Vital Times 2020 - 99

credited with establishing the nation's first independent
department of anesthesiology, which emphasized
research and clinical training, in 1928.
Historical accounts of both physician and nurse
anesthesia in the U.S., however, have tended
to ignore the early achievements of pioneering
women anesthesiologists, many of whom practiced
in California at the turn of the 20th century. As
an example, Mary Botsford, MD (1865-1939), a
contemporary of nurse anesthetist Alice Magaw,
graduated from the University of California, San
Francisco (UCSF) in 1896, became the first UCSF
faculty member in 1909, and became the first president
of the Anesthesia Section of the California Medical
Association in 1922.7

Efforts to Limit Nurse Anesthesia
Not just a modern phenomenon, the relationship
between physicians and nurses in American
anesthesiology has been strained since the early
20th century. Francis McMechan (1879-1939), a
third-generation doctor, founder of the International
Anesthesia Research Society (IARS), and leader in
organized anesthesia during his era, initiated attempts
to restrict nurse anesthesia in the 1910s.
In 1916, Dr. McMechan convinced the Ohio Medical
Board to disallow nurse anesthesia on grounds that
nurses were overstepping bounds by practicing
medicine without a physician license. However,
surgeons in Ohio, led by George Crile, MD, convinced
the state legislature to create an exemption that would
allow nurses to provide anesthesia under the medical
supervision of surgeons.
Other state courts also upheld the practice of nurse
anesthesia. When the Kentucky State Board of Health
resolved in 1916 that only physicians could provide
anesthesia except in cases of emergency, surgeon
Louis Frank, MD, and nurse anesthetist Margaret
Hatfield, reversed the resolution at the appellate level in

Frank v. South (1917). When the California State Board
of Medical Examiners circulated a 1928 resolution that
nurse anesthesia violated the state's Medical Practice
Act, many hospitals and surgeons protested.
The most famous trial, Chalmers-Francis v. Nelson
(1934), occurred in Los Angeles. The Anesthesia
Section of the Los Angeles County Medical Association
(LACMA) put Dagmar Nelson, a nurse anesthetist who
had previously worked at the Mayo Clinic, on trial as
a test case to prove that nurse anesthetists illegally
practiced medicine. Nelson, backed by surgeons, won
the case, and nurse anesthesia was declared legal as
nursing, not medical, practice, as it was performed
under surgeon " supervision. "
However, many testifying anesthesiologists posed the
question: how could surgeons truly direct anesthetic
administration from the other side of the drape?
The attempts to limit nurse anesthetists in the
early 20th century had the unintended effect of
strengthening their political cause. The California
Association of Nurse Anesthetists (CANA), for instance,
was established in 1931 in direct response to growing
efforts to prohibit nurse anesthesia at the state level.
Although physicians led the movement to restrict
nurse anesthesia, it is important to recognize that
many anesthesiologists still accepted the practice as
a clinical necessity. The founders of the ASA (1936)
departed from McMechan's stance in including as
its members physicians who still worked with nurse
anesthetists, like John Lundy, MD, Chief of Anesthesia
at the Mayo Clinic.8

Nomenclature and the Quest for
Professional Distinction
Early 20th-century American anesthesiologists
were naturally averse to being compared to nurses,
especially as they struggled to gain other physicians'
acceptance of anesthesiology as an independent
medical specialty.

Annual Publication 2020

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