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.