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Ansel Marion Caine, M.D.: A Timeless Lesson in Professionalism?

Bacon, Douglas R. M.D., M.A.

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WHY study the life and career of Ansel Marion Caine (1882–1961)? There are those in the history community who have de-emphasized biography as a tool in historical study because it brings together the twin sins of “hero worship” and elitism. However, this argument is fallacious, because in writing a biography, the author studies carefully the person, his or her life, and the times in which he or she lived. It is a picture of an individual set in the background of events of the person’s life that makes compelling reading. Drs. Broussard, Vachon, and Winthrop have done just that with Dr. Caine.1 They are to be especially commended for seeking not just the secondary source material, i.e., what has been written about the subject, but seeking family members and primary documents such as correspondence, telegrams, and photographs and doing interviews with those who remember Dr. Caine. This article is an excellent example of how the history of medicine needs and ought to be written by physicians.
Methodology aside, why does an anesthesiologist who has been dead for 45 yr make for such compelling reading? In essence, the question becomes, is there anything that can be learned from the life of a physician who practiced a half century ago? What compelling thoughts or actions did Dr. Caine have to which the modern reader can relate? Why does the leading journal in the specialty devote pages to this New Orleans, Louisiana, anesthesiologist when there are clinical studies ready to be published that may have a more direct impact on clinical care? How does Ansel Caine “stack up” when compared with 21st century ideals of medical professionalism?
First and foremost, the word portrait painted by Dr. Broussard and his colleagues of Ansel Caine brings to life a figure who, until now, has not been recorded as being on the forefront of the development of anesthesiology. But he was. As the article points out, he cared deeply for and about the patient, the most important person in any anesthetic. Dr. Caine was willing to leave his practice and see to a patient in Miami, Florida. Jumping on a plane and flying from New Orleans to southern Florida seems of little significance to the 21st century reader. But in 1930, air travel was new, novel, and risky. A scant 3 yr before, Charles Lindbergh had been the first to fly solo across the Atlantic Ocean. A plane coming into a city was often a time for spectators to gather to see this novel flying machine. In another episode, Dr. Caine anesthetized Tomas Gabriel Duque, the President of Panama. Dr. Caine faced a patient most likely in thyroid storm, weak, frail, and at extremely high risk. A bad outcome could have ended in his death, but Ansel Caine was willing to put his own life in jeopardy to see to the life of another.
Dr. Caine did not have the facilities of the modern anesthesia department, a formalized curriculum in anesthesiology, or any of the amenities we associate with academia. But he taught all those willing to learn anesthesia. Moreover, when Charity Hospital in New Orleans recruited a chief anesthetist, which would today be regarded as the chair of the department, Dr. Caine supported the new person, Dr. John Adriani (1907–1988), personally and financially. The idea presented by Jerome Model, M.D., D.Sc. (Professor Emeritus, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida), during his 2004 Rovenstine Lecture, of giving a small percentage of each anesthesiologist’s annual salary to help support academics, seems to be a continuation of a tradition started by those who helped to create the medical specialty of anesthesiology as this article so clearly documents.
In the true sense of being a physician, Dr. Caine published his observations. In the current medical literature, the “how I do it” article has been transformed into the clinical study, replete with sophisticated statistics and randomization methodologies, but in Dr. Caine’s era, this did not exist. However, it was important that successful patient management strategies be published. His work with oxygen was innovative for the time, and there were concerns about how much oxygen patients could inspire without damage to their lungs. In addition to publishing his clinical observations and experience, Dr. Caine also worked to improve the equipment with which he administered anesthesia. In an age when there was no standardization of connectors and tubing and no temperature-compensated vaporizers, and while working as a full-time clinician, he managed to devise and patent a method to warm ether and overcome the loss of heat due to vaporization.
Ansel Caine also understood the need to be involved with the professional organizations in the specialty. His willingness to travel to Rochester, Minnesota, to see what Dr. John Lundy (1894–1973) had to offer in the inaugural Anesthetists Travel Club meeting demonstrates this commitment. His further work with the club, including hosting the meeting, shows that he had innovative anesthesia techniques to offer the group. The fact that Dr. Caine sought certification by the then fledgling American Board of Anesthesiology, after more than 25 years as a specialist, demonstrated his commitment to advancement of the field. He was a founding member of the American Society of Anesthetists (which became the American Society of Anesthesiologists in 1945) board of directors and was integral to the creation of the Louisiana Society as an American Society of Anesthesiologists component in the late 1940s.
Why should one study Ansel Caine? His career is in many ways a road map for anesthesiologists in the 21st century studying professionalism. In 2002, the Annals of Internal Medicine published an article entitled “Medical Professionalism in the New Millennium”2 as a guide to the study and teaching of professionalism. The article cites three fundamental principles and 10 commitments. Ansel Caine’s story clearly demonstrates one of the principles, the Principle of primacy of patient welfare. He also exhibits several of the commitments starting with the Commitment to professional competence—both by his desire to be American Board of Anesthesiology certified and by his ongoing teaching of the art of anesthesiology to other physicians. By recruiting and supporting new anesthesiologists in New Orleans, he demonstrated his Commitment to improving access to care; likewise, his publications and invention show a Commitment to scientific knowledge. His work within the professional organizations could be classified as a Commitment to professional responsibilities.
However, Ansel Caine was unaware of how his story would be used a half century later. To him, patient care was paramount, even if the circumstances could endanger the life of the physician. Be it air travel, infectious disease, or a dictator’s bullet, caring for the patient was what Dr. Caine held in highest esteem. To deliver the best care possible, he continued to study his methods, report results, and create new and hopefully better ways by which patients could be helped. Dr. Caine’s mind, his pen, and his time elevated the specialty of anesthesia, often at some personal risk. What if the credentials committee of the American Board of Anesthesiology had refused his petition, and he had to take the examinations? No doubt Caine would have, because it was the right thing to do—to demonstrate to his patients that he was a recognized specialist and to elevate the practice of this particular part of medicine he so enjoyed. Until now, memories of Dr. Ansel Marion Caine may have been few, as his contemporaries and students are slowly fading from the anesthesia scene. But today, decades after his death, Dr. Caine’s biography outlined in this issue of Anesthesiology clearly resonates with a clear demonstration of the highest forms of professionalism. It is for this reason we should study his career and continue work in the history of anesthesiology to better understand the foundations on which the current practice of anesthesiology rests.
Douglas R. Bacon, M.D., M.A.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota. bacon.douglas@mayo.edu
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References

1. Broussard DM, Vachon CA, Winthrop BE: Ansel Marion Caine, M.D. Anesthesiology 2006; 104:1329–35

2. ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine: Medical professionalism in the new millennium: A physician charter. Ann Intern Med 2002; 136:243–6

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