%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 16 0 R 24 0 R 32 0 R 38 0 R 44 0 R 52 0 R 58 0 R ] /Count 8 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R >> /XObject << /I1 11 0 R >> >> /MediaBox [0.000 0.000 595.280 841.890] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20140902094224+01'00') /ModDate (D:20140902094224+01'00') /Title (Operations Without Pain: The Practice and Science of Anaesthesia in Victorian Britain) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 12 0 R 14 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 4492 >> stream q 381.750 0 0 120.000 34.016 687.874 cm /I1 Do Q 0.000 0.000 0.000 rg BT 34.016 676.469 Td /F1 12.0 Tf [(Published on )] TJ ET BT 99.356 676.469 Td /F2 12.0 Tf [(Reviews in History)] TJ ET BT 190.016 676.469 Td /F1 12.0 Tf [( \()] TJ ET 0.000 0.000 0.800 rg BT 197.012 676.469 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 197.012 675.075 m 357.332 675.075 l S 0.000 0.000 0.000 rg BT 357.332 676.469 Td /F1 12.0 Tf [(\))] TJ ET 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d 34.391 653.743 526.499 1.500 re S BT 34.016 615.321 Td /F3 18.0 Tf [(Operations Without Pain: The Practice and Science of Anaesthesia )] TJ ET BT 34.016 593.937 Td /F3 18.0 Tf [(in Victorian Britain)] TJ ET BT 34.016 237.683 Td /F1 12.0 Tf [(In her introduction the author emphasizes that her book, )] TJ ET BT 305.972 237.683 Td /F2 12.0 Tf [(Operations Without Pain: The Practice and Science )] TJ ET BT 34.016 223.427 Td /F2 12.0 Tf [(of Anaesthesia in Victorian Britain)] TJ ET BT 202.028 223.427 Td /F1 12.0 Tf [(, is ?In no way ? intended to be a linear history of discoveries, techniques, )] TJ ET BT 34.016 209.171 Td /F1 12.0 Tf [(or famous men? \(p. 4\). It is a pity, therefore, that the title is so misleading, since this book is not a history of )] TJ ET BT 34.016 194.915 Td /F1 12.0 Tf [(?the practice and science of anaesthesia in Victorian Britain? either. ?Aspects of...? or ?A Consideration of )] TJ ET BT 34.016 180.659 Td /F1 12.0 Tf [(?? would have been a fairer description. Nor, although it is one in the series entitled ?Science, Technology )] TJ ET BT 34.016 166.403 Td /F1 12.0 Tf [(and Medicine in Modern History?, is there a great deal of science or medicine, and technology is hardly )] TJ ET BT 34.016 152.147 Td /F1 12.0 Tf [(mentioned at all. Thus such neglected technological topics as the contribution of the commercial chemists )] TJ ET BT 34.016 137.891 Td /F1 12.0 Tf [(and instrument makers, still of great relevance today, do not feature. Instead, taking Pernick?s treatise on the )] TJ ET BT 34.016 123.635 Td /F1 12.0 Tf [(early years of anaesthesia in the United States as an example \()] TJ ET 0.000 0.000 0.800 rg BT 332.276 123.635 Td /F1 12.0 Tf [(1)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 332.276 122.241 m 338.276 122.241 l S 0.000 0.000 0.000 rg BT 338.276 123.635 Td /F1 12.0 Tf [(\), Dr. Snow has used the history of )] TJ ET BT 34.016 109.379 Td /F1 12.0 Tf [(anaesthesia ?to illuminate three areas of current historical interest: the relationship between medical practice )] TJ ET BT 34.016 95.123 Td /F1 12.0 Tf [(and science; the dynamics which structured patient-doctor relations; and the specialization of medical )] TJ ET BT 34.016 80.867 Td /F1 12.0 Tf [(practice?. She has, also, ?approached the first two issues from a particular historiographical vantage, using a )] TJ ET BT 34.016 66.611 Td /F1 12.0 Tf [(typological model of medicine?. So, essentially, it is an intellectual and social history of the introduction of )] TJ ET BT 34.016 52.355 Td /F1 12.0 Tf [(general anaesthesia and of the response of surgeons and the general public to its early problems, leading up )] TJ ET BT 34.016 563.315 Td /F3 12.0 Tf [(Review Number:)] TJ ET BT 34.016 549.059 Td /F1 12.0 Tf [(573)] TJ ET BT 34.016 534.803 Td /F3 12.0 Tf [(Publish date:)] TJ ET BT 34.016 520.547 Td /F1 12.0 Tf [(Thursday, 1 February, 2007)] TJ ET BT 34.016 506.291 Td /F3 12.0 Tf [(Author:)] TJ ET BT 34.016 492.035 Td /F1 12.0 Tf [(Stephanie Snow)] TJ ET BT 34.016 477.779 Td /F3 12.0 Tf [(ISBN:)] TJ ET BT 34.016 463.523 Td /F1 12.0 Tf [(9781403934451)] TJ ET BT 34.016 449.267 Td /F3 12.0 Tf [(Date of Publication:)] TJ ET BT 34.016 435.011 Td /F1 12.0 Tf [(2005)] TJ ET BT 34.016 420.755 Td /F3 12.0 Tf [(Price:)] TJ ET BT 34.016 406.499 Td /F1 12.0 Tf [(52.00)] TJ ET BT 34.016 392.243 Td /F3 12.0 Tf [(Pages:)] TJ ET BT 34.016 377.987 Td /F1 12.0 Tf [(288pp.)] TJ ET BT 34.016 363.731 Td /F3 12.0 Tf [(Publisher:)] TJ ET BT 34.016 349.475 Td /F1 12.0 Tf [(Palgrave Macmillan)] TJ ET BT 34.016 335.219 Td /F3 12.0 Tf [(Publisher url:)] TJ ET BT 34.016 320.963 Td /F1 12.0 Tf [(http://www.palgrave.com/products/title.aspx?PID=269093)] TJ ET BT 34.016 306.707 Td /F3 12.0 Tf [(Place of Publication:)] TJ ET BT 34.016 292.451 Td /F1 12.0 Tf [(Basingstoke)] TJ ET BT 34.016 278.195 Td /F3 12.0 Tf [(Reviewer:)] TJ ET BT 34.016 263.939 Td /F1 12.0 Tf [(David Zuck)] TJ ET endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Times-Roman /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /XObject /Subtype /Image /Width 509 /Height 160 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 509 /BitsPerComponent 8>> /Mask [ 255 255 255 255 255 255 ] /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3280>> stream x[EQ㎦fVttҒ +3O{?lGDQԯDrB^.ϯ%~'0۠/2>0AG_>0j0GCfE67>rB^}@  !&y+r?INp:erc b8f=rQC!~-Wf^^zF[)G 2ޯe7V_Go3Ke GEGOo8rώ#\1ZY~N6^H}yLxS-!:412V+u\-LSO?xVvZ|GjǮT_8EYJF=Tw^ 7GxfN/S:Ʌ~ʟtt?5n÷J'JcF-GVξx{rO~tJd;#a\7}|~y'>}c2C vR}f׈**h.)_&@pfzjsx:5;S\vKhM5j=!Cn+h"u]a EUN]jn=k<,:Ք>sU!ni~6EJ)¦72?G}[y}_vc$t?iSܟ2Zݞ,VN?_`='RFK1A2qv&X_lLRWY'%:I㢖zb_UEx\>&ɆBˏ~K@ \gYØU4}$8Dv!'Q'*+Εj(UCGo[#< 2Ja(sZi9fZKE Rn`u\9r^Zmɯ׹}mstO4uc~#'jEvۼ Dx[z ޏQ4KL5,5u3>i^uÒ-53ba ~,~/pyt1fMU'CVm:qv~=Y'Es"WsφG?l_kN5}],Ow7 uh`xƫ?zMl7ٻv$A(4Dl(wwH} ?=[=S;yC]^BK>㕪9`Z'Wj;E|:bf>kCԘ#RY,iv쵗~}n'"1u" *uO΄/2^Sxr(!/DD\~mJyZ!MmrA!#u[if|99WB WΡpp}w}sh#,\ &:%˳X?D3 %W0cC?o̲^} F3XLVn]Cߖiϧ!7}yZJ#P7]=)7Ρp;>> Ye^xx{Oafw{ ;>4gfLt ʊ:q%#r/)pv!O4wGh|dS ӣݽހ-gVUC'pBxrB^} 7JA^} /'8!`:r?}}],X  }6y!`/~Br?}Q< >k7vx"] ,' .3jn{-i}|~%-};b6#U)7繎kiEw 㤳:E}[޼c"rꬊ7Dc$~"/Y&zSd:tFȌCrʙ`7u .#[-<)j ?TGS(j~oTup(hjU4PlJ=}|it.ҽ@\wʨuXÞZcx18Wo<~ikOg,ވ\^?EneyZcc0[R١z|zv7_m:_n]a?osS3~j^ hD.a_X'KfBX6w wݶ"Oa:,bvhrWH[uCF-Xfc}>x+Rz)2N-B 7y^٨;[/vg? | |2Sve}=o䑰j[vWjF0{굦?VI~}xM(_TlG__+]:#к?S} c>GŸD7 !w{S{B =x7a?oE#)+Gz:o_4Q<;n?\tt7?mGCџQGu4kņOF>F?#} hP&ђߴM#u!.СtL2^#o nIk_i.~7tr@n 1P~3?.[]=S5b߮~Yo^HFH YBi8a4iom>CKgMy*;?zqEӕ` >zB9iFzC?XF?ޟIܰ펉A}{I5ᄊx%ez#Mp@rߎpi]IOVjzuJt\۰f׺u5><,J~PTJp1)}){9N {!`/> endstream endobj 12 0 obj << /Type /Annot /Subtype /Link /A 13 0 R /Border [0 0 0] /H /I /Rect [ 197.0117 675.3895 357.3317 687.2695 ] >> endobj 13 0 obj << /Type /Action /S /URI /URI (http://www.history.ac.uk/reviews) >> endobj 14 0 obj << /Type /Annot /Subtype /Link /A 15 0 R /Border [0 0 0] /H /I /Rect [ 332.2757 122.5555 338.2757 134.4355 ] >> endobj 15 0 obj << /Type /Action >> endobj 16 0 obj << /Type /Page /Parent 3 0 R /Annots [ 18 0 R 20 0 R 22 0 R ] /Contents 17 0 R >> endobj 17 0 obj << /Length 7997 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(to its secure establishment in medical practice and its gradual acceptance as a specialty, and which is written )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(from the viewpoint of a particular school of social history. As such it invites comparison with Pernick?s )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(approach.)] TJ ET BT 34.016 741.701 Td /F1 12.0 Tf [(Dr. Snow, in her introduction, explains that, ?Most writers portray anaesthesia as a natural and inevitable )] TJ ET BT 34.016 727.445 Td /F1 12.0 Tf [(phenomenon of ?modern? medicine which enjoyed an immediate and sustained take-up and developed )] TJ ET BT 34.016 713.189 Td /F1 12.0 Tf [(uniformly. But this was not so; the early use was uncertain and differed between nations?. She suggests that, )] TJ ET BT 34.016 698.933 Td /F1 12.0 Tf [(ether being a difficult agent to use, it was only the introduction of chloroform that saved anaesthesia from )] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(remaining ?on the margins of British practice?. But chloroform was occasionally associated with sudden )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(death, and she notes the different responses in different parts of the world, abandonment in some, acceptance )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(in others, with the development of different methods of administration in, for example, England and )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(Scotland. ?To skate over such complexities is to prevent the history of anaesthesia from informing our )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(deeper understandings of nineteenth-century medicine and society.? This accusation is hardly fair, since the )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(response of the medical profession during the remainder of the century is a major feature of serious histories )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(of anaesthesia. In Duncum?s book, for example, the bible of the historian of anaesthesia, over one hundred )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(pages are devoted to the first twenty five years of the use of chloroform, including some twenty to an )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(analysis of the report of the Chloroform Committee of 1864 alone \()] TJ ET 0.000 0.000 0.800 rg BT 357.644 570.629 Td /F1 12.0 Tf [(2)] TJ ET 0.24 w 0 J [ ] 0 d 357.644 569.235 m 363.644 569.235 l S 0.000 0.000 0.000 rg BT 363.644 570.629 Td /F1 12.0 Tf [(\). In this respect Dr. Snow?s exclusion )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(of the physiologist A. D. Waller and the second dosimetric movement that he spearheaded is a major )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(omission.)] TJ ET BT 34.016 515.861 Td /F1 12.0 Tf [(Now we come to the crux of Dr. Snow?s book. The late Richard Ellis developed the thesis, not generally )] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [(accepted, that after the initial enthusiasm, a run of time-wasting failed inductions and inadequate )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(anaesthesias put the procedure in danger of being abandoned, and that it was only kept going by the )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(persistence of the dentist James Robinson, until John Snow produced predictable and reliable effects by )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(establishing it on sound scientific principles. This would have put it at hazard for at most two months. But )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(Dr. Snow, ?putting anaesthesia under a wider historical lens?, has turned her gaze onto the ?complex )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(patterns of innovation, reversals, debate, and geographical difference by which anaesthesia became )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(established in British medicine?, and as a result feels that the doubts persisted for up to twenty years. She )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(has identified two distinct phases, the first extending from 1846 to 1860, during which it was debated )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(whether the risks were greater than the benefits??That issue is the heart of this book ?? \(p. 4\). So although )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(she covers the period 1790 to 1900, by which time the practice of anaesthesia had become ?embedded into )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(social and medical culture?, the larger part of her discourse is devoted to a close examination and analysis of )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(opinion, theory, and practice, during the years up to the mid-1860s. Her penultimate chapter takes the )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(emerging specialty to 1900, and she concludes with an overview of national similarities and differences, and )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(a brief look at developments into the twenty-first century.)] TJ ET BT 34.016 290.021 Td /F1 12.0 Tf [(It is impossible in the space available to comment, as an anaesthetist, on all the disputatious points that Dr. )] TJ ET BT 34.016 275.765 Td /F1 12.0 Tf [(Snow makes; that would require an even longer book than the original. So I will try to answer two questions )] TJ ET BT 34.016 261.509 Td /F1 12.0 Tf [(and deal only with her main thesis in any detail, commenting briefly on others points. Unlike Pernick, the )] TJ ET BT 34.016 247.253 Td /F1 12.0 Tf [(book begins conventionally with the pre-history of inhalational anaesthesia, with Humphry Davy?s and his )] TJ ET BT 34.016 232.997 Td /F1 12.0 Tf [(friends? observations on the effects of inhaling nitrous oxide, and its analgesic property. Dr. Snow )] TJ ET BT 34.016 218.741 Td /F1 12.0 Tf [(comments that historians have failed to tackle the commonest of the FAQs about the history of anaesthesia: )] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(why neither Davy nor his contemporaries pursued his suggestion that nitrous oxide ?may be used with )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(advantage during surgical operations ??. Careful reading of Davy?s treatise on nitrous oxide, )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(however?something it doesn?t get very often nowadays?shows this was a throw-away remark, and that his )] TJ ET BT 34.016 161.717 Td /F1 12.0 Tf [(real interest was elsewhere \()] TJ ET 0.000 0.000 0.800 rg BT 169.964 161.717 Td /F1 12.0 Tf [(3)] TJ ET 0.24 w 0 J [ ] 0 d 169.964 160.323 m 175.964 160.323 l S 0.000 0.000 0.000 rg BT 175.964 161.717 Td /F1 12.0 Tf [(\). But nitrous oxide )] TJ ET BT 272.300 161.717 Td /F2 12.0 Tf [(was)] TJ ET BT 290.972 161.717 Td /F1 12.0 Tf [( tried, with alarming results, at a meeting of the )] TJ ET BT 34.016 147.461 Td /F1 12.0 Tf [(Askesian Society in March 1800, which was attended by, among others, the influential surgeon Astley )] TJ ET BT 34.016 133.205 Td /F1 12.0 Tf [(Cooper. William Allen, of Allen and Hanburys, lecturer on chemistry at Guy?s Hospital, related his own )] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(sensations, and the reaction of his friends. ?The company said that my eyes were fixed, face purple, veins in )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(the head very large, apoplectic stertor. They were all much alarmed, but I suffered no pain and in a short )] TJ ET BT 34.016 90.437 Td /F1 12.0 Tf [(time came to myself? \()] TJ ET 0.000 0.000 0.800 rg BT 143.996 90.437 Td /F1 12.0 Tf [(4)] TJ ET 0.24 w 0 J [ ] 0 d 143.996 89.043 m 149.996 89.043 l S 0.000 0.000 0.000 rg BT 149.996 90.437 Td /F1 12.0 Tf [(\). His friends thought he was having a stroke, and this was sufficiently alarming for )] TJ ET BT 34.016 76.181 Td /F1 12.0 Tf [(the experiments to be terminated. Does one need more explanation of why Davy?s suggestion was not taken )] TJ ET BT 34.016 61.925 Td /F1 12.0 Tf [(up? Furthermore, it is tacitly understood by anaesthetists that nitrous oxide was the wrong agent. It was )] TJ ET endstream endobj 18 0 obj << /Type /Annot /Subtype /Link /A 19 0 R /Border [0 0 0] /H /I /Rect [ 357.6437 569.5495 363.6437 581.4295 ] >> endobj 19 0 obj << /Type /Action >> endobj 20 0 obj << /Type /Annot /Subtype /Link /A 21 0 R /Border [0 0 0] /H /I /Rect [ 169.9637 160.6375 175.9637 172.5175 ] >> endobj 21 0 obj << /Type /Action >> endobj 22 0 obj << /Type /Annot /Subtype /Link /A 23 0 R /Border [0 0 0] /H /I /Rect [ 143.9957 89.3575 149.9957 101.2375 ] >> endobj 23 0 obj << /Type /Action >> endobj 24 0 obj << /Type /Page /Parent 3 0 R /Annots [ 26 0 R 28 0 R 30 0 R ] /Contents 25 0 R >> endobj 25 0 obj << /Length 8133 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(suitable for the uncomplicated extraction of a small number of teeth or the lancing of an abscess, but for )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(nothing more. This was the limitation faced by Horace Wells, the real pioneer of general anaesthesia, who, )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(sadly, Dr. Snow has airbrushed almost completely out of the picture. Wells?s search for a method of pain )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(relief in dentistry was philanthropic, motivated by his desire for improvements in denture technology, and )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(neither his nor Morton?s discoveries were, as she says, serendipitous. Wells?s mind was the prepared soil )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(into which the Colton-scattered seed fell and germinated. Morton, following Wells, was looking for a better )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(agent deliberately; in his case, for commercial gain.)] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(Dr. Snow continues with the influence on medical practice in the early-nineteenth century of changes in the )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(attitude to the body, from what she calls ?biographical? to ?scientific? medicine. This is the typological )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(model to which she referred earlier. I am not clear from her description whether in their essentials these not )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(necessarily exclusive approaches to medical practice are different from what has been described elsewhere )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(as ?bedside? and ?scientific? or ?hospital? medicine \()] TJ ET 0.000 0.000 0.800 rg BT 290.948 627.653 Td /F1 12.0 Tf [(5)] TJ ET 0.24 w 0 J [ ] 0 d 290.948 626.259 m 296.948 626.259 l S 0.000 0.000 0.000 rg BT 296.948 627.653 Td /F1 12.0 Tf [(\). It appears to be distinct from the change from )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(?Rush heroic? to the more moderate approach labeled ?environmental moral? by Pernick. At any rate, a )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(gradual change did occur, but slowly, as can be seen from the conservative nature of some of the )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(contributions to discussions in the Westminster Medical Society as late as the mid-1840s, in spite of the )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(efforts of John Snow. But whatever they are called, these attitudinal changes, while she concedes that they )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(had no influence on the actual introduction of general anaesthesia, were of great importance in preparing )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(?elite physicians and doctors??a group Dr. Snow mentions several times, one wonders who these were?for )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(its acceptance.)] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [(This leads to the second of the FAQs about anaesthesia echoed by Dr Snow?why it emerged in the 1840s )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(rather than in an earlier period, ?though the gases used had been known for some time and inhaling vapours )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(was an established therapeutic practice?. She comments that few historians have sought to explain this; so, )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(the answer being crucial to the main burden of her book, let us try. Just posing the question implies, rather )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(ahistorically, that since we now know that general anaesthesia is ?a good thing?, therefore it was the duty of )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(someone to have introduced it as soon as it became feasible. It also makes the enormous assumption that the )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(procedure could, like Botticelli?s Venus, have emerged from the foam fully formed, perfect, demure, and )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(ready to go. But great innovations are made by people, and Dr. Snow, by excluding from her discourse the )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(vagaries of ?the crooked timbers of humanity?, such as enthusiasm, inventiveness, persistence, ambition, )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(greed, inertia, and lack of interest or of imagination, has, unlike Pernick, excluded a whole stratum of )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(explanation. Because the truth is that, humanitarian arguments notwithstanding, before Henry Hickman no )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(one was looking; it never appears to have entered anyone?s mind that it could be done \()] TJ ET 0.000 0.000 0.800 rg BT 454.604 344.789 Td /F1 12.0 Tf [(6)] TJ ET 0.24 w 0 J [ ] 0 d 454.604 343.395 m 460.604 343.395 l S 0.000 0.000 0.000 rg BT 460.604 344.789 Td /F1 12.0 Tf [(\). The possibility )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(had been positively dismissed by the great French surgeon Velpeau, and by the American Valentine Mott. )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(So, conceptually speaking, )] TJ ET BT 165.668 316.277 Td /F2 12.0 Tf [(acceptance of the idea)] TJ ET BT 273.308 316.277 Td /F1 12.0 Tf [( that one might safely and reversibly deliberately produce )] TJ ET BT 34.016 302.021 Td /F1 12.0 Tf [(unconsciousness, hitherto an ominous sign of life-threatening illness, was a )] TJ ET BT 398.648 302.021 Td /F2 12.0 Tf [(Kuhnian paradigm shift)] TJ ET BT 513.332 302.021 Td /F1 12.0 Tf [( \()] TJ ET 0.000 0.000 0.800 rg BT 520.328 302.021 Td /F1 12.0 Tf [(7)] TJ ET 0.24 w 0 J [ ] 0 d 520.328 300.627 m 526.328 300.627 l S 0.000 0.000 0.000 rg BT 526.328 302.021 Td /F1 12.0 Tf [(\). )] TJ ET BT 34.016 287.765 Td /F1 12.0 Tf [(Other biological examples may be mentioned. Until Pasteur?s flash of inspiration, no one believed that )] TJ ET BT 34.016 273.509 Td /F1 12.0 Tf [(living organisms could survive without oxygen, but seeing dead bacteria round the edge of a cover slip he )] TJ ET BT 34.016 259.253 Td /F1 12.0 Tf [(discovered, or constructed, anaerobes. No one believed that any living organisms could withstand prolonged )] TJ ET BT 34.016 244.997 Td /F1 12.0 Tf [(boiling, or live under the enormous pressures of the depths of the Pacific Ocean, until the opposite was )] TJ ET BT 34.016 230.741 Td /F1 12.0 Tf [(demonstrated. The acceptance of the controlled and reversible unconsciousness of general anaesthesia was a )] TJ ET BT 34.016 216.485 Td /F1 12.0 Tf [(conceptual change of similar magnitude, and once this acceptance is recognized as a Kuhnian shift, then all )] TJ ET BT 34.016 202.229 Td /F1 12.0 Tf [(is illuminated. The twenty years of uncertainty, the acceptance by the next generation, and the normal )] TJ ET BT 34.016 187.973 Td /F1 12.0 Tf [(science developed by John Snow, are then to be expected, being, by definition, predicted. Although she does )] TJ ET BT 34.016 173.717 Td /F1 12.0 Tf [(not give any indication that she recognizes the nature of this acceptance, Dr. Snow is moving in the right )] TJ ET BT 34.016 159.461 Td /F1 12.0 Tf [(direction when she claims that the attitudinal change already mentioned prepared her ?elite physicians and )] TJ ET BT 34.016 145.205 Td /F1 12.0 Tf [(doctors? for it.)] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(There are two further considerations. In early-Victorian times people were not as accustomed to the rate of )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(change as we ourselves have become conditioned to, and this has to be taken into account when looking )] TJ ET BT 34.016 90.437 Td /F1 12.0 Tf [(back at that period. Consequently, prolonged opposition to such a dramatic and potentially dangerous )] TJ ET BT 34.016 76.181 Td /F1 12.0 Tf [(procedure as general anaesthesia is not surprising. The second and clinching factor was the introduction of )] TJ ET BT 34.016 61.925 Td /F1 12.0 Tf [(antiseptic, shortly followed by aseptic, procedures into surgery. If general anaesthesia had not already )] TJ ET endstream endobj 26 0 obj << /Type /Annot /Subtype /Link /A 27 0 R /Border [0 0 0] /H /I /Rect [ 290.9477 626.5735 296.9477 638.4535 ] >> endobj 27 0 obj << /Type /Action >> endobj 28 0 obj << /Type /Annot /Subtype /Link /A 29 0 R /Border [0 0 0] /H /I /Rect [ 454.6037 343.7095 460.6037 355.5895 ] >> endobj 29 0 obj << /Type /Action >> endobj 30 0 obj << /Type /Annot /Subtype /Link /A 31 0 R /Border [0 0 0] /H /I /Rect [ 520.3277 300.9415 526.3277 312.8215 ] >> endobj 31 0 obj << /Type /Action >> endobj 32 0 obj << /Type /Page /Parent 3 0 R /Annots [ 34 0 R 36 0 R ] /Contents 33 0 R >> endobj 33 0 obj << /Length 7016 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(arrived, it would have had to be invented. Anyone who has seen a patient, restless under regional or spinal )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(anaesthesia, disturbing the sterile drapes will see the force of this argument. In the words of the great )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(physician Sir Clifford Albutt,)] TJ ET BT 64.016 729.701 Td /F1 12.0 Tf [(When I was a boy ? the best surgeon was he who broke the three-minute record for amputation )] TJ ET BT 64.016 715.445 Td /F1 12.0 Tf [(or lithotomy. What place could there be in record-breaking operations for the fiddle-faddle of )] TJ ET BT 64.016 701.189 Td /F1 12.0 Tf [(antiseptic precautions? The obvious boon of freedom from pain, precious as it was ? was the )] TJ ET BT 64.016 686.933 Td /F1 12.0 Tf [(boon of time. With anaesthesia ended slapdash surgery; anaesthesia gave the necessary time for )] TJ ET BT 64.016 672.677 Td /F1 12.0 Tf [(the theories of Pasteur and Lister to be adopted in practice.)] TJ ET BT 34.016 634.421 Td /F1 12.0 Tf [(Pernick makes a similar point, less eloquently. So really, by the mid-1860s there was no question of turning )] TJ ET BT 34.016 620.165 Td /F1 12.0 Tf [(back.)] TJ ET BT 34.016 593.909 Td /F1 12.0 Tf [(To proceed with Dr. Snow?s arguments, most of four chapters are devoted to what we may now call the )] TJ ET BT 34.016 579.653 Td /F1 12.0 Tf [(phase of paradigm resistance. She makes a great point of the restraint, the self-control, that had become )] TJ ET BT 34.016 565.397 Td /F1 12.0 Tf [(expected by the early-Victorian period of patients undergoing surgery, sometimes described as ?bottom?, )] TJ ET BT 34.016 551.141 Td /F1 12.0 Tf [(and suggests that after the first successful demonstration, ?reputable doctors? would have difficulty )] TJ ET BT 34.016 536.885 Td /F1 12.0 Tf [(accommodating to ether anaesthesia because it ?placed patients beyond individual self-control? \(p. 40\). It )] TJ ET BT 34.016 522.629 Td /F1 12.0 Tf [(seems that she is referring to the stage of excitement through which most patients passed, more marked with )] TJ ET BT 34.016 508.373 Td /F1 12.0 Tf [(ether than chloroform, before full surgical anaesthesia was reached. Yet in her introduction she says, without )] TJ ET BT 34.016 494.117 Td /F1 12.0 Tf [(supporting references, that ?surgeons were accustomed to terrified or restless patients, but not to the newly )] TJ ET BT 34.016 479.861 Td /F1 12.0 Tf [(insensible body which still breathed and might struggle in a way that inhibited surgery? \(p. 3\). The only )] TJ ET BT 34.016 465.605 Td /F1 12.0 Tf [(author I am aware of who clearly expressed the reaction of the surgeon to operating on the anaesthetized )] TJ ET BT 34.016 451.349 Td /F1 12.0 Tf [(patient was the great Russian, Pirogoff, whose treatise on ether is required reading for anyone setting out to )] TJ ET BT 34.016 437.093 Td /F1 12.0 Tf [(write about the early days of general anaesthesia \()] TJ ET 0.000 0.000 0.800 rg BT 273.944 437.093 Td /F1 12.0 Tf [(8)] TJ ET 0.24 w 0 J [ ] 0 d 273.944 435.699 m 279.944 435.699 l S 0.000 0.000 0.000 rg BT 279.944 437.093 Td /F1 12.0 Tf [(\). He described with great eloquence his initial reluctance )] TJ ET BT 34.016 422.837 Td /F1 12.0 Tf [(to use ether, his rapid acceptance, and his equally rapid realization that it greatly extended the scope of )] TJ ET BT 34.016 408.581 Td /F1 12.0 Tf [(palliative surgery; yet his work is not referenced nor included in the bibliography.)] TJ ET BT 34.016 382.325 Td /F1 12.0 Tf [(After the initial demonstrations, there was a short period during which many doctors, druggists, and )] TJ ET BT 34.016 368.069 Td /F1 12.0 Tf [(pharmacists, thought that anyone could administer anaesthetics, and inhalers were designed by the dozen. )] TJ ET BT 34.016 353.813 Td /F1 12.0 Tf [(Few practitioners realized the physiological complexity of the process, and speedy disillusionment resulted )] TJ ET BT 34.016 339.557 Td /F1 12.0 Tf [(in a spate of horror stories. John Snow, in the meantime, designed an inhaler that allowed him to control the )] TJ ET BT 34.016 325.301 Td /F1 12.0 Tf [(concentration of the ether inhaled, and embarked on a programme of research that aimed principally to )] TJ ET BT 34.016 311.045 Td /F1 12.0 Tf [(establish the relationship between the resulting blood content and the depth of anaesthesia. But Dr. Snow )] TJ ET BT 34.016 296.789 Td /F1 12.0 Tf [(describes his approach in terms that will be foreign to most anaesthetist historians. He had placed )] TJ ET BT 34.016 282.533 Td /F1 12.0 Tf [(anaesthesia, ?in the elite frameworks of anatomical and physiological knowledge, and then, by the use of )] TJ ET BT 34.016 268.277 Td /F1 12.0 Tf [(analytical principles, he had tailored a specific intellectual framework for the etherisation process? \(p. 59\). )] TJ ET BT 34.016 254.021 Td /F1 12.0 Tf [(Whether the high level of intellectualization that one encounters here, and throughout the book, is )] TJ ET BT 34.016 239.765 Td /F1 12.0 Tf [(appropriate to the subject may be debated. After all, the chap just prepared a table of concentrations at )] TJ ET BT 34.016 225.509 Td /F1 12.0 Tf [(different temperatures, designed an appropriate apparatus, and experimentally determined the percentages )] TJ ET BT 34.016 211.253 Td /F1 12.0 Tf [(necessary to produce the required depths of anaesthesia. Was it not Freud himself who is reported to have )] TJ ET BT 34.016 196.997 Td /F1 12.0 Tf [(said, that whether we have snipped the end off it or not, there must be an occasion when a cigar is just a )] TJ ET BT 34.016 182.741 Td /F1 12.0 Tf [(cigar?)] TJ ET BT 34.016 156.485 Td /F1 12.0 Tf [(The chapter concludes with the replacement of ether by chloroform, and an account of the first chloroform )] TJ ET BT 34.016 142.229 Td /F1 12.0 Tf [(death. There is not room here to discuss this in detail, but Dr. Snow is not entirely accurate in suggesting that )] TJ ET BT 34.016 127.973 Td /F1 12.0 Tf [(Fife and Glover, the expert witnesses, equated the congestion of the lungs that they found with asphyxia \()] TJ ET 0.000 0.000 0.800 rg BT 540.944 127.973 Td /F1 12.0 Tf [(9)] TJ ET 0.24 w 0 J [ ] 0 d 540.944 126.579 m 546.944 126.579 l S 0.000 0.000 0.000 rg BT 546.944 127.973 Td /F1 12.0 Tf [(\).)] TJ ET BT 34.016 101.717 Td /F1 12.0 Tf [(Dr. Snow continues with an account of the Snow/Simpson dispute, and John Snow?s attempts to persuade )] TJ ET BT 34.016 87.461 Td /F1 12.0 Tf [(the profession to establish the practice of anaesthesia on sound physiological principles. This is analysed in )] TJ ET BT 34.016 73.205 Td /F1 12.0 Tf [(terms of ?the very different models of the body and its systems each drew on?, and in Simpson?s case there )] TJ ET BT 34.016 58.949 Td /F1 12.0 Tf [(was also the ?particular resonances of Scottish Enlightenment philosophies? with their emphasis on )] TJ ET endstream endobj 34 0 obj << /Type /Annot /Subtype /Link /A 35 0 R /Border [0 0 0] /H /I /Rect [ 273.9437 436.0135 279.9437 447.8935 ] >> endobj 35 0 obj << /Type /Action >> endobj 36 0 obj << /Type /Annot /Subtype /Link /A 37 0 R /Border [0 0 0] /H /I /Rect [ 540.9437 126.8935 546.9437 138.7735 ] >> endobj 37 0 obj << /Type /Action >> endobj 38 0 obj << /Type /Page /Parent 3 0 R /Annots [ 40 0 R 42 0 R ] /Contents 39 0 R >> endobj 39 0 obj << /Length 8057 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(philanthropy. ?For Simpson and other Scottish doctors anaesthesia was a vivid articulation of the )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(humanitarianism which lay at the heart of medical practice?, but there is nothing to suggest that John Snow )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(was any less humane, and it is very likely that he was as well acquainted with the works of the Scottish )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(Enlightenment philosophers as Simpson \()] TJ ET 0.000 0.000 0.800 rg BT 234.020 753.701 Td /F1 12.0 Tf [(10)] TJ ET 0.24 w 0 J [ ] 0 d 234.020 752.307 m 246.020 752.307 l S 0.000 0.000 0.000 rg BT 246.020 753.701 Td /F1 12.0 Tf [(\). The difference can be explained more simply by reference to )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(Celsus, who wrote, around the beginning of the first millennium, in the introduction to his )] TJ ET BT 469.340 739.445 Td /F2 12.0 Tf [(De Medicina)] TJ ET BT 531.656 739.445 Td /F1 12.0 Tf [(: ?? )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(there is a primary difference of opinion, some holding that the sole knowledge necessary is derived from )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(experience, others propounding that practice is not efficient enough except after acquiring a reasoned )] TJ ET BT 34.016 696.677 Td /F1 12.0 Tf [(knowledge of human bodies, and of nature ??. The conflict described by Celsus runs throughout this book, )] TJ ET BT 34.016 682.421 Td /F1 12.0 Tf [(exemplified by the difference between John Snow and the English school of anaesthetists, and Simpson and )] TJ ET BT 34.016 668.165 Td /F1 12.0 Tf [(the Scottish.)] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(The next chapter deals with the risks of anaesthesia, and its use in midwifery. Here Dr. Snow says that by the )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(early 1850s the patient?s dread of surgery had metamorphosed into a particular fear of the anaesthetic. But it )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(is not generally recognized that patient reluctance dates back to the very earliest days of general anaesthesia. )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(On 28 December 1846, a patient of Robinson?s refused to inhale ether vapour, having heard, ?that I sent )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(people to sleep and then took out all of their teeth?. Here, astonishingly, is the birth of a meme, a )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(transferable unit of cultural information, that has multiplied and spread beyond measure. Where could this )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(fear have come from? Robinson by then had administered fewer that ten anaesthetics. The patient had no )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(reason to fear death, because there had been none. His fear was of the loss of autonomy, of what might )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(happen to him while unconscious; and patient reluctance continued to be a feature. Pernick makes the same )] TJ ET BT 34.016 513.605 Td /F1 12.0 Tf [(point. Hooper?s remarkable suggestion about the desirability of patient-controlled inhalational analgesia to )] TJ ET BT 34.016 499.349 Td /F1 12.0 Tf [(overcome it was published as early as April 1847 \()] TJ ET 0.000 0.000 0.800 rg BT 277.640 499.349 Td /F1 12.0 Tf [(11)] TJ ET 0.24 w 0 J [ ] 0 d 277.640 497.955 m 289.640 497.955 l S 0.000 0.000 0.000 rg BT 289.640 499.349 Td /F1 12.0 Tf [(\)!)] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(The almost equal reluctance of doctors to administer anaesthetics, which Lister spent some twenty years )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(trying to overcome, which operates even to this day, and which is an important factor in its availability, is )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(barely recognized by any of the writers on this subject. Dr. Snow, by focussing, as we shall see later, on the )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(practice of John Snow, which was by no means typical, has excluded consideration of what was happening )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(elsewhere. Thus Lister, writing in 1862 in T.A. Holmes?s )] TJ ET BT 313.652 416.069 Td /F2 12.0 Tf [(A System of Surgery)] TJ ET BT 410.636 416.069 Td /F1 12.0 Tf [(, was concerned that general )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(anaesthesia ?was scantily used in parts of the United Kingdom because of fear of fatalities?. In Scottish )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(hospitals, where most of the anaesthetics were given by medical students ?coming fresh every three months? )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(a simplified technique had to be developed. For the conscientious anaesthetist this concern never wholly )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(goes away. Some years ago a very distinguished dean of the then Faculty of Anaesthetists?now the Royal )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(College?confided to me his initial nervousness on returning to the anaesthetic room after an absence of )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(several weeks, a feeling well-known among the specialty; ?It was just like starting all over again?. So there )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(is always the mundane possibility that the patient did not receive an anaesthetic because there was no one )] TJ ET BT 34.016 302.021 Td /F1 12.0 Tf [(prepared or available to administer it, a situation not unknown in our hospitals today. Even John Snow )] TJ ET BT 34.016 287.765 Td /F1 12.0 Tf [(records occasions when, under pressure of work, he induced anaesthesia but did not stay for the operation, )] TJ ET BT 34.016 273.509 Td /F1 12.0 Tf [(relying on the speed of the surgeon to see the patient through. While Dr. Snow mentions part of Lister?s )] TJ ET BT 34.016 259.253 Td /F1 12.0 Tf [(article, she references not the original but only the excerpt in Duncum. If that is all she read, she missed )] TJ ET BT 34.016 244.997 Td /F1 12.0 Tf [(some matters of great importance.)] TJ ET BT 34.016 218.741 Td /F1 12.0 Tf [(Pernick surveyed anaesthetic usage as recorded in three sets of mid-nineteenth century surgical records. Dr. )] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(Snow, similarly, has examined the records of a number of London teaching hospitals, and, taking John Snow )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(as an exemplar of anaesthetists practising during the 1850s, has analysed his work as described in his )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(casebooks in some detail. John Snow anaesthetized regularly for William Fergusson, and Dr. Snow, from an )] TJ ET BT 34.016 161.717 Td /F1 12.0 Tf [(examination of patients? statistics recorded at King?s College Hospital, and a comparison of the ratio of the )] TJ ET BT 34.016 147.461 Td /F1 12.0 Tf [(total of Fergusson?s hospital consultations to those operated on at various times, has identified a period )] TJ ET BT 34.016 133.205 Td /F1 12.0 Tf [(during 1854 when fewer operations were performed under general anaesthesia than in the preceding and )] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(following months. She attributes this to Fergusson?s anxiety about an increase in the number of chloroform )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(deaths, although a comment in the )] TJ ET BT 201.668 104.693 Td /F2 12.0 Tf [(Lancet)] TJ ET BT 234.332 104.693 Td /F1 12.0 Tf [(, cited in an earlier chapter but not here, is also of relevance. The )] TJ ET BT 34.016 90.437 Td /F1 12.0 Tf [(samples, however, are small, and there are a number of inconsistencies in the tables?I am indebted to Dr. )] TJ ET BT 34.016 76.181 Td /F1 12.0 Tf [(Henry Connor FRCP for his very careful examination of these?and we are not told whether they have been )] TJ ET BT 34.016 61.925 Td /F1 12.0 Tf [(subjected to statistical analysis, nor what was happening in other hospitals. Only one of the deaths was at )] TJ ET endstream endobj 40 0 obj << /Type /Annot /Subtype /Link /A 41 0 R /Border [0 0 0] /H /I /Rect [ 234.0197 752.6215 246.0197 764.5015 ] >> endobj 41 0 obj << /Type /Action >> endobj 42 0 obj << /Type /Annot /Subtype /Link /A 43 0 R /Border [0 0 0] /H /I /Rect [ 277.6397 498.2695 289.6397 510.1495 ] >> endobj 43 0 obj << /Type /Action >> endobj 44 0 obj << /Type /Page /Parent 3 0 R /Annots [ 46 0 R 48 0 R 50 0 R ] /Contents 45 0 R >> endobj 45 0 obj << /Length 8126 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(King?s \(p. 104\), although this is missing from the list in the Appendix, and John Snow had none. It must be )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(significant that during the month immediately after John Snow?s amylene death in 1857 he anaesthetized the )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(greatest number of Fergusson?s private patients in any four weeks, as well as Queen Victoria. A reduction in )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(the number of operations in 1857 similar to that in 1854 receives no comment. There are many reasons for )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(the curtailment of operating lists, as we know only too well today, staff shortages, ward closures, and so on, )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(and these need to be excluded. Also, while John Snow may rightly be regarded as an example to be )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(followed, he was in no way an exemplar in the sense that Dr. Snow is using the word, that is as a fair sample )] TJ ET BT 34.016 696.677 Td /F1 12.0 Tf [(of the average in anaesthetic practice. He was unique, and it would be misleading to generalize from his )] TJ ET BT 34.016 682.421 Td /F1 12.0 Tf [(experience.)] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(Dr. Snow?s discussion of the pros and cons of the use of inhalational analgesia to relieve the pains of labour )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(is comprehensive, occupying ten pages. It culminates in the experiences of Queen Victoria, expressing the )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(conventional view that after her first child, in 1853, ?there had been a significant change in attitudes to )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(childbirth anaesthesia ?? \(p.122\), but she does not mention the research of the Connors, which throws )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(serious doubt on the need for, and extent of, Her Majesty?s influence \()] TJ ET 0.000 0.000 0.800 rg BT 372.608 599.141 Td /F1 12.0 Tf [(12)] TJ ET 0.24 w 0 J [ ] 0 d 372.608 597.747 m 384.608 597.747 l S 0.000 0.000 0.000 rg BT 384.608 599.141 Td /F1 12.0 Tf [(\).)] TJ ET BT 34.016 572.885 Td /F1 12.0 Tf [(It is not apparent that Dr. Snow consulted any anaesthetists during the course of her research, since they )] TJ ET BT 34.016 558.629 Td /F1 12.0 Tf [(would surely have advised her, among other things, that ether and chloroform are not gases; that chloroform )] TJ ET BT 34.016 544.373 Td /F1 12.0 Tf [(kills by inducing ventricular, not atrial, fibrillation; that atropine, which causes excitation of the central )] TJ ET BT 34.016 530.117 Td /F1 12.0 Tf [(nervous system, is not a narcotic, and, since it dilates the pupils, is not used to treat this condition; and that )] TJ ET BT 34.016 515.861 Td /F1 12.0 Tf [(Junker?s apparatus, the first plenum vaporizer, introduced in 1867, which is mentioned only in passing, was )] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [(technologically a great step forward in that it allowed anaesthesia to be maintained during operations with )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(the mouth open. The importance of this is seen in the tribute paid by Fergusson to Thomas Smith, surgeon to )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(St Barts, who greatly increased the success rate of operations for congenital cleft palate by advocating, in )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(1868, the use of his gag to keep the mouth open, together with general anaesthesia. She would have been )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(advised also not to dismiss Joseph Clover?generally recognized as John Snow?s successor as the leading )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(English anaesthetist, who for a while practised also as a surgeon, inventing the Clover crutch, a lithotrite, )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(and a cervical cautery?because he ?did not champion anaesthetic matters through medical networks? \(p. )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(192\). Duncum says exactly the opposite \(p. 457\). Clover spoke at meetings, especially of the Odontological )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(Society, where in the late 1860s most of the action was as regards advances in anaesthetic techniques, taught )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(medical students, invented apparatuses, published papers in journals, and wrote the article on anaesthesia in )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(Quain?s encyclopaedia. Dr. Snow does not explain what other medical networks she has in mind.)] TJ ET BT 34.016 332.789 Td /F1 12.0 Tf [(The book concludes by considering the acceptance towards the end of the century of anaesthetics as a )] TJ ET BT 34.016 318.533 Td /F1 12.0 Tf [(specialty, and, without supporting references, unconventionally attributes the anaesthetists? claim to this )] TJ ET BT 34.016 304.277 Td /F1 12.0 Tf [(status not to their technical expertise, as one might expect, but to their ability to induce a sense of calm in the )] TJ ET BT 34.016 290.021 Td /F1 12.0 Tf [(patient. I would have thought that the ability to give an effective anaesthetic smoothly and safely was the )] TJ ET BT 34.016 275.765 Td /F1 12.0 Tf [(primary consideration of most surgeons. This view was expressed most strikingly at a meeting reported in )] TJ ET BT 34.016 261.509 Td /F1 12.0 Tf [(the )] TJ ET BT 51.680 261.509 Td /F2 12.0 Tf [(British Journal of Dental Science)] TJ ET BT 212.336 261.509 Td /F1 12.0 Tf [( in 1868 by a dental surgeon, Mr. Mummery, who said, ?? that the )] TJ ET BT 34.016 247.253 Td /F1 12.0 Tf [(Dentist was often placed in very painful circumstances of anxiety by the medical attendant of the patient )] TJ ET BT 34.016 232.997 Td /F1 12.0 Tf [(coming and volunteering to give chloroform, when, perhaps, he knew a great deal less about it than the )] TJ ET BT 34.016 218.741 Td /F1 12.0 Tf [(Dentist did?. Of three of his cases that had nearly terminated fatally, he was sorry to say that two of the )] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(gentlemen administering the chloroform were Scotch doctors. ?They had seen Dr. Simpson give chloroform, )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(and therefore thought they knew all about it.? One doctor, ?seemed to think he had a sort of heaven-born )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(talent for administering chloroform, because he had seen Dr. Simpson exhibit it ? He had operated many )] TJ ET BT 34.016 161.717 Td /F1 12.0 Tf [(times with Mr. Clover? and never had the slightest passing uneasiness, but he had been frightened out of his )] TJ ET BT 34.016 147.461 Td /F1 12.0 Tf [(wits by people?s own doctors?. So it seems that it is the ability to induce a sense of calm in the operator, not )] TJ ET BT 34.016 133.205 Td /F1 12.0 Tf [(the patient, that is the criterion.)] TJ ET BT 34.016 106.949 Td /F1 12.0 Tf [(Dr. Snow does not give us her definition of a specialty. The one I have found most applicable is an extension )] TJ ET BT 34.016 92.693 Td /F1 12.0 Tf [(of that formulated by Friedson for a profession \()] TJ ET 0.000 0.000 0.800 rg BT 265.976 92.693 Td /F1 12.0 Tf [(13)] TJ ET 0.24 w 0 J [ ] 0 d 265.976 91.299 m 277.976 91.299 l S 0.000 0.000 0.000 rg BT 277.976 92.693 Td /F1 12.0 Tf [(\), that it should determine its own standards of training, )] TJ ET BT 34.016 78.437 Td /F1 12.0 Tf [(recognize its practitioners by some form of licensure, and control and man its own examination board; and )] TJ ET BT 34.016 64.181 Td /F1 12.0 Tf [(anaesthetics did not fulfil these requirements until the 1930s \()] TJ ET 0.000 0.000 0.800 rg BT 330.320 64.181 Td /F1 12.0 Tf [(14)] TJ ET 0.24 w 0 J [ ] 0 d 330.320 62.787 m 342.320 62.787 l S 0.000 0.000 0.000 rg BT 342.320 64.181 Td /F1 12.0 Tf [(\). But even by Dr. Snow?s standards, the )] TJ ET BT 34.016 49.925 Td /F1 12.0 Tf [(position of the anaesthetist was by no means secure at the beginning of the twentieth century. ?Who, in the )] TJ ET endstream endobj 46 0 obj << /Type /Annot /Subtype /Link /A 47 0 R /Border [0 0 0] /H /I /Rect [ 372.6077 598.0615 384.6077 609.9415 ] >> endobj 47 0 obj << /Type /Action >> endobj 48 0 obj << /Type /Annot /Subtype /Link /A 49 0 R /Border [0 0 0] /H /I /Rect [ 265.9757 91.6135 277.9757 103.4935 ] >> endobj 49 0 obj << /Type /Action >> endobj 50 0 obj << /Type /Annot /Subtype /Link /A 51 0 R /Border [0 0 0] /H /I /Rect [ 330.3197 63.1015 342.3197 74.9815 ] >> endobj 51 0 obj << /Type /Action >> endobj 52 0 obj << /Type /Page /Parent 3 0 R /Annots [ 54 0 R 56 0 R ] /Contents 53 0 R >> endobj 53 0 obj << /Length 7730 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(eye of the law, is qualified to administer an anaesthetic?? asked Buxton in the 1914 edition of his textbook. )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(?Nurses, students, butlers, coachmen, dispensers, and various unqualified persons have been frequently )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(permitted to give the anaesthetic, or, as the phrase is, ?keep it going?, while the surgeon, besides operating, )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(is supposed to exercise a general supervision over the administrator?s proceedings?. Six years later, Barton )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(laconically summed up the contemporary situation \()] TJ ET 0.000 0.000 0.800 rg BT 283.988 739.445 Td /F1 12.0 Tf [(15)] TJ ET 0.24 w 0 J [ ] 0 d 283.988 738.051 m 295.988 738.051 l S 0.000 0.000 0.000 rg BT 295.988 739.445 Td /F1 12.0 Tf [(\):)] TJ ET BT 64.016 701.189 Td /F1 12.0 Tf [(The anaesthetist does not loom largely in the public eye. With few exceptions his very name is )] TJ ET BT 64.016 686.933 Td /F1 12.0 Tf [(unknown to the public, and his services are not carefully selected by the patient ? The patient )] TJ ET BT 64.016 672.677 Td /F1 12.0 Tf [(writes the cheque and promptly forgets the anaesthetist?s name; he probably never considers, )] TJ ET BT 64.016 658.421 Td /F1 12.0 Tf [(and certainly is not in a position to know, what he owes in safety and comfort to his skill.)] TJ ET BT 34.016 620.165 Td /F1 12.0 Tf [(Dr Snow says, confusingly, that by the 1890s ?the minutiae of anaesthetic practice was outside the )] TJ ET BT 34.016 605.909 Td /F1 12.0 Tf [(experience of most doctors?, and a little later, that ?until the inauguration of the National Health Service in )] TJ ET BT 34.016 591.653 Td /F1 12.0 Tf [(1948 ? general practitioners undertook the majority of administrations ??. This was certainly true of elective )] TJ ET BT 34.016 577.397 Td /F1 12.0 Tf [(anaesthetics in large areas of the country, but emergencies were almost all anaesthetized by junior hospital )] TJ ET BT 34.016 563.141 Td /F1 12.0 Tf [(doctors \()] TJ ET 0.000 0.000 0.800 rg BT 76.340 563.141 Td /F1 12.0 Tf [(16)] TJ ET 0.24 w 0 J [ ] 0 d 76.340 561.747 m 88.340 561.747 l S 0.000 0.000 0.000 rg BT 88.340 563.141 Td /F1 12.0 Tf [(\). It is doubtful whether there was one anaesthetist in specialist whole time practice between )] TJ ET BT 34.016 548.885 Td /F1 12.0 Tf [(Birmingham and Bristol before the NHS. However, lumping all general practitioners together is misleading. )] TJ ET BT 34.016 534.629 Td /F1 12.0 Tf [(Some of the leading anaesthetists, right until 1948, when the NHS drove a wedge between hospital and )] TJ ET BT 34.016 520.373 Td /F1 12.0 Tf [(domiciliary practitioners and forced them to choose, also engaged in general practice?the great Alfred Lee, )] TJ ET BT 34.016 506.117 Td /F1 12.0 Tf [(author of the Synopsis, in its tenth edition at the time of his death, translated into six languages and used )] TJ ET BT 34.016 491.861 Td /F1 12.0 Tf [(worldwide, and John Beard, of the Royal Postgraduate Medical School and Hammersmith Hospital, a )] TJ ET BT 34.016 477.605 Td /F1 12.0 Tf [(pioneer in anaesthesia for vascular and cardiac surgery?to mention two.)] TJ ET BT 34.016 451.349 Td /F1 12.0 Tf [(Dr. Snow makes wide generalizations without supporting references. Her criticisms may apply to some of )] TJ ET BT 34.016 437.093 Td /F1 12.0 Tf [(the standard histories of anaesthesia, most of which were published many years ago, but she almost )] TJ ET BT 34.016 422.837 Td /F1 12.0 Tf [(completely ignores the considerable mass of more recent work to be found in the thirty-five volumes of the )] TJ ET BT 34.016 408.581 Td /F2 12.0 Tf [(Proceedings of the History of Anaesthesia Society)] TJ ET BT 273.992 408.581 Td /F1 12.0 Tf [(, of which she is a member, and the proceedings of the five )] TJ ET BT 34.016 394.325 Td /F1 12.0 Tf [(international symposia?the sixth is under preparation?held since 1982. Similarly her journal references are )] TJ ET BT 34.016 380.069 Td /F1 12.0 Tf [(strongly biased towards the )] TJ ET BT 168.668 380.069 Td /F2 12.0 Tf [(Lancet)] TJ ET BT 201.332 380.069 Td /F1 12.0 Tf [( and the )] TJ ET BT 242.324 380.069 Td /F2 12.0 Tf [(London Medical Gazette)] TJ ET BT 360.980 380.069 Td /F1 12.0 Tf [(, with the result that such important )] TJ ET BT 34.016 365.813 Td /F1 12.0 Tf [(matters as the enquiry and campaign to replace chloroform by ether, led by the )] TJ ET BT 414.932 365.813 Td /F2 12.0 Tf [(British Medical Journal)] TJ ET BT 34.016 351.557 Td /F1 12.0 Tf [(during the 1870s, are not mentioned. Her bibliography, by listing the editions she presumably referred to, )] TJ ET BT 34.016 337.301 Td /F1 12.0 Tf [(and not including the earliest date of publication, is disconcerting, to say the least. Dr. Duncum?s book was )] TJ ET BT 34.016 323.045 Td /F1 12.0 Tf [(first published in 1947, not 1994; Bichat, who died in 1801, did not first publish his )] TJ ET BT 438.368 323.045 Td /F2 12.0 Tf [(Physiological )] TJ ET BT 34.016 308.789 Td /F2 12.0 Tf [(Researches)] TJ ET BT 88.664 308.789 Td /F1 12.0 Tf [( in 1987; and Davy?s treatise on nitrous oxide came out in 1800, not 1972. There are also )] TJ ET BT 34.016 294.533 Td /F1 12.0 Tf [(references which could not be found in the bibliography, one or two entries that are out of order, and the )] TJ ET BT 34.016 280.277 Td /F1 12.0 Tf [(founder and first editor of )] TJ ET BT 160.988 280.277 Td /F2 12.0 Tf [(The Lancet)] TJ ET BT 214.652 280.277 Td /F1 12.0 Tf [( has become reconstructed into Wakely. The impression is left of not )] TJ ET BT 34.016 266.021 Td /F1 12.0 Tf [(very careful attention to accuracy of detail.)] TJ ET BT 34.016 239.765 Td /F1 12.0 Tf [(The high level of intellectualization has already been mentioned. Space is spent, for example, discussing the )] TJ ET BT 34.016 225.509 Td /F1 12.0 Tf [(difference between mesmerism and inhalational anaesthesia, without mentioning the down-to-earth fact that )] TJ ET BT 34.016 211.253 Td /F1 12.0 Tf [(ether is a substance that can be seen, felt, smelled, and measured, while hypnotism is not. In some places the )] TJ ET BT 34.016 196.997 Td /F1 12.0 Tf [(language is obscure, and shows evidence of inadequate editorial attention. ?The surgical focus was on the )] TJ ET BT 34.016 182.741 Td /F1 12.0 Tf [(body??where else? ?The design of inhalers should mesh with the clinical context? \(p. 81\). Presumably this )] TJ ET BT 34.016 168.485 Td /F1 12.0 Tf [(means that they should be suitable for the conditions in which they are being used. ?Prior to ether the )] TJ ET BT 34.016 154.229 Td /F1 12.0 Tf [(surgeon and patient functioned as a symbiotic unit.? To discover that this means more than that if asked, the )] TJ ET BT 34.016 139.973 Td /F1 12.0 Tf [(patient would move a limb or change position, it is necessary to turn to Pernick. Also there are certain )] TJ ET BT 34.016 125.717 Td /F1 12.0 Tf [(expressions, the nuances of which were not appreciated, that will mislead the anaesthetist. Thus neither )] TJ ET BT 34.016 111.461 Td /F1 12.0 Tf [(Brodie nor Hawkins ?used? chloroform \(p. 100\), they operated on patients anaesthetized by it. John Snow )] TJ ET BT 34.016 97.205 Td /F1 12.0 Tf [(used it, and would have used it on Peel, at their request. One wonders why he was not consulted?an )] TJ ET BT 34.016 82.949 Td /F1 12.0 Tf [(interesting sociological question.)] TJ ET BT 34.016 56.693 Td /F1 12.0 Tf [(I hope I have not been unfair in any of my comments. Obviously a lot of hard work has gone into writing the )] TJ ET endstream endobj 54 0 obj << /Type /Annot /Subtype /Link /A 55 0 R /Border [0 0 0] /H /I /Rect [ 283.9877 738.3655 295.9877 750.2455 ] >> endobj 55 0 obj << /Type /Action >> endobj 56 0 obj << /Type /Annot /Subtype /Link /A 57 0 R /Border [0 0 0] /H /I /Rect [ 76.3397 562.0615 88.3397 573.9415 ] >> endobj 57 0 obj << /Type /Action >> endobj 58 0 obj << /Type /Page /Parent 3 0 R /Annots [ 60 0 R 62 0 R 64 0 R 66 0 R 68 0 R 70 0 R 72 0 R 74 0 R 76 0 R 78 0 R 80 0 R 82 0 R 84 0 R 86 0 R 88 0 R 90 0 R 92 0 R ] /Contents 59 0 R >> endobj 59 0 obj << /Length 9022 >> stream 0.000 0.000 0.000 rg 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(book, as Dr. Snow says in her acknowledgements. It contains a collection of information on the disputation )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(phase of the paradigm shift that is not readily available elsewhere. It is well referenced, nicely produced, )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(well bound, with good heavy covers, and, although expensive, I hope it will score a bulls-eye on the target )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(readership at which it is aimed.)] TJ ET BT 34.016 718.803 Td /F3 18.0 Tf [(Notes)] TJ ET BT 48.816 688.186 Td /F1 12.0 Tf [(1.)] TJ ET BT 64.016 688.181 Td /F1 12.0 Tf [(M. S. Pernick, )] TJ ET BT 136.016 688.181 Td /F2 12.0 Tf [(A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth Century )] TJ ET BT 64.016 673.925 Td /F2 12.0 Tf [(America)] TJ ET BT 104.672 673.925 Td /F1 12.0 Tf [( \(New York, 1985\). )] TJ ET 0.000 0.000 0.800 rg BT 201.980 673.925 Td /F1 12.0 Tf [(Back to \(1\))] TJ ET 0.24 w 0 J [ ] 0 d 201.980 672.531 m 255.968 672.531 l S 0.000 0.000 0.000 rg BT 48.816 659.674 Td /F1 12.0 Tf [(2.)] TJ ET BT 64.016 659.669 Td /F1 12.0 Tf [(B. M. Duncum, )] TJ ET BT 142.016 659.669 Td /F2 12.0 Tf [(The Development of Inhalation Anaesthesia)] TJ ET BT 352.664 659.669 Td /F1 12.0 Tf [( \(London, 1947\). )] TJ ET 0.000 0.000 0.800 rg BT 436.988 659.669 Td /F1 12.0 Tf [(Back to \(2\))] TJ ET 0.24 w 0 J [ ] 0 d 436.988 658.275 m 490.976 658.275 l S 0.000 0.000 0.000 rg BT 48.816 645.418 Td /F1 12.0 Tf [(3.)] TJ ET BT 64.016 645.413 Td /F1 12.0 Tf [(D. Zuck, ?Humphry Davy, Nitrous Oxide, Lung Volumes, and Elective Affinity?, )] TJ ET BT 460.292 645.413 Td /F2 12.0 Tf [(Proceedings of the )] TJ ET BT 64.016 631.157 Td /F2 12.0 Tf [(History of Anaesthesia Society)] TJ ET BT 211.004 631.157 Td /F1 12.0 Tf [(, 25 \(1999\), 19?30. )] TJ ET 0.000 0.000 0.800 rg BT 305.324 631.157 Td /F1 12.0 Tf [(Back to \(3\))] TJ ET 0.24 w 0 J [ ] 0 d 305.324 629.763 m 359.312 629.763 l S 0.000 0.000 0.000 rg BT 48.816 616.906 Td /F1 12.0 Tf [(4.)] TJ ET BT 64.016 616.901 Td /F1 12.0 Tf [(T. E. Keys, )] TJ ET BT 121.340 616.901 Td /F2 12.0 Tf [(The History of Surgical Anesthesia)] TJ ET BT 289.340 616.901 Td /F1 12.0 Tf [( \(New York, 1945\), 17?18. )] TJ ET 0.000 0.000 0.800 rg BT 421.976 616.901 Td /F1 12.0 Tf [(Back to \(4\))] TJ ET 0.24 w 0 J [ ] 0 d 421.976 615.507 m 475.964 615.507 l S 0.000 0.000 0.000 rg BT 48.816 602.650 Td /F1 12.0 Tf [(5.)] TJ ET BT 64.016 602.645 Td /F2 12.0 Tf [(Cholera, Chloroform, and the Science of Medicine: A Life of John Snow)] TJ ET BT 410.996 602.645 Td /F1 12.0 Tf [(, ed. P. Vinten-Johansen et al )] TJ ET BT 64.016 588.389 Td /F1 12.0 Tf [(\(Oxford, 2003\). )] TJ ET 0.000 0.000 0.800 rg BT 142.664 588.389 Td /F1 12.0 Tf [(Back to \(5\))] TJ ET 0.24 w 0 J [ ] 0 d 142.664 586.995 m 196.652 586.995 l S 0.000 0.000 0.000 rg BT 48.816 574.138 Td /F1 12.0 Tf [(6.)] TJ ET BT 64.016 574.133 Td /F1 12.0 Tf [(D. Zuck, review of )] TJ ET BT 157.988 574.133 Td /F2 12.0 Tf [(Tarnished Idol)] TJ ET BT 228.992 574.133 Td /F1 12.0 Tf [( by R.J. Wolfe, )] TJ ET BT 304.652 574.133 Td /F2 12.0 Tf [(Proceedings of the History of Anaesthesia Society)] TJ ET BT 544.628 574.133 Td /F1 12.0 Tf [(, )] TJ ET BT 64.016 559.877 Td /F1 12.0 Tf [(30 \(2002\), 115?120. )] TJ ET 0.000 0.000 0.800 rg BT 164.336 559.877 Td /F1 12.0 Tf [(Back to \(6\))] TJ ET 0.24 w 0 J [ ] 0 d 164.336 558.483 m 218.324 558.483 l S 0.000 0.000 0.000 rg BT 48.816 545.626 Td /F1 12.0 Tf [(7.)] TJ ET BT 64.016 545.621 Td /F1 12.0 Tf [(T. Kuhn, )] TJ ET BT 110.012 545.621 Td /F2 12.0 Tf [(The Structure of Scientific Revolutions)] TJ ET BT 295.340 545.621 Td /F1 12.0 Tf [(, second edn. \(Chicago,1970\). )] TJ ET 0.000 0.000 0.800 rg BT 441.980 545.621 Td /F1 12.0 Tf [(Back to \(7\))] TJ ET 0.24 w 0 J [ ] 0 d 441.980 544.227 m 495.968 544.227 l S 0.000 0.000 0.000 rg BT 48.816 531.370 Td /F1 12.0 Tf [(8.)] TJ ET BT 64.016 531.365 Td /F1 12.0 Tf [(N. Pirogoff, )] TJ ET BT 124.676 531.365 Td /F2 12.0 Tf [(Recherches Pratiques et Physiologiques sur l?thrization)] TJ ET BT 407.660 531.365 Td /F1 12.0 Tf [( \(St. Petersbourg, 1847\), )] TJ ET BT 64.016 517.109 Td /F1 12.0 Tf [(translated by B. R. Fink, Park Ridge, Illinois, Wood Library-Museum, 1992. )] TJ ET 0.000 0.000 0.800 rg BT 434.672 517.109 Td /F1 12.0 Tf [(Back to \(8\))] TJ ET 0.24 w 0 J [ ] 0 d 434.672 515.715 m 488.660 515.715 l S 0.000 0.000 0.000 rg BT 48.816 502.858 Td /F1 12.0 Tf [(9.)] TJ ET BT 64.016 502.853 Td /F1 12.0 Tf [(D. Zuck, ?Death from Chloroform?? )] TJ ET BT 242.972 502.853 Td /F2 12.0 Tf [(Anaesthesia)] TJ ET BT 300.968 502.853 Td /F1 12.0 Tf [(, 59 \(2004\), 834. )] TJ ET 0.000 0.000 0.800 rg BT 383.960 502.853 Td /F1 12.0 Tf [(Back to \(9\))] TJ ET 0.24 w 0 J [ ] 0 d 383.960 501.459 m 437.948 501.459 l S 0.000 0.000 0.000 rg BT 42.816 488.602 Td /F1 12.0 Tf [(10.)] TJ ET BT 64.016 488.597 Td /F1 12.0 Tf [(A. Herman, )] TJ ET BT 123.332 488.597 Td /F2 12.0 Tf [(The Scottish Enlightenment)] TJ ET BT 255.332 488.597 Td /F1 12.0 Tf [( \(London, 2001\). )] TJ ET 0.000 0.000 0.800 rg BT 339.656 488.597 Td /F1 12.0 Tf [(Back to \(10\))] TJ ET 0.24 w 0 J [ ] 0 d 339.656 487.203 m 399.644 487.203 l S 0.000 0.000 0.000 rg BT 42.816 474.346 Td /F1 12.0 Tf [(11.)] TJ ET BT 64.016 474.341 Td /F1 12.0 Tf [(A. Macdonald and D. Zuck, ?The Robinson-Hooper Connection?, )] TJ ET BT 383.960 474.341 Td /F2 12.0 Tf [(Anaesthesia)] TJ ET BT 441.956 474.341 Td /F1 12.0 Tf [(, 61 \(2006\), 553?6. )] TJ ET 0.000 0.000 0.800 rg BT 64.016 460.085 Td /F1 12.0 Tf [(Back to \(11\))] TJ ET 0.24 w 0 J [ ] 0 d 64.016 458.691 m 124.004 458.691 l S 0.000 0.000 0.000 rg BT 42.816 445.834 Td /F1 12.0 Tf [(12.)] TJ ET BT 64.016 445.829 Td /F1 12.0 Tf [(H. Connor and T. 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