The Genesis of Surgical Anesthesia

On 16 October 1846, surgical anesthesia was first demonstrated publicly at the Massachusetts General Hospital. This date is the standard beginning for most serious studies of the history of anesthesiology, yet this book covers in great detail the work that came before that momentous occasion. Its handsome red leather binding with gold filigree does justice to the book’s contents; The Genesis of Surgical Anesthesia should be required reading for any serious student of the history of anesthesiology.

One of the strengths of the book is the way in which Norman Bergman demonstrates the development of physiology, chemistry, and anatomy to a point where “modern” anesthesia could be understood. Painstakingly analyzing the works of Harvey Boyle, Hooke, Boerhaave, Priestley, Lavoisier, and many others, he weaves the story of how the chemistry and physics of gases were studied. Physiology, another basic science cornerstone of anesthesiology, is similarly developed. Bergman also describes in detail Davy’s work with nitrous oxide and Hickman’s with carbon dioxide, and their ability to anesthetize animals with these agents.

Bergman brings his unique perspective as an anesthesiologist to the work. In discussing the many attempts at anesthesia prior to 1846, he attempts to explain, from the vantage point of late-twentieth-century knowledge, why these approaches, suggested to bring about a sleep that permitted surgical trespass, were a failure. He comments on the herbal concoctions alleged to produce anesthesia that “experience with these drugs in modern clinical practice clearly shows that . . . their use could not predictably produce a state of sleep with insensibility to the pain inflicted by the cutting of the body” (p. 25), and that “attempts to use them in this manner would certainly have caused an appalling and unacceptable mortality from anesthesia” (ibid.). Yet he strives to define the mechanism of action of each agent and to describe how it might have produced an anesthetic state in a manner that is universally understood. Most interesting is his discussion of opium: he demonstrates from the writings of various physicians that opium alone, unless given in massive doses, cannot produce the anesthetic state without the arrest of respiration.

Bergman also discusses the many techniques, prior to 1846, that reportedly reduced the pain of surgery. Chapter 17, in particular, covers the methods of nerve compression, exsanguination, refrigeration, and hypnosis in vivid detail; by the end of the chapter the reader is convinced that surgery before ether anesthesia was truly barbaric, and that patients must have been desperate before submitting to this torture. The book’s epilogue touches on the “ether controversy.” For a short essay on this still hotly debated topic, this is an excellent and even-handed job.

The one great failing of the book, however, is that Bergman does not speculate on why Davy, Hickman, and others who clearly demonstrated the anesthetic state in animals did not take the next step and apply their knowledge to human patients undergoing surgery. This is one of the great unanswered questions of the history of anesthesiology. While no explanation has been completely satisfying, Emmanuel Papper’s work Romance, Poetry, and Surgical Sleep: Literature Influences Medicine (1995), which attempts to show a change in the way in which pain was viewed due to the influence of the romantic poets in the early nineteenth century, comes closest by theorizing that the cultural perception of pain changed, and therefore the search for surgical anesthesia became far more important.

The book’s bibliography contains every reference on the subject to date; it is most complete, and worth the price of the book alone. Additionally, there are many excellent illustrations throughout the volume. The index of subjects and people is well done.