07th June 2021

Book in Focus

Leadership in Anaesthesia

Five Pioneers of the Deadly Quest for Surgical Insensibility

By Berend Mets

Leadership is like beauty—obvious when we see it, but hard to characterise, it manifests very differently in different individuals and circumstances, but nevertheless can flourish.

Leadership in Anaesthesia: Five Pioneers of the Deadly Quest for Surgical Insensibility tells the vivid biographies of five anaesthetists who sequentially helped transform the historically crude practice of anaesthesia to the sophisticated medical specialty of anaesthesiology encountered today. I then perform a comparative leadership analysis of Drs William Morton, John Snow, Arthur Guedel, Virginia Apgar, and Bjørn Ibsen at the end of each protagonist’s chapter, using an analytical skeleton composed of seven key leadership ingredients to conduct the post mortem (see below).

What follows are the opening excerpts from the chapters dedicated to each of the five pioneers. I close with A Leadership Reckoning, the title of the last chapter.

The Discovery

A trouble maker and narcissist!

That is what we would call William T.G. Morton today. Not so on Friday October 16, 1846. Poised to publicly demonstrate sulphurous ether as a practical anaesthetic, the swashbuckling charmer Morton was merely known as a raw dentist, a mendacious huckster, a swindler, a confidence trickster, and a counterfeiter extraordinaire as he made his way confidently, but anxiously, and hurriedly, along the straight gravel path past the half-constructed Harvard Medical School on his way to the three-storied Massachusetts General Hospital looming up in front of him.

He was late.

Very late.

Forestalled by needed adjustments to the newly invented, albeit never used, glass-globed-apparatus held tightly under his right arm, he also cradled a demi-john filled to the brim with the deadly explosive ether he was planning to administer.       

The First Death

Dr John Snow worked himself to death.

The first physician scientist to dedicate his life to transforming the art of anaesthesia into a science, he was far from the first to put his patients’ health before his own—striving to find the perfectly safe anaesthetic.

Chloroform was not that drug. Even so, ever hopeful, Snow would back it—literally—to his dying day.

The Great War: 1918

All was not quiet on the Western Front!

In fact, it was bedlam. Casualties from the American Expeditionary Force stationed in France were in their thousands: the 26th division advancing up the Marne River pushing back the Germans that dreadful July of 1918. The machine gun bullets, exploding shrapnel, and toxic phosgene gas taking their heavy toll as the soldiers breached the trenches, ran across No Man's Land, and advanced towards Germany; moving the Firing Line and the Western Front east.

Arthur Guedel’s start with the AEF was inauspicious.

In truth, it would not have started at all if he had not been persistent—his service application was at first rejected because of his claw-like right hand; comprising just a thumb and an index finger, it looked like a lobster’s pincer.

The Apgar Score

At the Sloane Hospital for women, it was the first minute after birth that was most treacherous. It was then that the new-born was in the worst situation. Swaddled in a blanket and abandoned in a crib in the back of the delivery room; all attention was focused on the mother. The mother’s belly massaged, the afterbirth delivered, fluids administered, and, as the labour pains subsided, the inevitable question asked: “Is my baby alright?”

The baby, left to its own devices, sometimes faltered—a few weak breaths and then nothing. No one any the wiser until the crib was moved to the post-natal room, and it was found dead in bed.

Sitting together with a group of medical students in the hospital cafeteria early one morning after a particularly harrowing night on call, Virginia was asked a seminal question:

“Dr Apgar, how would you evaluate a new-born?”

“That’s easy—you do it like this”, Virginia replied, reaching over to grab a ‘Do Not Bus Your Trays’ sign left on a trolley alongside the table they were sitting at, and jotted down: “Five points—heart rate, respiratory effort, muscle tone, reflex response and colour—are observed and given zero, one or two points. The points are then totalled to arrive at the baby’s score". A total of nine or ten was optimal. Then she rushed off to try it for herself, her white coat flapping behind as she made her way upstairs to the obstetric unit.


Doctor Bjørn Ibsen had been given one chance to prove himself, one chance to demonstrate that anaesthetic techniques used inside the operating theatre could be used outside it.

One chance to save a life! Much like the time he found his breathless daughter: turned blue on the family couch, her airway plugged by oatmeal, five years earlier; this time, Ibsen had been asked to intervene on Vivi Ebert paralyzed and suffocating from bulbo-spinal poliomyelitis, a victim of the polio epidemic sweeping through Denmark.

The polio epidemic, centred in Copenhagen, reaching a crescendo in August of 1952, creating a crisis of almost biblical proportions—Dr Henry Cai Alexander Lassen, an epidemiologist, and Physician-in-Chief of the Blegdams communicable diseases hospital, sketched the predicament well.


A Leadership Reckoning

The book concludes with the chapter, A Leadership Reckoning. To compare the five pioneers, I have developed a leadership skeleton comprised of seven key ingredients for successful leadership which is presented in the rubric entitled Creative LEADER.

Using the values Creativity, Legitimacy, Emotional Competence, Adaptability, Determination, Empathy and Resilience, I dissect and lay bare the protagonists’ successes or failures in order to create a putative leadership score for eventual comparison in this final chapter.

To create this rubric, I relied heavily on C. Northcote Parkinson’s work on the subject.

In The Law of Delay, a book written over half a century ago, Parkinson spelled out the six elements that he thought the art of leadership required: imagination (creativity), ability (legitimacy), personal magnetism (emotional competence), knowledge (adaptability to change), determination (determination), and ruthlessness (resilience), leaving out the seventh, empathy, that I have added to the leadership rubric.

I conclude the book with the following statement:

The total leadership score was very different, in differing individuals: varying from 12/21 for Dr Morton to 21/21 for Dr Apgar—although each leader was nevertheless effective in diverse ways, suggesting that indeed:

Leadership, like beauty, can manifest differently in different individuals and yet can flourish.

Read Extract

"As an anesthesiologist with a PhD in pharmacology, Dr Berend Mets has staked out an unapologetic island between these authorship extremes with this remarkable new book. To readers, Leadership in Anaesthesia: Five Pioneers of the Deadly Quest for Surgical Insensibility simultaneously offers meaty biographies and a leadership primer. […] Had I been wise enough to begin reading this book earlier in the day, I would have finished it in one sitting. […] This book is certainly required reading for any aspiring anesthesiology leader or anybody hoping to maintain a leadership position. A lot of facts and a load of wisdom are packed inside this volume."
George S. Bause, MD, MPH
Case Western Reserve University School of Medicine; Anesthesiology Vol. 134, No. 6

"This is a book for doctors in every discipline, but particularly those pursuing careers in anaesthesia and intensive care who want to know more about their history. It will also have appeal for the general reader with an interest in medical history. This book is fast-paced and fun; it is written with a dramatic style, but is very readable."
Christine Ball
Prahran, Victoria, Australia; British Journal of Anaesthesia, 126 (2)

"In this book, Mets examines concepts of leadership through the lives and careers of five pioneers of anaesthesia. The book will appeal to leaders or aspiring leaders, as well as to anaesthetists and historians interested in biographies of the five pioneers selected by Mets. The pioneers are products of their own time and place. Nonetheless, the biographies cover the extraordinary story of the development of anaesthesia from an art to a science, and the expansion of the responsibilities of the anaesthetist from the administration of anaesthesia to the care of patients outside the operating room (such as neonatology and intensive care)."
Rajesh Haridas
Retired Anaesthetist, Sydney

Dr Berend Mets is Professor and Chair of Anesthesiology and Perioperative Medicine at the Pennsylvania State University, and is the author of Waking up Safer? An Anesthesiologist’s Record. He has published extensively on leadership, anesthesia, education and medicine.

Leadership in Anaesthesia: Five Pioneers of the Deadly Quest for Surgical Insensibility is available now in Hardback at a 25% discount. Enter the code PROMO25 at the checkout to redeem.