argument was always carefully studied and as carefully rendered. He sent
manuscript to the printer which required scarcely a letter of
correction. Both in writing and speaking, he made the expression of
truth his first business. Neither provocation nor temptation could ever
lead him aside from that principle. His readings were select. He chiefly
read scientific works, old and new. He had great relish for some of the
old medical writers—the masters in physic. He had read Bacon, but agreed
with Harvey’s criticism that Bacon wrote science like a lord chancellor.
He had a notion that there had been a history long previous to any we
know of from existing records, in which the sciences generally had risen
to a greater perfection than they are at this present. His conversance
with Sprengel’s _History of Medicine_ had possibly led him to this
opinion. He was fond of general history also, but studied it little. He
never read novels, because the hours devoted to them were, he felt,
hours thrown away. At the same time, he enjoyed as much as any man
ridiculous life-pictures naturally cast. When he came to see me, and
leisure was with us, I used often to read to him some of the more
amusing passages from Dickens and Thackeray, or from one of the older
writers, as Swift. It was a new world to him, and provoked great fun. He
would ask to have passages read over again, that he might better realize
the conception. He enjoyed vastly any anecdotes about the old men in
physic, the Cullens and Meads and Arbuthnotts and Harveys. Any such
anecdotes he took into his memory and never forgot them.
On such occasions I would, in ridiculous mood, sing him absurd songs to
any tune, two or three tunes, or to no tune at all, and without any
pretence at voice. At first he would listen with his hands flat together
and with a perfect melancholy on his face, as if he could hear it no
longer. Bit by bit he would relax, and at last get into a continued
laughter. Then I would stop, and he would begin to open out his list of
anecdotes, professional and general, upon which the laughter came over
to me with compound interest, for of men enriched with stores of droll
stories, few could equal him. Nor was he inventive in these narrations;
he had simply observed character shrewdly, and described it in its
humorous phases. If he had written as he related, he would have ranked
as one of the humorists of the age of no second order.
He thought severely of the reviewer’s art, and would never of late
review any book critically. If a book were good, it carried the review
of its own merits. If it were bad, it were better left untouched. He, at
all events, with so much original work before him, could not stop to
criticize his compeers or their transactions. Let the dead bury their
dead; he must march with the living while life gave power.
Notwithstanding, he was fond of controversy and courted it. I expressed
to him once some surprise that he with such an even temper should write
so often in controversial style; and that surely it were better to
follow Harvey’s and old Sam Johnson’s plan, to do the best oneself, and
leave the controversy altogether to others less personally influenced.
He agreed that this was by far the best system, but did not think it
practicable generally, and feared that silence might often be
misinterpreted.
Men who have something in them take different courses in the way of
accepting the world’s recognition of their labours. The beginning, in
most cases, is after a given pattern; the end is modified and turned
about variously, according to the stamp of the man. All start with an
exaggerated appreciation of their own doings, and with exaggerated
feelings respecting the critics who first notice them. The critic is
Jove the all wise, or Pluto the all black. There was never middleman
critic yet. Some men stop at the first, either too elated with the
pleasure of the first reception to venture more, or too cast down from
the pain of a sharp reception to tempt fortune further. Cowards these
both, in one word. Others enter into violent controversies; in the heat
of the same, drop one or two contradictions, and, wishing every month
that Cadmus had been still born, go on always at controversy, boring
everybody, and especially those who would believe if not bored. Others,
again, soon find their own level, and not only their own, but the level
of their critics. Surfeited with commendation, or hardened by attacks,
these care little for either, and make no retorts save such as are by
ambuscade and go right home. A fourth class, of immovable temper and
self-reliant, fall into what seems, superficially, indifference, but
which means, deeply, the soul of earnestness. These do always the best
thing at the time, and, when it is done to their own satisfaction, put
it forward, with no anxiety whatever as to what may be said of it, with
no intention of entering into any defence of it, and with no intention
of doing anything less than themselves correct all such errors in it as
after knowledge may indicate, or commit it to the flames, if destruction
be its best fate. Fatalists in letters, men of this class, if it be
pleasure to call them so; but great fatalists too—honest reviewers of
their own works, who fear their own criticisms, and none other; who
offer immense labours, and die to them as they offer. Dr. Snow, as we
have seen, was the representative rather of the controversial class of
workers. But he had his own way of doing the controversy business, which
saved friendships, and exhibited a firm principle and an exact
knowledge. It is not to be denied, however, that, had he put his labours
before the world, and trusted in them and on the world’s justice, never
replying a syllable, he would have avoided an extremity of argument
which was often not merely unnecessary in relation to his propositions,
but injurious to them, as reasonings overstrained.
He admired art, and felt real pleasure in advancing it. He enjoyed
innocent recreations, and was ever at home in the family circle. He had
his regrets that he had never married, the fates had been against him
permanently on that score. He loved the prattle of children. When he
went to court during last season, and had arrayed himself in his court
suit, nothing connected with the event amused him so much as the saying
of the child of a friend, who, on seeing him start, with his sword and
flattened hat, held up her hands, and exclaimed: “Oh! isn’t Dr. Snow
_pretty_, mamma.” The idea of being considered pretty roused in him
quite a new and droll sensation, which he could not help telling about
as a rare incident in a courtier’s career. The anecdote is simple, but
it gives a good idea of the simple and genial nature of the man.
It has been shown that the tendency of Dr. Snow’s mind for philosophical
pursuits led him away in some measure from the practical drudgery of
professional life. From this fact, it has been too hastily inferred that
he was therefore, in the common parlance, “not a practitioner.” Those
who knew him as a practitioner, who had had the advantage of his
assistance in cases of doubt or difficulty, have a very different
opinion. These speak of him, with one accord, as having been, without
any ostentation, one of the soundest and most acute of our modern
physicians. He had great tact in diagnosis; an observant eye, a ready
ear, a sound judgment, a memory admirably stored with the recollection
of cases bearing on the one in point, and a faculty of grouping together
symptoms and foreshadowing results, which very few men possess. Mr.
Peter Marshall, of Bedford Square, who often called in Dr. Snow in
consultation, has remarked to me in nearly the same terms as I have
expressed, his independent appreciation of Dr. Snow’s practical
knowledge. For my part, I never had the good fortune to put many fees
into his pocket; but as I had often the pleasure of meeting him on pure
scientific grounds in cases of interest, I can bear truthful testimony
to his eminent qualities as a practitioner, and to the fact that his
philosophical labours only served to render him more intelligent and
profound in matters relating to diseases and their treatment. He did not
become the idol of the people in common practice, far from it: but the
failure arose not from deficiency of knowledge, but from a more perfect
knowledge with assumption whipped out of it. It is no discredit to his
memory that he was not the idol of the people in common practice, though
it cost him much suffering to feel himself kept down, by that wisdom
which is the oil to the water of popular ignorance concerning life and
its laws. For, to be the idol of the people in physic, is too often to
be the Juggernaut of physic,—an idol of wood or of stone in showy gold
and tinsel. This idol has neither sense nor force; if it had, it were
not an idol; it would walk off, or tell the worshippers no longer to
shake hands constantly with themselves in its presence.
But, when the opportunity offered for obtaining remunerative practice by
the exercise of his scientific skill, Snow showed himself, both in act
and industry, competent for success. He soon overcame all difficulties,
and managed by his frugality to lay in store for a rainy day for
himself, and to help such friends as needed. Many rumours as to the
extent of his gains abound which it is right to correct. His income of
late years was near £1,000 a year, but it never exceeded that sum. For
this, he exhibited chloroform or one or other anæsthetic about four
hundred and fifty times annually, taking an average of the ten years
preceding his death. In a large number of these cases, however, his
services were gratuitously supplied.
In his private relations, Dr. Snow was a man of the strictest integrity
and purest honour. The experiences of life, instead of entwining about
him the vices of the world, had weaned him from the world. Without any
pretence, maintaining no connection with sect or party, living by the
rules of the eternal laws which, according to the best of his abilities,
he could read from the universe, he carried out a practical religion,
independently of any hypothesis or abstruse profession, which few
professors could approach. A child of nature, he knew no way of
recognizing the Divine influences so purely as in silent and
inexpressible admiration of those grand external phenomena which
pharisees see not, but which each moment convey to men of his character,
the direct impression of a Power all present and revealing itself for
ever.
We approach the end. In the midst of his success, when medicine most
needed him and his hand was most powerful, he stood one day in his
mental strength, and the next day fell. Death found him at his work, and
the stern enemy came on him suddenly, though not without
forewarnings.[2]
His health had long been indifferent; he had suffered from hæmatemesis
several times in the last few years, for which Dr. Budd had attended
him, and he had his own forebodings that his life was not of the
longest. In the month of December 1857 he was suddenly seized one
evening with vertigo and sickness, which compelled him to keep the
recumbent position for more than twenty-four hours. At the end of this
time he felt better, and went about his usual avocations. He had no
convulsions at this time, nor did he lose his consciousness. After this
attack, he complained on many different occasions, both to his
housekeeper and to several of his medical friends, of numbness in his
extremities. Some of these to whom he mentioned this circumstance, do
not recollect whether this symptom was greater on one side of the body
than on the other; while others distinctly state that it was referred to
the left side only. His housekeeper was certain that he never complained
of this numbness before the attack in December; and even afterwards, it
would appear to have been only an occasional symptom. For six weeks
before his final seizure he had made no mention of it. About three weeks
before his last attack, he had complained, for some days, of a severe
pain in the back of his head, which he himself considered neuralgic, and
for which he treated himself. This pain quite left him, and for about a
fortnight he had been enjoying excellent health.
On the evening of Tuesday, June the 8th, 1858, he attended a meeting of
the Royal Medical and Chirurgical Society. On the following evening
there was a meeting of a private society for the study of chest
diseases, held at Dr. Quain’s. The subject discussed was the cause of
the first sound of the heart. On this, the last occasion of the kind at
which he was present, he was in unusual spirits, and looked exceedingly
well. He entered into the debate with great earnestness, agreed to form
one of a committee to inquire into the cause of the first sound by
experiment, and left his friends with enthusiastic expression as to the
success of the proposed undertaking. We exchanged our last farewells
that night.
He went to bed at half-past eleven o’clock on June 9th, and on the
following morning he came down stairs at 8 A.M. When he came down, he
complained to his housekeeper of slight giddiness, and she thought he
did not walk very steadily. He reclined on the sofa, and said that he
should be well again in a few minutes, but that he did not think he
could eat any breakfast. Soon after, however, he got up, said he felt
very hungry, and ate a very hearty breakfast. When this was done, he
proceeded to write a portion of the manuscript of the work on
anæsthetics now published. He had written to the last printed sentence,
when his housekeeper, who had scarcely left him, heard a great noise, as
if some one had fallen. She ran up again and found her master on the
floor, making vain endeavours to regain his chair. He does not appear to
have had any convulsions, and his consciousness was unimpaired, for he
remarked when his housekeeper came into the room, that though he did not
quite understand the nature of his complaint, he was very sure he never
had had any such symptoms before. His housekeeper observed that he had
quite lost all power over his left arm and leg, and that his mouth
appeared drawn to the right side. She had him lifted on the sofa; and
here he remained for twenty-four hours before any medical assistance was
sent for. This was his own wish, as he said he should soon be better,
and that he did not wish to trouble any one. During this period he
complained much of pain over the lower end of the sternum, which he
endeavoured to relieve by frequent inhalations of sulphuric ether, but
he neither ate nor slept the whole time. At 6 A.M. on the morning of
Friday, June 11th, retching came on, and he vomited a considerable
quantity of blood. Upon this his housekeeper sent for Dr. Budd, who,
along with Dr. Murchison, continued to attend him to the last. His
symptoms, when seen by these gentlemen, were briefly as
follows:—Complete paralysis of motion over the whole of the left side of
the body, but without loss of sensibility; the left angle of the mouth
falling down, and the apex of the tongue deviating to the left; memory
and consciousness were unimpaired; there was pain and great tenderness
in the epigastrium, with urgent hiccup and hæmatemesis; there were
slight indications of albuminuria, but there were no dropsical symptoms.
The hæmatemesis ceased after about twenty-four hours, but the vomiting
and hiccup continued. By Monday, the 14th, these symptoms also had
subsided, but others of a more alarming nature began to show themselves.
The pulse and respiration became accelerated, the countenance and
extremities became livid, and there was occasional wandering delirium.
These symptoms gradually increased in severity; but he retained his
consciousness until 11 A.M. of Wednesday, June 16th, when the breathing
became stertorous, and deglutition impossible. Throughout his illness,
he had been sanguine of recovery, and expressed his belief frequently
that he should soon be at his professional work again. On this, the last
morning of his life, the fact of the danger in which he was placed was
explained. He met the intelligence with calmness, but felt a wish to see
Dr. Todd. Soon he sank into a somnolent state approaching to
dissolution, and at 3 P.M. death took him.[3]
On the Monday following, Dr. Snow was buried at the Brompton Cemetery.
It was the wish of many of his medical friends to follow him to his last
home. But his relations, recalling his own unostentatious feelings, laid
him in the grave in simple ceremony; and there, ingenuous friend, in the
sleep that knows no waking, he sleeps on and takes his rest; the rest he
has earned. The old changes of the world live after him, women mourning
for their children; youths exulting on the marriage day; the inanimate
returning to the elements; the animate returning to the infinite. But in
the gaping time shall it chance rarely, for another science-man to come
and go, who, taking him all in all, may call him “brother”!
HISTORICAL INTRODUCTION.
The most important discovery that has been made in the practice of
medicine since the introduction of vaccination, is, undoubtedly, the
power of making persons perfectly insensible to the most painful
surgical operations, by the inhalation of the vapours of ether,
chloroform, and other agents of the same kind.
In giving a brief outline of this discovery, it is necessary to inquire
into the attempts of every kind which had previously been made to
prevent severe pain; and also to notice the history of medicinal
inhalations, whether undertaken with the view of preventing pain, or of
relieving or curing disease.
The practice of taking opium and other vegetable narcotics, to relieve
pain or procure sleep, was common in the most remote periods to which
history extends; but the earliest notices which remain of any attempts
to prevent the pain of surgical operations were written at the period of
the Roman Empire. They were alluded to by Dr. Simpson at the
Medico-Chirurgical Society of Edinburgh in November, 1847.[4]
Dioscorides,[5] speaking of mandragora, says, “Some persons boil the
root in wine down to a third part, and preserve the decoction, of which
they administer a cyathus (rather more than an ounce and a half) in want
of sleep and severe pains of any part, and also before operations with
the knife or the actual cautery, that they may not be felt.” (Ante
sectiones ustionesve, ut ne sentiantur.) Further on he says: “A wine is
prepared from the bark of the root without boiling, and three pounds of
it are put into a _cadus_ (about eighteen gallons) of sweet wine, and
three cyathi of this are given to those who require to be cut or
cauterized: when being thrown into a deep sleep they do not feel any
pain.”
The same author also adds,[6] in speaking of a kind of mandragora called
morion, “They relate that a drachm of it being taken as a draught, or
eaten in a cake or other food, causes infatuation, and takes away the
use of the reason. The person sleeps without sense, in the attitude in
which he ate it, for three or four hours afterwards. Medical men also
use it when they have to resort to cutting or burning.”
In treating of mandragora, Pliny[7] remarks that the juice of the leaves
is more powerful than the preparations made from the root. He says,
“Some persons even die from a considerable draught. It has the power of
causing sleep in those who take it. The dose is half a cyathus (six
drachms). It is taken against serpents, and before cuttings and
puncturings, lest they be felt. For these purposes it is sufficient for
some persons to have sought sleep from the smell (of the medicine).”
Apuleius,[8] under the head mandragora, says, “If any one eat it he will
immediately die, unless he be treated with butter and honey, and vomit
quickly. Further, if any one is to have a limb mutilated, burnt, or
sawn, he may drink half an ounce with wine, and whilst he sleeps the
member may be cut off without any pain or sense.”
After reading the above passages from such well-known authors, it may be
asked how it was that the practice of preventing the pain of surgical
operations was entirely unknown just prior to 1846.
The reason, no doubt, was that the statement these passages contain was
looked upon as a vulgar error of the period, which had imposed on the
credulity of the authors. Dr. Woodville,[9] speaking of the use of
mandragora by the ancients, says, “They employed it principally in
continued watchings, and in those more painful and obstinate affections
which were found to resist less powerful medicines.” He gives, in a foot
note, a reference to the place in Dioscorides from which the passages
above quoted are taken, and had he believed in the performance of
operations without pain, we may conclude he would not have passed over
so important a fact in silence.
With the knowledge we at present possess, however, a different view must
be taken of the subject; and it must at least be allowed that the
statements of the ancients had some foundation in truth. This is
rendered more certain by the circumstance that atropa mandragora belongs
to the same genus as belladonna, which has a greater power in annulling
the common sensibility than any plant in present use, unless it be
aconite. The loss of reason, described by Dioscorides as caused by
mandragora, is a striking symptom of poisoning by the class of plants
(the solanaceæ) to which it belongs. It appears from some remarks of
Aretæus[10] and Cælius Aurelianus[11] that people were in the habit of
taking mandragora as an inebriating agent in the time of the ancients,
as an allied plant, the datura, is used at present by the natives of
India. This practice would lead to a correct knowledge of the quantity
which might be taken with impunity.
The mandrake is scarcely used in medicine at present, but its narcotic
properties are well established. Hoffberg[12] administered the root in
doses of three grains in some cases of gout, with the effect of
relieving the pain.
Cases of poisoning by belladonna end, with very few exceptions, in
recovery, however large the dose, and however alarming the symptoms may
be; and, taking all the above circumstances into account, it is
probable, that after ascertaining the right quantity to be administered
for the purpose, this medicine or mandragora might be used, with
considerable success, and no great danger, to prevent the pain of
operations, if chemistry had not supplied us with agents much more
convenient.
Not many ages after the Greek and Roman authors above quoted were
describing the effects of mandrake in preventing the pain of operations,
another plant, the Indian hemp, was employed for the same purpose in a
more remote part of the world. M. Stanislas Julien, in an article on
Chinese Medicine,[13] gives a notice of a work entitled “Koukin-i-tong,
or a General Collection of Ancient and Modern Medicine,” in fifty
volumes, 4to., and makes an extract from it respecting Hoa-tho, a
practitioner, who flourished under the dynasty of Wei, between 220 and
230 of our era. Respecting Hoa-tho, it is stated that—“When he found
that it was necessary to employ acupuncture, he applied it in two or
three places; he did the same with the moxa, if it was indicated by the
nature of the affection which he had to treat. But if the malady was
situated in parts on which the needle, the moxa, or liquid medicines
could not act—for example, in the bones, in the medulla of the bones, in
the stomach, or the intestines, he gave to the patient a preparation of
hemp (Ma-yo), and, at the end of some instants, he became as insensible
as if he had been drunk, or deprived of life. Then, according to the
case, he made openings and incisions, performed amputations, and removed
the cause of mischief; he then brought together the tissues with points
of suture, and applied liniments. After a certain number of days (at the
end of a month, according to the annals of the later Hân) the patient
found himself reestablished, without having experienced the slightest
pain during the operation.”
We are not informed of the way in which the hemp was administered. If
insensibility was caused so quickly, as is stated, it must have been by
inhaling the fumes of the hemp when exposed to heat, and not by taking
it into the stomach. This view of the matter is rendered more probable
by the circumstance that the ancient Scythians were in the habit of
inhaling the fumes of hemp,[14] several centuries before the time of
Hoa-tho, and also by the practice of the Hindoos at present, who inhale
the fumes of hemp from a pipe. The remark that the patient became
reestablished at the end of a certain number of days, must refer to his
recovery from the wound caused by the operation, and we are not informed
how long the state of insensibility continued.