By E. M. Papper. Contributions in Medical Studies. Number 42. Westport, Greenwood Press, 1995. Pages: 176. Price:$55.00.

A curious delay occurred between the discovery of early inhaled gases and their eventual use to relieve surgical pain. Ether was first synthesized in 1540, but not until 1842 did Crawford W. Long show its anesthetic application, followed by William T. G. Morton's public demonstration in 1846 of its effects during surgery. Nitrous oxide was developed by Joseph Priestly in the 1770s, and its anesthetic properties were described by Humphry Davy in 1799, but the gas did not come into use for surgery until Gardner Quincy Colton administered it for a dental procedure in 1844. Why was there a lag in the appropriation of these gases for anesthesia? In this book, E. M. Papper, Professor of Anesthesiology and Pharmacology at the University of Miami School of Medicine and a legend in American anesthesiology, sets out to answer that significant question.

Papper believes that understanding the evolution of early anesthetic practice demands studying "its relationships to other cultural events, especially in literature." In Papper's words, crossing the border between the sciences and the humanities meant that "a unilaterally but highly developed individual in medicine like myself became a graduate student in English and Comparative Literature," notably at the "relatively advanced age" of 70 yr. The result of his interdisciplinary odyssey is this cultural analysis of pain, not just as a message conducted along nerves but as a changing social construct, a concept defined by particular social attitudes that had great bearing on the evolution of anesthesia.

Papper states, "The thrust of this book is that societal concerns with pain and suffering, and the subsequent development of surgical anesthesia in the Romantic era (approximately 1795–1850) are outgrowths of Romantic subjectivity." The concept of an interior, "subjective" self, taken for granted today, was a relatively new idea in the late 18th century. Papper argues that the validation of an inner, psychologic realm as a central aspect of individuality was partly the result of a broad-gauge emphasis on the "rights of man" in America and Europe by the late 1700s. Along with this attention to the individual came the belief, among certain British writers and scientists, that "there was an intrinsic right to be free of pain and suffering or to be able to bear the hurt with the help of others."

This was a new attitude toward pain, explains Papper. Opposed to it were traditional concepts from the two main currents in Western culture. From the Greeks came the belief that pain was a "cosmic experience of generalized nature" and even an ennobling quality, a gift of the gods, as opposed to unwarranted or undue suffering for the individual. From the Judeo-Christian tradition came views of suffering as divine retribution or a route to salvation. These religious and moral ideas about pain were deeply entrenched. Until physicians and the public generally agreed that alleviation of pain was a noble end, advances in anesthesia would be slow.

According to Papper, a key person in anesthesia's progress was Thomas Beddoes, Sr., physician, chemist, humanitarian, and founder of the Pneumatic Institute in 1793, who attracted a coterie of scientists and writers to support his project. The Institute was located in Bristol, England, a spa town to which patients went for cures and which provided a good population base for the group's studies on inhaled gases in the control of disease. Although Beddoes and such scientific luminaries at the Institute as Davy did not directly focus on the anesthetic properties of such gases as nitrous oxide, their experiments with gases gave support to their systematic study and later breakthroughs in their anesthetic use.

After informative chapters on Beddoes and the Pneumatic Institute, Papper turns to the biography and writings of contemporary Romantic poets Samuel Taylor Coleridge, involved in the Pneumatic Institute, and Percy Bysshe Shelley. He demonstrates the preoccupation these two poets had with individual struggle and pain. Papper suggests that the personal suffering explored in Coleridge's "Dejection: An Ode," for example, reveals an interest in personal affliction and the relief of pain that had to become more widespread in society before anesthetic advances could occur. Traditional attitudes toward suffering held sway in the practice of medicine. Papper notes that, even after the 1840s, other factors combined with misconceptions about pain to retard the use of anesthetics, including a fear of side effects and doubts about anesthetic agent safety. He also reminds that antiquated attitudes persisted as late as the 1980s, when it was commonly held that young infants felt no pain and could endure surgery without anesthesia. Papper further speculates that America, rather than Britain or Europe, was the logical place for the first use of anesthetic gases in surgery because of its concern for individual rights and a proclivity toward experimentation in U.S. society.

This wide-ranging book is intended for the anesthesiologist, surgeon, others in the medical community, and students of cultural history in any field dealing with the cultural biases influencing the practice of medicine. Priced within the usual range for specialty monographs, it will be a distinctive buy for those interested in these issues. The details as well as the large themes make this book memorable. For instance, Papper records the experience of noted New York surgeon Valentine Mott, who required a 7-yr break from surgery beginning in 1834, apparently because of personal distress at the suffering of his unanesthetized patients. He also shows how Beddoes' concern for individual health led the chemist to advocate toys for children that would increase their sensory experience of the world, anatomy lessons for the general public, and "identical teaching for boys and girls in science and in manual crafts."

Rather than a rigorous academic tome, this text is an entertaining, personal venture. Papper's work has the flavor of an extended, informal report, in which he makes excursions into sociology, literary criticism and biography, and the history of medicine in pursuit of his subject. The index for this book is very serviceable, and the supplementary reading list is worth consulting for those wishing to explore further the confluence of medicine, art, and cultural history around the issue of pain. This work is also a testament to intellectual curiosity that spans disciplines and provokes reassessment of fundamental concerns. Papper's examination of the Romantic period is particularly instructive as we consider how social biases influence concepts of pain and pain management in today's managed-care environment.

A. Wilson Somerville, Jr., Ph.D., Medical Editor, Department of Anesthesia, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157–1009