Follow Us On
Contact Us
info@ampainsoc.org847.375.4715
American Pain Society
4700 W Lake Ave
Glenview, IL 60025
John D. Loeser, MD, Department Editor
Reviewed by John D. Loeser, MD
E.M. Papper, Greenwood Press, Westport, CT, 1995, $61.25, 162 pages, ISBN 0-3133-29405-4
One of the most prominent American anesthesiologists has embarked on a new journey relatively late in life and has done us the service of reporting on his travels. Manny Papper decided to become an English literature scholar after he had contributed more than 40 years of his life as a physician. Now he asks a question fundamental to the history of our profession: What determines when new concepts of medical treatment are introduced? Most physicians would reflexively answer that the steady march of science determines when. On the other hand, almost all nonphysician students of human behavior know that health care, like any other facet of human endeavor, is culturally determined.
Papper has chosen the Romantic Era in English literature to symbolize the growing interest in the rights of the individual as key to the realization that inhaled drugs could serve not only for recreation or the treatment of disease but also for surgical anesthesia. He asks, but does not fully explain, why it took so long for these anesthetic gases, which had been known for almost 100 years, to be introduced into the mainstream of health care. We all know that the development of surgery was built on the twin towers of antisepsis and anesthesia. So why, then, is there no literature by early surgeons crying out for the development of anesthesia? Perhaps it's explained by the same reason that pus was considered laudable, and pain was considered inevitable. The microscope was known long before infection was recognized as microbial in origin. As these are not laboratory phenomena, one cannot apply the scientific method to explanations of cultural change. Whether Beddoes, Shelley, Wordsworth, or Coleridge were responsible for the cultural change or reflect the same changes that led to inhalation agents is not clear from Papper's exegesis.
Perhaps his thesis would be bolstered if the eventual medicinal adoption of nitrous oxide and ether had occurred in England, where these authors lived. How the Romantic poets influenced a rural dental practice in Georgia or Boston is unclear. We can only hope that Professor Papper will continue his journey and lead us to new insights.
John Loeser is professor of neurological surgery and anesthesiology and director of the Multidisciplinary Pain Center at the University of Washington in Seattle.
