Blessed Days of Anaesthesia: How Anaesthetics Changed the World.  By Stephanie J. Snow, Ph.D. New York, Oxford University Press, 2008. Pages: 226. Price: $34.95. ISBN: 978-0-19-280586-7.

“Pain is a universal experience.” Thus begins Stephanie J. Snow's Blessed Days of Anaesthesia: How Anaesthetics Changed the World , a delightful volume that explores the whys and wherefores of the beginnings of anesthesiology and its effect on the modern world. As a relative of Dr. John Snow, the founder of epidemiology and the anesthetist to Queen Victoria, the author focuses predominantly through the lens of Victorian England, explaining how the period's prevailing social, scientific, and religious views regarding pain came into question. The book has something to offer for everyone, historian, surgeon, and anesthetist. As a student of both medicine and history, I greatly enjoyed the book's exploration of the founding days and watershed occurrences of anesthesia.

In the Victorian world through which Snow guides us, suffering was an Old Testament virtue. Pain was God's will, payback for Eve's original sin, but could also serve as a transcendent means to understanding and faith, just as Job's trials were to him. Blessed Days  begins with the graphic account of Fanny Burney, a novelist forced to endure her own mastectomy without any pain control, and who later recounts the anguish she suffered in nauseatingly vivid detail. Surgical suffering would affect the patient, family, and surgeon alike. If at all possible, the caring physician would prescribe surgery as a last resort, and many were known to suffer immense guilt and even physical illness because of their overwhelming empathy for the poor patient. Given the prevailing religious interpretation of suffering, many surgeons were inculcated with an acceptance of pain as an unavoidable, even necessary component of human experience. One surgeon even opined that pain was “given us as a blessing.” Although the slow advance of surgical science before anesthesia is understandable, what may be less obvious is the slow reception by both medical and lay communities of many well-meaning attempts to decrease suffering. The idea of pain as virtuous or even protective to the suffering patient was so entrenched that many prominent surgeons initially dismissed anesthesia as either “a questionable attempt to abrogate one of the general conditions of man” or a dangerous negation of the body's natural response to stress.

Thankfully, the seeds of anesthesia were being sown in an era fertile with new ideas. Its gradual acceptance by society was aided by the revolutionary view that human suffering was neither a necessity nor a blessing. Enabled by the freedom of thought espoused by such great minds of the time as Charles Darwin, Jeremy Bentham, and Charles Dickens, the tradition of suffering as indispensable to existence was dispelled, and anesthesia helped to usher in more enlightened beliefs of humanism, compassion, and the worth of individual life. Fanny Longfellow, herself a recipient of ether for childbirth, hailed anesthetics as “the greatest blessing of the age.” As Snow explains, by gradually breaching religious doctrine and entrenched thinking, anesthesia made and continues to make known its true impact on the world.

Throughout the book, Snow convincingly argues that the growth of anesthesia was more than the simple accumulation of scientific knowledge. Perhaps, more gratifying than the influence of anesthesia on patients' bodies is its impact on patients' lives; time and again, the author explains how anesthesia positively influenced the prevailing attitudes of the time by profoundly affecting many facets of life in the Victorian world. After presenting how news of the first public demonstration of ether spread from Boston to England, the author explains how the important achievements of pioneers like James Simpson and John Snow influenced social groups such as women (including Queen Victoria), the military, academia, and even the underworld.

Although one of the great strengths of the book is its brevity, the more intense student of medical history may find the desired degree of development of Snow's ideas lacking. However, what the author has done is to offer busy clinicians an enjoyably brief overview of anesthesia history, while also providing rigorous historians an easily applied compendium of source material and ample suggestions for further reading by chapter. In the balance between too little and too much, I believe Snow chose “just right.”

The end result of the author's labors is a very readable and enjoyable journey through the history in which her ancestor played a pivotal role, and which, through slow reassessment of societal views, challenged the bleak views of the mid-nineteenth century. For both the practicing anesthesiologist with only a passing interest and the serious scholar of medical history, the book will be a valued addition.

Massachusetts General Hospital, Boston, Massachusetts.