Blessed Days of Anaesthesia: How Anaesthetics Changed the World (review)

This is a very interesting book describing one of the major advances of the Victorian period in medicine, the discovery, acceptance, and scientific investigation of anesthesia. Stephanie J. Snow, coincidentally a distant relative of the first anesthesiologist John Snow, attempts to explain the cultural context of the elimination of surgical pain during this era, skillfully bringing the culture of the period alive. Snow describes the societal attitude toward pain in great detail, leaving the reader with an understanding of the shift in thought, from pain as a natural part of the human experience to one that medicine was able to control. The control of surgical pain, along with antisepsis and later asepsis, ushered in the myriad of possibilities for surgical correction and treatment of disease.

One of the most interesting sections in the volume deals with the use of anesthesia in obstetrics. Her description of Charles Darwin’s administration of anesthesia during his wife’s labor and delivery in 1850 is both vivid and new. As a member of the scientific community, Darwin knew of the use of chloroform for obstetrical anesthesia by James Simpson, Edinburgh Professor of Midwifery. So concerned was Darwin for his wife’s suffering that he took it upon himself to learn about chloroform, consulting with several of the leading scientists and physicians of his day. When his wife went into labor, he poured chloroform over a handkerchief and rendered her insensible for an hour and a half. Darwin’s administration was both cavalier, in that maternal vomiting and aspiration are an ever-present danger in this type of anesthetic, and dangerous to the unborn child, facts that the author presents in the light of John Snow’s contemporary knowledge of those untoward events.

Another fascinating passage deals with anesthetics and race in the nineteenth-century United States. Snow admirably describes the contemporary thought that racial minorities did not perceive pain as intensely as whites. She discusses James Marion Sims’s work on vesicovaginal fistulas on three slave women who endured around thirty operations without anesthesia while Sims perfected his techniques. While there is great controversy over Sims’s work in the contemporary medical-historical literature, Crawford Long’s similar experimentation on slaves has gone unnoticed. Long’s article, “An Account of the First Use of Sulphuric Ether by Inhalation as an Anaesthetic in Surgical Operations” (Southern Medical and Surgical Journal 5 [1849]), describes the series of anesthetics he administered beginning in 1842, documenting one particular case in which Long amputated two fingers of a male slave. He used ether for one, and not the other, to test the effectiveness of anesthesia. This particular point is germane to Snow’s overall argument about the nature of the perception of pain in Victorian society and has been overlooked by historians of anesthesia.

The greatest weakness of this book is the final chapter, where the author steps out of the Victorian era and tries to summarize the twentieth century, the most explosive era in the history of anesthesia, in a scant few pages, resulting in many factual and interpretive errors. Snow states, for example, that there were fewer than ten anesthetic specialists in the United States prior to the First World War. By 1914, the New York Society of Anesthetists had been meeting for nine years and had a membership that exceeded forty members. The first meeting of a national association dedicated to anesthesiology was held in 1913 in Minneapolis, during the American Medical Association meetings. The American Journal of Surgery published an Anesthesia Supplement four times a year from 1914 to 1926. It is difficult to fully understand what is meant by “anesthetic specialist” during this time period, as many physicians who derived their primary income from the administration of anesthetics supplemented their finances with a small general practice.

While discussing the introduction of muscle paralytics to anesthesia practice, Snow misnames one of the pivotal...