As Stephanie Snow reminds us in the introduction to her excellent first book, anaesthesia has since the mid-nineteenth century widely been seen as “the most powerful example of medicine's capacity to transform human experiences of suffering and pain” (p. 2). Perhaps, then, it is not surprising that the historiography of anaesthesia is one of the last outposts of unreconstructed medical triumphalism. Titles such as Milestones in anesthesia and The battle for oblivion reflect a general unwillingness amongst writers on this subject (frequently senior or retired anaesthetists themselves—plus ça change) to go beyond an uncritically deterministic narrative, in which the adoption of anaesthetics in Britain after Robert Liston's demonstration of ether in December 1846 was rapid, universal and historically inevitable.
Operations without pain is both a magnificently acute corrective to this outdated corpus and a fascinating, original piece of historical analysis in its own right. Snow breaks down the traditional celebratory story to give a richer and more subtle account of the introduction and dissemination of anaesthetic theories and techniques, drawing on John Pickstone's work on the shift from biographical to scientific models of medicine. By exploring the writing of Humphry Davy, Thomas Beddoes and other Enlightenment experimentalists she gives British anaesthesia a substantial prehistory, based around a compelling demonstration of the “dissociation of sensibility” (noted by T S Eliot in a different context) that enabled early nineteenth-century physicians to conceive of life without (apparent) nervous irritability, and hence to imagine the possibility of inducing controlled, reversible anaesthesia.
Snow divides the six decades between Liston's demonstration and the end of the century into two broad and overlapping periods. Between the late 1840s and the early 1860s every aspect of anaesthesia—its mode of action, practical applicability, safety and ethics—was widely debated in medical, public and governmental circles. From the early 1860s anaesthetic techniques were a generally accepted, but certainly not unproblematic, part of medicine, surgery and dentistry, and by 1900 the practices and structures of anaesthesia as a medical speciality were firmly established in Britain. Public views of anaesthesia, however, were not so straightforward. Snow identifies a widespread “fear of unconsciousness” in the late nineteenth century: in clumsy or malicious hands chloroform might result in robbery, kidnapping, “violation”, a loss of proper self-control or even death. Such fears informed a more selective attitude in submitting to anaesthesia than the casual observer of this period might at first imagine.
For this reader the most fascinating part of Snow's book is an analysis, taken from her doctoral research, of almost 4,500 anaesthetics from the casebooks of Dr John Snow, backed up with case reports from several large London hospitals. John Snow's self-confessedly scientific attitude to anaesthetics is contrasted with James Young Simpson's more traditional biographical approach to show that, contrary to received wisdom, “scientific medicine” before 1860 was as much a determinant of practice as it was a rhetorical strategy.
Snow's prose is lucid and expressive, her theses insightful, her conclusions illuminating and well supported. Though neither dental nor military anaesthesia here receive the attention they merit, this is less an omission and more a call to further research in these fields. This book deserves to become both a standard reference work for students of Victorian medicine and a template for future workers in this field. If Operations without pain receives the perceptive readership it demands we may expect to witness the beginning of a rewarding new era in the historiography of anaesthesia.