The first reported anesthesia in a territory that would become part of Canada (in 1867) was in the British colonial province of New Brunswick, in January 1847. In the late 19th century, Canadian anesthesia was linked primarily with that in the UK, leading to a physician-based practice, which continues to the present. In the early 20th century, US influence increased. By the 1930s a true Canadian identity began to emerge and, in time, to dominate.

The Canadian Society of Anaesthetists formed in 1920, but lapsed in 1929 with the start of the Anaesthesia Section of the Canadian Medical Association. The Montreal Society of Anaesthetists, established in 1930, became the Canadian Anaesthetists’ Society (CAS) in 1943. The CAS was renamed the Canadian Anesthesiologists’ Society in 1993. The CAS began a medical journal in 1954, an international education fund in 1967, and a research foundation in 1979.

McGill University established the first Canadian academic Department of Anesthesia in 1945, with independent departments evolving in all sixteen Canadian universities over the next 25 years. Important for these departments was the Royal College of Physicians and Surgeons of Canada (RCPSC), established in 1929, which oversaw the education curriculum in all specialty training programs and offered specialty examinations. In 1972, the RCPSC mandated that all specialty training programs operate under the auspices of a university. The Association of Canadian University Departments of Anesthesia (ACUDA) formed in 1976 to support academic departments and research. Canadian anesthesia researchers have contributed to many areas of medicine.

In the 1970s the focus on patient safety became increasingly important, and led to the CAS publishing Guidelines for the Practice of Anesthesia. The CAS assisted in creating and implementing new anesthesia gas machines standards of the Canadian Standards Association.

Since 1972, the Canadian universal healthcare system has provided patients in all provinces with comprehensive health services, including physician services. This unique system allows anesthesiologists (specialist or family-practitioner) to provide anesthesia services for all patients, regardless of their ability to pay.

Canadian anesthesia began before the four eastern provinces formally amalgamated as the Dominion of Canada on July 1, 1867. Physicians, drugs and techniques from the neighboring United States (US) and the United Kingdom (UK) strongly influenced medical care in the provinces that would become Canada. According to the 22 Jan edition of the Weekly Chronicle, St. John, New Brunswick, the first reported anesthetic was on 17 Jan 1847, three months following the successful demonstration of ether anesthesia by William Morton in Boston. A visiting dentist from Boston (Samuel Adams) administered a “vapor of a compound of which aether appeared to form the chief ingredient” to a man to produce “complete sleep and insensibility” for removal of a tumor on his arm [1]. The proximity of St. John to Boston by sea explains how the news spread quickly. Other newspaper reports of the use of ether in Canada in early 1847 have been reviewed, [2] but none antedated that in St. John. A surgeon, Edward Worthington, provided the first medical report of the use of ether in Canada, in Eaton Center, Quebec, on 11 March 1847, describing a below-knee amputation [3]. Worthington was also the first in Canada to report (4 November 1847) the use of chloroform, soon after its introduction into surgical practice by James Simpson in Edinburgh.

Despite the proximity of the US, Canadian medicine in general and anesthesia in particular, were linked primarily to the UK during the second half of the 19th century. Many physicians then in Canada had completed their medical training in the UK before immigrating to a country that was part of the British Empire. The pioneering anesthesia research in the UK by John Snow (1813–1858) also encouraged the long-term link between anesthesia in Canada and the UK. From the outset and continuing to the present, anesthetic practice in Canada has been physician-based, as in the UK. Although US influences on Canadian anesthesia became stronger by the early 20th century, a Canadian identity evolved and later dominated. This chapter charts the key steps in the development of that Canadian identity.

From 1899 to 1920, anesthesia was performed as a ‘craft’, with a developing empirical base but little scientific evidence to guide its use [4]. Hospital appointments were an important step in recognizing anesthesia as a worthy profession. The appointment, in 1899, of William Hutton as an ‘honorary anaesthetist’ at the Winnipeg General Hospital in Manitoba, marks the beginning of the specialty in Canada [5]. Hutton graduated from the Manitoba Medical College in 1887 and was later appointed as Professor of Practical Chemistry and also Registrar of the College [6]. Other appointments soon followed, most notably William Webster (1865–1934) in Winnipeg, and Samuel Johnston (1869–1947) in Toronto [7]. Webster, born in Manchester, UK, came to Snowflake in rural Manitoba as a school teacher in 1888, then entered the Manitoba Medical College, graduating in 1895. After postgraduate training in Pathology in the UK, he returned to Winnipeg, working in both General Medicine and Pathology. Without further formal training, he began to include anesthesia in his practice, eventually on a full-time basis. In 1905, he was appointed Lecturer on Anesthesia at the Manitoba Medical College. He found that safe anesthesia relies on application of basic physiological and pharmacological principles [8]. His 1924 publication ofThe Science and Art of Anaesthesia, the only comprehensive anesthesia textbook written by a Canadian anesthetist, demonstrated his interests in teaching and research.

Johnston graduated from Trinity Medical College in Toronto in 1901. He began a general medical practice, but turned to full-time work in anesthesia. He later wrote: “I know I was the first physician in Canada to give up general practice and go into the specialty of anaesthesia.” (Personal Communication: Edward Shorter, Hannah Professor of History, University of Toronto. 2012.) Johnston was invited to organize the Department of Anesthesia at Toronto General Hospital in 1904, where he instructed house officers in anesthesia. In 1907, he was appointed Lecturer in Anesthetics in the Faculty of Medicine, University of Toronto. He spent 1908–09 in the UK, acquiring further training before returning to Toronto to his career in anesthesia. He taught medical students about anesthesia and was probably the first anesthesiologist to do so in Canada. Canada’s ‘formal’ teaching track record in anesthesia therefore goes back to 1910.

Charles LaRocque, at Hotel Dieu Hospital, and William Nagle, at the Royal Victoria Hospital, both in Montreal, Quebec, joined Webster and Johnston as the only doctors in Canada at that time devoting themselves solely to anesthesia [9]. General practitioners, or interns and residents supervised by surgeons (in some of the teaching hospitals), provided much of the clinical anesthesia in Canada. Of interest, Margaret McCallum Johnston (wife of Samuel Johnston) was appointed as the first Chief of Anesthesia at Women’s College Hospital in Toronto in 1914, and is believed to be the first woman to practice anesthesia full-time in Canada.

Webster and Johnson travelled to the UK and the US to observe anesthetic practice, teaching, and the beginnings of anesthesia-related research. Although links to the UK had a greater influence on Canadian anesthesia in the first decade of the 20th century, influences from the US increased after 1910 because of mutual concerns about the quality of basic medical education resulting from Abraham Flexner’s comprehensive report [10]. The report, entitled “Medical Education in the United States and Canada”, transformed medical education in both countries. Academic-based training programs undertaken in Universities replaced the apprentice model, controlled by private practitioners.

Francis McMechan (1879–1939) of Cincinnati, Ohio probably created the most significant US link to Canada, from the late 1910s to the 1930s. Despite severe rheumatoid arthritis, which prevented him from continuing his anesthetic practice, he profoundly affected the organization of anesthesia in the US, Canada, and indeed worldwide. This included the creation of several anesthesia societies, which held annual scientific meetings, and his creation and editorships of both the Quarterly Supplement of Anesthesia and Analgesia of the American Journal of Surgery (1914–26), and Current Researches in Anesthesia and Analgesia, starting in 1922. Through his worldwide contacts with anesthetists, including Webster, Johnston and others in Canada, and Waters in the US, McMechan promoted academic anesthesia, with an emphasis on the link between the basic science laboratory and the clinical practice of anesthesia. Canadian anesthesia benefited greatly from McMechan’s promotion of anesthesia as a valid specialty.

Leaders in the specialty from both countries met regularly, including as the “Anesthesia Travel Club”, formed in 1929. Four of the 14 members at the initial meeting were Canadian’Easson Brown, Charles Robson, Harry Shields and John Blezard.

In 1933, Ralph Waters (1887–1979) was appointed Head of the first autonomous Department of Anesthesia, in Madison, Wisconsin. He created an academic department that provided exemplary patient care, undergraduate and postgraduate teaching, and quality research. Waters had a major impact on Canadian anesthesia, similar to his influence on American anesthesia.

In the subsequent decades, the scientific foundation for anesthetic practice established by Webster and Johnston, became the base for the evolution of anesthesia in Canada from that of a ‘service-oriented craft’, to a discipline recognized by others, and finally to a specialty based in science.

The Canadian Society of Anaesthetists, Canada’s first formal association of specialists, [11] was founded mainly through the efforts of Wesley Bourne of Montreal as Secretary, and Samuel Johnston as the first President. They were encouraged and assisted by McMechan, who had established several anesthesia societies in the US and who had developed links with anesthesia organizations outside North America. The first annual scientific meeting was held in 1921 at Niagara Falls, Ontario, in conjunction with the Interstate Association of Anesthetists (Ohio, Kentucky), and the New York Society of Anesthetists (the precursor of the American Society of Anesthesiologists). The scientific program included presentations from Canadian, American and British anesthetists. HEG Boyle of London was the Honorary Chairman of the meeting and the Official Representative of the Anaesthesia Section, Royal Society of Medicine. Boyle’s participation demonstrated both McMechan’s far-reaching influence, and the different maturity of anesthesia organizations in the UK and Canada. By 1926, the Canadian society had over 100 members, but in 1928 the society Executive decided to terminate the Canadian society, and transfer its role to the Section of Anaesthesia of the Canadian Medical Association, thereby muting the voice of anesthesia. Although consideration was given in the 1930s to reviving the Society, no action was taken [6].

The Montreal Society of Anaesthetists was established to facilitate interactions between and support French and English-speaking Montreal anesthetists. Its national importance emerged in 1943. Five members of the Society, with the support of colleagues in Toronto, applied to have the Society formally converted into a national entity – the Canadian Anaesthetists’ Society. The applicants were Wesley Bourne, Harold Griffith, M. Digby Leigh, Georges Cousineau, and Romeo Rochette.

A Memorandum of Agreement of 27 May 1943, signed by the five anesthetists, established the objectives of the new society, objectives that remain in place today:

“To advance the art and science of Anaesthesia and to promote its interests in relation to Medicine with particular reference to the clinical, educational, ethical and economic aspects thereof, to associate together in one corporate body members in good standing of the Medical Profession who have specialized in this particular science, to promote the interest of its members, to maintain a Society Library and Bureau of Information, to edit and publish a journal of Anaesthesia, to acquire and own such property and real estate as may become necessary to effectively carry out the purposes of the Society, and to do all such lawful acts and things as may be incidental or conducive to the attainment of the above Objects.”

On 24 June 1943, the Office of the Registrar General of Canada signed the Letters Patent confirming registration of the CAS in Canada as a “Body Corporate and Politic”. Canadian Anesthesia again had its own voice and this time had no intention of relinquishing it. The CAS office was initially sited in Montreal but moved to Toronto in 1946, where it remains. The CAS grew to its present size of 2000 members across Canada, with Divisions in each province. There are now 12 sub-specialty Sections within the CAS, reflecting expansion of modern anesthetic practice beyond the operating room, and advances in anesthesia for specialist surgical interventions. The Society name was changed to the Canadian Anesthesiologists’ Society in 1993. Although never officially recognized as such, the adoption of the US term anesthesiologist and the elimination of the dipthong (‘ae’) indicate the shift away from the early primary links of Canadian anesthesia with the UK. While a full description of CAS activities exceeds the scope of this summary, three Society programs deserve note, as do CAS roles in the World Federation of Societies of Anaesthesiologists (WFSA).

The Founders’ vision in 1943, that the Society publish a “journal of Anaesthesia”, was fulfilled in July 1954 with the first issue of the Canadian Anaesthetists’ Society Journal. The quarterly publication was distributed to the 500 Society members and a small number of subscribers. The first editor, Roderick Gordon of Toronto, held that post for 28 years (1954–1982). While the content initially consisted of papers presented at national and regional meetings in Canada, the Journal soon attracted manuscripts and subscribers from outside Canada. By 1961, 25% of the content originated from the US. In time, an increased volume of submissions prompted the publication frequency to increase to bi-monthly and then monthly. The title change in 1987, toCanadian Journal of Anaesthesia/Journal Canadien d’Anesthésie, reflected the expanding international nature of submissions and readership. From the first issue, articles have been published in English or French, according to the language of submission. The inclusion of international Editorial Board members and Guest Editors also indicates the evolution of the Journal to a member of the international community of anesthesia journals.

Gordon (1911–1998) deserves recognition beyond his role as journal Editor. Within the CAS, he served as Secretary-Treasurer from 1946 to 1961, and President in 1963–64. He received the CAS Gold Medal in 1969. He was Professor and Head of the University of Toronto Department of Anesthesia from 1961 to 1977. The Dr. R.A. Gordon Research Award of the CAS continues to honor the man who influenced Canadian Anesthesia for decades.

CARF was established as the Canadian Anaesthetists’ Society Research Fund. The CAS Research Fund became the CARF in 1992, without changing its basic structure and mission. CARF is a Registered Charity in Canada and supports the Research Awards Program of the CAS. Led by a founding Trustee, Gordon Sellery of London, Ontario, CARF’s resources grew until it could fund the first annual award in 1985, assisted by the CAS and its Journal. This award became a catalyst for additional awards in the CARF/CAS awards program, supported either by CARF or external sources. With total annual awards exceeding $200,000, the CARF/CAS Program has become the largest provider of funds for Canadian anesthesia research, increasing from one award in 1985, to 12 in 2005 [12]. CARF supported 3 of the 12 awards in 2005, the remainder being externally funded. The seed planted in 1979 with the start of CARF grew to a single tree in 1985’and a small forest by 2005! The review also noted the important role of CAS new-investigator awards, [12] as the first step in successful long-term research careers of Canadian anesthetists. By 2012, the cumulative number of awards from the CARF/CAS Program had increased to more than 200’with the Program being the primary source of funding for new anesthesia investigators in Canada.