In Anesthesia from Colonial Times, Eckenhoff covers the history of anesthesia at the University of Pennsylvania for the 200 years prior to 1966. Clearly the history of the Department of Anesthesia at Penn, as an academic department, starts with the appointment of Robert Dunning Dripps as the Department Chair.
The Dripps Years: 1943-1972
Two 1918 graduates of the Medical School (the nation's first medical school, started in 1765) recognized the inadequacies of anesthesia care and a need for direct physician involvement. I.S. Ravdin, a surgeon, and Carl F. Schmidt, a pharmacologist, recruited Dripps, a 1936 graduate of the Medical School who had been doing postgraduate work in the Pharmacology Department, and sent him to the University of Wisconsin to work with Ralph Waters, who had founded the first independent anesthesia department in a medical school and is considered the Father of academic anesthesia. That Dripps spent only six months as a resident is as much a reflection of the knowledge base for the specialty at that time as to his brilliance.
In 1943, Dripps became Chair of Anesthesia at Penn. He was not able to pass the physical exam for the Armed Services. (Otherwise, he would undoubtedly have served with the U.S. Army 20th General Hospital, which served with distinction in the China-Burma-India Theatre and was made up largely of Penn physicians and nurses, and commanded by Colonel, later General, Ravdin.) The manpower situation on the homefront was such that Dripps quickly obtained extensive clinical experience. One month he spent 27 of 31 nights in the hospital! As a result, he quickly became a superb clinician, adept at management of the difficult airway and finding the subarachnoid space, as well as possessing sound clinical judgment.
Dripps also started the residency program at Penn. Predictably, his first resident recruit at the time of war was a female, Margery Deming, who went on to become the Chief of Anesthesia at Children's Hospital of Philadelphia when C. Edward Koop went there in 1945 as Chief of Surgery.
The end of the war resulted in many physicians being discharged from the Army where they had received limited training in anesthesia and then served as anesthetists. Many of these "90 day wonders" elected to take formal training in anesthesia upon discharge from the Armed Services. Foremost among them was Jim Eckenhoff, a 1941 graduate of the Medical School who, upon completion of residency, joined the faculty with Dripps to form a most dynamic academic duo. In 1967 Eckenhoff moved to Northwestern as Chair of a new Anesthesia Department and shortly thereafter became Dean of the Medical School.
In his 30-year tenure, Dripps trained over 500 residents, many who have become well known in anesthesia. Indeed, at the time of his death Dripps had trained more academic anesthesia chairs than anyone. His own contributions included teaching the art of anesthesia as well as the technique. He was a fine, caring physician who had a large VIP practice — e.g. when the FDA approved enflurane he commented that this drug had been tested on more corporate executives than any other in history, for he often combined clinical investigation with his VIP practice.
Dripps served as Chair until 1973 when he became Vice President for Health Affairs at Penn with responsibility for the medical, dental, veterinary, and nursing schools, well as the Hospital of the University of Pennsylvania. His sudden death in 1973 at age 63 was a great loss not only to the Department, but to the University and to the specialty.
The Wollman Years: 1972-1987
In 1972 Harry Wollman, a 1956 graduate of Harvard Medical School, who completed his anesthesia residency and pharmacology fellowship at Penn, followed Dripps and became the first Robert Dunning Dripps Professor of Anesthesia. (Although the funds to endow the Chair had been made available several years earlier by the McNeil family, Dripps declined to be the first incumbent — commenting that the stationery alone would be too confusing!)
Under Wollman, the three-fold academic mission of clinical care, education, and research continued, with the growth in residency size and the number of hospitals covered. In addition to HUP, CHOP, and the VAMC, residents began to rotate to Graduate Hospital and Pennsylvania Hospital and the size of each resident class more than doubled, from 12 to 30. As a result, in his 15 years, Wollman trained as many residents as Dripps had in his 29 years. During this period of clinical expansion, the efforts in the education of medical students, residents, and fellows expanded also. Two faculty, Alan J. Schwartz and Frederick W. Campbell, received the Lindback awards for medical student education; and Frank L. Murphy, was awarded the Dripps Award, which was funded by the Department and is awarded by the medical school to a staff member in any specialty who distinguishes himself as a resident instructor.
Wollman started subspecialization within anesthesia when he and Alan Ominsky began to provide 24/7 coverage for cardiac surgery in 1971. Wollman extended this concept early in his chairmanship with separate critical care and pain management teams. Later additional emphasis was given to coverage of obstetrics, thoracic, neurosurgical and vascular anesthesia.
The Longnecker Years: 1988-2002
In 1988 David E. Longnecker, MD, a 1963 graduate of the University of Indiana School of Medicine and its residency came to Penn from the University of Virginia to become the second Dripps Professor and Chair. A combination of hospital mergers and his desire "to get better by being smaller" resulted in the elimination of Graduate and Pennsylvania Hospital rotations and a reduction in resident class size to 25. Longnecker trained over 300 anesthesia residents during his tenure as Chair. Longnecker markedly expanded the research productivity of the department, resulting in increased NIH funding and publications. In tribute to his success in revitalizing the departmental research activities, the new anesthesia research laboratories, which were occupied during his tenure, were named in his honor.
Longnecker worked to integrate the department into hospital and university. In the latter years, first with Frank L. Murphy and later Robert R. Gaiser, Longnecker increased teaching of medical students in core and elective courses. Gaiser also won both the Dripps and Lindbach Awards.
Longnecker also proposed a joint critical care service where both anesthesiology and surgical residents worked jointly under the supervision of anesthesiologist and surgeon in alternate weeks. This experience as primary care providers has been a marked improvement over the former consultant status.
The Fleisher Years: 2004-2020
In January 2004, Dr. Lee A. Fleisher, a 1986 graduate of SUNY-Stony Brook Medical School and the Yale anesthesia residency, came to Penn from Johns Hopkins (much like Austin Lamont many years ago) to become the third Dripps Professor and Chair. During his tenure, the Department grew enormously, from 45 to 125 faculty. The department expanded its critical care footprint, including the co-development of a neuro-intensive unit, together with fellowships in neurocritical care and in cardiac anesthesia/critical care. To align better with its expanded mission, the department was renamed to “Anesthesiology and Critical Care,” with a new leadership structure that included vice chairs in each of the tripartite missions; clinical care, education and research. Clinically, there was a marked expansion of services including multiple pain management sites, out-of-OR anesthesia, and the recruitment and development of a large number of Certified Registered Nurse Anesthetists with integration into the teaching program for SRNAs through the School of Nursing. Regional anesthesia was expanded including development of a new fellowship. A large number of physician scientists were recruited and the Dripps Fellowship Program, a research-intensive residency program, was developed for selected incoming residents. This led to the development of new centers of research excellence, including the Centers for Perioperative Outcomes Research and Transformation (CPORT) and Neuroscience of Unconsciousness and Reanimation Research Alliance (NEURRAL), and many individual laboratories exploring diverse topics related to perioperative and critical care medicine. Dr. Fleisher was tasked by ASA to lead a patient safety initiative, termed the Perioperative Brain Health Initiative (PBHI), which has been responsible for broad visibility of this important topic and the integration of anesthesiology into new areas of geriatrics, neurology, psychiatry and neuroscience. The residency continued to have a national reputation, ranked #5 by US News & World Report and developed a research arm under the vice chair for education, Dr. Emily Gordon. In March 2020, Dr. Fleisher led the department through the initial response to the COVID-19 pandemic, during which the department exhibited leadership of critical care throughout the health system. Recognizing his long and broad experience in health policy research, Dr. Fleisher was then recruited by the Centers for Medicare and Medicaid Services (CMS) to be the CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality in July 2020.