End Notes
A Look Back
The role of the nurse anesthetist at Mayo Clinic.
The Mayo brothers entrusted the task of administering anesthesia to nurses. Alice Magaw was their primary anesthetist for many years. Charles Mayo eventually dubbed her the “mother of anesthesia.”
The debate about who should administer anesthesia was already underway in this country by the time William J. and Charles H. Mayo began doing surgery at Saint Marys Hospital in Rochester in the late 1800s. At the time, anesthesia was administered by medical students, nurses, interns, general practitioners, and surgeons themselves. The Mayo brothers were among those who decided to enlist nurses to do the work—a decision that may have unwittingly fostered acceptance of the idea of the nurse as anesthetist. William Worrall Mayo, founder of the Mayo Clinic, launched one of the country’s first formal training programs for nurse anesthetists in 1889.
Alice Magaw, who served as the Mayos’ primary anesthetist from 1893 until 1908, gained such expertise that she lectured and wrote on the topic. Her first paper appeared in 1899 in the medical journal Northwestern Lancet, a precursor to Minnesota Medicine. These excerpts offer a glimpse into the techniques of the day and the relationship between nurses and doctors in the OR.—Carmen Peota
Having been educated only as a nurse, I am not expected to make the choice of an anaesthetic. The Drs. Mayo prefer ether as the anaesthetic of choice; they, as well as many other surgeons, believe ether to be safer. Chloroform is given as a rule to old people and children, also when there is pulmonary trouble and in most cases where there is kidney disease. Whenever there is high arterial tension from any cause chloroform is selected. Ether should be given as an anaesthetic pure and simple and not combined with asphyxia, as has been recommended and is now practiced in many hospitals ... If given with plenty of air, there will not be the cyanosis and stertorous breathing which too often characterizes its use. ...
The face is anointed with vaseline, a thick pad of moistened cotton placed over the eyes, and the anaesthetic preferred by the surgeon commenced. The inhaler we use at present and have for some time is the Esmarch mask with two thicknesses of stockinette. We sent to the mills and had a bolt of stockinette woven loosely for this purpose; it has more body than the regular surgeon’s gauze. We usually put two thicknesses of the gauze over the mask and get both ether and chloroform ready, and give whichever is best for the conditions observed. If we start out to give ether we commence with the drop method as carefully and with as much air as though it were chloroform, until the patient’s face is flushed, when we have a large piece of surgeon’s gauze of several thicknesses and about the size of a towel convenient, and keep adding a few more layers of the gauze and giving the ether a trifle more faster until the patient is asleep, then remove the gauze and continue with the same covering as at the start and the drop method. ...
The great secret of giving an anaesthetic of any kind is not to feel hurried and to have the operator say occasionally, “there is no hurry, lots of time.” There is such a difference in patients; some will be as calm and fall asleep as easily and quickly as babes, while others are nervous and can not give up and when you try to crowd the anaesthetic you are lost. Nothing is ever made by crowding the anaesthetic; I have tried it: rather than crowd ether, it is best to give a few drops of chloroform. The surgeon should not hurry the anaesthetist, neither should he begin the operation until the patient and the anaesthetizer are ready. … MM
Sources: History of Anesthesia with Emphasis on the Nurse Specialist by Virginia Thatcher. “Observations in Anesthesia” by Alice Magaw, Northwestern Lancet. 1899;19:207-10.