To the Editor:--We applaud the recent article [1]that highlights the career of Dr. Lamont, a frequently overlooked Figure whosemajor contributions followed a pattern learned from his mentor, Ralph Waters. The Waters model for an academic department of anesthesiology required that four basic criteria be met to facilitate successful developments as they were seen at the University of Wisconsin in Madison from 1927 to 1948. First, surgeons had to support the anesthesiologists' efforts. Second, support of the basic scientists was needed, including a willingness to collaborate on research efforts of mutual interest. Third, residents and medical students had to be available for instruction and introduction to clinical anesthesia. Finally, financial support for research and adequate staff was necessary. [2]These were the principles shared by Waters with his resident group, which included Lamont and Dripps.

During Lamont's struggles at Johns Hopkins, Blalock was initially supportive of the intent to build a program on the Wisconsin model. In a letter to Waters dated February 9, 1946, Lamont wrote about a letter of resignation he had been about to send to the University Board. Having sent it first to Blalock for comment, Lamont informed Waters that Blalock said “Please don't. I'm sure the University will accept your proposals. As for the money, you can have $10,000 from the University for Anesthesia tomorrow. Please give us a little more time.”* Two months later, the situation changed, and Lamont was denied the funding and the additional staff necessary to move toward an academic program. Blalock was a member of the committee that recommended against Lamont's proposals.** Where Blalock stood on these issues remains unclear. However, Lamont's letters tend to argue against a flat refusal of Lamont's proposals by Blalock. [1].

The history of the Department of Anesthesia at the Hospital of the University of Pennsylvania is a bit more complex than suggested by Murvachick and Rosenberg. The brief mention of Ivan Taylor is somewhat misleading and a bit unfair. Taylor had a full 3-yr residency with Waters and Rovenstine, and a subsequent 2-yr experience as a departmental staff member with Waters at the Wisconsin General Hospital. When appointed at the University of Pennsylvania as the first physician anesthesiologist, Taylor came, in September 1938, into a most unfavorable situation in an institution where inhalation anesthesia had been in the hands of nurse anesthetists for 30 yr. He was caught in a situation where only one of several surgeons, I.S. Ravdin, offered full support. Taylor had a large clinical load to shoulder, as well as being the sole supervisor of nurse anesthetists and teacher to medical students and interns. He was frustrated by not having sufficient time and support for research activity. The Board of Managers for the hospital further complained that anesthetic fees had not increased sufficiently to justify an increase in the anesthesia budget. [3]Taylor stayed at the University of Pennsylvania for nearly 3 yr, hoping things would improve, but when he received a better offer from Wayne State University, he took it.

During World War II, Dripps threatened to leave the Anesthesiology Department at the University of Pennsylvania. It was in a series of letters between 1941 and 1944 that Ralph Waters counseled Dripps to be patient, that manpower would be more than sufficient after the war.*** Dripps, during the war, faced the same conditions and problems as Taylor had, but Dripps, because of having been at the University of Pennsylvania for several years, and by working also with the Pharmacology Department, ultimately found more support. Consequently, Dripps may have had a greater ability to negotiate the necessary agreements with the hospital's Board of Managers.

Douglas R. Bacon, M.D., M.A.; Assistant Professor of Anesthesiology, State University of New York at Buffalo, Chief, Anesthesiology Service, Veterans Affairs Western New York Healthcare System.

Richard Ament, MD; Vice-Chairman for Education and Clinical Professor of Anesthesiology, State University of New York at Buffalo, 3495 Bailey Avenue, Buffalo, New York 14215.

Lucien Morris, MD; Emeritus Professor, Medical College of Ohio, P.O. Box 10008, Toledo, Ohio 43699.

*Letter from Austin Lamont to Ralph Waters, February 9, 1946. The Collected papers of Ralph Waters, M.D., Steenbock Library Collection, University of Wisconsin, Madison, Wisconsin.

**Letter from Austin Lamont to Ralph Waters, April 20, 1946. The Collected Papers of Ralph Waters, M.D., Steenbock Library Collection, University of Wisconsin, Madison, Wisconsin.

***Letters between Ralph Waters and Robert Dripps. The Collected Papers of Ralph Waters, M.D., Steenbock Library Collection, University of Wisconsin, Madison, Wisconsin.

(Accepted for publication May 2, 1996.)

Muravick S, Rosenberg H: Austin Lamont and the evolution of modern academic anesthesiology. ANESTHESIOLOGY 1996; 84:436-41.
Bacon DR, Ament R: Ralph Waters and the beginnings of academic anesthesiology in the United States: The Wisconsin template. J Clin Anesth 1995; 7:534-43.
Eckenhoff JE: Anesthesia From Colonial Times. Montreal, J.B. Lippincott, 1966, pp 52-4.