ON
CHLOROFORM
AND
OTHER ANÆSTHETICS:
THEIR
ACTION AND ADMINISTRATION.
BY
JOHN SNOW, M.D.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS.
EDITED,
WITH A MEMOIR OF THE AUTHOR,
BY
BENJAMIN W. RICHARDSON, M.D.,
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS.
LONDON:
JOHN CHURCHILL, NEW BURLINGTON STREET.
MDCCCLVIII.
PREFACE.
The book here presented to the reader is the legacy to science of Dr.
JOHN SNOW. The completion of the work was his last act and deed. In
editing the book, therefore, all that remained to be done consisted in
the construction of the index, and in this a plan suggested by the
author himself has been followed.
In contributing the memoir, I have performed a painful and unexpected
duty: the fulfilment of a promise given at a moment when two friends who
often enjoyed close companionship met at one of their happiest meetings.
The promise was given with the idea of fulfilment far distant, or
improbable altogether, and, as connected with a more extended
biographical survey, reserved for the work of years long in the future;
it is called for now hastily and in deep sorrow.
Writing with the fact of my late friend’s death not as yet fully
realized; with the sensation still on me at intervals (like one who has
lost a part of his own body, and yet at times conceives the lost
present), that he cannot possibly be so far away; I may, perchance be
pardoned for any deficiencies in style or matter. I have done my best,
and leave it so.
B. W. RICHARDSON.
_12, Hinde Street, Manchester Square.
August 6th, 1858._
CONTENTS.
HISTORICAL INTRODUCTION 1 to 24
GENERAL REMARKS ON INHALATION 25–26
CHLOROFORM 27–344
History and composition of 27–8
Mode of preparation 28–9
Chemical and physical properties 29–30
Adulterations 30–32
Vapour of 32–34
PHYSIOLOGICAL EFFECTS OF CHLOROFORM 34–48
Degrees of narcotism 35–43
Effect of chloroform on the pulse 43–4
Action of chloroform on the nervous system 44–8
CIRCUMSTANCES WHICH INFLUENCE OR MODIFY THE EFFECTS OF
CHLOROFORM 48–58
Age 49–50
Strength or debility 50
Hysteria 50–2
Epilepsy 52–3
Pregnancy 53
The menstrual period 53
Diseases of lungs 53–4
—— —— heart 54–6
Cerebral disease 56–7
Insanity 57
Hard drinking 57–8
AMOUNT OF VAPOUR OF CHLOROFORM ABSORBED TO CAUSE THE VARIOUS
DEGREES OF NARCOTISM 58–74
Experiments 60–73
PREPARATIONS FOR INHALING CHLOROFORM 74–78
MODE OF ADMINISTERING CHLOROFORM 78–97
Signs of insensibility 87–97
Repetition of chloroform during an operation 97
RECOVERY FROM THE EFFECTS OF CHLOROFORM 97–100
OCCASIONAL SEQUELÆ OF THE INHALATION OF CHLOROFORM 100–107
Sickness 100–3
Faintness and depression 103–4
Hysteria 104–7
CAUSE AND PREVENTION OF DEATH FROM CHLOROFORM 107–120
FATAL CASES OF INHALATION OF CHLOROFORM 120–200
ALLEGED FATAL CASES OF INHALATION OF CHLOROFORM 201–212
SYMPTOMS IN FATAL CASES OF INHALATION OF CHLOROFORM 212–217
MODE OF DEATH IN THE ACCIDENTS FROM CHLOROFORM 217–222
THE TWO KINDS OF SYNCOPE 222–228
SUPPOSED CAUSES OF DEATH FROM CHLOROFORM 228–245
Idiosyncrasy 231–2
Alleged impunity of chloroform 233
Apparatus employed 233
Alleged exclusion of air 233–4
Alleged closure of glottis 234–8
Alleged exhaustion from struggling 238–9
Sitting posture 239–40
Effect of surgeon’s knife 240–3
Sudden death from other causes 243–5
Falling back of the tongue 245
STATE OF THE CHIEF ORGANS AFTER DEATH FROM CHLOROFORM 245–8
FURTHER REMARKS ON THE PREVENTION OF ACCIDENTS FROM CHLOROFORM 248–251
TREATMENT OF SUSPENDED ANIMATION FROM CHLOROFORM 251–262
EFFECT OF CHLOROFORM ON THE RESULTS OF OPERATIONS 263–270
ADMINISTRATION OF CHLOROFORM IN THE DIFFERENT KINDS OF
OPERATIONS 271–318
Lithotomy 271–4
Lithotrity 274–5
Perinæal section 275–6
Stricture 276
Amputation of thigh 276–7
—— —— leg 277
—— —— arm 277–8
—— —— ankle 278
Other amputations 278
Operations for necrosis 278–9
Excision of head of femur 279
Excision of elbow 279–80
—— —— knee 280
—— —— wrist 280
Removal of tumours of upper jaw 280–5
—— —— —— of lower jaw 285
Tumours of female breast 285–7
Other tumours 287–9
Nævi 289
Ligature of arteries 289–91
Tumours of bone 291
Hare-lip 291–3
Cancer of the lip 294
Division of nerves 294–6
Operations on the eye 295–8
—— —— —— ear 298
—— —— —— nose 298–9
—— —— —— mouth 299–300
Plastic operations 300–1
Raising depressed skull 301–2
Operations for ununited fracture 302
Reduction of dislocations 302–3
Forcible movement of joints 303
Tenotomy 303–4
Operations for hernia 304–5
—— —— —— hæmorrhoids and prolapsus 305–7
Fissure of anus 307–8
Fistula in ano 308
Operations on ovarian tumours 308–10
Operations for cancer of vagina 310
—— —— —— rupture of perinæum 310
Removal of testicle 310–1
Operations for phymosis 311
Removal of bursa 311
Evulsion of nails 311
Laryngotomy 312
Extraction of teeth 313–18
Secondary hæmorrhage after operations 318
CHLOROFORM IN PARTURITION 318–329
THE INHALATION OF CHLOROFORM IN MEDICAL CASES 329–344
Neuralgia 329–31
Spasmodic asthma 331
Spasmodic croup 331–2
Hooping-cough 332
Infantile convulsions 332–3
Delirium cum tremore 333–4
Delirium in fever 334–5
Hydrocephalus 335
Tetanus 335–6
Epilepsy 336–7
Puerperal Convulsions 337–9
Hysterical paralysis and contractions 339–41
Mania 342
Spasmodic pain 342–3
Frequent and long continued use of chloroform 343–4
SULPHURIC ETHER, OR ETHER 345–371
History and composition 345
Chemical and physical properties 345–9
Physiological effects 349–55
Administration of ether 356–61
Great safety of 362–9
The combination of chloroform and ether 369–71
AMYLENE 372–410
Preparation and properties 372–7
Physiological effects 378–86
Use in surgical operations 386–94
Use in parturition 394–7
Its effects 397–419
THE MONOCHLORURRETTED CHLORIDE OF ETHYLE 420–23
ILLUSTRATIONS.
Chloroform inhaler 82
Ether inhaler 349
THE
LIFE OF JOHN SNOW, M.D.
There is not much credit in the mere acts of living and dying; in being
driven by unavoidable fate through the common journey, with shoulders
uncovered and the whip over them; in doing nothing save the drudgery of
existence; in enjoying, in an approach to the recognition of enjoyment,
the brief dreams of childhood; in struggling into manhood; in battling
through the after-strife obedient to the castigator behind; and in dying
at last, as though life had never been; dead to-day, wept for tomorrow,
and forgotten by the morrow’s succeeding sun. There is not much credit
in this surely, for credit must be earned by something done beyond that
which all must perforce do. But, in the face of all the struggles
incidental to the existence, so to have managed as to have stolen out of
time hours which other men knew not in their calendar—so to have defied
the inexorable taskmaster as to perform more than is included in his
demands; so to have willed and acted as to live on when death has done
his worst; to assist all coming wayfarers in their conflict wherever
they may meet it; to prove that there is something more in life than
labour lost, and nothing more in death than an idea—_Hoc opus hic labor
est_—in this there is achieved the grand attainment; the perpetual life.
He whom I, with poor biographer’s pencil, put forward now in brief
sketch, is one amongst the few who have thus realized the ideality of
death. It were but little matter, therefore, though no biography should
appear at all; it is of but little count that such biography, as the
recollections of friends and intimates shall call forth, be scanty in
its details; it is of but little count that the life of him who is to be
shadowed forth is destitute of incident fitted for the taste of
wonder-loving, passion-courting, romance-devouring, readers. Biographies
for these are common. Good men are scarce.
JOHN SNOW, the subject of the present memoir, was born at York, on the
fifteenth day of June, 1813. He was the eldest son of his parents. His
father was a farmer. His mother, who is living, resides still at York.
As a child, he showed his love of industry; and increasing years added
only to the intensity with which he applied himself to any work that was
before him. He occasionally assisted his father in agricultural
pursuits, and often in later life spoke with great _naïveté_ of the
recollections of those early winter mornings when his boy’s fingers were
too intimately to be pleasantly acquainted with the effects of benumbing
cold. He was first sent to a private school at York, where he learned
all that he could learn there. He was fond of the study of mathematics,
and in arithmetic became very proficient. At the age of fourteen, he
went to Newcastle-on-Tyne, as an apprentice to Mr. William Hardcastle,
surgeon, of that place. He had also the opportunities of studying at the
Newcastle Infirmary. During the third year of his apprenticeship, viz.,
when he was seventeen years old, he formed an idea that the vegetarian
body-feeding faith was the true and the old; and with that consistency
which throughout life attended him, tried the system rigidly for more
than eight years. He was a noted swimmer at this time, and could make
head against the tide longer than any of his omnivorous friends. I have
heard him tell that so long as he continued to qualify his vegetables
with milk and butter, the vegetarian plan supported him fairly. But on
one unfortunate morning, when taking his milk breakfast, some quizzical
friend, learned in botany, cross-examined him as to the vegetable on
which he was then feeding. The joke went home; and the use of milk, as
food for a pure vegetarian, became too absurd for consistency. The milk,
therefore, must be put aside, and the butter and the eggs. The
experiment did not answer; the health of our pure vegetarian gave way
under the ordeal, and although in after life he maintained that an
approach to the vegetarian practice was commendable, in that it kept the
body in better tone for the exercise of the mind, he admitted that in
his own case his health paid the forfeit of his extreme adherence to an
hypothesis. Amongst his earlier scientific readings was a book in
defence of the vegetable regimen by John Frank Newton. This book is
annotated by himself, 1833. It is an useful book, full of curious
arguments, facts and suggestions, many of which, as his own after
writings indicate, he had carefully studied and applied.
At or about the same time that he adopted his vegetarian views, he also
took the extremity of view and of action, in reference to the temperance
cause. He not only joined the ranks of the total abstinence reformers,
but became a powerful advocate of their principles for many succeeding
years. In the latter part of his life, he occasionally and by necessity
took a little wine, but his views on the subject remained to the end
unchanged; he had strong faith in the temperance cause, and a belief
that it must ultimately become an universal system.
In 1831–32, cholera visited Newcastle and its neighbourhood, and proved
terribly fatal. In the emergency, Mr. Snow was sent by Mr. Hardcastle to
the Killingworth Colliery, to attend the sufferers from the disease
there. In this labour he was indefatigable, and his exertions were
crowned with great success. He made also on this occasion many
observations relating to this disease, which proved to him of immense
account in after years.
He left Newcastle in 1833, and engaged himself as assistant to Mr.
Watson of Burnop Field, near Newcastle. Here he resided for twelve
months, fulfilling the assistant duties; regarding which it can only be
said, and that from analogy, that they were neither without their
anxiety nor their reward. Leaving Burnop Field in 1834–5, he revisited
his native place, York; made a short stay, and thence, to a certain
half-inaccessible village called Pately Bridge, in Yorkshire, to
assistant it with Mr. Warburton, surgeon there. Some few years ago a
friend of mine went to the same village, by the recommendation of Dr.
Snow, as assistant to the present Mr. Warburton of that place, a son of
Dr. Snow’s “old master”. The circumstance of this recommendation often
led Dr. Snow to refer to his life at Pately Bridge in our conversations.
He invariably, on such occasions, spoke of Mr. Warburton, his “old
master”, in terms of sincere respect, and depicted his own life there
with great liveliness. He was a vegetarian then, and his habits puzzled
the housewives, shocked the cooks, and astonished the children. His
culinary peculiarities were, however, attended to with great kindliness.
Eighteen months at Pately Bridge, with many rough rides, a fair share of
night work, a good gleaning of experience, and this sojourn was over.
Now back again went our student to York, to stay this time a few months,
and—not to be idle—to take an active share in the formation of
temperance societies. In leisure days during this period it was his
grand amusement to make long walking explorations into the country. In
these peregrinations he collected all kinds of information, geological,
social, sanitary, and architectural.
At last York must be again left; the London student life was in view. In
the summer of the year at which we have arrived, 1836, he set off from
York to Liverpool, and, trudging it afoot from Liverpool through the
whole of North and South Wales, turned London-ward, calling at Bath by
the way, on a visit to his uncle, Mr. Empson, to whom, to the end of his
life, he was devotedly attached. October 1836—eventful October—brought
him to the “great city”, and placed him on the benches of the Hunterian
School of Medicine in Windmill-street: a school long since closed, and
now almost a myth; like the mill which gave the name to the locality.
I am indebted to the courtesy of Mr. Joshua Parsons of Beckington, near
Bath, for an insight into the life and manners of my beloved friend
during his student career. Mr. Parsons had the happiness to be the
special fellow-student of Snow. Their friendship, cemented early in
life, never declined, but had added to it, “on my part,” says Mr.
Parsons, “respect and admiration for the solid talents and industry of
my old colleague.” Speaking of their common labours, Mr. Parsons writes
as follows:
“Our acquaintance commenced in 1836, at the Hunterian School of Medicine
in Windmill-street, where we were both dissecting at that time. It
happened that we usually overstayed our fellows, and often worked far on
into the evening. The acquaintance thus grew into intimacy, which ended
by our lodging and reading together. We were constant companions from
that time till I left town, in October 1837. During that period Dr. Snow
was, as a student, characterized by the same mental qualities which have
marked him ever since. Not particularly quick of apprehension, or ready
in invention, he yet always kept in the foreground by his indomitable
perseverance and determination in following up whatever line of
investigation was open to him. The object of this steady pursuit with
him was always _truth_: the naked truth, for its own sake, was what he
sought and loved. No consideration of honour or profit seemed to have
power to bias his opinions on any subject. At the period of our
co-residence he was a strict vegetarian, and many and great were the
controversies held between us on the subject. These led to trials of our
comparative strength and endurance, in one of which, on Easter Monday
1837, we walked to St. Alban’s, and back to town through Harrow,—a
distance, I believe, of rather more than fifty miles. On reaching the
Edgeware Road, my companion was fairly beaten, and obliged to reach home
in an omnibus. But though this, you will say, shows a fair amount of
strength, yet it was my impression that my friend’s constitutional
powers were impaired by his mode of living, for I observed that he
suffered from an amount of physical excitability not to be looked for in
a man of his bodily powers and placid mental organization. I remember,
on two or three occasions, so slight an injury as a cut of the finger
with a dinner knife, or a graze of the skin, producing such an amount of
fever, attended by so rapid a pulse, and so intense a flush upon the
cheeks, that I once asked the opinion of an experienced medical friend
about him, and was by that opinion alone restrained from summoning his
uncle to his bedside. He also was subject to great drowsiness, so that
he was obliged often to close his books, and retire to bed long before
his inclination would have led him to do so.”
In October 1837, Mr. Snow took out his hospital practice at the
Westminster Hospital. On May 2nd, 1838, he passed his examination, and
was entered duly as a member of the Royal College of Surgeons of
England. He lived at this time at 11, Bateman’s Buildings, Soho-square.
In July 1838, Mr. Thurnham having resigned his post of apothecary to the
Westminster Hospital, Mr. Snow, with much promise of support from the
medical staff, competed for the vacant post. He presented excellent
testimonials from Mr. Hardcastle, Mr. James Allen of York, Dr. Conquest,
Mr. W. B. Lynn, Surgeon to the Westminster Hospital, Mr. Anthony White,
Sir Anthony Carlisle, Mr. Warburton, and Dr. Hunter Lane. His canvass
was very satisfactory; but he was compelled to resign his claims from a
cause which he did not expect. By the laws of the hospital, the office
of apothecary could only be held by a member of the Apothecaries’
Company. In those days the worshipful Company were sometimes lenient in
admitting students to examination. The leniency, however, clearly
extended to those only who had friends at court. To render himself
eligible, Mr. Snow addressed a very simple, earnest, and gentlemanly
request to the Court of Examiners of the Apothecaries’ Company, begging
to be allowed to go up to his examination at the second court in July
instead of the first in October, at which he was legally admissible. The
request, under the circumstances, was not very great; but for some
reason it met with refusal. After the refusal he addressed a second note
to the Court, equal in tone with the first. In this note he urged the
simple character of the request; he reminded the sapient body that they
had allowed a similar extension of privilege to that asked by himself to
others, and even for less important reasons. He explained that he had
attended the practice of the Newcastle Infirmary; and promised that if
he could be admitted, he would fulfil the required term of hospital
curriculum rigidly. Lastly, he stated the expenses into which the
canvass had led him, and once more prayed for leniency of the examiners,
from “confidence in their kindness”. The confidence was misplaced. The
Blackfriars Shylocks demanded the pound of flesh; and our disappointed
student, on the very eve of success, was compelled to relate his
discomfiture in the following address:
“_To the Governors of Westminster Hospital._
“MY LORDS, LADIES, AND GENTLEMEN,
“I became a candidate for the vacant office of Apothecary to
the Hospital a little before my term of study was completed, expecting
that the Court of Examiners of the Apothecaries’ Company would admit
me for examination in time for the election, knowing that they had
granted a similar boon to my fellow-students on less important
occasions. I have asked the favour of that Court with all due respect
and ceremony, showing them that my course of study had already been
twice as long as they require; and they have refused to examine me
till my last item of study was completed according to their own
peculiar curriculum, without stating any reason for their refusal. I
must therefore necessarily resign, which I beg most respectfully to
do, and to offer my sincere thanks to all those who have taken trouble
in my behalf,”
On the first Court of October 1838, held on October 4th of that year,
Mr. Snow met the Blackfriars Shylocks by legal right. They had not
forgotten him, and gave him good proof of their remembrances. He passed,
however, safe and sound; and, having the double qualification, laid
himself out for the duties of a general practitioner in medicine in the
great city.
At this time there existed in London a society (now sunken into the
“Medical Society of London”) called the “Westminster Medical Society.”
It was a society which had long given encouragement to those junior
members of the medical profession who might wish for a hearing at its
meetings and debates. Mr. Snow was not the man to lose an opportunity
such as this. I have often heard him say, both privately and publicly,
that, upon this early connexion with the “Westminster Medical,” his
continuance in London depended, and all his succeeding scientific
success. When he first attended the meetings of the “Westminster
Medical,” he was very timid; and although he always spoke to the point,
found it difficult to obtain a favourable notice. At first, as he told
me, nobody ever replied to what he said. After a long time some grave
counsellor condescended to refer to him as the “last speaker”. “In
reference to an observation made by the last speaker, Mr. President, I
could bring forward many practical objections; but I prefer to observe
on the admirable, and, I have no hesitation in saying profound, remarks
which Dr. Goldstick” (a very great gun, of course) “has done us the
favour to lay before the society.” A little later and somebody ventured
to name the “last speaker” even by his name. Then some one, bolder
still, concurred with Mr. Snow; and ultimately Mr. Snow became
recognized more and more, until, as we shall see in the sequel, the
presidential honours were his own.
Frith-street, Soho-square, No. 54, was the house at which Mr. Snow, to
use his own words, first “nailed up his colours”. He removed from
Bateman’s Buildings in the beginning of September 1838, and became, in
Frith-street, the tenant of Mrs. Williamson, widow of Captain
Williamson, known as the author of several works on India. He bought no
practice, nor exhibited any pretence. Like mighty Columbus, his caravel
was very insignificant when compared with the voyage on which he
embarked, and through which he sailed so successfully. He did not find
the voyage very smooth either at first. How could he? A man cast at
large in the modern Babylon, with few introductions, no plethora of
purse, and great purposes in hand, need never ignore the necessities
from the idea of rising to the crest of the wave by three cheers and a
long pull. Snow was too foreseeing to be ignorant of this, and he
prepared accordingly. A more thoroughly girded man for the world’s
encounter could hardly be conceived than he at this time. He took no
wine nor strong drink; he lived simply of the simple, on anchorite’s
fare, with more than anchorite resolution, with the temptations of the
world always before him; he clothed plainly, and made the best of
everything; he kept no company, and found every amusement in his science
books, his experiments, in his business, and in simple exercise.
To fill up time till the money patients should come, he became one of
the visitors of the out-patients of Charing Cross Hospital; and to many
a poor representative of the great half-starved, extended a skill which
would have been a blessing to a duke. The Librarian of the College of
Surgeons’ Library knew him as a quiet man, who read closely, and was not
too proud to ask for a translation when an original bothered him. All
who knew him said he was a quiet man, very reserved and peculiar—a
clever man at bottom perchance, but not easy to be understood and very
peculiar.
The connection with the “Westminster Medical” led to Mr. Snow’s first
attempts at authorship. On October the 16th, 1841, he read at the
Society a paper on “Asphyxia and on the Resuscitation of new-born
Children.” The paper in full will be found in the _London Medical
Gazette_ for November the 5th of the same year. The paper is remarkable
for the soundness of its reasonings, and the advanced knowledge which it
displays. The object of the paper was to introduce to the Society a
double air-pump, for supporting artificial respiration, invented by a
Mr. Read, of Regent Circus. The instrument was so devised that by one
action of the piston, the air in the lungs could be drawn into one of
the cylinders, and by the reverse action, the said air could be driven
away, and the lungs supplied with a stream of pure air from the second
cylinder. There was also advanced, in the concluding part of the
communication, a sentence or two on the cause of the first inspiration,
which is well worthy of note. The cause of the first inspiration, he
explained, is probably the same as the second or the last, viz., a
sensation or impression arising from a want of oxygen in the system. So
long as the placenta performs its functions, the fœtus is perfectly at
ease, and feels no need of respiration; but whenever this communication
between the child and its mother is interrupted, at least in the later
months of pregnancy, the child makes convulsive efforts at respiration
similar to those made by a drowning animal.
On December the 18th, 1841, Mr. Snow was again before the “Westminster
Medical” with a very ingenious instrument which he had invented for
performing the operation of paracentesis of the thorax. The description
of the instrument will be found in the _Medical Gazette_ of January
28th, 1842.
In the _Medical Gazette_ for November 11th, 1842, Mr. Snow published a
note on a new mode for securing the removal of the placenta in cases of
retention with hæmorrhage; and in the same journal for March 3rd, 1843,
he communicated an essay on the circulation in the capillary vessels.
The essay was selected and rearranged from papers read before the
“Westminster Medical” on January 21 and February the 4th. We have in
this essay an admirable sketch of the capillary circulation. He
advanced, on this occasion, the idea that the force of the heart is not
alone sufficient to carry on the circulation, but that there is a force
generated in the capillary system which assists the motion. He explained
also the great importance of the cutaneous exhalation, and reasoned that
in febrile states, accompanied with hot skin, the transpiration from the
skin is in reality greater than is normal, and that the good effect of
poultices and similar applications to inflamed skin is due to their
influence in checking the transpiration from the affected part.
But what of practice during all this work at the purer science of
medicine? The story to be told is an old one. Practice did not come, at
least not from the wealthy. He had plenty of practice in so far as
seeing patients was concerned certainly, for he was encumbered with four
sick clubs; and his club practice, together with the out-patient work at
the Charing Cross Hospital, kept the bell ringing all day, and not
unfrequently enlivened the night with the clamorous music. But the
patients with the fees in their hands kept at a respectful distance.
Why? The answer gives another old story—because the practitioner at 54,
Frith Street, Soho, was an earnest man, with not the least element of
quackery in all his composition, with a retiring manner and a solid
scepticism in relation to that routine malpractice which the people
love. I have heard many reasons alleged for the want of success which
attended Mr. Snow’s first labours as a claimant on the public
confidence. These reasons have all had one reading, in that they refer
to every cause but the true one. The true cause was, that a young man
having no personal introduction to the bedsides of dowagers of the
pillmania dynasty, sought to establish his fame on the basis of a sound
and rational medicine—because impressed with the knowledge of the
external origin of disease, he went in for the removal of external
causes, and studied nature in preference to the Pharmacopœia.
Pushing on in the higher branches of his profession, and aiming always
at the best, the degree of the University of London became a temptation,
and _Mr._ became _Dr._ Snow on the 23rd of November, 1843, by passing
the M.B. examination. He was enrolled in the second division on this
occasion. On the 20th of December in the following year, he passed the
M.D. examination, and came out in the first division of candidates.
The harass of London life by this time commenced to tell on Dr. Snow. He
had suffered a few years previously from threatened symptoms of phthisis
pulmonalis, but took plenty of fresh air, and recovered. He again became
slowly unhinged for work, and in the summer of 1845, was attacked with
acute and alarming symptoms of renal disorder. His friend and neighbour,
Mr. Peter Marshall, then of Greek Street, now of Bedford Square, gave
him his able assistance, and the advice of Dr. Prout, and, I believe, of
Dr. Bright, was obtained. He was induced by their general opinion to
change his mode of living, and even to take wine in small quantities. In
the autumn of 1845, he paid a visit to his friend and old colleague, Mr.
Joshua Parsons, at Beckington, with whom he stayed a fortnight, enjoying
himself very much. The friends resumed their old controversies, and the
Doctor admitted that he had been obliged to relinquish his vegetable
diet in favour of a mixed regimen. He improved greatly, says Mr.
Parsons, during his stay; but it was obvious that London life and hard
study had hold of him. From Beckington he went to the Isle of Wight, but
soon returned to London and to his work. A little after this, he was
elected Lecturer on Forensic Medicine at the Aldersgate School of
Medicine, and held the appointment till the establishment dissolved in
1849. I have often heard from him, in his quiet droll way, many
laughable stories in relation to his duties in the forensic chair. When
he left off teaching, he found that, in addition to the labour implied
and the cost of experiments, he had to pay, with the rest of his
colleagues, a ransom for his release.
There is no night without its morning. The eventful medical year of 1846
proved the turn of tide season with our struggling Esculapian. In this
year, the news came over from America that operations could be performed
without pain under the influence of sulphuric ether.
The fact was just such an one as would at once attract the earnest
attention of Dr. Snow. It was a physiological, as well as a practical
fact. It was rational in its meaning, and marvellously humane in its
application. The question once before him, was in a scientific sense his
own. His previous experimental studies on respiration and asphyxia had
prepared him for this new inquiry. He lost no time, therefore, in
investigating the new fact; he took it up for its own sake, however, not
from any thought, at the time, of a harvest of gold.
The first inhalations of ether in this country were not so successful as
to astonish all the surgeons, or to recommend etherization as a common
practice. The distrust arose from the manner in which the agent was
administered. Dr. Snow at once detected this circumstance; and, as he
explains in the pages of the work now in the hands of the reader,
remedied the mistake by making an improved inhaler. He next carried out
many experiments on animals and on himself, and brought the
administration to great perfection. One day, on coming out of one of the
hospitals (I am giving the narrative as he gave it to me), he met Mr. ——
(a druggist whom he knew) bustling along with a large ether apparatus
under his arm. “Good morning!” said Dr. Snow. “Good morning to you,
doctor!” said the friend; “but, don’t detain me, I am giving ether here
and there and everywhere, and am getting quite into an ether practice.
Good morning, doctor!” “Good morning to you!” Rather peculiar! said the
doctor to himself; rather peculiar, certainly! for the man has not the
remotest chemical or physiological idea on the subject. An “ether
practice! If he can get an ether practice, perchance some scraps of the
same thing might fall to a scientific unfortunate.” Consequently, with
his improved inhaler, Dr. Snow lost no time in asking to be allowed to
give ether at St. George’s Hospital. He got permission to give it there
to the out-patients, in cases of tooth-drawing. Dr. Fuller, of
Manchester-square, standing by, was surprised to see with what happy
effects ether was administered when administered properly. A day or two
afterwards, an operation having to be performed, and the surgeon (I
believe, Mr. Cutler) not approving of the ether in the way in which it
had previously acted, Dr. Fuller remarked on the superiority of Dr.
Snow’s mode of administering it; and the result was, that he was asked
to give it on operating days. He did so with great success. He
administered it at University College with the same success. Liston,
then the leading operator, struck with the new man who came before him
in such an able and unaffected way, took him by the hand; and from that
time the ether practice in London came almost exclusively to him.
Science for once put assumption in its right place.
The new field once open, it were impossible but that he should cultivate
it diligently. The Westminster Medical Society was often favoured with
his communications and experiments on etherization; and in the September
of 1847, he embodied, in his first work, the whole of his experience up
to that time. The work was remarkable for the care with which it was
written, the science which it displayed, and the complete mastery of the
subject which it everywhere conveyed.
What had been a mere accidental discovery, I had almost said a lucky
adventure, was turned by the touch of the master into a veritable
science. The book was readily appreciated by the profession, and was
just beginning to sell, when the discovery of the application of
chloroform threw ether into the shade and the book with it.
Dr. Snow, though a man of great firmness when once his mind was made up,
was always ready for new inquiry. Chloroform, therefore, was no sooner
brought before the profession by Dr. Simpson, than he began to institute
a series of independent researches, and having satisfied himself
personally as to the effects and greater practicability of chloroform,
he at once commenced its use, and forgot sooner almost than others all
predilections for ether. In 1848, he commenced a series of experimental
papers on narcotic vapours in the _Medical Gazette_, and continued them
until 1851, when the _Medical Gazette_ virtually ceased to exist. The
papers on narcotics, in accordance with his other and earlier
productions, were stamped with the evidences of profound and careful
research, and still more careful deduction. I infer that they have been
more talked about than read, for few people seem to be aware of the
enlarged and positive physiological arguments which they contain.
Chloroform and ether are not alone discussed, but all narcotics.
Narcotics are not alone considered, but various of the great functions
of life. The records of a vast number and variety of experiments are
here related, and an amount of information, original in kind, collected,
which will always remain as a memorable record in the history of medical
literature. But the great points in these papers are those in which the
author enters on the physiological action of narcotics. Here appear the
generalizations and insights into the relations of allied phenomena
which mark the man of true power. His greatest deduction on these
matters, and the proofs on which it is based, are to be found in his
observations, where he explains that the action of the volatile
narcotics is that of arresting or limiting those combinations between
the oxygen of the arterial blood and the tissues of the body, which are
essential to sensation, volition, and all the animal functions. He
demonstrated that these substances modify and, in large quantities,
arrest the animal functions in the same way, and by the same power as
that by which they modify and arrest combustion, the slow oxidation of
phosphorus and other kinds of oxidation unconnected with the living body
when they (the narcotics) are mixed with the atmospheric air.
In his modest way, he often spoke to me, with honest pride, on this
observation. He himself thought it the best observation he had ever
made, and believed that it would not be lost as an historical truth.
Placing a taper, during one of our experiments, in a bottle through
which chloroform vapour was diffused, and watching the declining flame,
he once said, “There, now, is all that occurs in narcotism; but to
submit the candle to the action of the narcotic without extinguishing it
altogether, you must neither expose it to much vapour at once, nor
subject it to the vapour too long; and this is all you can provide
against in subjecting a man to the same influence. I could illustrate
all the meaning of this great practical discovery of narcotism on a
farthing candle, but I fear the experiment would be thought rather too
commonplace.”
The year of the world’s fair in London, 1851, may be considered a
fortunate one for Dr. Snow. His affairs had taken a new turn, and the
tide was fairly in his favour. He had a positive holiday, physical and
mental. The harass of the professional struggle was over, the world was
opening its eyes to his intrinsic merits; old friends flocked around
him, brought to the grand show in town, and all was well. He did but
little this year, except to write a characteristic letter to Lord
Campbell, who was pushing on a bill in the House of Lords, called the
“Prevention of Offences Bill,” in which a clause was introduced to
prevent, by severe punishment, any attempt that might be made by any
person to administer chloroform or other stupifying drug for unlawful
purposes. Dr. Snow, believing that Lord Campbell was actuated in
introducing this clause by the fact of certain trials having recently
occurred for the offence of using chloroform unlawfully, and being
himself convinced that, in two of the cases (the one the case of a
robbery in Thrale-street; the other, of a robbery attempted on London
Bridge), the evidence against the prisoners, of attempting to produce
insensibility by chloroform, was without any reason or possibility, he
opposed the afore named clause in the bill on the ground that if it
became law numerous frivolous and false charges would be constantly
brought up against innocent people, or against guilty persons, but
persons not guilty of the special charge laid against them, that,
namely, of administering a volatile narcotic by inhalation. Knowing that
weakness of human nature which leads a man, in the presence of all
evidence, never to admit intoxication as possible in his own proper
person, Dr. Snow felt that, in any case where an intoxicated person had
been robbed, such person might allege that he had been made insensible
by narcotic vapour. The two cases specially noticed in his letter
admitted readily of such interpretation, and were clearly not cases in
which chloroform had been administered. Lord Campbell, on the receipt of
Dr. Snow’s letter, referred to it in very complimentary terms in the
Lords’, but intimated that the reasoning of the letter did not alter his
determination. The editor of the _Medical Gazette_, Dr. Alfred Taylor,
opened fire on Dr. Snow; and for two or three weeks a sharp contest
occurred between the two doctors; but the matter soon rested, each
author retaining his own opinions, and both agreeing to differ.
Dr. Snow’s amiable but firm nature led him often to this ultimatum.
Freedom of expression was a right he always claimed; but for this reason
he extended the same privilege to others. He was never stirred into
provocation by any difference of opinion. It was enough for him to form
carefully his own opinions, and then to hold to what he had said, so
long as he felt, from his internal convictions, that he was right.
In the year 1848, Dr. Snow, in the midst of his other occupations,
turned his thoughts to the questions of the cause and propagation of
cholera. He argued in his own mind that the poison of cholera must be a
poison acting on the alimentary canal by being brought into direct
contact with the alimentary mucous surface, and not by the inhalation of
any effluvium. In all known diseases, so he reasoned, in which the blood
is poisoned in the first instance, there are developed certain general
symptoms, such as rigors, headache, and quickened pulse; and these
symptoms all precede any local demonstration of disease. But in cholera
this rule is broken; the symptoms are primarily seated in the alimentary
canal, and all the after symptoms of a general kind are the results of
the flux from the canal. His inference from this was, that the poison of
cholera is taken direct into the canal by the mouth. This view led him
to consider the mediums through which the poison is conveyed, and the
nature of the poison itself. Several circumstances lent their aid in
referring him to water as the chief, though not the only, medium, and to
the excreted matters from the patient already stricken with cholera, as
the poison. He first broached these ideas to Drs. Garrod and Parkes,
early in 1848; but feeling that his data were not sufficiently clear, he
waited for several months, and having in 1849 obtained more reliable
data, he published his views _in extenso_ in a pamphlet entitled “The
Mode of Communication of Cholera”. During subsequent years, but
specially during the great epidemic outbreak of the disease in London in
1854, intent to follow out his grand idea, he went systematically to his
work. He laboured personally with untiring zeal. No one but those who
knew him intimately can conceive how he laboured, at what cost, and at
what risk. Wherever cholera was visitant, there was he in the midst. For
the time, he laid aside as much as possible the emoluments of practice;
and when even, by early rising and late taking rest, he found that all
that might be learned was not, from the physical labour implied, within
the grasp of one man, he paid for qualified labour. The result of his
endeavours, in so far as scientific satisfaction is a realization, was
truly realized, in the discovery of the statistical fact, that of 286
fatal attacks of cholera, in 1854, occurring in the south districts of
the metropolis, where one water company, the Southwark and Vauxhall,
supplied water charged with the London fæcal impurities, and another
company, the Lambeth, supplied a pure water, the proportion of fatal
cases to each 10,000 houses supplied by these waters, was to the
Southwark and Vauxhall Company’s water 71, to the Lambeth 5.
There was, however, another fact during this epidemic, which more than
the rest drew attention to Dr. Snow’s labours and deductions. In the
latter part of August 1854, a terrific outbreak of cholera commenced in
and about the neighbourhood of Broad-street, Golden-square. Within two
hundred and fifty yards of the spot where Cambridge-street joins
Broad-street, there were upwards of five hundred fatal attacks of
cholera in ten days. To investigate this fearful epidemic was at once
the selfimposed task of Dr. Snow. On the evening of Thursday, the 7th of
September, the vestrymen of St. James’s were sitting in solemn
consultation on the causes of the visitation. They might well be solemn,
for such a panic possibly never existed in London since the days of the
great plague. People fled from their homes as from instant death,
leaving behind them, in their haste, all the mere matter which before
they valued most. While, then, the vestrymen were in solemn
deliberation, they were called to consider a new suggestion. A stranger
had asked, in modest speech, for a brief hearing. Dr. Snow, the stranger
in question, was admitted, and in few words explained his view of the
“head and front of the offending”. He had fixed his attention on the
Broad-street pump as the source and centre of the calamity. He advised
the removal of the pump-handle as the grand prescription. The vestry was
incredulous, but had the good sense to carry out the advice. The
pump-handle was removed, and the plague was stayed. There arose hereupon
much discussion amongst the learned, much sneering and jeering even; for
the pump-handle removal was a fact too great for the abstruse science
men who wanted to discover the cause of a great natural phenomenon in
some overwhelming scientific problem. But it matters little. Men with
great thoughts in their heads, think of little things which little men
cover with their wide-spread feet. It matters little, for the plague was
stayed; and whoever will now read dispassionately the report of a
committee, afterwards published by the vestry, and the demonstrative
evidence of the Rev. Mr. Whitehead, will find that the labours and
suggestion of Dr. Snow, in reference to the Broad-street epidemic of
cholera, must become each day better and better appreciated, as time,
which never yet told a lie, tells the tale and points the moral of the
event which is here so imperfectly described. Some who, at first, were
amongst those who held up the labours of our friend to ridicule, or
passed them over in contemptuous silence, have, indeed, since modified
their opinions, and have either tacitly accepted his facts, or have done
far worse by attempting to put them forward as though they were the work
of no single man, or of some one unknown, or as though their connection
with a theory destroyed the originality of the facts themselves. It was
my privilege, during the life of Dr. Snow, to stand on his side. It is
now my duty, in his death, as a biographer who feels that his work will
not be lost, to claim for him not only the entire originality of the
theory of the communication of cholera by the direct introduction of the
excreted cholera poison into the alimentary system; but, independently
of that theory, the entire originality of the discovery of a connection
between impure water supply and choleraic disease. The whole of his
inquiries in regard to cholera were published in 1855, in the second
edition of his work on the “Mode of Communication of Cholera”—a work in
the preparation and publication of which he spent more than £200 in hard
cash, and realized in return scarcely so many shillings.
In 1856, he made a visit to Paris in company with his uncle, Mr. Empson,
who having personally known the present Emperor many years, had on this
occasion special imperial favours shown to him, in which the nephew
participated. During the visit, Dr. Snow lodged a copy of his work on
Cholera at the “Institute”, in competition for the prize of £1,200
offered for the discovery of a means for preventing or curing the
disease. The decision of the judges has since been published, but no
note seems to have been made of Dr. Snow’s researches.
The Medical Society of London, reformed under that name in 1849–50, by
amalgamation with the Westminster Medical, was at this time the
principal scene of Dr. Snow’s scientific exertions. In 1852, the Society
elected him as Orator for the ensuing year; and at the eightieth
anniversary of the Society, held on March the 8th, at the Thatched House
Tavern, he delivered an admirable oration on “Continuous Molecular
Changes, more particularly in their Relation to Epidemic Diseases.” He
made no claim to the orator’s gown; but the address was too forcible and
first class not to call forth the enthusiasm of the audience. It was
admirably received; and few of us who were present on that interesting
occasion will forget the simple and genuine earnestness of our beloved
associate, as in the twinkling twilight he carried us along with the
smooth current of his thoughts. He spent nearly twelve months in the
preparation of this oration. It was intended to convey, in the most
pleasing manner at his command, a broad view of his observations on the
communication of certain spreading diseases. He advanced, on this
occasion, the idea that intermittent fever, and perhaps yellow fever,
are, like cholera, carried by their poisons direct into the alimentary
system.