Profiles In Nursing

Alice Magaw Kessel (1860-1928), Pioneering Nurse Anesthetist

She performed 14,380 procedures with no fatalities

Alice Magaw working with doctors to take care of a patient. They are all wearing white gowns and head covers with masks on

Around the turn of the last century, nurse anesthetist Alice Magaw and her longtime friend Edith Graham Mayo forever changed both anesthesia practice and physicians’ attitudes toward nurses who administer anesthetics.

Graham and the Mayo Brothers

Born in Ohio shortly before the Civil War, Alice Magaw grew up in Michigan and moved with her family to Rochester, Minn., in her early 20s. There, she met and befriended Edith Graham, who later became her classmate in the nursing school at Chicago Hospital for Women and Children.

When they graduated in 1889, Magaw remained in Chicago as a private duty nurse while Graham returned to Rochester and went to work at the newly established St. Marys Hospital as a nurse for surgeons Charles H. and William J. Mayo. When they graduated in 1889, Magaw remained in Chicago as a private duty nurse while Graham returned to Rochester and went to work at the newly established St. Marys Hospital as a nurse for surgeons Charles H. and William J. Mayo.

At the suggestion of their father, surgeon William W. Mayo, the Mayo brothers trained Graham to become what they originally called an “anaesthetizer”: a highly skilled nurse who would administer ether and other anesthetics to surgical patients. Graham was the Mayos’ first nurse anesthetist and received considerable credit for minimizing the new hospital’s surgical mortality rate.

In April 1893, after more than 650 surgeries, Graham retired to marry Charles Mayo. The Mayos hired Magaw as her successor.

Talking Them to Sleep

The most common anesthetics at that time were nitrous oxide, chloroform and ether. The Mayo brothers strongly preferred ether, which was less pleasant but more effective than nitrous oxide and much safer than chloroform. Magaw once remarked, “ether kills slowly, giving plenty of warning, but with chloroform there is not even time to say good-bye.”

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Although vaporizer-type inhalers had been developed as early as 1847, they were not commonly used in the U.S. American surgeons generally dripped anesthetic onto a towel, gauze pad or conical sponge and held it firmly over the patient’s nose and mouth.

Magaw detested this “so-called ‘choking or smothering’ method,” deriding it as “cone and struggle.” While some providers of the time believed that hypoxia was an aid to anesthesia, Magaw insisted, “Ether should not be combined with asphyxia.”

Her preferred technique involved the Esmarch inhaler, a wire-frame mask covered with cloth onto which she dripped ether from a can. Instead of forcing the mask into position over nose and mouth, she slowly lowered it to the patient’s face.

While doing this, she spoke naturally to the patient about “just how the anaesthetic [was] expected to affect him.” Magaw argued that talking in this way not only increased the patient’s confidence, but also aided the anesthetic process through the power of suggestion, which she called “a great aid in producing a comfortable narcosis.”

Evidence-Based Practice

Once the patient was unconscious, Magaw would switch from the first ether can to a second, smaller one, which she applied to maintain anesthesia during the procedure. She would also carefully position the patient’s head and jaw to avoid obstructing the airway.

This “open drop” technique was not new (the Esmarch inhaler had been developed in Germany in the late 1870s), but Magaw was one of its most skilled practitioners. She refined her technique through careful research and observation, documenting the unique complications associated with different types of surgeries and different types of patients.

Hiring Now

As a nurse, Magaw could not submit her findings directly to medical journals, but she later received invitations to lecture before local medical societies, which gave her the opportunity to publish her work. Her first article, an 1899 piece in The Northwestern Lancet, recapped her recent lecture to the Olmsted County Medical Society. In all, she would publish six scholarly articles, which helped secure her international recognition.

In her last article, published in Surgery, Gynecology and Obstetrics (now Journal of the American College of Surgeons) in early 1906, Magaw said that had personally performed 14,380 anesthetics with no fatalities. Charles Mayo dubbed her “the Mother of Anesthesia.”

Later Life

In 1903, the Mayo brothers and their partners opened the now-famous Mayo Clinic in Rochester, although the Mayos also continued to practice at Saint Marys through 1905. Thanks in no small part to the efforts of Graham and Magaw, Mayo Clinic soon became renowned as a center of surgical expertise.

In 1908, Magaw married George Kessel, M.D., founder of the Kessel Hospital in nearby Cresco, Iowa. For a time, she became her husband’s nurse anesthetist, but the couple separated in 1919.

She returned for a while to Mayo Clinic, whose staff now included 18 nurse anesthetists, but health problems led her to retire completely by the mid-1920s. Magaw suffered from diabetes, which was then still a poorly understood disease whose rudimentary treatments were fraught with serious complications. She died in a Wisconsin sanitarium in February 1928.

Although the specific anesthetic techniques Magaw used are now long obsolete, her thorough professionalism decisively established that nurses could safely and effectively administer surgical anesthesia. Her work is foundational to the modern specialty and has even been cited as part of the legal basis for CRNA scope of practice.

Photo above: Alice Magaw (far right) during an operation at St. Mary’s Hospital. Source: Mayo Clinic

CLAIRE SANTOS, RN, M.S., NHDP-BC, is a burn care and emergency nurse and an ANCC-certified national healthcare disaster professional. Reach out to her at .

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