Christine Ball - The Chloroformist

Christine Ball is an anaesthetist at the Alfred Hospital in Melbourne, co-manages a Master of Medicine (Perioperative) at Monash University, and is the 20202024 Wood Library-Museum Laureate of the History of Anesthesiology. She has been an honorary curator at the Geoffrey Kaye Museum of Anaesthetic History for thirty years and is the author of many works in this field.

MELBOURNE UNIVERSITY PRESS

An imprint of Melbourne University Publishing Limited

Level 1, 715 Swanston Street, Carlton, Victoria 3053, Australia

www.mup.com.au

First published 2021

Text Christine Ball, 2021

Images various contributors, various dates

Design and typography Melbourne University Publishing Limited, 2021

This book is copyright. Apart from any use permitted under the Copyright Act 1968 and subsequent amendments, no part may be reproduced, stored in a retrieval system or transmitted by any means or process whatsoever without the prior written permission of the publishers.

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Text design and typesetting by Cannon Typesetting

Cover design by Pfisterer + Freeman

Cover image by John Templeton Lucas, 1862

Printed in Australia by McPhersons Printing Group

9780522877748 (paperback)

9780522877755 (ebook)

I T STARTED WITH a bookan old casebook, written in beautiful cursive scriptpressed into a picture frame and then forgotten. When it resurfaced, it was a mystery, the first clue on the front cover. It had been a gift from a British anaesthetist to Geoffrey Kaye, a colleague in Melbourne. Inscribed in 1935, almost a hundred years after it was written, it was intended as a contribution to the anaesthetic museum Kaye was establishing.

The Geoffrey Kaye Museum resides in the Australian and New Zealand College of Anaesthetists. It has had many homesattics, basements, cupboards and corridorsand at times has been neglected, and at other times much loved. Today it is carefully tended, professionally managed and beautifully displayed. The long-lost casebook has been lovingly restored, and during that restoration, the book revealed some of its secrets.

The casebook belonged to Joseph Thomas Clover, who worked as a surgeon in London in the middle of the nineteenth century. It was written when he was still a medical student, before he trained as a surgeon, and around the time that anaesthesia was discovered. Eventually Clover abandoned surgery and became the most important authority on anaesthesia in Britain. He is featured on the crest of the Royal College of Anaesthetists, alongside John Snow, who is probably the best-known figure in the history of anaesthesia. There is a green plaque in London at the site of Clovers former home and another in Aylsham, where he was born. Yet little has been written about Clover and few outside the world of anaesthesia have heard his name. Some biographical articles have been prepared over the years, and several articles about the equipment he designed, but the man himself remains elusivewhat he thought, what he believed, whom he loved.

Clover left many papers but, like the casebook, they were dispersedscattered all over the world, sold or given to others, hidden in private libraries or obscure public collections. The growth of technology and the opportunities afforded by the internet have now allowed most of his papers to be rediscovered and digitally reunited. There are diaries in Vancouver and Chicago, letters in America and England, case notes in the Wellcome Library in London, family documents in Norwich, photographs in the Netherlandsand, of course, a casebook in Australia. Periodically, other items appear at auctions. Some manage to find their way into anaesthetic history collections but others disappear back into private hands.

Over the years, as I have reassembled this collection, I have discovered a person I understand, someone who embodies the speciality of anaesthesia as it exists today. At the same time, a story has evolved the story of how anaesthesia and surgery developed together, as interrelated disciplines.

Patients who have operations generally remember their surgeon, bearing the scars for the rest of their lives. But few remember their anaesthetist. Anaesthesia is a poorly understood specialtyeven within the medical profession, few know exactly what anaesthetists do. Yet they are essential to the patients surgical journey. Before an operation can take place, the anaesthetist must ensure the patient is fit enough for the surgery. During the operation, the anaesthetist keeps a close watch over the patient, continuously monitoring their vital signs. If there is blood loss, shock, heart failure, an allergic reaction, any emergency at all, the anaesthetist deals with it. They keep the patient unconscious, unaware and alive while the surgery is conducted. Once the procedure is complete, the anaesthetist remains until the patient is safe and conscious, their pain under control and their resuscitation complete. During this whole process, there is constant communication between the surgeon and the anaesthetist, each dependent on the other to know what should happen next, each alert to anything unusual or unexpected. Together, the surgeon and the anaesthetist steer the patient through the operation, working closely as a team, relying on each others skill, experience and expertise.

It was not always that way. Until 1846, surgery was performed without anaesthesiaextraordinary surgery, performed on conscious, terrified patients. Surgeons of that era were bold and courageous and saved many lives. But anaesthesia changed everything. With an unconscious patient, the surgeon could take their time. Surgery became slower, more careful, more delicate. And as anaesthesia removed the pain of surgery, the medical world gave more attention to surgical infection, heralding the use of antiseptics and eventually aseptic surgery. By 1881, the operating theatre was unrecognisablein just thirty-five years, everything had changed.

Joseph Clover began his career as an apprentice in 1841, learning the art of surgery in the pre-anaesthetic era. He was present when the first major surgical operation was performed under ether anaesthesia in London, in December 1846. He must have realised this was a groundbreaking moment, but he could not have anticipated the impact it would have on his career, or the huge role he was to have in the future.

Clover continued his surgical training and worked for a while as a specialist surgeon. But he gained great expertise in anaesthesia and a number of significant life events led him to eventually largely abandon operating to concentrate on administering anaesthesia for his surgical colleagues. While this was often done by untrained personnel in the nineteenth century, Clover became an expert, and his status as a surgeon gave him greater credibility with his colleagues. He was their peer, their equal, and they trusted him. He was the person they turned to when they had difficult cases or important patients in positions of power and authority. He helped them in every way: giving anaesthetics, designing surgical equipment, attending their meetings, even lending them money.