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Anesthesiology:
doi: 10.1097/ALN.0b013e3181e2bfa5
Reviews of Educational Material

From Craft to Specialty: A Medical and Social History of Anesthesia and Its Changing Role in Health Care

Mandabach, Mark G. M.D.*; Wright, A. J. M.L.S.
Section Editor(s): Avram, Michael J. Ph.D., Editor

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From Craft to Specialty: A Medical and Social History of Anesthesia and Its Changing Role in Health Care. By David Shephard, M.B., F.R.C.P.C., in association with Alan Sessler, M.D., Francis Whalen, M.D., Tuhin Roy, M.D., Ph.D. Bloomington, Indiana, Xlibris Corporation, 2009. Pages: 451. Price: $35.00 (hardcover); $24.00 (paperback).
From Craft to Specialty is a carefully written and meticulously referenced history of the birth and development of surgical anesthesia. The book begins with the premise that surgical anesthesia became possible only after men and women conceived of its possibility. This seminal idea came to life in a very special social and political setting, and Dr. Shephard's focus in this book is as much about how the developments in anesthesiology came to pass as it is on the actual events and the major players responsible for these events. In the second chapter, in the section “1800–1840: The Nonuse of Nitrous Oxide and Ether,” Dr. Shephard makes the point that, although they were available, no one thought of using these agents for surgical anesthesia, stating “In short, early in the nineteenth century, the moral climate was not compatible with the idea of inducing unconsciousness for surgical purposes. Patients needing surgery just had to withstand the pain, perhaps with the aid of established anodynes. Some were able to do so; others just collapsed; and others simply succumbed.” The second facet that the book covers is the evolutionary development of anesthesia outside the operating room, in areas such as obstetrics, critical care, and pain management. These areas of specialization are discussed carefully within the social and political context in which they developed. Finally, the growth of professionalism in anesthesiology is explored, encompassing the establishment of professional societies, such as the American Society of Anesthesiologists, the genesis of academic departments worldwide, and the birth and development of formal training programs and the accreditation processes, such as those governed by the American Board of Anesthesiology. The focus of the text is international, and the author elucidates events as they occur in the United Kingdom, Germany, Australia, and elsewhere.
This book is, in many ways, the “big little book” of anesthesia history. The text itself comprises 329 pages. The balance of the book, a little more than 100 pages, consists of two appendices, a glossary, a bibliography, endnotes (specific textual references), and two indices: one entitled “Personal Names” and the other “Objects and Topics.” Overall, the author's plan for the book is to trace the development of the practice of anesthesia from a craft (from the discovery and public demonstration of ether in 1846) to a discipline (beginning in 1900 to the mid-1930s) to a specialty and, finally, to the growth and development of the subspecialties that are in existence today. The topics are covered within the social and political context in which they occurred.
Dr. Shephard covers this material in 15 chapters, which are dense with details and referenced extensively. The first chapter covers the period until 1800 and discusses ancient anodynes, such as the poppy and opium, mandragora, henbane, cannabis, and spongia somnifera. Even ether may have been an ancient anodyne. We found this chapter quite fascinating and comprehensive, a formidable task given the antiquity of the material. In subsequent chapters, the topics are divided primarily by periods: 1800–1846, 1846–1896, 1896 to the mid-1950s, and the 1950s to the present era. Rather than trying to explore and delineate every development in anesthesia in these distinct periods, important events are grouped by category, for example, chapter 3 is entitled “Laying a Foundation of Anesthetic Practice: 1846–1896.” Chapter 4 covers the development of general anesthesia in the 20th century. Separate chapters cover the birth of local anesthesia, airway management (including laryngoscopes, the endotracheal tube, and the Laryngeal Mask Airway [LMA™; LMA Worldwide, Netherlands Antilles]), and the introduction and evolution of anesthesia machines and monitors. In the other chapters, the author covers the emergence of anesthesia as a professional specialty with subsequent subspecialization. The text is rich with figures and legends and brief biographical sketches. Notable names in the first chapter alone include Vesalius, Paracelsus, Harvey, Boyle, Beddoes, and Priestley. The final chapter brings the whole book together, reexploring topics such as positive and negative forces and specialty recognition, the influence of science and technology on anesthesia, expansion of the nature and scope of anesthesia, and the relationship between anesthesia and society.
The book succeeds on many levels and is delightful, although challenging, to read. It has so much information, and each subject is explored in such great detail that the book is a tough read at times. In any event, it is a great reference for those looking for pieces to the puzzle of anesthesia history, and readers at all levels will find much to delight them. It is a welcome addition to the literature chronicling our heritage.
Mark G. Mandabach, M.D.,*
A. J. Wright, M.L.S.
*University of Alabama Birmingham School of Medicine, Birmingham, Alabama. mmandabach@uab.edu

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