Leroy David Vandam, M.D., the first Harvard Medical School Professor of Anesthesia at the Peter Bent Brigham Hospital, now Brigham and Women’s Hospital, died April 8, 2004 in Needham, Massachusetts in the 90th year of his life.
Roy, as friends knew him, served as Anesthetist-in-Chief at Brigham and Women’s from 1954 to 1979. For more than a half century his scholarly achievements and distinguished service in anesthesiology were essential components in the maturation of the specialty to the position it now comfortably occupies at the high table of academe.
At HMS/BWH he served on or chaired, among others, the HMS Committee on Admissions, Committee on Human Studies, Standing Committee on the Countway Library, Conflict of Interest Committee, Department of Anesthesia and the Committee to Consider the Organization of the Department of Anesthesia. The latter led to the creation of an autonomous Department of Anesthesiology at HMS on October 17, 1969. Because of his long tenure as the most senior of anesthesiologists, he was often referred to as the ‘Dean’ of anesthetists at Harvard, a distinction he rather enjoyed.
Roy also served nine years as Trustee of the Wood Library-Museum of Anesthesiology, the world’s largest anesthesia museum/library, contributing for many years thereafter to the publication of more than 25 annual editions of anesthesia history.
After a period with the World Health Organization, Vandam chaired the Advisory Panel of the U.S. Pharmacopoeia, and was a member of the editorial boards of nine major journals, among them Survey of Anesthesiology, Clinical Pharmacology and Therapeutics, New England Journal of Medicine and the Journal of Clinical Anesthesiology. He served as Editor of Anesthesiology, now the specialty’s most prestigious journal, from 1962-1970, transforming it from a trade publication featuring medical case reports and descriptive clinical studies into, in his own words “a truly scientific and medical resource.”
Those were the years – at the hospital in which he fully matured as an administrator, mentor, and ambassador of the specialty – in which he was engaged in the Herculean task of transforming a service-only division of the surgical services into a thoroughly professional and independent department committed to the educational and research mission of the academic enterprise.
In Washington, he chaired the National Academy of Science’s Committee on Anesthesia of the Medical Research Council from 1965-1970, and served on the National Institute of Health’s Training Grant Committee for Surgery, Radiology and Anesthesiology as well as the Pharmacology and Toxicology Training Grant Committee from 1963-1966.
Vandam’s contributions to and recognition by the American Society of Anesthesiologists are legend. He received its highest honor, the Distinguished Service Award, in 1977. He delivered the society’s most prestigious oration, The Rovenstein Lecture, in 1979.
Leroy David Vandam was born in New York City on January 19, 1914, the only son and the second of three children born to Esther, a homemaker, and Albert Vandam, owner of a successful textile business. His son, Albert, writes, “In today’s parlance, Roy was a prodigy, jumping from the 5th grade to an exam-required, very progressive preparatory school, Townsend Harris Hall. Among his classmates were Cornell Wilde, Herman Wouk, and Jonas Salk. He entered Brown University at age 16, undertaking a rigorous pre-medical curriculum with high honors as a Francis Wayland Scholar for consecutive Dean’s List participation in addition to achieving both the Phi Beta Kappa and Sigma Xi distinctions.” His last two summers as an undergraduate were further enriched by the study of invertebrate biology and biophysics at the Cold Spring Harbor on Long Island, New York.
During these years he also developed an artistic side that he would continue to hone throughout his life.
Both medicine and art occupied Vandam during his years at NYU Medical School. During his first two summers of training, he escaped academic work for classes at the Art Students League of New York. Notebooks and single sheets preserved from that era show the detailed attention and representational fidelity that would so beautifully enhance his early watercolors. He spent one summer session studying pathology at Bellevue Hospital and filled a notebook with drawings of cadavers. His interest in pathology continued after graduation, when he accepted a residency at Boston’s Beth Israel Hospital.
In 1940, Roy switched fields. He entered a surgical residency at Beth Israel Hospital and distinguished himself by becoming Chief Resident in 1942. At the urging of a surgeon, Dr. Charles Mixter, he joined the Army Medical Corps that same year and was assigned to the 4th Auxiliary Surgical Group at Lawson General Hospital in Atlanta. Not long after, he received a medical discharge due to a deteriorating eye condition that would lead, after two years of recurring ocular hemorrhages deemed to be tuberculin-related, to the loss of his left eye.
This loss had a profound influence in his personal life and professional career. While a patient at Hopkins’ famed Wilmer Eye Institute for tuberculin desensitization, Roy was given an appointment as a Research Fellow. He became deeply involved first with research in pharmacology and then cardiac physiology, and it was here that he encountered the Chief of Anesthesia, Austin Lamont, M.D., who influenced his eventual entry to anesthesia.
Roy also became closely allied with the vascular and cardiac research of Alfred Blalock and others. Ironically, Blalock, Chief of Surgery at Hopkins, opposed the formation of an academic department of anesthesia, so Lamont departed for the University of Pennsylvania. This left Vandam stranded at Hopkins as a research fellow. He began new work on catheterization of human vessels, joining with Richard Bing in order to better understand, and to correct surgically, the pathology of coronary artery malformations. Vandam further became involved in a series of novel studies of human cardiac function, calculating cardiac output with catheters for invasive intravascular pressure, gas analyses for oxygen and CO2.
In 1949, Vandam matriculated from Hopkins to the more anesthetist-friendly environs of Philadelphia, where he and Professor Robert Dripps published an article in Circulation on the anesthetic management of patients with heart disease.
Roy’s interest in the neuropathological actions of local anesthetics was reborn after the move to Penn. Sent by Dripps to Bellevue to attend a course on nerve blocks (for the relief of chronic pain) taught by E.A. Rovenstine, he returned to establish a pain therapy clinic with James Eckenhoff, beginning a collaboration and close friendship that was to last throughout their lives. A neurologist at Cornell had raised concern about the neurological sequelae of spinal anesthetics, and Vandam and colleagues began a four-year prospective study of the complications of spinal anesthetics. Concern about the very same issue has recently arisen again, and the early work of Vandam and Dripps on 10,098 spinal anesthetics, and of Vandam and E.J. Wolley on a similar concern regarding brachial plexus blocks, is still quoted as evidence for the great safety of such procedures when the correct methods are followed.
Vandam became the Chief of the anesthesia service at Peter Bent Brigham Hospital in 1954. Vandam’s time at the Brigham was characterized by his desire to bring a new distinction to the nature and practice of anesthesiology, a task he undertook at the expense of his own research. The effort to create an independent academic department from a clinical service associated with surgery was not unique to the Brigham but was underway in most major medical centers in the USA. But it took longer and was much more difficult at the Brigham because of firmly held beliefs of the senior surgical leaders. He concentrated his efforts on building his residency program into one of the best in the country, attracting young men and women who would become, under his tutelage and with his continued guidance, outstanding scholars, teachers, researchers, and leaders in an increasingly complex medical and scientific world.
Roy was uncompromising in his defense of the rights, safety and needs of patients. And he stood by his residents. If a surgeon said he did not want a particular resident, that resident would be assigned to that surgeon’s cases with Roy himself as staff-visit in the same room!”
In settling in to his life and work at the Brigham, Roy again found time for his painting. During summer vacations in New Hampshire and later in Maine and on Nantucket, he rediscovered and more painstakingly explored his gift for and commitment to watercolor.
Roy’s elegantly spare illustrations added greatly to early editions of his book, Introduction to Anesthesia, first published in 1957 and still considered a standard text for residents. Four times, his paintings graced the cover of JAMA, a spot usually reserved for works from an artist with historical credentials.
Vandam’s legacy will always rest in the strength of mind and constancy of heart that generated seminal research on a major anesthetic technique, spinal anesthesia, produced a basic textbook, Introduction to Anesthesia, now in its 9th edition, and created many of the specialty’s academic leaders that are widely held in large measure responsible for the maturation of the profession as a distinguished and learned discipline.
Samuel Van Dam
Richard Kitz, Chairman