Clarence J. Durshordwe, the International Anesthesia Research Society, and the World Federation of Societies of Anesthesiologists: The Last True Disciple of Francis Hoeffer McMechan

Clarence J. Durshordwe (Fig. 1) was a self-trained anesthesiologist whose entire career was spent in the hospitals affiliated with the University of Buffalo. 1 He was the partner of John Henry Evans (1) (Fig. 2), President of the Board of Governors of the International Anesthesia Research Society (IARS) from 1925 until 1947, and friend and confidant of Francis Hoeffer McMechan (Fig. 3), the IARS founder. In the years after McMechan’s death on June 26, 1939, Durshordwe spent 20 years, from 1946 to 1966, as a member of the board of the IARS and the editorial board of Current Researches in Anesthesia and Analgesia, carrying forth McMechan’s vision for organized anesthesia.Figure 1: Clarence J. Durshordwe (Photograph courtesy of the Wood Library-Museum, Park Ridge, IL).Figure 2: John Henry Evans (Photograph courtesy of the Wood Library-Museum, Park Ridge, IL).Figure 3: Francis Hoeffer McMechan (Photograph courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, IL).Perhaps most interesting, in 1953, Durshordwe was appointed by Ralph Knight, the president of the American Society of Anesthesiologists (ASA) to represent the United States at the first World Congress of Anaesthesiologists held at The Hague in June 1954. Why did Ralph Knight appoint the unassuming Buffalo native to make this historic trip? What credentials did Durshordwe hold that qualified him for this task? Were his relationships with other anesthesiologists across the world, fostered by his relationship with McMechan and Evans, sufficient for him to assess the impact of American membership on the fledgling World Federation of Societies of Anaesthesiologists (WFSA)? Did he believe in McMechan’s dream of a united world of anesthesiologists represented by the WFSA? (2) Buffalo Roots Durshordwe was born on the ethanically German-dominated East Side of Buffalo, New York, August 21, 1896. Of Alsatian heritage, 2 he was the only son of Louisa Becker and Frank Durshordwe, a journeyman carpenter who did fine interior woodworking. 3 After graduating from Masten Park High School in 1915, he rejected his parents’ advice to learn a trade and attended the University of Buffalo School of Arts and Sciences for two years. In the fall of 1917, Durshordwe enrolled in the School of Medicine at the university. Before graduating from medical school, however, Durshordwe volunteered for the United States Army, and was stationed in South Carolina as an artillery officer for the duration of World War I. Returning to Buffalo, he resumed his medical studies and supported himself by working in area steel mills. He also did original basic science research with Herbert Williams, a professor of pathology, attempting to create an animal model for glomerular nephritis. He spent two years injecting mercury IV into rabbits and doing blood counts and histologic examination of the kidneys, but the work was never published and the data were discarded. 4 This frustrating experience haunted Durshordwe, and later John Evans had great difficulty convincing him to do scientific investigations or to write papers. 5 After medical school, Durshordwe interned at the 68-bed Marine Hospital in Buffalo (3). On completing his training, he was hired as an assistant surgeon for the Public Health Service. Early in his five years of service, he discovered that the lowest ranking physician was assigned to give anesthetics. Concerned that he might harm a patient, Durshordwe went to Buffalo City Hospital to observe nurse anesthetists administer anesthetics. Toward the end of his tenure at the Marine Hospital, now assigned to perform surgery, Durshordwe found he spent more time worrying about the anesthetic than the surgical procedure. 4 The experience at the Marine Hospital was significant to Durshordwe’s career; there, he learned the importance of anesthesia to the success of surgery, and there he met Evans, his mentor and future partner. Evans’ smooth and reliable anesthetic technique for major abdominal surgery helped relieve Durshordwe’s anxiety regarding that aspect of the procedures. The two men soon became friends and Durshordwe spent much of his free time learning Evans’ techniques. On January 1, 1928, Durshordwe became Evans’ associate at the Buffalo General and Buffalo Children’s Hospitals. 4 Thus, he was introduced to the inner circle of Buffalo medicine, as the attending staff of the General was heavily involved in teaching at medical school. Throughout his life, Durshordwe was an avid outdoorsman. Hunting and fishing trips with the surgeons from the Buffalo General Hospital were legendary. Twenty years after he retired, his exploits with the rod and gun were still being told in the operating rooms. When not in the operating room, he could be found at the exclusive Buffalo Club. His wit was popular among the upper echelons of Buffalo society. Thus, Durshordwe was well connected both inside the medical school and in the city of Buffalo and remained so until his death on September 24, 1990. The Evans Influence Evans wanted to be sure that Durshordwe was capable of giving anesthetics safely before he would assume responsibility for his partner. 4 Therefore, during the first six months of their partnership Evans demonstrated various anesthetic techniques, beginning a process of continuing education for the younger man. Nitrous oxide-oxygen induction followed by ether was Evans’ preferred technique, and the induction could take upward of 15 minutes to complete. In addition to personal supervision, Evans, through his contacts in various anesthetic organizations, arranged in 1928 for Durshordwe to visit leading centers of anesthetic excellence across the country. Durshordwe spent time with Brian Sword in Hartford, Connecticut and observed with Paul Wood in New York City. 4 Both Wood and Sword were members of the exclusive Anesthesia Travel Club, a group of 30 prominent anesthesiologists in the United States at that time. One member would host the others once a year, demonstrating techniques in use at the host facility. 6 Evans also arranged for Durshordwe to participate in the two postgraduate training programs then functioning in the United States. Durshordwe spent a week with John Lundy at the Mayo Clinic, where he first saw sodium thiopental administered. Lundy gave Durshordwe several vials of the new experimental anesthetic, and on his return to Buffalo, Durshordwe attempted to anesthetize two patients with the drug. The cases did not go well, and the remaining vials collected dust on a shelf at Buffalo General Hospital. 5 The other training program Durshordwe visited was Ralph Waters’ program at the University of Wisconsin in Madison. Waters, a close personal friend of Evans, gave Durshordwe several large cylinders of another new and expensive anesthetic, cyclopropane, to take back to Buffalo. 4 Durshordwe evidentially did not like the anesthetic, and it too gathered dust for 20 years until Richard Ament introduced cyclopropane for routine use at the Buffalo General in 1949. 7 Durshordwe was leery of both research and innovation. Not only had he disappointed Evans by not eagerly joining in clinical research, but Durshordwe also failed to embrace anesthetic innovations. A Busy Buffalo Practice Durshordwe’s leadership talent lay some years ahead in medical politics, not in research and writing; meanwhile, he mastered his mentor’s anesthetic techniques. Evans pushed Durshordwe to increase his clinical load and to do more cases because he himself was increasingly occupied giving surgical anesthesia to the patient’s of Professor Herbert Smith, one of the leading surgeons in Buffalo who had been an assistant to Roswell Park, the former professor and chairman of the department of surgery at the University of Buffalo. Roswell Park’s interest in malignancy, whose prevalence was above average in the Western New York area (4), lead him to establish the first multidisciplinary cancer center in the United States in Buffalo. The institute was named in his honor after Park’s death. 8 Eventually, Durshordwe, a large man, participated in Evans’ supplemental oxygen practice by carrying heavy oxygen cylinders into patients’ homes. There he helped administer subcutaneous oxygen to treat chronic pain problems, 9 cancer, tuberculosis, asthma, and heart failure, and relieve cyanosis in patients with pneumonia. 10 While Evans was concerned with determining what inspired oxygen concentration was lethal to his ill patients, Durshordwe was happy to encourage Evans, see patients with him, lug the necessary equipment, and help carry more of the operative clinical load. 10 Nonetheless, immersed in the academic environment created by Evans, Durshordwe did publish six scientific articles, three coauthored with his mentor. The first two articles concerned blood pressure and pulse as guides to the patient’s physiologic state under anesthesia. The first article, in 1930, noted that cardiovascular changes under anesthesia, especially an increase in the pulse and a decrease in blood pressure, heralded shock (5). The second article, in 1932, emphasized the need to study these values preoperatively as prognostic indicators (6). Durshordwe’s Entree into the National and International Scenes in Anesthesiology At the time Durshordwe joined Evans in the practice of anesthesiology, Evans had established himself as one of the pioneer leaders of the specialty. He had been President of the Board of Governors of the IARS since 1925, and had traveled as part of the IARS delegation to Great Britain for the first joint meeting with the British Medical Association’s Section on Anesthetic in the summer of 1926. The July 1927 issue of the British Journal of Anesthesia was dedicated to Evans. Of importance, Evans was president of the Associated Anesthetists of the United States and Canada in 1927, the only national anesthesia organization of its day. He also was a founding member of the Eastern Society of Anesthetists and served as its president in 1928 (1). A small, quiet, and unassuming man, 9 Evans was well suited to be the power behind the throne of McMechan. Francis McMechan, however, was anything but quiet and unassuming. Crippled with rheumatoid arthritis since 1915 and wheelchair bound, McMechan used his pen to create an international network of physicians and friends dedicated to the advancement of the specialty of anesthesiology across the world (7). It was he who started the first quarterly journal in anesthesia as the QSupplement to the American Journal of Surgery. Later, he founded the first journal devoted solely to anesthesia, Current Researches in Anesthesia and Analgesia. Almost single-handedly, McMechan developed scientific meetings in anesthesiology referred to as the Clinical Congress of Anesthetists (8). Between 1910 and 1925, he created the infrastructure of organized anesthesiology. Evans and McMechan enjoyed a close personal relationship. Twice yearly, McMechan and his wife Laurette would travel by train from Rocky River, Ohio to Buffalo to be guests of Evans and his wife. Because of his disability, McMechan needed someone to become his arms and legs in the struggle for the professionalization of anesthesia. Evans was his choice, 11 and the two men spent much of their time together discussing the politics of anesthesia. 4 Through this association, Evans became known to the national and international anesthesia community. Evans proved to be a loyal officer to McMechan, and Durshordwe was equally loyal to both. Evans let his membership in the New York Society of Anesthetists 12 elapse because the society was the only one at the time that McMechan did not control, and with the Depression raging, the dues were a financial burden Evans felt he could not afford. Durshordwe did the same. The two men were fully behind McMechan’s International College of Anesthetists as the certifying body for physician anesthetists, and they often used the initials FICA 13 after their names in their professional publications. So intense was their loyalty to McMechan that, as the ASA began to certify specialists along American Medical Association guidelines, neither Evans nor Durshordwe would participate until almost the final moment (9). Indeed, this delay caused Durshordwe to be excluded from the founders group of the American Board of Anesthesiology! 14 The death of McMechan on June 29, 1939, changed the lives of Evans and Durshordwe. As President of the Board of Governors of the IARS, Evans had the unenviable task of presiding over the McMechan’s organizations as they folded. Many physician anesthetists could not see the logic in paying dues to a regional society, the Associated Anesthetists of the United States and Canada, the IARS, and the ASA. There was a feeling among the physicians that the McMechan organizations were not growing and that a reorganization was necessary. Respect for McMechan prevented this from happening during his lifetime (10). Strained by the effort of overseeing the collapse of half of organized anesthesia, Evans looked to younger men, especially his partner, to carry the load. Indeed, he and Durshordwe alternated attendance at the national IARS meetings so that at least one of them would be present. 4 Durshordwe could not help but be influenced by this environment and the new political role he was being asked to play as Evans’ designated representative when he could not attend the Board of Governors. After World War II, Evans introduced Durshordwe into the hierarchy of the IARS. Importantly, Durshordwe and his wife Helen were good friends with Laurette McMechan, whose life’s work was to keep her husband’s legacy alive. Her influence was still very strong despite her husband’s death some six years before (8). Durshordwe was immediately accepted, mostly on the word of Evans. 9 He served on the Board of Governors of the IARS for 12 years and on the editorial board of Anesthesia & Analgesia. He enjoyed the work, and became close friends with physician anesthetists across the country. The Crowning Glory: American Observer at the First World Congress of Anesthetists The first World Congress of Anaesthetists was held in The Hague in the Netherlands in 1954. Although invited to join, the ASA was reluctant to commit to this organization for a variety of reasons. Among American observers, Durshordwe was sent to collect information and to study the operations of the WFSA and recommend if the ASA should join. Ralph Knight, ASA president, knew that Durshordwe could garner reliable inside information about finances and the direction the organization was likely to take, because of his IARS connections to members of the Council of the WFSA. The commitment of time and energy of physicians closely associated with the IARS were consistent with McMechan’s vision of a world anesthesiology community. In many ways, the world federation as an ideal was conceived in 1936 when two French physicians attended the Congress of Anesthetists. After lengthy discussions, McMechan suggested that a European Congress of Anesthetists be established. Plans went forward under the sponsorship of the French for just such a meeting in 1940 in Paris. Robert Monard (Fig. 4) was one of the two Frenchmen to attend the 1936 meeting. A member of the IARS since the early 1930s and a Fellow of the International College since 1938, he was the driving force behind the proposed 1940 meeting, which never took place because of the outbreak of World War II, and Monard opened discussions to form the WFSA. The IARS was a key component in the development of the WFSA, thus continuing McMechan’s work long after his death (2). The Board of Governors of the IARS, with Durshordwe as a member, sponsored the translation and publication of all abstracts presented at the meeting, an investment of more than 10,000 1955 dollars! (11)Figure 4: Robert Monard (Photograph courtesy of the Wood Library-Museum, Park Ridge, IL).For many reasons, Durshordwe was a natural selection to represent the ASA. Perhaps because of his close personal friendship with Sir Geoffrey Organe 15 (Fig. 5), one of the organizers of the WFSA, the ASA leadership felt that he could obtain the best information on the future direction of the organization. In addition, Durshordwe was present at organizational meetings in Paris and London in the early 1950s when the WFSA was formed. He also was a close personal friend of Harold Griffith, chairman of the organizing committee of the WFSA. Well known on the international scene thanks to introductions by Evans and McMechan, and friend to virtually all physicians present at these meetings, 4 Durshordwe as an American observer made sense as he was in a position to know where the WFSA was headed. He was not just an ordinary observer however, but he was a highly motivated spectator who was recognized as both a member of the sponsoring IARS and representative of the ASA. With his loyalty to Evans and McMechan, this was his chance to fulfill their shared vision of a united world of anesthesiologists represented by the WFSA. Finally, it was Durshordwe’s opportunity to contribute to the professionalization of anesthesiology internationally and forever change the specialty. His mission was “successful” as the ASA joined the WFSA two years later. The IARS felt that this was appropriate, as theirs was a research organization and not a political one.Figure 5: Sir Geoffrey Organe (Photograph courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, IL).Conclusion Clarence Durshordwe’s early career was typical of his generation of anesthesiologists in that he was largely self-taught; he learned by doing. But there the similarity ended. While he continued to practice clinical anesthesia, he set an example for all practicing anesthesiologists. Through his association with John Henry Evans, he was introduced to the world of academic and professional anesthesiology and he participated actively in the organizations that shaped his specialty. Unquestionably, the influence of Durshordwe and the world view he inherited from McMechan catalyzed the linkage of the ASA with the WFSA, a large step in the process of professionalization of the world of anesthesiology. Durshordwe’s political influence as a board member of the IARS and an envoy of the ASA clearly demonstrates the pos- sibilities open to active members of anesthesia organizations.

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