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A-1265
2003
Dr. Mary Botsford (1865-1939) of San Francisco: The First Physician To Practice Anesthesia on the West Coast
Selma H. Calmes, M.D.
Anesthesiology, Olive View-UCLA Medical Center, Sylmar, California.
Dr. Mary Elizabeth Botsford (MEB), an 1896 graduate of the University of California (UC) medical school, was the first West Coast physician known to practice anesthesia, beginning in 1897. She made many advances during her long career, founding the first section on anesthesia in a state medical society, getting a state law passed requiring anesthesia be taught in medical schools, serving as president of the Associated Anesthetists of the US and Canada in 1932, being the first faculty member and first clinical professor of anesthesia at UC, and writing numerous papers.

Many questions still remain about her life. New information is presented in this paper and significantly expands what is known about this first generation physician anesthetist. The information is in five areas:

1. Why she entered medicine: Botsford's obituaries stated that she entered medicine after her husband's "tragic death." It was found that her husband was alive and well, practicing medicine in San Francisco and living separately from her until he died in 1905. She was listed as "divorced" in the 1900 census and as "widowed" in 1910 and 1920. This story of her entry into medicine was a convenient cover for a difficult social situation. 2. Her war service: MEB initially planned to go to England, which offered commissions to women physicians, and later signed up to go to France with the Lakeside Unit. She backed out at the last minute and was a contract surgeon, teaching nitrous oxide and ether to nurse anesthetists at Letterman General Hospital. She began teaching in mid-1917. Her official service was from October 1918 through January 1919. This local position allowed her to continue to generate private practice income to meet her family's needs.

3. Her situation at UC: In 1910 MEB was appointed "Assistant in Surgery" and "Anesthetist" at UC's medical school and hospital, the first faculty position in anesthesia there. By 1932, she was Clinical Professor of Anesthesiology, UC's first professor of anesthesia. Although never a separate department, the department expanded to five women physicians by 1921. Medical students had lectures and demonstrations on anesthesia during surgery lectures and later could take an elective in anestheisa. No official residents were appointed, typical for the time, but informal training was going on continually.

4. Her situation at Children's Hospital of San Francisco (CHSF): MEB's professional life was based at this hospital founded by women physicians in 1875. She was an intern and stayed on to become chief of anesthesia. She finally retired in 1934 at age 69, after a 3 year conflict about who would replace her. All interns had to rotate on anesthesia; many went on to other Bay Area hospitals as anesthesiologists.

5. Botsford and Ralph Waters: Waters knew of MEB, who was active nationally in the McMechan organizations. He wrote Arthur Guedel in 1926 that the Bay Area was MEB's area and that it was handled extremely well. The two first met in Chicago in 1929. Their final meeting in 1933 led to an argument about how anesthesia should advance. MEB advocated fighting legally against nurse anesthetists, a McMechan method. Waters had a more measured approach of developing the specialty through better training, teaching and research, and proving clinically that physician anesthesia was superior to nurse anesthesia.

Anesthesiology 2003; 99: A1265