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Chloroform. The Quest for Oblivion

2004; Elsevier BV; Volume: 92; Issue: 2 Linguagem: Inglês

10.1093/bja/aeh514

1471-6771

I.D. Conacher,

Medical History and Innovations

When the history of halothane comes to be written, there will be chapters on its discovery, development, introduction, toxicity, metabolites, accidents, and its use and abuse. Cardiac irritability and liver toxicity will feature. The safety reports and erudite debates will be re-examined through the microscopes of time. And, long after its sell-by-date, someone will say how it was maligned and defend the indefensible—10% vaporizers and other follies. When it is no longer manufactured, there will be the same outcries as when that awful dry cleaning fluid was no longer available to grace anaesthetic machines. Well, the chloroform story has it all in spades and more. I listened to an ether guru. It was safe, he said, it was cheap, it was portable, it could be used in difficult environments, war zones, did not need sophisticated equipment, improvisation … and so on. Most was absolutely true but the silence, when asked if he would like an ether anaesthetic, was eloquent. And, so it was with chloroform. As this book tells it, it took nearly 75 yr for most of the world, piecemeal, to recognize a very dangerous seed to sew. But, even then the lessons were being ignored. As I worked with some of the first successful survivors of lung transplantation, the stuff was still being used as an anaesthetic. Not on the young and terrified (and that was just me), it wasn't! And, we think erotic dreams and handsome anaesthetists are the propofol revolution; or toxic metabolites part of the story of new generation muscle relaxants. Houses of horror, student hedonism, recreational drugs, poisoning, seduction and date-rape, sex slaves, investigative and crusading journalism! New? Huh! Oh no they are not! Chloroform antecedes in a big way and then knocks them into a cocked hat. Stratmann has put together a cast of Dickensian characters: mad scientists, eccentrics, charlatans, quacks, psychopaths, murderers, femme fatales (literally), and opportunists; and woven them into a heady tapestry of innovation, 19th and 20th century medicine, wars, religion, intelligence and forensics, crime and sex. But, it is not just the salacious and tabloid. Stratmann also has done service to the broadsheet and thesis. The arguments of the host of protagonists and the antagonists are portrayed in temporal, religious, philosophical and cultural context: the patently loony are given voice and not lampooned. Those of the peculiarly British pantheon, who loved it or hated it, like Simpson, Syme, Snow, Lister, and Clover are portrayed with their modest feet of clay, some as they lost touch with their objectivity and human frailty. Isn't ‘homicide by imprudence’ a wonderful charge for the crime of an anaesthetic death; Paul Bert's ‘zone mandiale’ so much more interesting than the minimal lethal dose; or, an 1820s annual output of 30 scientific papers an object lesson for the 21st century academic and the RAE? Anyone who can make debates about precedence, chemical purity and endless chloroform commissions not read like the repealing of the Corn Laws, has got talent. Put aside the few errors of fact about the history of anaesthesia, mouth to mouth resuscitation, tracheal intubation, and the wrongly labelled vaporizer. Kate Dickens’ (Charles’ wife) chloroform anaesthetic, some 4 yr before ‘anaesthésie à la reine’ when anaesthesia received the ultimate imprimatur, has been missed. The greats are portrayed in more scholarly works to be found in the references and extensive bibliography'some very recent but not half as much fun. Stratmann has done the hard work. This is highbrow populism, replacing the genre of fictionalized surgical history like The Century of the Surgeon or its anaesthesia manqué, The Sleep of Life. Stratmann may not do for anaesthesia what Sobel did for horology (Longitude), or Alder for the metric system (The Measure of All Things), but she is going to come close. I can see the TV faction. This is a darn good read. If you are having difficulty making the skiing holiday look like CME, take this book with you.