What the great moment in the Ether Dome really marked was something less tangible but far more significant: a huge cultural shift in the idea of pain. Operating under anesthetic would transform medicine, dramatically expanding the scope of what doctors were able to accomplish. What needed to change first wasn't the technology - that was long since established - but medicine's readiness to use it.
Before 1846, the vast majority of religious and medical opinion held that pain was inseparable from sensation in general, and thus from life itself. Though the idea of pain as necessary may seem primitive and brutal to us today, it lingers in certain corners of healthcare, such as obstetrics and childbirth, where epidurals and caesarean sections still carry the taint of moral opprobrium. In the early 19th century, doctors interested in the pain-relieving properties of ether and nitrous oxide were characterized as cranks and profiteers. The case against them was not merely practical, but moral: They were seen as seeking to exploit their patients' base and cowardly instincts. Furthermore, by whipping up the fear of operations, they were frightening others away from surgery and damaging public health.
The "eureka moment" of anesthesia, like the seemingly sudden arrival of many new technologies, was not so much a moment of discovery as a moment of recognition: a tipping point when society decided that old attitudes needed to be overthrown. It was a social revolution as much as a medical one: a crucial breakthrough not only for modern medicine, but for modernity itself. It required not simply new science, but a radical change in how we saw ourselves.
In Bonn, Germany, I noticed a bookcase full of books in the public park where I run, with a young woman removing one book and returning another. These are used books that make up essentially a free voluntary lending library.
Would this cabinet last undamaged in a U.S. city one day? I doubt it. Similar things exist elsewhere — such as outdoor vending machines for DVD’s in Kyoto, Japan. Both of these indicate a certain level of mutual trust in the population and a certain level of civility; both reduce the transactions costs of daily living: easier access to books in one case, 24-hour DVD availability in the other.
Mutual trust is important in reducing transactions costs, and this aspect of culture has been viewed by economists as helping to determine some economic outcomes. (Although how different levels of trust arise has not been considered by the mostly macroeconomists who worry about this; it’s creating trust that seems to me to be the central issue.)
How many other examples like the books and the DVD’s are there in foreign countries that we don’t see at home?