Military anaesthesia (2006)

In his second paper on military influences on the development of anaesthesia [1], Metcalfe claims that 25% of those injured in the American Civil War received anaesthesia compared with only 8% of French soldiers in the Crimean War. This comparison is not valid, however, because the denominators for the two percentages are different. The French figure of 8%, which was calculated by Howat [2], is a percentage of the total army and not, as in the American data, of those who were wounded. Far from there having been a three-fold difference, it is probable that the use of anaesthesia in these two armies was similar. Metcalfe states that ‘the scarce sources detailing the medical aspects of the Franco-Prussian War (1870–1871) do much to show that enthusiasm for military anaesthesia in Europe had declined since the Crimean War.’ If sources were indeed scarce it might be because military anaesthesia was now fully accepted and no longer thought worthy of discussion. In fact, the sources detailing the medical aspects of this war are by no means scarce and a number of them (for a selection of those in the English language see [3-6]) mention either that the use of chloroform was almost universal or report the occasional shortages when demand outstripped supply. The reference which is cited as stating that Prussia ‘was the main site of medical research in the world at this time’ makes no such claim [7]. Metcalfe suggests that, as a consequence of the Franco-Prussian War, ‘the development of European knowledge about nitrous oxide and oxygen was delayed for nearly three decades’, but does not explain how a war which lasted for 6 months could have delayed progress on this subject for nearly 30 years. The notebook which is cited as evidence that ethyl chloride was used during the Boer War belonged to a Dr Davson, not Davison as stated by Metcalfe [8]. At the time of the Boer War, Davson was working in West Africa. He was not involved in the Boer War and I can find no reference to ethyl chloride in this notebook. This same reference [8] is also used, incorrectly, as evidence of the British Surgeon-General's claim that ‘the proper anaesthetic for the field and the only one available in hot climates is chloroform’. The correct reference for this statement is the report by Wilson [9]. The reference cited to support the statement that Treves tried to promote interest in the need for medical specialisation in the Territorial Army but received little support [10] makes no mention of either specialisation or of lack of support. Finally, this paper contains a number of debatable statements for which no evidence is given: for example the claim that the American Civil War provided anaesthesia with the ‘strong first foothold’ which was needed before any future development could occur; the statement that ‘official bureaucracy in many of the armies of the world was adversely affecting the development of anaesthesia’ in the early 20th century; and the statement that ‘academic anaesthetic minds were therefore constantly being directed to the forefront of other specialties’. Clinicians have a proud record of making important contributions to the study of the history of anaesthesia, and many of those contributions have been published in Anaesthesia. However, if the wider academic community and professional historians in particular are to recognise the value of these contributions, then the review process for historical papers must be every bit as rigorous as that to which clinical and research papers are subjected.