VOLUME 36, ISSUE 1

Bailey S. Rodich, M.D.

Chief Resident
Baylor Scott & White Health Central Division
Texas A&M College of Medicine
Temple, TX

Amy P. Woods, M.D., FASA

Medical Director, Parkland Pre-Anesthesia Evaluation Clinic
Associate Professor of Anesthesiology
Department of Anesthesiology and Pain Management
The University of Texas Southwestern Medical Center
Dallas, TX

On the Shoulders of Giants: Legends of Texas Anesthesiology
Robert Miller, M.D.: The Man Behind the Blade

The Texas Society of Anesthesiologists (TSA) has many strong examples of leadership within our own society as well as throughout organized medicine, including within the American Society of Anesthesiologists (ASA). It is a privilege to get to learn so many lessons from those who have come before us and taken the lead in support of our specialty. Our current TSA President, Dr. Bhaskar Padakandla, has done a great job leading our society and will soon pass the torch to another experienced leader, Dr. Amr Abouleish, who is well equipped to lead our society during an important Texas legislative year. Many of you saw that our dynamic and well-spoken TSA Past President, Dr. Ray Callas, was recently installed as the President of the Texas Medical Association (TMA). He becomes only the third anesthesiologist to serve in that capacity since the inception of the TMA (Dr. Valington Fontain Borum was the first 1988-1989, followed by Betty Pearce Stephenson 1994-1995, both of whom are TSA Past Presidents!).

Robert Arden Miller, M.D. was born in Williamsport, Pennsylvania on June 5, 1906. He grew up in South Fork, Pennsylvania, alongside his adoptive parents, Ellen Gramling and Robert LaRue Miller.1 He attended school at the University of Pittsburgh and Eclectic Medical College (now University of Cincinnati), where he got his medical degree in 1929.2 He initially worked for a couple of years in Michigan after interning at Grace Hospital in Detroit. He also worked as a doctor on a cruise ship early on in his career. He was stationed at Fort Sam Houston in San Antonio in 1936 and eventually served as a Captain in the army during World War II from 1940-1942.3 He was noted to have a “soft spot” for the inductees but was also not above disqualifying a draftee if needed. Dr. Miller thoroughly enjoyed the warmer weather offered by the Texas climate and made the southern state his residence until his death. It is unclear what initially drove his passion for anesthesia but, once he settled in San Antonio, he began devoting all of his time to the field.3 After his time in the army, he worked at the Robert B. Green Hospital for a short time before eventually joining the Nix Hospital, which became his home in medicine and where he stayed for the majority of his career. He genuinely loved the Nix, his fellow physician colleagues, and staff that worked there. When his son, Robert, was in high school, Dr. Miller encouraged him to work as a surgical orderly at the Nix Hospital to give his son a glimpse into his world of medicine.

Dr. Miller traveled worldwide for the Welch-Allyn company, which is the company that manufactured his laryngoscope. The Miller laryngoscope blade was first produced in 1941. Dr. Miller published an article that same year that remarked how endotracheal intubation was being used more regularly within the world of anesthesia, particularly with the prevalence of cyclopropane at the time. Dr. Miller boasted that his design modifications to the laryngoscope optimized conditions for direct laryngoscopy and eased the process of intubation. Alterative blades available at the time were often noted to be “too short” and “too thick at the base”, but the Miller ‘straight’ blade was described as “shallow, round, narrow, and curved two inches back,” a design that would allow for better visual exposure during laryngoscopy. 3

In addition to making difficult intubations easier, the blade was also praised for decreasing the risk of dental trauma. Although the blade was noted to be “adequate and adaptable for all patients”, Dr. Miller did find that the blade, available only in one size at the time, was thought to be unsuitable for the pediatric community.3,4 This is somewhat ironic given the notable popularity of the Miller blade within the pediatric anesthesia community today, owing to the blade’s utility in lifting the long and floppy epiglottis of children. It was not until 1946 when Miller developed a blade that could be used for children as well.5 Originally designed over 80 years ago, the Miller blade is still widely used throughout the anesthesia community today, in both children and adults alike.

Coming from humble beginnings, Dr. Miller was proud of his position in society as a doctor. He was always impeccably dressed, often in suit and tie. He did not own any jeans, casual T-shirts, or tennis shoes. This formality extended beyond his attire. He made a point to never eat in the kitchen (even for a snack) and would instead sit at the dining room table to dine, complete with tablecloth, cloth napkins, and silverware. 6

Robert Miller met his wife, Mary Elizabeth Green, originally as a patient. They married and later adopted two children, Nancy Arden Miller and Robert Benson Miller. While Robert cared greatly for his family, he was a traditional doctor of the time and tended to put his work and practice first. He had a philanthropic heart and would occasionally travel with a small group of surgeons to provide care in underserved small hospitals throughout the southern region of Texas. He fed his creative side with his own TV show that aired on Sunday afternoons in San Antonio for a while. He had many hobbies and was known to be an avid photographer, organ player, and Jaguar car enthusiast. He craved adventure and loved to travel, especially near places of water. One of his favorite places was the Mirador Hotel in Acapulco, Mexico, which he visited several times each year. He earned his pilot’s license and enjoyed flying a bit before starting a family. Dr. Miller made several friends in the world of aviation, and he and his pilot friends made an annual pilgrimage trip to the Indianapolis 500 for many years.

Dr. Robert A. Miller lived for 70 years before passing away from a heart attack on September 30, 1976.7 His ambition and ingenuity forever changed the landscape of anesthesia with his contributions to the field. In addition to the creation of the renowned Miller blade, Dr. Miller was also heavily involved in the betterment of the medical and anesthesia communities. He was profoundly involved in organized medicine through the TSA, ASA, and ABA. He also held several prominent positions of leadership at the Nix Hospital, including Chief of Anesthesia.2,8

The next time you go to pick up a Miller blade for your laryngoscope, take a moment to remember the man behind the blade. For he was a Texas giant, on whose shoulders we all stand.

References:

  1. Robert Arden Miller. 2022. https://www.ancestry.com/family-tree/person/tree/11242593/person/-500615554/facts
  2. Miller. Newspaper. 2022. https://newspapers.com/image/51025112/
  3. Maltby R. Notable Names in Anesthesia. 1st ed. The Choir Press; 2013.
  4. Robert A. Miller MD. A New Laryngoscope. Meeting Abstract. Anesthesiology. May 1941 1941;2:317-320. doi:https://doi.org/10.1097/00000542-194105000-00008
  5. Miller RA. A new laryngoscope for intubation of infants. Anesthesiology. Mar 1946;7:205. doi:10.1097/00000542-194603000-00014
  6. Kamenou I. Robert Arden Miller. Life In The Fast Lane. 2022. https://litfl.com/robert-arden-miller/
  7. Certificate of Death (Bureau of Vital Statistics) (1976).
  8. Miller RB. Dr. Robert Miller. Email2022.

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