vice-president, the Society elected him to the highest honour it can
confer,—to the presidential chair. He took his place as President, in
his unassuming manner, on March 10th, 1855, delivering a short but
pleasing address. Throughout the year he carried out the duties of his
office with great success. One of his presidential acts was peculiarly
graceful. One evening, while presiding, Dr. Clutterbuck (then the
father, or oldest member of the Society) came into the meeting. The
venerable and distinguished old man, then long past his eightieth year,
had lately been a stranger to the assembly, and was known but to few of
the members. The President, as Dr. Clutterbuck entered the room, himself
rose, and in a way that was irresistible in its simple courtesy resigned
his chair to the veteran Esculapian. “It is near fifty years,” said Dr.
Clutterbuck with emotion, as he took the proffered seat, “since I last
occupied this honourable position.” At the next anniversary meeting,
held on March the 8th, 1856, Dr. Clutterbuck came to his last meeting,
and to see (so the fates willed it) his friend the President play also
his last part in presidential duties. At the anniversary dinner on that
same day, the President reviewed, in feeling terms, his own career in
the professional strife, and expressed that his success in life had
originated in his acquaintance with the Society over which he then
governed by the general will.
In addition to the fellowship of the Medical Society, Dr. Snow belonged
to the Royal Medical and Chirurgical, Pathological, and Epidemiological
societies. He was also a member of the British Medical Association. The
Medical Society, from its old associations, was, however, that in which
he took the most active part. Next to this, the Epidemiological Society
claimed his regard. When Mr. Tucker first contemplated the formation of
the Epidemiological Society, Dr. Snow was one of the first with whom he
held consultation, and from whom he received that able support which
enabled him to found that excellent institution. From the first of the
Society, Dr. Snow was an active member. He was on many of its
committees; he was a member of council, and a frequent contributor to
its _Transactions_. He used often to meet with opponents to his peculiar
opinions at the meetings of this Society, but he always retained
friendships.
The position which he took as an epidemiologist was original, and in
opposition to the views of many eminent men who had in the matters
relating to public health considerable influence, scientific and
political. He could not consequently, and did not, expect to go on his
way unopposed. But he did sometimes expect a more deliberate and
considerate attention to his hard wrought labours than he received or
deserved. He used constantly, though no great professor of Shakespearian
lore, to deplore the long admitted fact, that nothing so inevitably
tends to transform an earnest inquiring and enthusiastic man, into a
supercilious, superficial, and cold-hearted egotist, as translation from
the stool of self-reliance and independence, into the gilded chair of
office and brief authority.
It must be admitted that Dr. Snow’s views on the spread of epidemics
were extreme in character; but from the slight which they too hastily
received, they were not, I believe, properly understood. It has often
been said that he encouraged by his arguments the perpetuation of
certain offensive arts and occupations which are injurious to the public
health; and in 1855, several journalists commented on him severely for
this supposed error. But the fact is, he never presumed that any man
could breathe with impunity other gaseous mixture than oxygen and
nitrogen in atmospheric proportion. He knew too well the effect of
inhaling chemical substances to allow of such supposition to enter his
mind. But he contended, in regard to pure epidemic disorders,
distinguished by specific symptoms, that these have a specific poison,
which is propagated by certain fixed laws, which attains its progression
and increase in and through animal bodies; which is communicated from
one animal body to another, and which is the same in its essence from
first to last. This was his position, and he adhered to it. No mere
emanation arising from evolution of foul smelling gas can, per se,
according to his views, originate a specific disease, such as small-pox
or scarlet-fever; as well expect that the evolution of such gas should
plant a plain with oaks or a garden with crocuses. True, small-pox may
occur over a cesspool as an oak may spring up from a manure heap; but
the small-pox would never appear over the cesspool in the absence of its
specific poison; nor the oak rise from the manure heap in the absence of
the acorn which seeded it.
In 1855, Dr. Snow gave evidence before the select committee on the
“Public Health and Nuisances Removal Bill,” in which evidence he strove
to convey the impressions which are condensed above. Feeling that he had
not been correctly understood, he afterwards wrote a letter to Sir
Benjamin Hall, in which he set forth the whole of his argument very
distinctly and sensibly. He indicated in this letter that he was no
defender of nuisances, but that whereas a bad smell cannot simply
because it is a bad smell give rise to specific disease, so an offensive
business conducted in a place where it ought not be should be proceeded
against by ordinary law as a nuisance, without using in regard to it the
word pestiferous, or otherwise dragging in and distorting the science of
medicine. As time rolls on, it will probably be elicited that the
groundwork of Dr. Snow’s theory is sound. That if he committed error, it
was in adhering too closely to the abstract fact, and in not allowing
sufficient importance to the favouring influence of impure conditions in
the propagation and distribution of the specific poisons of the specific
diseases.
At all events, the view he had maintained originally, he maintained to
the end, and throughout conscientiously; and the aspersions that the
object of his argument was to support his special theory regarding the
communication of cholera, are utterly unfounded. In the present year,
1858, he read at the Epidemiological Society, and published in the
_Medical Times and Gazette_, a repetition of his previous opinions,
strengthening them by a statistical record, showing that the mortality
of persons working at so-called offensive occupations is at certain ages
lower, and at certain ages slightly higher, than in the general
population. When the paper was read at the Epidemiological Society, Mr.
Edwin Chadwick made a long series of objections to the paper, and
complained that the argument was illogical. It was so, doubtless, on Mr.
Chadwick’s premises; but on the premises advanced by Dr. Snow, as to the
specific propagation of specific diseases by specific poisons,
physiological problems on which, from his experimental researches and
knowledge, he was far the best authority, his arguments were perfectly
logical, and perfectly consistent.
In relation to public health, Dr. Snow contributed many other
observations. In the first number of the _Sanitary Review_, he
communicated a valuable paper, previously read at the Epidemiological
Society, on the “Comparative Mortality of Town and Rural Districts”;
and, previous to his decease, he was busily occupied in investigating
the question of adulteration of bread with alum. He made several
analyses of different specimens of bread, but his papers merely leave a
brief record of the fact, without any comments or results.
We return for a few moments to some further points connected with his
researches on inhalation. In addition to his experiments with volatile
narcotics, he carried out for a long time a series of inquiries with
other medicinal substances, and administered many remedies by inhalation
at the Brompton Hospital, during a period of twenty months. In 1851, he
recorded the result of this experience at the Medical Society of London,
and explained the modes of administering various agents. Some, as
morphia and stramonium, were inhaled with the aid of heat; others, as
hydrocyanic acid and conia, were inhaled at the ordinary temperature.
The particulars of these experiments will be found in a short paper in
the _London Journal of Medicine_ for January 1851.
He continued steadily to investigate the effects of various volatile
agents for the production of insensibility, and arrived by frequent
experiment to such a degree of positive knowledge regarding agents of
this class, that the composition and boiling point of any new chemical
body having been supplied, he could predict whether or not its vapour
would produce narcotism by inhalation. Other than the volatile narcotics
referred to in his present essay, he performed a variety of experiments
with carbonic acid, carbonic oxide, cyanogen, hydrocyanic acid, Dutch
liquid, ammonia, nitrogen, amylovinic ether, puff-ball smoke, allyle,
cyanide of ethyle, chloride of amyle, a carbo-hydrogen from Rangoon tar,
a carbo-hydrogen coming over with amylene, and various combinations of
these. His grand search was for a narcotic vapour which, having the
physical properties and practicability of chloroform, should, in its
physiological effects, resemble ether in not producing, by any accident
of administration, paralysis of the heart. The fact that in almost every
fatal case from chloroform the result had occurred from the action of
the narcotic on the central organ of the circulation, was never absent
from his thoughts. An agent having this effect, however intrinsically
valuable, was not to be put in the hands of every person for
administration. “There would be a great uproar,” he remarked on one
occasion, “if a student were to undertake on the operating table to tie
the femoral artery, and were to open the femoral vein. Yet at some of
our hospitals, the administration of chloroform has been entrusted to
the porter, who would only grin in ignorance, if informed that each time
his services were required, he performed the grand act of suspending for
a time the oxidation of the whole body, and of inducing a temporary
death; and who would tell you, if you asked him the composition of
chloroform, that it was smelling stuff.” He spoke this from no selfish
feeling, but with that kind of regret which an educated engineer would
feel, on referring to the fact of a railway porter who, knowing nothing
of steam, how to put it on, when to take it off, or why it propelled,
had mounted an engine and driven a host of confiding passengers to their
destruction. This is the way in which he expressed himself, and it would
be difficult to show that he was not correct.
Intent on the discovery of some new anæsthetic, which might be more
safely entrusted to general use, Dr. Snow began, in 1856, to experiment
with amylene. As usual, he went to work cautiously and with precision.
First he ascertained the boiling point of the specimen supplied to him;
then the point of saturation of air with the vapour at different
temperatures; then the effects of inhalation of the vapour by inferior
animals, and the quantity required to be inspired, with the air
breathed, to produce insensibility. These were the usual steps in all
his inquiries of this kind. When he had obtained any substance which
would produce insensibility favourably on animals, he pushed it, in one
or two experiments, to its extreme in animals of different kinds; and
having produced death by the inhalation, both by giving rapidly a large
dose, and by giving a small dose for a long period, he observed the mode
of death, whether it occurred by cessation of the heart, or by cessation
of the respiration primarily. If the agent seemed to promise favourably
from these inquiries, he commenced to try it on man; and the first man
was invariably his own self. His friends, knowing his unflinching
courage in the ardour of his inquiries, often expostulated with him in
regard to the risks he ran. It was of no avail. He felt the personal
trial a duty, and he did it. I do not believe, as some have supposed,
that these personal experiments had any effect in producing his early
death; but it is certain that he underwent many risks in the performance
of his investigations, and that he held his own life of least
consideration when the lives or well-being of others were under
consideration.
There is yet another trait in his character which I cannot but notice,
and which I would respectfully commend to all physiological inquirers.
While he held it as a necessity to use inferior animals for the purpose
of experiment, he never touched living thing with the physiologist’s
finger without having before him some definite object; and never
performed experiment on any animal without providing with scrupulous
care against the infliction of all unnecessary suffering. The interests
of humanity were, according to his rule, best advanced by the practice
of a humanity that was universal.
He paid considerable attention to the subject of local anæsthesia, and
tried numerous methods for attaining to a knowledge of a perfect local
anæsthetic. He performed experiments with freezing mixtures, with
chloroform; and for the production of rapid and efficient benumbing by
cold, he tried, in 1854, the effects of applying solid carbonic acid to
the skin. At one of the meetings of the Medical Society, he reported at
length the results he had arrived at; but he was never satisfied with
them, and soon relinquished the inquiry, in order to concentrate his
energies on the discovery of what he felt sure must be discovered
ultimately,—an anæsthetic which might be inhaled with absolute safety,
and which would destroy common sensation without destroying
consciousness.
To some extent he succeeded in this latter direction, in his discovery
of the physiological effects of amylene; and for some time he was
sanguine as to the great safety of the new agent. But the deaths which
he has so faithfully recorded as occurring in his own hands from
amylene, removed his expectations, and he discontinued its use as soon
as he learned the risks which might follow its administration.
By his earnest labours Dr. Snow soon acquired a professional reputation,
in relation to his knowledge of the action of anæsthetics, which spread
far and wide; and the people, through the profession, looked up to him
from all ranks, as the guide to whom to entrust themselves in “Lethe’s
walk”. On April the 7th, 1853, he administered chloroform to Her Majesty
at the birth of the Prince Leopold. A note in his diary records the
event. The inhalation lasted fifty-three minutes. The chloroform was
given on a handkerchief, in fifteen minim doses; and the Queen expressed
herself as greatly relieved by the administration. He had previously
been consulted on the occasion of the birth of Prince Arthur, in 1850,
but had not been called in to render his services. Previous to the birth
of Prince Leopold, he had been honoured with an interview with His Royal
Highness the Prince Albert, and returned much overjoyed with the
Prince’s kindness and great intelligence on the scientific points which
had formed the subject of their conversation. On April 14th, 1857,
another note in the diary records the fact of the second administration
of chloroform to Her Majesty, at the birth of the Princess Beatrice. The
chloroform again exerted its beneficent influence; and Her Majesty once
more expressed herself as much satisfied with the result.
Inquisitive folk often overburthened Snow, after these events, with a
multitude of questions of an unmeaning kind. He answered them all with
goodnatured reserve. “Her Majesty is a model patient,” was his usual
reply: a reply which, he once told me, seemed to answer every purpose,
and was very true. One lady of an inquiring mind, to whom he was
administering chloroform, got very loquacious during the period of
excitement, and declared she would inhale no more of the vapour unless
she were told what the Queen said, word for word, when she was taking
it. Her Majesty, replied the dry doctor, asked no questions until she
had breathed very much longer than you have; and if you will only go on
in loyal imitation, I will tell you everything. The patient could not
but follow the example held out to her. In a few seconds she forget all
about Queen, Lords, and Commons; and when the time came for a renewal of
hostilities, found that her clever witness had gone home to his dinner,
leaving her with the thirst for knowledge still on her tongue.
From the literary and general history of Dr. Snow, let us turn for a few
pages to his history personal. I will take the mean of the last eight
years of his life,—the period in which I knew him,—as the period from
which to draw particulars. He was of middle size, and, some years since,
slender; but of late he had become of slightly fuller build. His long
life in comparative student loneliness had made him reserved in manner
to strangers; but with private friends he was always open, and of sweet
companionship. With his increased popularity he became less reserved to
strangers; and within the last few years he so far threw off restraint
as to visit the opera occasionally. But he moderated every enjoyment,
and let nothing personal stand in the way of his scientific pursuits. He
was the impersonation of order. He had his time and place for
everything; he kept a diary, in which he recorded the particulars of
every case in which he administered chloroform or other anæsthetic, with
comments on the results of the administration, and hints as to dangers
avoided or chanced. He kept a record of all his experiments, and short
notes of observations made by his friends. He rose early, and retired
early to rest,—at eleven o’clock. He seemed, whenever he was waited on,
as though he had nothing in hand, and were always open to an engagement.
Anything and everything of scientific interest arrested his attention,
and his kindliness of heart was at all times in the foreground. When I
was living at Mortlake, he would run down, on request, after his day’s
duties were over, to a _post-mortem_, to see a poor patient, or to take
part in an experiment, returning as cheerily as though he had been to
receive the heaviest fee. I name this as but one example of his kindly
nature; there are many who could corroborate the example in like
personal manner.
He laid no claim to eloquence, nor had he that gift. A peculiar
huskiness of voice, indeed, rendered first hearings from him painful;
but this was soon felt less on acquaintance, and the ear once accustomed
to the peculiarity, the mind was quickly interested in the matter of his
discourse, for he always spoke earnestly, clearly, and to the point. In
the societies he spoke very often, and gave expression to views, on
which he had spent great thought, with a generous freedom which, in so
far as the fame of his originality was concerned, had been better held
in reserve. It had been better, that is to say, for him to have
carefully elaborated some of his views in the closet, and published them
fully, than to have sent them forth in the hurry of debate. Had he
lived, he would possibly have collected many stray labours thus put
forward, and have given to them the matured consideration which they
deserved. One of his views, on which he would have bestowed great
attention, refers to the origin of various morbid growths, as cancer. He
believed that these morbid formations are all of local origin; that they
arise in the parts of the body where they are found, from some
perversion of nutrition; and that the constitutional effects are
secondary to and dependent on the local disorder. He had made many
observations on this important subject, notices of which are to be found
scattered, here and there, in the proceedings of the Medical Society of
London, but no connected record was ever completed.
His private conversation was both instructive and amusing; he was full
of humorous anecdotes, which he told in a quiet, and irresistibly droll
style; and when he laughed, his goodnatured face laughed in every
feature.[1] His anecdotes were never given in set form, but were
elicited by some circumstance or other which might happen to suggest
them. Once, when a friend of ours related at dinner some of the
economical measures of an odd old doctor who was known to some of the
company, he gave us an anecdote, showing how a man may work too hard for
his money. “When I was a very young man,” he said, “I went for a brief
period to assist a gentleman who had a large parochial practice. I found
his surgery in a very disorderly state, and thinking on my first day
with him that I would enhance myself in his opinion by my industry, I
set to work, as soon as his back was turned, to cleanse the Augean
stable. I took off my coat, cleared out every drawer, relieved the
counter of its unnecessary covering, relabelled the bottles, and got
everything as clean as a new pin. When the doctor returned, he was quite
taken by storm with the change, and commenced to prescribe in his day
book. There was a patient who required a blister, and the worthy doctor,
to make dispensing short, put his hand into a drawer to produce one. To
his horror, the drawer was cleansed. Goodness! cried he, why where are
all the blisters? The blisters, I replied, the blisters in that drawer?
I burnt them all; they were old ones. Nay, my good fellow, was the
answer, that is, the most extravagant act I ever heard of; such
proceedings would ruin a parish doctor. Why, I make all my parochial
people return their blisters when they have done with them. One good
blister is enough for at least half a dozen patients. You must never do
such a thing again, indeed you must not. I did not, for he and I soon
found a good many miles of ground between us, though we never had any
more serious misunderstanding.”
His replies, when under the fire of cross-question, were ready and
commonsense. Once, he observed that in his opinion sulphuric ether was a
safer narcotic than chloroform. Why, then, said a listener, do you not
use ether? I use chloroform, he resumed, for the same reason that you
use phosphorus matches instead of the tinder box. An occasional risk
never stands in the way of ready applicability. On another occasion,
after one of the meetings of the “Medical Society,” when the subject of
a specific cholera cell had been under debate, some one asked him, as a
poser and rather ironically, where he thought the first cholera cell
came from? “Exactly,” he replied, with a droll face. “But to begin, do
you tell me where the first tiger or the first upas tree came from; nay,
tell me where you came from yourself, and I will then tell you the
origin of the first cholera cell, and give you the full history of the
first case; but I want a model before I venture on the description of
ultimate facts.”