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November 15, 1985

A Calculus of Suffering

Author Affiliations

Kaiser Foundation Hospital Los Angeles

JAMA. 1985;254(19):2826. doi:10.1001/jama.1985.03360190134046

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We modern physicians assume that every patient wants and needs relief from pain, and we deliver. With the help of such high-technology tools as precise vaporizers, sophisticated electronic monitors, powerful synthetic narcotics, epidural catheters, portable infusion pumps, and transcutaneous stimulators, even the most critically ill patient undergoes surgery free of pain.

This all-out attack on pain was not always the case, however. After anesthesia became available in 1846, physicians relieved the pain of only certain patients. Children, whites, the rich, the educated, and women were much more likely to receive anesthesia than were blacks, the poor, the uneducated, and immigrants.

Dr Pernick, a social historian from the University of Michigan, discusses in detail the period from Oct 16,1846 (the date of the first successful public demonstration of surgical anesthesia), to the 1880s, by which time anesthesia was accepted by nearly all practitioners and patients. His sources are patient records from