2025/11/20 by Brian Harrington, Kaitlyn J. Kulesus · 1 voice
Arts and Humanities · Physics and Astronomy · #History and Developments in Astronomy #Medical History and Innovations #Twentieth Century Scientific Developments
paper · doi:10.1097/01.asm.0001173488.82745.e5
openalex created_date 2025/11/20 · openalex publication_date 2025/11/20 · openalex updated_date 2026/07/23
It is no coincidence that the first two greats featured in the Anesthesiology Giants of the 20th Century series – Drs. Virginia Apgar and Emery Rovenstine – trained under the titan this third installment highlights, Ralph Waters, MD. A true giant among giants, it is unfortunate that publication constraints limit mention of many of Dr. Waters' diverse and groundbreaking achievements to mere footnotes. Readers are encouraged to learn independently about his pivotal roles as a founding member of the highly influential Anaesthetists' Travel Club, a driver and founding Director of the American Board of Anesthesiology, president of the American Society of Anesthesiologists (ASA) in 1945, and second-ever recipient of the ASA Distinguished Service Award in 1946 (J Clin Anesth 2009;21:137-42; J Clin Anesth 1990;2:3-6; Anesthesiology 1945;6:302-4). This article will focus on why and how Dr. Waters is most relevant here and now to anesthesiology professionals around the world. Ralph Milton Waters was born in 1883 and raised in northeastern Ohio. Following college and medical training in Cleveland, Ohio, he began general practice in Sioux City, Iowa, in 1913. There, he developed a growing interest in anesthesia. By 1916, he had devoted his entire practice to providing anesthetics (Br J Anaesth 1949;21:197-214). Despite the fact that the field lacked professional standing and most practitioners were self-taught, he was quick to see the enormous potential in the fledgling specialty. As he stated in his first published article: “The art of administering anesthetics offers newness, interest, and good remuneration if it is done thoroughly and well. The time is near when the public will demand the best that is to be had in this line. The non-professional person cannot properly give an anesthetic” (Journal-Lancet 1919;39:32-4).Ralph M. Waters, MD (1883-1979). Image courtesy of the Wood Library-Museum of Anesthesiology, Schaumburg, Illinois.Throughout his career, Dr. Waters' creativity and innovation would propel the specialty of anesthesiology into a brighter future. With the Waters “To-and-Fro” canister, he was one of the first proponents for removing carbon dioxide from exhaled anesthesia gasses (Anesth Analg 1924;5:20-2; asamonitor.pub/4naOAHi). With his friend Arthur Guedel, MD, he developed an early cuffed endotracheal tube (Anesth Analg 1928;7:238-9). Their dramatic “Dunked Dog” demonstration famously showcased their collaborative spirit by using both a Waters Canister and the Guedel family pet – aptly named “Airway”! The all-metal Waters oral airway was a precursor of modern plastic designs (asamonitor.pub/4naOAHi). These advances, along with more than 160 scientific papers, established him as a prolific inventor and researcher who helped shape the safe practice of anesthesiology (Anaesthetists' Travel Club 1929-1952: An Historical Review. 1990). Dr. Waters' most enduring contribution to anesthesiology, however, would begin in 1927 when he established the very first academic anesthesia training program at the University of Wisconsin-Madison. Here, Dr. Waters – or “The Chief,” as he was known – developed an anesthesia residency that would appear familiar to the trainees of today (J Clin Anesth 1995;7:534-43). The rigorous “Wisconsin Model” – in which residents mastered physiology and pharmacology, designed and tested equipment, participated in research, and contributed to teaching – would serve as a template for anesthesia training and help turn Madison into an unlikely mecca for anesthesiologists throughout the world (Anaesthesia 1970;25:4-13). In Madison, Waters had a special interest in getting to know his residents and staff on a personal level (Br J Anaesth 1949;21:197-214). He and his family frequently opened their home to both junior and senior department members, with virtually all experiencing at least one “excellent meal and a jolly evening” during their time in Wisconsin. He was a true servant leader, “willing himself to do the work that he requires of us,” known for taking call on holidays, such as New Year's Eve, so that his young residents could go out and enjoy themselves. He liked discussing with his residents the house to buy or apartment to rent, and then be the one to “bring his car to help transport their effects and, with his own hands, help them move.” It is little wonder that Dr. Waters is said to have been “idolized” by his residents (Anaesthetists' Travel Club 1929-1952: An Historical Review. 1990).Aqualumni in 1938. Note Drs. Waters (seated, center), Virginia Apgar (standing, second from left), and Emery Rovenstine (standing, fourth from left). Photo courtesy of Virginia Apgar Papers, Mount Holyoke College.The “Father of Academic Anesthesia” and “Mentor to a Profession,” Waters retired to Orlando, Florida, in 1949. There he lived relatively quietly, spending time with family and relishing the consistently pleasant weather. He enjoyed reading and fresh citrus from his own grove. In an era before the internet, he kept up a steady correspondence with friends and colleagues throughout the world. He died in 1979 at age 96, having outlived his wife Louise and most of his contemporaries. Dr. Waters entered anesthesiology at a time when it was neither recognized as a formal profession nor afforded much respect. Through his innovations and leadership, he helped transform it into a legitimate medical specialty. His career embodied both vision and humanity: the scientific drive to advance patient care and the personal generosity that inspired devotion in his residents. Perhaps most significantly, Dr. Waters recognized the enormous value of mentorship. Rather than teaching his residents to simply practice anesthesia, he amplified and perpetuated his impact by setting out “to teach doctors to go out and teach other doctors.” In total, Dr. Waters would train 60 residents, of whom 40 would go on to teaching positions in academic centers, with 20 of those becoming chairs or directors of academic programs (ASA Monitor 2001;65:21-4). His protégés coined themselves “Aqualumni” as they founded and influenced anesthesiology departments around the country and the world. Their camaraderie and connection to Dr. Waters was demonstrated in annual reunions held in Madison during the 1930s and 1940s, with another in Florida in 1966. The generational legacy of the Aqualumni would later be illustrated as a tree by Lucien Morris, MD, and his wife Jean, which has been more recently updated by Rafael Ortega, MD (ASA Monitor 2001;65:21-4; Anesth Analg 2024;138:740-5). Today's anesthesiologists are encouraged to reflect upon the role of mentorship in their own careers and trace their probable connection to Dr. Ralph Waters via the Aqualumni Tree (asamonitor.pub/4hgCw63). Just as his mentees carried on his tradition of friendship, mutual support, and collegiality, we hope others will continue Dr. Waters' legacy of excellence in mentoring – and, in passing the proverbial torch, continue to lead our specialty on the bright path Dr. Waters helped first illuminate.Brian E. Harrington, MD, Board of Trustees, Wood Library-Museum of Anesthesiology, and Staff Anesthesiologist, Billings Clinic Hospital, Billings, Montana.Kaitlyn J. Kulesus, DO, Assistant Professor, Assistant Program Director, Director of MOCA Simulation, and John H. Saxon III, MD, Endowed Professor, Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma.