Book Review

The Genesis of Surgical Anesthesia

N Engl J Med 1999; 341:458-459August 5, 1999

Article

The Genesis of Surgical Anesthesia
By Norman A. Bergman. 448 pp., illustrated. Park Ridge, Ill., Wood Library-Museum of Anesthesiology, 1998. $85. ISBN: 0-9614932-0-0

In the first successful public demonstration of surgical anesthesia, dentist William T.G. Morton administered “Letheon,” his patented preparation of diethyl ether, to a patient on October 16, 1846, at Massachusetts General Hospital. But long before that celebrated event, there had been many other efforts to control surgical pain, numerous medical uses of inhaled gases, and several less well publicized successful attempts to use inhalation anesthesia. These three strands of the history of anesthesia before 1846 are the subject of The Genesis of Surgical Anesthesia.

Bergman provides a fascinating, detailed record of attempts to make surgery painless from antiquity to the 18th century. He demonstrates that the concept of anesthesia was not a new, humanitarian innovation of the 19th century. However, he also rejects the claim that any ancient anesthetic methods would be considered safe and effective by modern standards.

The use of pain relief was long sought by some surgeons and patients, but it was long opposed by others. One much-discussed example of such opposition was the 1591 execution for witchcraft of Eufaemia MacCalyan. That case involved many nonmedical religious and political offenses. But Bergman's careful reading of the transcribed court records shows that MacCalyan's attempt to relieve the pain of childbirth constituted a crime in itself in 16th-century Edinburgh, whether or not supernatural methods were used.

Although the sections on attempts to control surgical pain span the ages, more than half the book focuses on the use of “pneumatic medicine” from the 1760s to the early 1800s. The Pneumatic Institution established in 1798 by Thomas Beddoes in Bristol, United Kingdom, has been mentioned in passing by many prior historians of anesthesia. It provided the setting for Sir Humphry Davy's often-quoted 1800 suggestion that because nitrous oxide can eliminate pain, it might be useful in surgery.

This book shows that the history of inhalation medicine is much more interesting and complex. First, Bergman traces the surprisingly diverse chemical roots and medical branches of gas therapy before, during, and after the work of Beddoes and Davy. Second, he shows that many other eminent scientists, including such members of Birmingham's Lunar Society as Erasmus Darwin, James Watt, and William Withering, also made important contributions to pneumatic medicine. Third, he argues that Davy never meant to suggest that nitrous oxide could be used to eliminate surgical pain itself. Rather, Bergman claims plausibly that Davy saw laughing gas as simply a stimulant that might combat the harmful exhaustion produced by surgery. Though Davy's experiments had a key role in promoting the medical use of gases that turned out to have anesthetic properties, Davy himself never anticipated their use to produce surgical anesthesia. Bergman judiciously concludes that there was no one discoverer of surgical anesthesia, but that the 1846 demonstration resulted from a convergence of many events.

Bergman's extensive reference list contains many original documents in English and older histories of anesthesia. However, it omits many more recent and useful cultural histories of pain and pain relief, including influential works by David Morris, Roselyne Rey, Mary Poovey, Elaine Scarry, Karen Halttunen, Elizabeth B. Clark, and Helen King.

This book deserved better editing. Too many anecdotes are told more than once, sometimes within a few pages of each other. More repetitions were averted only by the use of intrusive cross-references, instead of by a reorganization of the material to achieve a tighter, more coherent overall structure. These organizational problems are annoying and may obscure the important points being made. On balance though, this book is clearly a valuable contribution to the little-known field of the history of inhalation medicine and pre-1846 approaches to surgical pain.

Martin S. Pernick, Ph.D.
University of Michigan, Ann Arbor, MI 48109-1003