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

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.