The Anaesthetist 1890–1960: A Historical Comparative Study between Britain and Germany explores the evolution of anesthesia as a medical specialty in Britain and Germany. The author opens with an introductory chapter, which (1) defines his thesis statement; (2) introduces the disparity between anesthetic practice in Britain (the leader), where physicians led the introduction and development of anesthesia, and Germany (the laggard), where surgeon-directed nurse anesthesia was the norm; and (3) explores in general terms the history of medical specialization. The author uses the term “anaesthetic specialization” to describe the physician practice of anesthesia, avoiding the United States equivalent, which is “Anesthesiology.” This book explores the unique aspects of the development of modern, specialized anesthetic practice in Britain and Germany, looking at individual, physician contributions, technological and industrial influences, and political, social, and economic differences in these two countries.

The book is organized into eight chapters, with introductory and three summary chapters (one in English, one in German, and one in Dutch). The five main textual chapters cover the following historical periods: (1) 1890–1914 (the turn of the century), (2) 1914–1918 (the Great War), (3) 1919–1939 (interim period between World War I and World War II), (4) 1939–1945 (World War II), and (5) 1945–1960 (postwar period). A graphic section, appendices, sources and literature, and an index of key people of the period make up roughly the last 25% of the book. The appendices are five in number, entitled (1) “The shortest history of anaesthesia and its specialty,” (2) “The operation registers,” which summarizes the operative records from specific hospitals in Great Britain and Germany and the administration of anesthesia at those institutions, (3) “The surgical instruments companies and their catalogues,” (4) “Some key figures,” both British and German, and (5) “The sizes of anaesthetic devices,” which briefly deals with inconsistencies in the sizing of these devices in use at the time.

The sources and literature section includes an impressive collection of archival references from Great Britain and Germany, a bibliography of surgical and anesthetic textbooks, industrial catalogs, obituaries and laudations, and a multitude of citations from scientific journals (a total of 11 pages). In addition, the text itself is richly illustrated with sketches of medical instruments, a line drawing of Weiss & Son, surgical instrument makers in London, early anesthesia machines and airway devices, and other interesting items.

The author does a remarkable job tracing the development of anesthetic practice from its early periods into the modern, near current era. The book sorts out the unique differences in the practice of medicine and the different traditions of hospital organization and management and how that influenced the development of anesthesia as a medical specialty. The author asserts that the primary stimulus for change in Britain was the formation of the National Health Service in 1948. This development led to the reorganization of hospitals and a new hierarchy that was based on specialization. That the Faculty of Anaesthetists of the Royal College of Surgeons was also established in 1948 was no coincidence. Although external forces influenced specialization in Great Britain, in Germany, it would be internal forces that led to rapid and profound changes in the practice of anesthesia. Young surgeons saw the advantages of new techniques—for example, muscle relaxation and tracheal intubation—and pressed for the utilization of these and others in their practices.

Overall, this book is an excellent piece of work, extensively referenced, beautifully illustrated, and massive in scope. It has universal appeal to anesthesiologists and physician/historians and may perhaps be best appreciated by those with a background in the history of medical specialization in Europe. Unfortunately, the book is apparently only available directly from the publisher in the Netherlands. At the time this review was written, it was not listed on Amazon’s web site* and had limited exposure in the United States as evidenced by limited hits on a Google search. Perhaps this review will increase awareness and availability in the United States and elsewhere of this excellent book that offers a rare comparison of anesthesia development in two different Western nations.