Posted by: Lisa Hill | September 3, 2021

The Chloroformist, by Christine Ball

I’m going to preface my thoughts about Christine Ball’s fascinating story of The Chloroformist who brought anaesthesia to the operating table with a confession: I am brave about snakes, spiders and the dentist, but although everybody else has their cataracts done with a local anaesthetic, I didn’t.  I got myself in such a state about the mere idea of being conscious while they messed about with my eyes, that they had to knock me out properly to do it.  I felt even more ashamed of myself when I read in the first chapter, the list of procedures performed without anaesthetic during the chloroformist’s apprenticeship :

For the rest of the summer, young Joseph Clover followed Dr Lubbock around Norfolk.  Together, they excised skin tumours, opened abscesses, divided contracted tendons, tapped hydrocoeles, amputated toes and removed a cataract.  All these procedures were performed on conscious, terrified patients who were held tightly by friends or relatives, and who struggled to control their desire to flee from the surgeon’s knife and the agonising pain. (p.7)

[…]

Operating with bare hands, dressed in his street clothes, he had taken those first steps that every training surgeon must take — gripping the handle of a scalpel and making the first, irrevocable cut into live human flesh. For the surgeon training in the early 1840s, these first surgical milestones were performed on a person who would recoil in terror and horror, flinch, pull away, shake — and scream and scream and scream. (p.13)

According to the MUP website, the author of The Chloroformist, Christine Ball is an anaesthetist at the Alfred Hospital in Melbourne, who co-manages a Master of Medicine (Perioperative) at Monash University, and is the 2020–2024 Wood Library-Museum Laureate of the History of Anaesthesiology. She has been an honorary curator at the Geoffrey Kaye Museum of Anaesthetic History for thirty years — where the Casebook of Joseph Clover (1825-1882), an English surgeon and pioneer of anaesthesia, is held.


#Digression: If you scroll down the museum’s homepage you will come to Isolation Jigsaws, and if you click the link, there are online theme-related jigsaws to amuse you during lockdowns. The jigsaws are based on some amazing photos from the museum collection!


Joseph Clover (1825-1882) was the inventor of apparatus to deliver a controlled quantity of anaesthetics including ether and chloroform, and he was much in demand because by 1871 he had administered anaesthetics 13,000 times without a fatality.  This was an extraordinary achievement, and you only need to look at the photo on the front cover of the book to see why.  If —as it was in the early days of his career— chloroform delivered drop by drop on a piece of cloth was risky, the invention of a mask did not solve the problem of delivering the anaesthetic safely and consistently when surgery took place in the mouth or nose. And all that Clover could do to monitor the patient’s heartbeat was to keep his hand on the pulse.

Deaths under anaesthesia were not uncommon at the time, and it is tempting to presume that, as a result, doctors took them in their stride. It is more likely, though, that they were as deeply upsetting as they would be today, and the aforementioned [quoted] letters, and others in Clover’s archives, suggest that doctors felt the unexpected deaths of patients keenly and sent letters of support to their colleagues in recognition of their distress. It is easy to look at the extremely high death rates from surgery, anaesthesia and infection in the 19th century and forget the pain these events must have caused to those involved, and how stressful the lives of these early anaesthetists, surgeons and dentists must have been. (p.215)

Some of these deaths occurred because the germ theory of disease was not understood at that time.  And for that discovery we owe thanks to another English surgeon Joseph Lister (1827-1912) who built on the discoveries of Louis Pasteur and revolutionised surgery with hand-washing and sterilisation procedures which led to the rise of aseptic surgery.)

The Chloroformist is a very ‘human’ story.  There is not a great deal known about Clover’s personal life, but in telling the story of an era when there were many developments in medicine, we learn about the pioneers of syringes, resuscitation and the work of Florence Nightingale in advances made during the Crimean War (1853-5).  Mouth-to-mouth ventilation as performed by midwives for the resuscitation of babies has been performed from time out of mind, but for the resuscitation of bloated drunks pulled from the Thames, the Humane Society promoted the use of bellows to blow air into the lungs via a tube through the nose, arranging the patient carefully to ensure that the air didn’t go into the stomach instead. However once breathing was re-established, the heart often needed to be restarted and it was not until 1855 when Alexander Wood‘s ‘narcotic injection syringes’ became available that medication could be administered directly.  These advances came just in time because chloroform was proving deadly in many circumstances, and anaesthesia was therefore unwittingly beginning to advance areas of medicine other than surgery. 

Behind all these advances was the 19th century shift towards more empiricism, and this is the basis on which we know today that C-19 vaccines are safe and will eventually restore our normal pre-pandemic lives.

What’s amazing about Clover is this:

The apparatus Clover created ultimately formed the basis of the anaesthetic machines used today; many steps were taken along the way, and it was not a straight evolutionary line, but the essence of his technique has survived.
[…]
Today’s anaesthetic machines operate on exactly the same principle, with carrier gases – oxygen, air and/or nitrous oxide – passing in a continuous stream over a manufactured ether derivative, usually sevoflurane. The modern anaesthetic machine is a large piece of furniture, but the sophisticated electronic monitors above the workspace and the heavy drawers below its make the machine appear more complicated than it actually is. At its heart the anaesthetic machine just delivers gases and vapours. It is a precision instrument that has replaced Clover’s ever-present finger on the pulse which accurate measuring devices and electronic monitoring but fundamentally it is based on the principle devised by Clover in the mid-1870s. (p.234)

That’s a legacy, eh?

Author: Christine Ball
Title: The Chloroformist
Publisher: MUP (Melbourne University Press, 2021)
ISBN: 9780522877748, pbk., 322 pages
Review copy courtesy of MUP.


Responses

  1. I’d probably be the same about not wanting to see any procedure being done on myself.

    When I read Fanny Burney had a mastectomy without anesthetic, I was terrified just thinking of the experience. I dread reading her account of it.

    Liked by 1 person

    • It just shows you how desperate people must have been…

      Liked by 2 people

  2. Reblogged this on The Logical Place.

    Liked by 1 person

  3. I chat with a retired Scrub Nurse in the USA and he would love this! Wish I knew how to forward it to him. Any suggestions how I can send a link to his blog or is this not possible Lisa?

    Like

    • Just send him an email with the URL https://anzlitlovers.com/2021/09/03/the-chloroformist-by-christine-ball
      and it should work just fine!

      Like

      • Brilliant thanks Lisa!

        Liked by 1 person

        • Thanks for this lovely review Lisa. If your friend is interested Sue, they can get the book here or watch the book launch which was also fun. https://www.mup.com.au/books/the-chloroformist-paperback-softback

          Like

          • Hello Christine, thanks for your kind comment, and thanks for all the work that went into writing the book too.
            One thing I’d like to know, how did a Melbourne museum come to be in possession of the casebook?

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            • The casebook was given by Clover’s daughter to the professor of anaesthesia (the first in the world), Robert Macintosh in Oxford, along with many of his other papers. He gave the casebook to Geoffrey Kaye, a Melbourne based anaesthetist who was establishing an anaesthetic museum here. But that was so long ago that no records were ever kept of that transaction, apart from the writing inside the cover. And BTW, the museum is open to the public (once lockdown is over) by appointment through the website https://www.geoffreykayemuseum.org.au/
              Our wonderful professional curator (and creator of the jigsaws) would love to see any of your readers. We also have many online displays.

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              • Hello again, I’m listening to the launch video as I write this, and yes, you explain the provenance of the casebook in your talk. The photos via screen share are so interesting!
                PS My husband is reading the book now, and we’re both keen to come to the museum.

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                • Thanks – and for watching. I was initially sad that we couldn’t have a live component to the launch but in the end so many people attended from all around the world, including my mother in Wales and my sister in law who was sitting in the middle of a Finnish forest. Book launches in a pandemic! Look forward to seeing you both at the museum sometime soon

                  Liked by 1 person

  4. Oh, this sounds fascinating. I read a biography years ago about Astley Cooper, the world’s first surgeon, and some of the things he did, like amputating arms and removing organs etc, were all done without anaesthesia which seems unbearable to think of.

    Oh, and I’m with you, I’d want to be knocked out if anything was being done to my eyes! Mind you, the one and only time I was knocked out for an operation (to have all of my wisdom teeth removed before they had emerged) I had such a bad reaction to the anaesthetic I was ill for days.

    Like

    • I had a bad reaction when I had the same op for impacted wisdom teeth in the 1980s, but I think there must have been improvements since then because I’ve been under the knife a few times for this and that and had no adverse reaction at all.
      I just looked up Astley Cooper (because I’d never heard of him). He was obviously a great surgeon, but surely not the first? Or is it mythology that Caesareans are named after Julius Caesar who was delivered that way?

      Like

      • Should have prefaced it with “famous”… I believe he was first famous surgeon, or certainly one of the first to be known outside of usual medical circles, because he performed operations for public viewing and treated royalty. By all accounts he was a very clever man but not particularly likeable. My review of the book I read is here: https://readingmattersblog.com/2008/06/15/digging-up-the-dead-druin-burch/

        Like

  5. Fascinating! I must read this. Thank you, Lisa, for adding to my reading list. I had my cataracts done under local anaesthesia/light sedation in 2009. It was handled really well but if I’d had any doubts/concerns I would have opted for a general anaesthetic. You should never feel ashamed about knowing your limits. ;-)

    Like

    • You get a bravery award from me, Jennifer. I think it was because it was my eyes, if it had been anywhere else I would have been ok.

      Like

  6. I understand that a Japanese doctor, Hanaoka Seishū, was the first to use anaesthesia during operations, a mastectomy was the first in 1804. I remember thinking what a shame poor Fanny Burney didn’t know because she had one without anaesthesia in the 1830s? The history of medicine is so interesting.

    And, btw, I’ve never heard of anyone having general anaesthetic for cataracts but that’s what I want. Several of my friends have had their cataracts done but I can’t bear the thought. I tell myself that if they can do it, so can I, but! (So far I have only tiny beginnings of cataracts that haven’t advanced for a few years, but it’s going to happen, and when it does I’m going to remember your story!

    Like

    • Re cataracts: my specialist just told me what was going to happen and didn’t take any notice when I tentatively expressed doubts. I had had sleepless nights the whole week beforehand, and when the anaesthetist came in to talk to me, as they do, she realised what a state I was in, and went off to reschedule the surgery to allow for a proper anaesthetic. I was very grateful to her for her sensitivity to my distress. However, I realise this was a nuisance for them because it would have put their operating schedule out and made everybody late, so I would suggest being very firm from the outset about what you want. We are not all the same and what works fine for some people doesn’t work for everyone.
      (The other thing that’s relevant to my anxiety was that I had had experimental eye surgery as a child and things didn’t go as planned and there was concern that I might have permanently lost my sight. No one knew that it was successful until some time later when they took the bandages off and I could see.)

      Liked by 1 person

      • It’s lovely to meet a medical person who listens to you, isn’t it. I’ll remember this.

        Liked by 1 person

  7. I’m with you – I had two of my three caesarians awake with an epidural, but I would have to be knocked for cataracts – I am so squeamish about eyes it’s ridiculous…

    Like

    • I hope I would have been brave enough for that. I had a rough time but being awake for the birth of my child was the most wonderful moment of my entire life.

      Liked by 1 person

  8. Medical history is so fascinating. I remember having ether administered as a 7 yr old when I had tonsils out in 1950s. They got some of the powder in my eye and I had more trouble with that than the tonsils removal. It has stayed with me all these years. I’m glad they have progressed. We are so fortunate living in the time period we do.

    Like

  9. How gruesomely fascinating. As for the terror of being conscious for cataract surgery, you are far from alone. My cousin, for instance, had a panic attack just as the procedure was about to begin. It had to be rescheduled under general anaesthetic. I know everyone says cataract surgery is no big deal, you don’t know a thing etc, but that does not reassure me in the least. It’s our eyes, for heaven’s sake. The optician told me it is better, when the time comes, to be upfront with the surgeon about my dread. I think we are seldom alone in our fears…

    Like

    • That’s interesting… I did get the impression that being a wuss was a rarity. I feel better now!

      Like


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