YON 2020 Day 255: Agatha Cobourg Hodgins

This fascinating narrative recounts the accomplishments of nurse Agatha Cobourg Hodgins. In the early 1900’s, she was appointed chief anesthetist in the Surgical Department of Lakeside Hospital, taught anesthesia to other nurses as well as physicians and dentists, and went on to establish a national association for nurse anesthetists.

This biography of Agatha Cobourg Hodgins was written by Christopher Dawson of University Hospitals (UH) on the occasion of the 150th anniversary of UH and was provided by Margaret Burzynski-Bays, UH Archivist. The photo was provided courtesy of the Stanley A. Ferguson Archives.

Agatha Cobourg Hodgins (1877-1945) was born in Toronto, Canada, where she received her early education. She entered the Boston City Hospital School of Nursing for training as a nurse. After graduation, she followed classmate and fellow Canadian Calvina MacDonald to Cleveland in 1900, and was hired at Lakeside Hospital as a nurse in the private pavilion. In 1908, Lakeside Hospital’s chief surgeon, Dr. George Crile, asked her to consider becoming his special anesthetist. He had been looking into different kinds of anesthesia, and was becoming convinced that nitrous oxide, which was then mostly used by dentists, would be a more effective anesthetic than ether or chloroform, the two dominant types of anesthesia used in surgery. Needing to test his theory, he felt he needed an anesthetist who could undertake this new method with him, and one who could make anesthesia their primary clinical interest. Deciding that a nurse would be the best candidate for the job rather than a physician, he selected Agatha Hodgins, whom he already admired, but whom he had not warned about his project. She accepted immediately, and threw herself into the work. Crile and Hodgins began testing nitrous oxide on animals, but Hodgins also spent additional time reading everything she could on anesthesia, and would even spend time at night in the patient wards, observing the breathing patterns of sleeping patients to detect differences. She also kept copious notes on every procedure, and was able over time to show the differences in effectiveness between using ether and nitrous oxide. By 1911, Crile had presented their results to the American Surgical Association, showing that nitrous oxide was a safer anesthesia for surgery, and medical professionals flocked to Lakeside Hospital to learn the techniques that he and Agatha Hodgins had pioneered. Agatha Hodgins was also no longer just Crile’s personal anesthetist anymore, but was appointed chief anesthetist for all of the Surgical Department at Lakeside Hospital. They then began planning for a school to teach anesthesia to other nurses.

These plans were interrupted by the outbreak of World War I in 1914. Crile followed events in war-torn France, and was invited by the American Ambassador to France, Myron Herrick, to come to France to study the medical conditions in France; the French, in turn, were interested in what the Americans were doing with nitrous oxide anesthesia. Crile assembled a team of surgeons and nurses, including Agatha Hodgins, and with the financial backing of Samuel Mather, the group, called the Lakeside Unit, sailed to France in December 1914. The Lakeside Unit spent three months in France, working in the “American Ambulance,” a French military hospital that had been set up in a newly-constructed high school. In the three months they served in France, the Lakeside Unit treated over 1,200 patients with all manners of battlefront wounds. Hodgins’ work focused on teaching nitrous oxide anesthesia to French and English medical personnel, and her work was so important that she remained in France for several more months after the Lakeside Unit returned to Cleveland. In fact, the Lakeside Unit was replaced by a unit of medical staff from Harvard University, and they requested that Agatha Hodgins stay until she trained them in her techniques.

Upon her return to Cleveland, Dr. Crile requested that she turn her focus to organizing a formal training program for nurse anesthetists. It is believed that the Lakeside School of Anesthesia, which graduated its first class in 1916, was one of the first schools of anesthesiology in the United States. It not only trained doctors and graduate nurses, but also dentists. The school had a 6-month course of study, and the students paid a tuition of $50, and were also required to arrange their own housing. Agatha Hodgins did much of the lecturing herself, though soon the school was busy enough to require her to have two assistants. The importance of the school and her work in training anesthetists was such that when the United States entered World War I in 1917, and the Lakeside Unit was reactivated and sent to France to staff a hospital, she remained behind, too important to send overseas.

In a 1971 oral history, former UH staff member and nurse anesthetist Gertrude Fife recalled her experiences at the Lakeside School of Nurse Anesthetists in the 1920s. She remembered Hodgins as well-liked by her students and associates and having “such a keen mind,” that allowed her to make quick and precise decisions and have an unusual organizational ability. Fife’s appreciation for Agatha Hodgins only increased as she finished the coursework, and was then invited to join the faculty, eventually becoming one of Hodgins’ assistants in running the program. Another recollection of Hodgins was printed in a 1950s history of anesthesia, where a surgeon who trained as a student at Lakeside Hospital was told by his mentor that “George [Crile] will talk a lot, but you watch Agatha!”

In 1931, Agatha Hodgins invited all the alumnae from the Lakeside school, as well as other nurse anesthetists around the country, to join together in a national organization. The group, which was initially called the National Association of Nurse Anesthetists, convened in Cleveland, wrote a constitution and bylaws, and elected Agatha Hodgins as their first president. In 1939, the group became known as the American Association of Nurse Anesthetists, and still exists today. Agatha remained a board member of the group for the rest of her life. In 1934, Agatha Hodgins suffered a heart attack, and was forced to retire from Lakeside Hospital. She moved to Chatham, Massachusetts, on Cape Cod, living out her remaining years in a house she had purchased in 1919. She died in 1945 and was buried in Chatham under a grave marker engraved with the words “She only counted shining hours.”

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