Drugs and narcotics in history

administered anaesthesia also was remarkable: in patients' houses or lodgings, the private consulting rooms of surgeons and dentists, the great London hospitals, fashionable West End hotels, and Buckingham Palace. Presented with this range in social space and social position, one wonders whether the expectations about differential need for anaesthesia according to the individual sufferer's place in class, ethnic, and gender hierarchies that Martin Pemick, in A calculus ofsuffering (1985), elegantly extracted from American case books, might be teased out of Snow's records. Awaiting careful analysis are Snow's changing appraisals of anaesthesia and the expectations, choices, and experiences of patients. We hear of the tooth extraction under chloroform of a "working man" at St George's Hospital who, in Snow's words, "said that it hurt him nearly as much as if he had not had the stuff' (p. 70), while another patient treated at his Charing Cross lodgings reported "he did not remember anything of the operation, but dreamed that he had been sailing in the Mediterranean" (pp. 105-6). Some patients were desperately eager to be anaesthetized, while others resisted or refused. Generally, Snow seems to have administered anaesthesia at the request of the surgeon or dentist performing the operation, but in a few instances patients sought out Snow's aid in defiance of their own medical advisors. Such records offer a promising wedge into the history of pain. What Snow did not record is difficult to gauge, though Ellis draws attention to some significant omissions. His conjecture that Snow inscribed entries at the end of each day makes sense, and emphasizes that this written record is the product of selective and-as evident slips make clear-sometimes unreliable memory. More than this, reports on several particularly important cases that Snow published appear nowhere in these case books. Other silences are equally perplexing. The very first daily entry includes a measurement of the specific gravity of a patient's urine, for example, yet only a few further reports appear in the hundreds of pages that follow. Were instances of urinanalysis rare, or was the test so unremarkable in Snow's practice that he saw no particular reason to make note of it? We have no way of telling, an inbuilt limitation of using case books as an historical source. This volume issues an invitation to investigate further Snow's practice during the early years of anaesthesia. At the same time, it should remind us of the wider possibilities of private practice case books both as a source of information about behaviour at the bedside and as a vehicle for exploring one of the medical practices most neglected by historians, namely, the practice of record keeping.