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08The Rise of a Speciality

For its first fifty years administering an anaesthetic was a task handed to whoever was least needed elsewhere. How it became a discipline with its own literature is a case study in how any field acquires an identity.

A task without a role

In the years after 1846 the vapour was usually given by a student, a junior assistant, a porter or anyone else standing near the head of the table. The reasoning was straightforward: the operation was the skilled work, and holding a cloth appeared to require no skill at all. The early mortality reports make it clear how badly that reasoning failed, since the deaths clustered exactly where one would expect if the state were being managed by people with no idea what they were watching for.

The four things a field needs

The transition from task to discipline is not mysterious, and it required four things, each of which can be dated.

A body of knowledge that is not obvious. The systematic treatises of 1847 and 1858 supplied this. By treating administration as a matter of delivered concentration rather than of poured quantity, and by analysing the recorded deaths carefully, they established that there was something to know which could not be picked up by watching someone else do it for an afternoon.

People who do it repeatedly. Volume creates expertise, and expertise creates the recognition that the work is not interchangeable. By the last quarter of the nineteenth century, in the larger hospitals, particular individuals were doing this work often enough to become noticeably better at it than the students.

Somewhere to publish. A society was formed in London in 1893, and another in New York in 1905. Dedicated journals followed from 1922 onward. A journal is more consequential than it sounds: it creates a forum in which claims are made to a specialist readership and can be contradicted by it, which is the mechanism by which a body of knowledge becomes cumulative rather than anecdotal.

A defensible boundary. The most difficult requirement, since it means being able to say what falls inside the field and what does not. It was settled by the twentieth-century expansion of the work well beyond the operation itself, into the preparation of the patient beforehand, the management of the recovery afterwards, the care of the seriously ill, and the study of pain, all of which follow naturally from the same knowledge and none of which anyone else was claiming.

The name and the record

The naming of the field is a small subject in itself. The state was named in 1846; the practitioner acquired a settled name much later and it still differs between countries, which is a normal consequence of professional organisations forming independently in different places at different times. For anyone reading the historical literature this matters mainly as a caution: the same word does not always denote the same role across periods and countries, and the older sources have to be read with that in mind.

Why the case is instructive

What makes this a good example is that the work did not change much in kind between 1850 and 1900. The same substance was given for the same purpose. What changed was that a body of knowledge accumulated around it, a group of people took responsibility for that knowledge, and a literature came into existence in which the knowledge could be argued over. That is what a discipline is, and the sequence has been repeated in every field that has emerged since.