Social Darwinism in France

women needed a little, and, more frequently, immigrants needed less than the native-born, while black men and women had a natural immunity to pain. In general, the available surgical records of hospitals in the late nineteenth century show these theoretical ideas reflected in the actual frequency of anaesthesia used for different groups of patients. Pernick's account displays the many arguments adduced for and against anaesthesia, including the disputed "value" of pain, the role of anaesthetics in changing the power relations between physicians and patients, and the possible sexual threat to anaesthetized females. Much more could doubtless be said about the issues of sexual dominance, unconsciousness, and professional power; Pernick raises the issues but does not pay them extended attention. His calculus, and the one on which he lavishes most attention, is the trade-off between the relief of suffering and the (perceived) increased danger of surgery: at least some surgeons were willing to accept a five per cent increase in risk of death for painless major surgery. Pernick's evidence shows that the availability of anaesthesia did lead to an increase in surgical rates: immediately after the discovery of anaesthesia, the rate of surgery for men doubled, while that for women tripled. (In accordance with the calculus of suffering, women were more likely to be given anaesthesia than men; overall, anaesthetics made major surgery and intricate procedures more feasible.) Pernick also argues, however, that anaesthesia probably had little effect on the death rate from surgery and, interestingly, that rising surgical mortality was more a function of increasing industrial and railroad accidents than of the use of anaesthetics. This engaging account of the introduction and use of anaesthesia rests on an extensive substructure of scholarly research. Whether the reader agrees with the precise weighting of theoretical arguments, there can be little doubt that Pernick has placed the discovery and application of anaesthesia at the centre of the social history of medicine, relating it clearly to contested issues about the process of professionalization and suggesting, at least, its possible implications for questions of class, race, and gender in relation to selective medical therapies and professional power. In this short volume, Dr Clark has attempted to tackle the enormously difficult problem of the relationship of evolutionary thought to political philosophy, assessing in turn the penetration of such ideas into Republican, leftist, and right-wing ideologies in France. Neither does the author stop there. She proceeds with …