Vital Times 2020 - 98

History, Education, and
Organized Anesthesia
History is important to any political organization,
including both the American Society of
Anesthesiologists (ASA) and the American Association
of Nurse Anesthetists (AANA). Historical facts can be
selected or omitted to bolster institutional narratives.
The Wood Library-Museum of Anesthesiology (WLM),
an ASA Foundation that houses the largest anesthesia
history collection in the world, has primarily celebrated
scientific and political achievements by physicians in
anesthesiology.
The AANA, in addition, has used history to emphasize
the contributions of American nurse anesthetists. The
organization's 2019 statement " CRNAs: We Are the
Answer, " for example, began with a history section that
magnified nurse anesthetists' early predominance in
the field.
While few anesthesiology residency programs today
teach the history of our profession, many CRNA
training programs require that SRNAs read Marianne
Bankert's politically charged book, Watchful Care: A
History of America's Nurse Anesthetists (1989). In her
book, Bankert celebrates the historical achievements
of nurse anesthetists, and tracks anti-nurse anesthetist
activity by physicians throughout the 20th century. She
likens CRNAs to " racial and ethnic minorities " in their
forced " historical invisibility, " predicting that " physiciananesthetist authors " will only continue in their " refusal
to acknowledge publicly any meaningful contribution by
pioneering nurse anesthetists. " 4

Historical Achievements by
Nurse Anesthetists and Physician
Anesthesiologists
What are some of the nurse-anesthetist achievements
of which Bankert speaks? By the late 19th century,

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CSA Vital Times

nurse anesthesia had become an increasingly accepted
practice in the U.S., especially in hospitals that lacked
house officers.
Surgeon Charles Mayo, MD, of Mayo Clinic fame,
christened Alice Magaw (1860-1928) the " Mother of
Anesthesia " for her mastery of open-drop ether for
over 14,000 cases.5 Agatha Hodgins (1877-1945),
who worked closely with Cleveland surgeon George
Crile, MD, also gained renown for refining a nitrous
oxide-oxygen technique, establishing a school of
nurse anesthesia, and, in 1931, founding the National
Association of Nurse Anesthetists (NANA), which
became the AANA in 1933.4
Many academic centers also employed nurse
anesthetists. At Johns Hopkins, Olive Louise Berger
(1898-1981) worked with cardiac surgeon Alfred
Blalock to deliver anesthesia for infants with congenital
heart disease. At Yale, Alice Maude Hunt (1880-1956)
was appointed Assistant Professor of Anesthesia in the
Department of Surgery in 1930, and published the first
textbook of nurse anesthesia in 1949.5
Historian Virginia Thatcher wrote the first survey of
American nurse anesthesia, History of Anesthesia:
With Emphasis on the Nurse Specialist (1953). In it, she
astutely dedicated her work to the nurse anesthetists
" who made anesthesia an art, that it might become a
science. " 6
As Thatcher implied, it was physicians, not nurses,
who truly pioneered scientific advancements that
modernized anesthetic practice and transformed it
into a medical specialty. These numerous innovations,
easily taken for granted today, include: the oral airway,
the cuffed endotracheal tube, closed-circuit anesthesia,
volatile agents, neuraxial and regional techniques,
blood-gas analysis, and pulse oximetry-to name a
few. Physicians also deepened our understanding of
physiological changes under anesthesia and the stress
of surgery, applying critical care principles to improve
perioperative outcomes. Ralph Waters, MD, has been



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