Christine Ball,The Chloroformist

Reviewed by: Michael G Cooper, Sydney, Australia

I have always thought that Joseph Clover (1825–1882) was an ‘unsung hero’ of anaesthesia – without a truly definitive review of his life and contributions to anaesthesia – until now.

Dr Christine Ball has spent many years extensively researching and writing this great book, the reading of which made a week in COVID lockdown very pleasant. Dr Ball is an Australian anaesthetist living in Melbourne. She is an internationally renowned anaesthetic historian and is currently the 2020–2024 Wood Library-Museum Laureate of the History of Anesthesiology.

Anaesthesia is often said to be a mixture of art and science, and in Victorian England, art was a major component. Joseph Clover was undoubtedly one of the most skilled anaesthetists in the world at the time and was a pioneer in placing anaesthesia on a scientific basis.

The author paints a clear picture of Victorian medicine in Clover’s early days – the terrible infant and maternal mortality rate, tuberculosis, infection from surgery – and not infrequently this happened to the surgeon with a small cut on a finger in the presence of a dirty or infected wound leading to sepsis and often death. This happened to Clover as a junior surgeon, and he was fortunate to survive. Medicine was certainly not for the faint-hearted in that era, with Clover assisting at the post mortems of some of his colleagues and mentors.

You will read how Clover worked and appreciate his deep understanding of the administration and problems of volatile anaesthesia – this is impressive, considering what we know today. Nearly all his anaesthetics were done without oxygen, it only becoming more readily available at the end of his career. He later used ether (but never chloroform) with nitrous oxide and realised the advantage in a more rapid induction.

Clover had given nearly 14500 chloroform anaesthetics before he had a death, and he was in high demand by the leading surgeons of the day. Clover cared for royalty and many famous people, including Sir Robert Peel, Florence Nightingale and Napoleon III who was exiled in the UK and fortuitously died an hour before Clover was to re-anaesthetise him. There are many names that we still know today who were Clover’s friends and contemporaries – Spencer Wells, Lister, Paget, Ringer and others.

All of this is placed in the context of the development of surgery of that era, especially the emerging surgery of lithotrity for large bladder stones and ovariotomy for huge ovarian cysts. These were major challenges for all concerned – especially the patient. I found it impressive that Clover coped with difficult airways in the presence of major head and neck tumours which would fill us with horror today, and there is an early description of Clover successfully performing a front-of-neck access (FONA) for a can’t intubate/can’t oxygenate (CICO) event – not that he used oxygen.

Clover was a key player in the first days of anaesthesia in London with both ether and chloroform and with other agents such as ethidene dichloride which I hadn’t read about, but Clover used it on more than 1800 occasions. He had an interest in expired air resuscitation, using bellows, galvanism and other stimulants which were all that was available for resuscitation and chloroform-induced disasters.

Clover contributed professionally at many levels. He presented at meetings and played a part in the evolving dental scene in London as anaesthesia, especially nitrous oxide, became more prominent. He designed equipment for the safer and more accurate administration of chloroform and ether, some of which was manufactured for years. I was unaware of Clover’s involvement in the nitrous oxide committee in London, especially in the early 1870s with the analysis of 58,000 cases – all done manually and helping to put anaesthesia firmly on a scientific basis.

Even the enthusiastic anaesthetic historian will find facts and stories they were unaware of in this book – I did. This is all due to Dr Ball’s extensive research over many years, including that of William Marcet and his description of a cuffed endotracheal tube in 1862 well before the main publications on this topic in the 1920s.

Dr Ball’s style is concise and engaging to read. The 33 chapters flow well and tantalise the reader with topics such as a New Zealand banker, a cobra and a draper’s shop – all connected to Clover and chloroform. Most importantly, after reading this book, you feel you know the type of man that Joseph Clover was – a compassionate, intelligent, innovative and competent doctor who truly cared for and was gentle with his patients. His obvious humanity shines through this book.

This book is a valuable addition to the history of anaesthesia, medicine and surgery. I would highly recommend it.

Supplemental Material

sj-pdf-1-aic-10.1177_0310057X211038958 - Supplemental material for Christine Ball, The Chloroformist

Supplemental material, sj-pdf-1-aic-10.1177_0310057X211038958 for Christine Ball, The Chloroformist by Michael G Cooper in Anaesthesia and Intensive Care

Supplemental Material

sj-pdf-2-aic-10.1177_0310057X211038958 - Supplemental material for Christine Ball, The Chloroformist

Supplemental material, sj-pdf-2-aic-10.1177_0310057X211038958 for Christine Ball, The Chloroformist by Michael G Cooper in Anaesthesia and Intensive Care