Blessed Days of Anaesthesia
Author: Stephanie J. Snow

Overview

The introduction of anaesthesia into medical practice constituted a revolutionary epoch in the history of the profession, and this book brilliantly captures the eventful and dramatic events that led to the breakthrough. With a vivid narrative, the book chronicles the scientific insights that spurned the three pioneering anaesthetic agents – nitrous oxide, ether and chloroform, and it recounted the almost miraculous ways in which they altered medical practice and upturned the sociocultural concepts of pain itself. At the centre to the book are the fascinating biographical accounts of the key players in the story, from the charismatic and villainous to the banal and virtuous, but the book’s remit goes beyond the narrow chronicling of the early history of anaesthesia. This is because it also tells the story of later anaesthetics such as cocaine, cyclopropane, ethylene, halothane, benzodiazepines and curare-based muscle relaxants, and because it explores the wider social consequences of pain control, from animal rights and anti-vivisection to penal reform and capital punishment (pages xii-xiii, 148-159, 166-167, 174-178, and 183-188).

Synopsis

Undoubtedly, the most phenomenal episode in the story which this book tells was the first public demonstration of ether anaesthesia, and the pioneer who stood out for his initiative and boldness was dentist William Morton. Attributing his success to ‘partly personality and partly chemistry‘, the author narrated how Morton learnt about ether from fellow dentist and landlord Charles Jackson, to how he convinced surgeon John Collins Warren to ‘let him demonstrate the remarkable powers of his discovery’. The author masterfully recreated the operating room atmosphere at Massachussets General Hospital on 16 October 1846 when Warren removed a tumour from the jaw of 20-year old Edward Abbott in the first-ever documented painless surgery – what the author also characterised as a feat of showmanship. Morton’s claim to primacy was however contested by dentists Crawford Long, who claimed to have ‘operated under ether’ before Morton, and Horace Wells, whose attempt to demonstrate the effectiveness of nitrous oxide anaesthesia failed because ‘the gas bag had been removed too soon’. The book also detailed the competing claims on patent rights that ensued between the three, noting rather poignantly that neither ‘ever received any kind of financial benefit for their part in the discovery of anaesthesia’ (pages 21-27).

The physician who stood out most prominently in the subsequent development of ether was London general practitioner John Snow. In documenting his momentous contributions to the history of anaesthesia, the author first cited his insights in improving the safety of ether whose erratic responses threatened its widespread adoption. The author described the meticulous experiments Snow carried out to determine ether’s physical and chemical properties, and how he designed an inhaler that would ‘regulate the strength of the ether vapour through temperature‘. She also showed how Snow’s innovative method became widely adopted, and how, ‘within months’, he took ‘almost exclusive command of London’s ether practice’. Snow’s other contributions which the book reviewed included his development of a portable inhaler, and his publication of a book on the surgical use of ether. Such was his influence on establishing and developing the field that the author said Snow ‘carved out a new medical role – the anaesthetist‘, adding that his place in the history of anaesthesia was assured by ‘his establishment of its scientific principles‘, and by his ‘leadership of the London practice’ (pages 30-43 and 69).

Another key development in the history of anaesthesia was the discovery of chloroform by Edinburgh surgeon James Simpson. ‘Determined‘ to find an alternative to ether, which had a ‘pungent odour’ and irritated the throat and nasal passages, the author said Simpson set out to carry out self-experiments with several volatile chemicals. The book described how these led to his discovery of chloroform, and how he quickly put it to clinical use. The author however highlighted the unpredictable mortality that became associated with chloroform – an adverse effect which Snow subsequently showed to be a dose-dependent cardiac toxicity preventable by the use of a dose-regulating inhaler. Despite Snow’s beneficial intervention, the use of chloroform did not become universal until Snow used it for Queen Victoria’s labour, the author remarking that ‘it had taken ten years for the use of pain relief in childbirth to be accepted as standard medical practice by even its most outspoken critics’. The author also pointed out that the British, unlike the Americans, preferred chloroform over ether despite the former’s higher fatality risk, and she attributed this to ‘a national social tolerance of its risks’ (pages 44-51 and 78-96).

The way anaesthesia altered the social constructs of pain also formed a key theme of the book. In exploring this subject, the author described how, prior to the introduction of anaesthesia, pain was seen as ‘integral to the body’s functions, and that it was ‘widely thought to be of physiological and moral value’ and ‘essential to healing’. Indeed, she asserted that pain was even conceived as ‘the stimulant that preserved life in the body during the stress of an operation’. The book illustrated the agony of pre-anaesthesia surgery with such stories as that of Fanny Burney who underwent an operation for a breast abscess and described the pain as ‘terror that surpasses all description’. The book also depicted the pain relief strategies that were in use prior to anaesthesia, from the relatively conventional opiates, to the unorthodox mesmerism. In contrast, the author said attitudes to pain were transformed by the introduction of anaesthesia when ‘a new attention to feeling and alleviation of painful sensations crept’ in on the back of English enlightenment philosophies’. The author nevertheless pointed out that the ‘old view‘ of pain ‘as a natural phenomenon that fulfilled a key function in nature’s design’ did not disappear, and this was most evident in its obstetric application (pages xi, 1-3, 9-17, 21-22 and 61).

The wider consequences of the adoption of anaesthesia were also exhaustively reviewed in the book. For example, the author described how the effectiveness of surgical anaesthesia ‘created powerful waves…that stimulated doctors to intensify their efforts to palliate the pain of chronic and terminal disease‘. The book also argued that the emergence of painless surgery opened the way for women to enter the medical profession because it dispelled the concern that women would otherwise be associated with ‘the pain and brutality of surgery’. The book however also explored the negative and unintended effects of anaesthesia, such as its use by criminals and dishonourable doctors to disable and abuse their victims, and the risk of addiction that emerged. On a wider societal level, the book maintained that anaesthesia altered people’s tolerance for pain, and it illustrated this with how ‘the new generation of Victorians who knew anaesthesia to be a routine blessing of modern society could no longer stomach physical suffering in any form’. The impact of this change in attitudes was such that the author said Victorian era anaesthesia became an ’emblem of humanitarianism‘, and freedom from pain became ‘a medical and social goal, consonant with the very essence of modern civilization‘ (pages 97-164).

Opinion

With a strictly chronological approach and with simple prose, this book provides an exhaustive history of a major medical advance. Just as it documents the major impact anaesthesia had on medical practice, the book also explored its wider social consequences. The biographical sketches of the diverse personalities that innovated and moulded the field were detailed but concise, and they highlighted the character traits that helped to bring about the momentous breakthrough that was painless surgery. Apart from some distracting narratives not directly relevant to the history of anaesthesia, this is a most informative account of the introduction of a field-changing discovery.

Overall assessment

The relied of pain is a central objective of medicine, and the discovery and application of anaesthesia is perhaps the single most important measure in achieving this goal. The author, an expert in the history of science, not only highlighted the efforts that enabled and refined the discovery, she also showed how it affected patients, medicine, and society as a whole. The accompanying biographical sketches of Snow and Simpson are particularly inspiring and full of lessons for healthcare. The book is an invaluable insight into one of medicine’s seminal advancements, and I recommend it to all doctors.

Book details

Publisher, Place, Year: Oxford University Press ,Oxford, 2008
Number of chapters: 8
Number of pages: 226
ISBN: 978-0-19-280589-8
Star rating: 5
Price: £15.99