anesthetists at Hopkins. In the community, he organized the first local society of Baltimore anesthetists." [3]

1944: Merel H. Harmel, MD participates in the first Blalock-Taussig shunt procedure. Dr. Harmel is the first anesthesiology resident. While in the 11th month of his residency at Hopkins, Harmel acts as the anesthesiologist for this novel procedure pioneered by surgeon Alfred Blalock, cardiologist Helen Taussig, and assistant Vivien Thomas. The operation is developed to shunt blood to the lungs in children with tetralogy of Fallot, also known as “blue babies.” [4] In 1946, Merel Harmel turns down Blalock's offer to stay at Hopkins.

Peter Safar, MD
Olive Berger, Nurse Anesthetist, stands at the head of the operating table assisting Dr. Alfred Blalock and Vivien Thomas during ground-breaking blue baby cardiac surgery in 1945. (Click to enlarge)
Photo credit: The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions

As Alfred Blalock performs the first Blalock-Taussig shunts on "Blue Babies", Olive Berger, the "Nurse in Charge" administers the anesthesia. Berger trains other nurses in the art of anesthesia.

Post-World War II

1950s

Physicians specializing in anesthesia struggled for decades to achieve the same respect accorded to other medical specialties.
Under Surgery's Yoke. In the early days of anesthesiology, cones were used to "drop" ether on patients. By the 1950s, anesthetists here had advanced to using tanks of cyclopropane (above). Photo by Chesney Medical Archives

Anesthesia is changing. Doctors returning from military service bring back new techniques from the front lines. These included sophisticated I.V. and regional anesthetics. At the Johns Hopkins Medical School, Dr. Austin Lamont seeks to develop the first department of anesthesiology.

1951: The Department of Anesthesiology is established. Dr. Donald F. Proctor is appointed the first Professor of Anesthesiology at Johns Hopkins School of Medicine. [5]

1952: Olive Louise Berger is named Instructor in Anesthesia in the School of Medicine.

Doctors Proctor, Safar, and Bachman continue to build the anesthesiology department during the decade of the 1950s. [6]

Donald W. Benson, MD
"Anyone can put you to sleep, but it takes an anesthesiologist to wake you up." - Donald W. Benson, MD, PhD

Donald W. Benson, MD, PhD, becomes the first anesthesia leader to have completed a residency in the specialty (from the University of Chicago Clinics). With the support of senior surgeon George Zuidema, Benson begins organizing a formal anesthesiology residency program and starts recruiting physicians and staff. [7]

1956: Donald W. Benson, MD, PhD, becomes Associate Professor of Anesthesiology and Anesthesiologist-In-Charge at the Johns Hopkins Hospital.

Peter Safar, MD
Peter Safar, MD

Peter Safar, MD joins the faculty of the Department of Anesthesiology at Johns Hopkins University as an assistant professor while also serving as Chief of Anesthesiology at Baltimore City Hospital (Later to become Bayview Medical Center.) Safar is remembered as the founder of modern cardiopulmonary resuscitation and cardiopulmonary cerebral resuscitation. [8]

1958: Dr. Safar establishes the first multidisciplinary adult and pediatric ICU in the U.S. at Baltimore City Hospital. [9]

1960s

Donald W. Benson, MD, PhD
Speaking of her father, daughter Jane Benson '80, an assistant professor of radiology and pediatrics at the School of Medicine said, ""He felt like a pioneer". She continued, "Anesthesiology had always been the handmaiden to surgery. Now the whole specialty was being born at Hopkins, and here was Dad trying to put it on equal footing with surgery in the operating room." - Under Surgery's Yoke

Donald W. Benson, MD, PhD, continues to head the department as Anesthesiologist-In-Charge.

1970s

Mark C. Rogers, MD, MBA
Mark C. Rogers, MD, MBA

1977: Mark C. Rogers, MD, MBA establishes the Pediatric Intensive Care Unit or PICU at the Johns Hopkins Hospital, after training in pediatrics, cardiology, anesthesiology, and critical care medicine. [10]

Eugene L. Nagel, MD
Eugene L. Nagel, MD

1977: Eugene L. Nagel, MD is named Professor and Director of the Anesthesiology Department of Johns Hopkins University, a title which he holds until 1980. His interest in emergency medicine and the new technique of cardiopulmonary resuscitation (CPR) proves to be an important influence in his career. [11]

1980s

Mark C. Rogers, MD, MBA
Mark C. Rogers, MD, MBA (Chairman), Richard Traystman, MD, Phd, (Research) and Robert Dunham (Clinical Operations)

1980: Mark C. Rogers, MD, MBA is asked to become the inaugural Professor and Chair of the newly formed Department of Anesthesiology and Critical Care Medicine. For the next 12 years Rogers propels both the department and the Pediatric Intensive Care Unit to the forefront of medicine in the United States. His textbooks in pediatric intensive care in anesthesiology are used throughout the world. [12]

1981: Charles Beattie, MD, PhD, is recruited to the Johns Hopkins Hospital in Baltimore by Dr. Mark C. Rogers. For 13 years, he directs the division of Critical Care Anesthesia which provided anesthesia services for critically ill patients who were undergoing vascular, thoracic, liver transplant and major abdominal surgery. [13]

Robert Abraham, MD
Robert Abraham, MD

1982: Dr. Mark Rogers partners with the Hopkins Clinical Engineering Department to develop the first Operating Room Scheduling information system and computerized anesthesia record database.

1983: Researchers at the Johns Hopkins School of Public Health, Health Services Research and Development Center are engaged to evaluate the new Department of Anesthesiology and Critical Care Medicine data repository.

1985: Robert Abraham, MD becomes the first full time Director of Obstetric Anesthesia.

Dr. Robert Abraham is also chosen as “Teacher of the Year.” Today, The Robert A. Abraham, MD Endowed Lecture is named in his honor.

An Anesthesiology and Critical Care Medicine Department

1989: Dr. Mark C. Rogers is appointed to head the new Anesthesiology and Critical Care Medicine Department, and the specialty finally achieves full academic status.

1990s

Charles Beattie, MD, PhD
Charles Beattie, MD, PhD

1992: Charles Beattie, MD, PhD, becomes Interim Chairman of the Anesthesiology Department, a position he holds until 1994.

1993: The Donald W. Benson, MD Lectureship is established by family, friends and former colleagues to honor the contributions of Dr. Benson.

Edward D. Miller, MD
Edward D. Miller, MD

1994: Edward D. Miller, MD is named The Mark C. Rogers Professor and Chairman of the Anesthesiology Department.

Roger A. Johns, MD, MHS
Roger A. Johns, MD, MHS

1999: Roger A. Johns, MD, MHS is named The Mark C. Rogers Professor and Chairman of the Anesthesiology Department.

The Next Century

2000: The Robert A. Abraham, MD Endowed Lectureship in the Division of Obstetric Anesthesiology is established by former colleagues and residents to recognize Dr. Abraham’s contributions to obstetric anesthesia education and patient safety.

2001: Frederick Sieber, MD becomes Director of Anesthesiology and Clinical Research at the Johns Hopkins Bayview Medical Center.

2003: Myron Yaster, MD is named the inaugural Richard J. Traystman Professor in Anesthesiology and Critical Care Medicine.

John Ulatowski, MD, PhD, MBA
John Ulatowski, MD, PhD, MBA

2004: John Ulatowski, MD, PhD, MBA is named The Mark C. Rogers Professor and Director of of the Department of Anesthesiology and Critical Care Medicine and Anesthesiologist-in-Chief of The Johns Hopkins Hospital, positions he holds until 2013.

2005: Though the Johns Hopkins University closed its own CRNA program in 1985, Johns Hopkins Hospital is once again a clinical site for student nurse anesthetists. Each semester, students from several regional CRNA programs rotate through Hopkins. Dr. Ulatowski feels so strongly about the importance of the CRNA role that he establishes a nurse anesthesia division within the department.

2007: Nicholas A. Flavahan, PhD, is named the inaugural Edward D. Miller, MD Professor of Anesthesiology Research.

2010s

2010: Introduction of a vendor-based electronic Anesthesia Data Record system for intraoperative record keeping.

Daniel Nyhan, MD, M.M.BCh
Daniel Nyhan, MD, MMBCh

2013: Daniel Nyhan, MD, MMBCh is named Interim Director of the Department of Anesthesiology and Critical Care Medicine.

Colleen Koch, MD, MS, MBA
Colleen Koch, MD, MS, MBA, FACC

2014: Colleen Koch, MD, MS, MBA, FACC is named the Mark C. Rogers Professor and Director of the Department of Anesthesiology and Critical Care Medicine.

Marek A. Mirski, MD, PhD, is named the inaugural Thomas and Dorothy Tung Professor.

Mark C. Rogers, MD, MBA
Mark C. Rogers, MD, MBA shares his memories of the formation of the department: "Anesthesiology and Critical Care Medicine: Innovation in Academic Medicine"

Residency Program Leadership History

Since 1945, the Johns Hopkins Anesthesiology Residency Program has been producing tomorrow’s leaders in anesthesiology departments around the country, including the heads of anesthesiology at many major academic medical centers.

References

1Gunn, Ira P: Nurse Anesthesia: A History of Challenge; 2001: 6

2 Muravchick, Stanley MD, PhD; Rosenberg, Henry MD: Austin Lamont and the Evolution of Modern Academic American Anesthesiology. Anesthesiology: February 1996; 84: 436-41.

3Ibid.

4Anesthesiology & Critical Care Medicine Alumni News

5Rasmussen, Frederick N.: Donald F. Proctor, 92, Hopkins physician, teacher. The Baltimore Sun: April 1, 2006.

6Safar, Peter MD: Tribute to Dr. Austin Lamont. Anesthesiology 1997; 87:461.

7Blackburn, Maria: Under Surgery's Yoke. Hopkins Medicine: Fall 2009.

8Bryan-Brown, Christopher W. MD; Grenvik, Åke ,MD, PhD: Pioneer of Critical Care Medicine: Peter Safar (1924–2003). American Journal of Critical Care; January 2004; Vol. 13 no. 1 87.

9Mai, Christine L. MD; Yaster, Myron MD: Pediatric Anesthesia: A Historical Perspective. American Society of Anesthesiologists; October 2011; Vol. 75 no. 10

10Mark C. Rogers Chair In Anesthesiology And Critical Care Medicine web site.

11Nagel, Eugene L. MD; Cardiopulmonary Resuscitation (CPR)

12Mark C. Rogers Chair In Anesthesiology And Critical Care Medicine web site.

13Vanderbilt University Anesthesiology: Department History, 1994-2001.

 
 

Grand Rounds
Calendar and Webcasts

Grand Rounds take place Thursdays at 7 AM in Hurd Hall.

9/18: "Translational Therapies for Pediatric Traumatic Brain Injury" – Courtney Robertson, MD
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9/25: Quality Assurance Committee Meeting

10/2: "Patient And Family-Centered Approach To Advance Care Planning" – Rebecca Aslakson, MD, PhD

10/9: Patient-Based Learning Discussion – Tracey Smith Stierer, MD

Eighth Robert A. Abraham, MD Endowed Lecture: "Post-Cesarean Pain Management: Past, Present, and Future" – Brendan Carvalho, MBBCh, FRCA, MDCH
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Learn more about Robert A. Abraham, MD >>

"ACCM - Innovation in Academic Medicine" – Mark Rogers, MD
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Combined Multidisciplinary Grand Rounds with Department of Surgery – "Perioperative Services Initiatives: Reducing Risk and Improving Outcomes"
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