Liguori, Emily C.; Hargett, Mary J. BS; Liguori, Gregory A. MD
Thomas Linwood Bennett, MD, (Fig. 1) was one of New York City’s first prominent physician anesthetists. He was the first dedicated anesthetist at the Hospital for the Ruptured and Crippled (R&C), subsequently renamed Hospital for Special Surgery, and later practiced at multiple institutions throughout New York City. Bennett was widely considered the preeminent anesthetist of his time. His career combined a successful private practice with innovative research and education in the emerging field of anesthesia.1–3
THE EARLY YEARS
Bennett was born in Lancaster, MA, on January 3, 1868. His father, Seth Bennett, a musician, and his mother, Mary, were both originally from New Hampshire. He had 3 siblings: Harry, Frederick, and Aimee. Bennett attended Northwestern Ohio Medical College and graduated in 1889. Northwestern Ohio Medical College, located in Toledo, OH, had a very limited existence. It was organized in 1883 as an outgrowth of the Toledo School of Medicine and graduated its first class of physicians in 1884.4 As reported in The Blade, a Toledo newspaper, a March 30, 1969, article states, “In 1892 a rival institution, the Northwestern Ohio Medical College, closed its doors. The Toledo Medical College purchased and took over the equipment and rented quarters which the defunct institution had occupied in a building on Lagrange Street.”5 Thus, a mere 8 graduating classes called themselves alumni of Northwestern Ohio Medical College.
In 1890, Bennett moved to Kansas City, MO, and became the first intern at the newly constructed St. Margaret’s Hospital. Father Anton Kuhls, who served as pastor of St. Mary’s parish in Kansas City for 50 years, founded St. Margaret’s, a relatively new institution overlooking the Kansas River. The hospital construction began on April 15, 1887, and cost $20,000. It is unclear whether Bennett’s interest in anesthesia began in Kansas City, at Northwestern Ohio, or sometime earlier. The records of St. Margaret’s hospital report that “Anaesthetics as a supervised department at St. Margaret’s Hospital began in the year 1894. During the next three years the first anaesthetist, Dr. Thos. L. Bennett carried out experiments with the then anaesthetic agents commonly used viz.; chloroform, ether, and mixtures of these with alcohol.”1 Bennett worked at St. Margaret’s Hospital from 1890 until 1897, developing a reputation as a physician with an interest and expertise in anesthesia. He also became interested in cardiac physiology, and he apparently performed some of the early experiments using open-chest cardiac massage (Fig. 2). He did not publish these experiments in a scientific journal. As a result, the only records of these studies are those described in this lay publication.
MOVING TO NEW YORK CITY
The R&C in New York City was founded by Dr. James A. Knight in 1863. Dr. Knight was a general practitioner, not a surgeon, and did not emphasize surgical therapies. As stated in the Medical Record of the R&C, “Prior to 1888, the mechanical side of orthopedic surgery prevailed to the exclusion of the operative, and achillotomies and fasciotomies were performed as adjuncts to the better employment of apparatus.”6 Surgical therapy and those who advocated for surgical treatments were clearly deferential to medical and rehabilitation remedies.
R&C began to evolve into a surgical institution in 1887 with the appointment of Dr. Virgil P. Gibney as the Surgeon-in-Chief. With Gibney’s appointment, surgical treatment for orthopedic conditions and hernias began to increase. Soon thereafter, Gibney recognized the importance of anesthesia in the care and outcome of surgical patients. Gibney states in the 1908 Medical Record at the R&C:
An operating room was provided for the first time in the winter of 1887–8, and while minor operations were performed during the early years of the hospital, say 1865–1887, anesthetics were provided very sparingly and not often beyond the primary stage.” He continued, “The junior assistant, fresh from the medical school, in our earlier years of operative work, was the anesthetist, and the operator was unable to give his entire time and attention to the site of operation.6
Over the ensuing decade, Gibney increasingly appreciated the role of the anesthetist, and he came to the conclusion that the current model was suboptimal. In 1897, he recruited Bennett from Kansas City and appointed him the first Anesthetist and Instructor in Anesthetics at R&C. Gibney states of the appointment of Bennett:
The junior assistant no longer has charge of the anesthetic, but he is coached, so to speak, by the instructor in anesthesia. This position is filled by Dr. Thomas L. Bennett, who has been regularly appointed by the board of managers, and who attends on all operating days, noting closely all the points for observation, examining the patient before operation and giving an opinion as to the kind of anesthetic that is best suited for the individual case, and then giving assurance to the operator.7
Gibney and his surgical colleagues incorporated the anesthetist as an integral member of the operative team. Bennett’s role, as described by Gibney, mimics that of the modern anesthesiologist working in the care team model.
On Bennett’s arrival in New York, he opened a private office at 7 East 87th Street in Manhattan. Surgeons Bull and Coley described Bennett’s anesthetic techniques at R&C in a review of hernia repairs. The review states:
During the past year, we have had the services of a skilled anaesthetist (Dr. Thomas L. Bennett). Nitrous oxide gas is employed for a few moments, then followed by ether. This method makes it possible to fully anaesthetize the child in from two to three minutes; does away with struggling, and materially lessens the quantity of ether inhaled.8
Bennett was one of the first anesthetists in the United States to introduce the concept of the nitrous oxide–ether sequence.9 The combination of nitrous oxide and ether as an anesthetic technique was developed in England in 1876 by Joseph Thomas Clover. As the primary successor to John Snow, Clover was one of the early pioneers of anesthesia. At the age of 17, Clover worked at the Norfolk and Norwich Hospital as well as an apprentice to a renowned surgeon in the area. After a bout of illness, Clover entered the University College Hospital in London as a medical student. Clover may have been present during the thigh amputation of Frederick Churchill in 1846, the first major operation completed under ether in England. If so, it may have piqued Clover’s interest in anesthesia. Clover was a talented inventor whose notable contributions to anesthesia practice included a chloroform inhaler, “Clover’s chloroform apparatus” in 1862, and an ether inhaler, “Clover’s portable regulating ether inhaler” in 1877. Surgeons sought out Clover for their most important patients, which resulted in Clover anesthetizing Napoleon III (who died 3 days later), Queen Alexandra, King Edward VII, King Leopold, and Florence Nightingale.10
In describing the nitrous oxide–ether sequence, the Buffalo Medical Journal states, “The chief object of this method of preceding the administration of ether by gas is the anesthetizing of the patient quickly without the usual ‘state of excitement.’”11 In 1898, Bennett, in a detailed report in the Medical Record, wrote an elegant description of the rationale for this technique entitled “Anaesthesia—‘Gas and Ether’” describing his protocols, as well as complications and side effects. Bennett also offers clinical pearls such as the limited use of morphine and topicalization of the airway with local anesthetics to minimize irritation. Quoting Dudley Buxton, a contemporary British anesthetist, Bennett concludes that this approach “is the best method of producing general anaesthesia.”12
In 1900, the Journal of the American Medical Association printed several original articles on various topics in anesthesia by prominent anesthetists of the time, including Bennett, John A. Wyeth, and S. Ormond Goldan.13 Bennett discussed the “amount of the anesthetic” and reported that it depended on 4 factors: the requirements of the patient, the requirements of the operation, the method of administration, and the administrator. He concluded that “the smallest amount of the anesthetic compatible with quiet relaxation and freedom from reflex manifestations during the operation, will give the patient the least possible after disturbance attributable to the anaesthetic.”13 Bennett effectively communicated these principles to his surgical colleagues. In 1898, Gibney wrote, “All surgeons are unanimous in recommending that the minimum amount of ether should be employed and that a stage of complete anesthesia should be reached as quickly as possible.”7 Bennett had rapidly won the confidence of surgeons at R&C.
In a 1900 Journal of the American Medical Association article, Bennett also astutely wrote, “Men differ greatly in their ability to administer anesthetics. Some acquire the art quickly, others slowly or never. A very great percentage of medical men actually dislike to anaesthetize and these never should.”13 This remains very good advice to this day.
The operative schedule at R&C in the first decade of the twentieth century remained quite limited. Gibney wrote:
We can get along with two operating days per week, one for the orthopedic and one for the hernia work. Hence, the service of the anesthetist is not required more than five or six hours a week, but those are very active hours, as two tables are under his divided supervision. From six to twelve operations are performed on the orthopedic days and from four to eight on the hernia days.6
The limited work at R&C allowed Bennett to pursue additional work in the rapidly growing health care complex of New York City. Other hospitals began to develop surgical services, and a skilled anesthetist slowly became an important part of the operative team. In 1898, Bennett joined the staffs at Roosevelt Hospital and New York Hospital. He spent approximately 3 years on staff at Roosevelt working with surgeon Charles McBurney.14 He spent a considerably longer period at New York Hospital. The following was noted at a Medical Board meeting of the hospital on December 4th of that year:
The following Resolution was moved seconded and carried resolved, that the Medical Board recommend Dr. T.L. Bennett to be appointed as Anesthetist and Instructor in Anaesthesia to the Hospital at a salary of $100. per annum, and that his duties shall consist in the instruction of the junior assistants in the use of anaesthetics and in the administration of ether & chloroform at the surgical clinics and in such other surgical causes as the surgeons may determine, in which special care in anaesthesia is demanded. Meeting then adjourned Sam W. Lambert Dec 4 protem. [sic]15
In 1901, Bennett left the position of Instructor in Anesthetics at R&C. The motivation for his departure is unclear; however, it is likely that finances played a role in the decision. For the next 30 years, anesthesia at R&C would be performed not by physicians solely dedicated to the specialty but by surgeons paid to perform the duty in their spare time. From 1898 through 1907, Bennett remained an anesthetist and medical officer at New York Hospital. In 1908, however, a transition occurred within the hospital. The June 5, 1908, Medical Board minutes reflect his change in position. Bennett “moved from [a] Medical Officer to a Physician of the Private Patients Building.”15 It became clear that the motivation for this move was again financial. Over the preceding few years, the hospital decreased payments to anesthetists on the medical staff, while the fee for anesthesia in the Private Patients Building was set by the physician. The October 1904 minutes of the New York Hospital Medical Board illustrate the financial transition as well as Bennett’s conversion. The October 11, 1904, minutes state, “The custom of the fee of $3 now paid by the hospital to the anesthetist be abolished, and that the fee of the anesthetist shall not exceed $10.”15 Similarly, the minutes of October 18, 1904, read, “Patients will be charged a maximum fee of $10 for anesthesia for patients coming to the hospital as patients of the hospital. Private patients of surgeons shall be charged for anaesthesia as in private practice outside the hospital.”15 Financial tensions between hospitals and anesthesiologists are clearly not new phenomena.
In response to New York Hospital limiting anesthetic fees for the Medical staff, Bennett expanded his clinical anesthesia practice to other prominent New York City hospitals. Mount Sinai added Bennett to the staff in 1905. The book, This House of Noble Deeds: The Mount Sinai Hospital, 1852–2002, states of Bennett, “Already well known for designing the Bennett apparatus for the administration of nitrous oxide and ether, and an excellent clinical anesthesiologist and teacher, he would remain on the staff until his death in 1932.”16 Presbyterian Hospital also recruited Bennett in 1907. Presbyterian Hospital created a new position entitled “Consultant in Anesthesia.” This was considered “a timely action since the process was attracting increasing interest and since in the Hospital anesthesia has been administered by inexperienced interns.”17 During the March 8, 1909, meeting of the Hospital’s Medical Board, it was “resolved that the Board recommend to the Board of Managers the creation of the Position of Special Consultant in Anaesthesia for the purpose of securing expert instruction for the House Staff and that Dr. Thomas L. Bennett be recommended for appointment to such position.”18 On April 13, 1909, the Board of Managers of the Hospital, on the recommendation of its Nominating Committee, appointed Bennett to this position “it being fully understood that Dr. Bennett … will give the instruction without charge.”19 This likely implied that Presbyterian would not pay Bennett for his work, but instead, he would bill patients directly for his services.
Bennett spent most of his professional life at R&C, New York Hospital, Presbyterian, Roosevelt, and Mt. Sinai. It is no coincidence that the same hospitals in New York City that recognized early on the importance of anesthesia care for their patients remain strong clinical and academic institutions over a century later.
Bennett remains widely recognized for his development of the Bennett Inhaler, developed while he worked at St. Margaret’s hospital, and introduced into practice in 1899 at R&C. According to St. Margaret’s hospital history, “During the time Dr. Bennett was anesthetist he invented and perfected the Bennett apparatus for ether administration”1 (Fig. 3). Bennett described his “New Anaesthetic Apparatus” in the New Instruments section of the Medical Record in 1900.20 The apparatus consisted of a facemask with rubber cushion, a gas cylinder, and a bag. It was manufactured by the KNY-Scheerer Company and sold for $40.00. The Bennett Inhaler, itself a modification of the Hewitt apparatus, ushered in many future anesthetic inhalers such as the Goldan, Ormsby,11 and Stephen-Bennett Inhalers.21 In 1904, Pedersen presented a detailed description of an anesthetic induction using the Bennett Inhaler.22 Later versions of this device designed by Bennett included adaptations that allowed for the “safe” and efficient administration of nitrous oxide, ether, and other inhaled drugs (Fig. 4) and became the industry standard for anesthetic practice in New York City during the first decade of the twentieth century.
In addition to his contributions to anesthetic equipment, Bennett remained a recognized authority in the anesthesia and surgical communities, and his comments on anesthetic techniques and patient safety became widely quoted and published.23–25 A variety of surgical journals also mentioned Bennett. Otorhinolaryngologists and urologists describe the importance of anesthesia in their work and cite Bennett by name as a “pioneer” and “expert in the field.”26,27
Bennett married Ida Young, a musician, on June 14, 1893, in Port Huron, MI. They had 2 daughters: Margaret, born in 1894 in Missouri, and Lida, born in 1900 in New York City. A few years after Ida died, Bennett met Ethel Hope, a trained nurse at New York Hospital, while working at the hospital. They were married on June 10, 1911, at Hope’s home on Second Street in Bayside, Long Island, by the Reverend William E. McCord, rector of All Saints’ Church.28 The 2 remained married for 21 years. Dr. and Mrs. Bennett parented a third daughter, Hope. All 3 daughters were grown and married by the time of Bennett’s death.
Bennett did well financially. In addition to his home in New York City at 580 Park Avenue, he maintained homes in Newport, RI, and Palm Beach, FL. Bennett’s Newport residence, designed by architect Irving Gill and landscaped by the Olmstead Brothers, was purchased in 1926.a Bennett’s third home named Casa Sonada is situated at Via Del Lago in Palm Beach.29 The value of these homes today would be many millions of dollars.
Bennett was a passionate art collector. In 1927, his collection of 100 canvasses auctioned for more than $32,000. After his death, Bennett’s collection of 176 etchings sold on April 13, 1934, for $16,117.50.30 The value of these collections today would be more than $600,000.
In 1930, at the age of 62, Bennett retired from clinical practice, although he remained, in name, on staff at several New York City hospitals. Bennett died on May 9, 1932, at the age of 64 in the Doctors’ Hospital in New York. The cause of death was reported as a pulmonary embolism.31 His body was laid to rest at Saint Mary’s Episcopal Churchyard in Portsmouth, Newport County, RI.b Two years after Bennett’s death, Ethel Hope Bennett married Lewis Fox Frissell on September 27, 1934.32 After Frissell’s death less than a month later, Ethel continued to live in Newport and Palm Beach until her death in 1971. She was buried in Berkeley Memorial Cemetery in Middletown, Newport County, Rhode Island.c
In February 1933, 9 months after Bennett’s death, physicians gathered together to commemorate Bennett and the medical knowledge he contributed to patient safety and science. A Public Forum article in The New York Medical Week states, “It was pointed out that since this life, devoted as it was to the wise and conservative practice of anaesthesia, had resulted in the frequent prevention of death, that a memorial, a living memorial, might well take the form of a ‘fund’ for the prevention of asphyxial death.”33 The “Bennett Memorial Fund” invited friends, patients, and colleagues to donate money to support the Society for the Prevention of Asphyxial Death. This society was chartered on February 8, 1933, in New York and aimed to avert asphyxial death as well as provide instruction to resuscitators. The Society for the Prevention of Asphyxial Death changed its name on April 23, 1956, to the National Resuscitation Society, Inc. Meetings convened annually with monthly courses in cardiopulmonary resuscitation. By the mid-1960s, the membership role included approximately 200 doctors of medicine and dental surgery. The Society, under the leadership of President George E. Armstrong in the 1960s, is situated at 2 East 63rd Street, New York, NY. Paluel J. Flagg served as Executive Director for many years.34
Thomas Linwood Bennett was one of the first prominent anesthetists in New York City and one of the first American physicians to dedicate his professional career to the practice of anesthesia. He was an innovative clinician, researcher, educator, and inventor. He also built successful private practice and pursued an active family life. His writings reveal his appreciation for the impact of anesthetics on patients and his prescient emphasis on patient safety. As one of the first full-time physician anesthetists in the United States, he helped to shape the modern profession of anesthesiology.
Name: Emily C. Liguori.
Contribution: This author helped in historical research and manuscript preparation.
Attestation: Emily C. Liguori approved the final manuscript.
Name: Mary J. Hargett, BS.
Contribution: This author helped in historical research and manuscript preparation.
Attestation: Mary J. Hargett approved the final manuscript.
Name: Gregory A. Liguori MD.
Contribution: This author helped in historical research and manuscript preparation.
Attestation: Gregory A. Liguori approved the final manuscript and is the archival author.
This manuscript was handled by: Steven L. Shafer, MD.
The authors of this article extend their appreciation to the staff at the Wood Library-Museum of Anesthesiology for their assistance with historical research, and to George Go, Research Assistant at Hospital for Special Surgery for technical assistance.
a United States Department of the Interior—National Park Service—National Register of Historical Places Inventory. Nomination Form. 2013. Available at: http://www.preservation.ri.gov/pdfs_zips_downloads/national_pdfs/newport/newp_ocean-drive-hd.pdf. Accessed February 22, 2013. Cited Here...
b Thomas Linwood Bennett (1868–1932)—Find a Grave Memorial. 2008. Available at: http://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=23858158. Accessed February 22, 2013. Cited Here...
c Ethel Hope Bennett Frissell (1884–1971)—Find A Grave Memorial. 2007. Available at: http://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=18514341. Accessed February 22, 2013. Cited Here...