The Worst of Evils

“Pain is such an uncomfortable feeling that even a tiny amount of it is enough to ruin every enjoyment.”—
Will Rogers

In a world where more and more people are voluntarily “going under the knife,” it is hard to imagine a time when anesthesia was frowned upon. In the late nineteenth century when ether and chloroform revolutionized surgery, childbirth, and the long struggle with pain, the medical establishment rose up in protest, according to the review of Thomas Dormandy’s The Worst of Evils (Yale University Press, 2006) in the San Diego Union – Tribune. The New York Journal of Medicine warned that “ether is not safe even when administered in the most skillful manner.” The president of the American Dental Association called anesthesia a “Satanic influence.”

“But that satanic influence banished forever the days when healthy patients died in surgery from the shock of unspeakable pain. Together with antisepsis, it meant survival for children with appendicitis, for women facing Caesarean section, and for wounded soldiers.

Until recently, pain was a constant companion to human existence …[P]ain has provoked a chorus of questions from the seekers and philosophers of every generation: What meaning has pain in our lives? Why does a loving Creator allow such suffering? How far can we mortals go in our quest for relief?

Thomas Dormandy’s The Worst of Evils explores these questions and the answers proffered by a long parade of Western cultures. For the ancient Greeks and Romans, body and mind were inextricably linked; the Stoic school of philosophy taught that pain was a disruption of that harmonious link, to be suppressed through mental discipline for the glory of Reason. With Christianity, the body was seen as a mere earthly vessel for spirit, and pain was a manifestation of divine will to be humbly borne for the glory of God. As recently as 1990, when most Americans had come to regard even a hangnail as cause for complaint, Pope John Paul II proclaimed that ‘Pain is essential to the nature of Man … an appeal to Man’s moral greatness and spiritual maturity.’

Dormandy calls surgical anesthesia ‘the most important single advance in man’s fight against pain.’ Of pre-anesthetic surgery he writes, ‘In terms of survival, men were safer on the battlefield of Waterloo than on admission to a surgical ward. … Almost inevitably patients passed into a state of shock on the operating table. … This imposed a universal imperative. Speed was essential.’

Under Dormandy’s masterful hand, the story of surgical anesthesia unfolds like a Wagnerian opera, complete with convoluted plotline and tragic – or tragicomic – heroes. . . . Dormandy combines a scientist’s passion for accuracy with a historian’s delight in the quirky back-story.”

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