For Fear of Pain: British Surgery, 1790-1850 (review)

Peter Stanley, principal historian at Australia's national military museum, has provided important new insights into the history of surgery. In For Fear of Pain, he covers the years ranging from the death of the eminent British anatomist and surgeon John Hunter in 1790 through the time when surgeons initially adopted anesthesia in their operations—a time span that Stanley regards as "the final decades of painful surgery" (p. 8). Central to this account, he repeatedly draws upon two lines of inquiry: How and why did sufferers submit to the excruciating pain of surgery? and, How and why did surgeons continue to operate on individuals knowing that they were inflicting considerable pain and, in many instances, bringing their patients' lives to an abrupt end?

As in general surgical histories that cover this era, Britain's master surgeons—including Sir Astley Cooper, Charles Bell, Robert Liston, James Syme, and William Ferguson—are present in Stanley's work, and readers are reminded of their major breakthroughs. However, rather than heaping further adulation upon the well-sustained hagiography of these masters, Stanley's innovative historical focus attempts to re-create the social scene in which they gained their respective prowess. Using a multitude of case studies, he forces us to rethink the received wisdom about surgeons in the era immediately preceding the introduction of anesthesia. He demonstrates with vivid examples that surgeons were not merely brutal butchers who were limited to a small number of operative procedures, all of which they performed with lightning speed while remaining stoically indifferent to the shrieking and squirming of those at the other end of the scalpel.

Stanley's eloquent descriptions emphasize that surgeons typically relied upon their patients' willing consent to surgery. It was rarely, we find, that nonmilitary patients ever accepted a surgeon's recommendation for an operation without securing at least one second opinion. In addition to teaching surgical techniques, some surgeons shared methods of psychological persuasion with their pupils in order to help them "manage the minds of [their] patients" (p. 194); at times, however, we find them expressing great relief after a patient had fled the operating theater, thereby resolving the need to inflict pain on that occasion.

Other notable glimpses into surgical practice include penetrating perspectives on the decision-making process surrounding an operation. We learn that friends and family often weighed in on such decisions, even accepting full responsibility whatever the outcome of the operation. The presence of family members at operations, however, often extended the pain involved with such scenarios, as they, too, often walked away traumatized by the experience. Stanley provides a series of examples in which surgeons, the mightiest of the era as well as the novices, were regularly traumatized, both before and after operations, knowing of the pain and potential death delivered by their hands. The confidence that they viewed as directly correlated with operative success was, at times, an enforced or pseudo-confidence, for, as Stanley shows, they were forced to endure considerable mental strain and physical disorders surrounding the performance of their professional art. For example, Charles Bell admittedly suffered "indescribable anxiety" (p. 205) over operations. John Abernathy, who once claimed that he felt as if he were "going to a hanging" as he walked into the operating theater, often left the theater crying and vomiting while lamenting "what he had just been compelled to do by dire necessity and surgical rule" (p. 204). Yet, these surgeons somehow gathered the courage to go back to the operating table on the next day. Such courage, we learn, was often met by a strong fortitude in many patients—especially, though somewhat surprisingly, in small children.

More clearly than in any other historical account, Stanley delineates and substantiates the "inescapable tension" (p. 234) that surgeons faced between inflicting pain...