Operations without Pain: The Practice and Science of Anaesthesia in Victorian Britain (review)

The history of anesthesia has long been an area of interest to bibliophiles and technical specialists, whose many valuable studies have provided materials that have been essential to recent social-historical approaches. In the last thirty years these new perspectives have transformed aspects of the history of the subject. Most notably, they have shown two things: First, the origins of surgical anesthesia were deeply embedded in a much broader therapeutic context. Martin Pernick's A Calculus of Suffering: Pain, Professionalism and Anesthesia in Nineteenth-Century America (1985) led the way here. Second, anesthesia did not transform surgery overnight: rather, it has become clear that many surgeons were reluctant to use it and many patients were unwilling to undergo the experience. In this respect, it has also been made obvious that much early anesthesia was most unsatisfactory insofar as patients often struggled and shouted while supposedly unconscious. The historiographic conclusion from this sort of work has been that the apparently sudden surgical revolution based on anesthesia was actually a later historical construct, and the transformation of surgery using anesthesia was something that happened much more slowly than was suggested by enthusiastic operators at the end of the nineteenth century.

Using insights from these new views and building on her own empirical studies, Stephanie Snow has written a most useful synthetic narrative of the early days of anesthesia in Britain. The overall structure of the book is conventionally chronological, but Snow addresses old conundrums with answers derived from modern scholarship. Thus, Humphry Davy's famous musing on whether nitrous oxide might relieve the pain of surgical operations is placed in the wider setting of experiments on sensibility and of Davy's view that pain was a physiological necessity. Snow makes full use of the view that categorizing Davy as a chemist (or physiologist) in the Clifton years is unhelpful: Davy was investigating and using nitrous oxide to explore life in all its aspects, from its material composition to the workings of the imagination. Quite rightly, Snow attempts to set the introduction of anesthesia in a changed attitude toward pain. She invokes Evangelical attitudes toward control as important. Jeremy Bentham gets an aside, but Benthamite views on pain were surely significant here.

After surveying the commercial context of William Morton's introduction of ether, Snow produces much new evidence to show how suspicious many surgeons were of anesthesia. The bulk of the book after this is centered on John Snow, whose massive casebooks were carefully edited by Richard Ellis (sadly, Ellis died, relatively young, shortly after completing the task).¹ Stephanie Snow's exposition of the early days of anesthesia is sensitively done, again by addressing old puzzles. Why did the English (and John Snow in particular) advocate using apparatus to administer chloroform, and why did the Scots (notably James Young Simpson) simply pour it on a cloth? This is a fascinating fact that probably runs counter to prediction: As a rough generalization, it could be said that in Edinburgh the idea that medicine should be based on science was a fundamental assumption, while in London (except at University College) the notion that medicine should be learned and transmitted empirically was probably more common—yet Stephanie Snow's argument that John Snow was using apparatus because he was trying to develop a quantitative science of anesthesia based on experiment is no doubt correct. In this respect her work has been marginally anticipated in print by the recent Cholera, Chloroform, and the Science of Medicine: A Life of John Snow by Peter Vinten-Johansen et al.; but in her overall narrative, the account of John Snow and science is nonetheless valuable.

Along with Peter Stanley's For Fear of Pain: British Surgery 1790–1850 (2003), we now have two excellent books that, together, describe the...