Chapter II: Preface (2)

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.”

As an author, his style was plain, clear, and smoothly elegant. His 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.

The next notice of any attempt to prevent the pain of operations, that I am aware of, occurs in the work on Surgery of Theodoric, an author who lived in Italy in the latter half of the thirteenth century. He writes as follows:[15] “The making of a flavour for performing surgical operations according to Dominus Hugo. It is thus made:—take of opium, of the juice of the unripe mulberry, of hyoscyamus, of the juice of hemlock, of the juice of the leaves of mandragora, of the juice of the woody ivy, of the juice of the forest mulberry, of the seeds of lettuce, of the seeds of the dock, which has large round apples, and of the water hemlock [cicuta]—each an ounce; mix all these in a brazen vessel, and then place in it a new sponge; let the whole boil, as long as the sun lasts on the dog days, until the sponge consumes it all, and it is boiled away in it (the sponge). As oft as there shall be need of it, place this sponge in hot water for an hour, and let it be applied to the nostrils of him who is to be operated on, until he has fallen asleep; and so let the surgery be performed. This being finished, in order to awaken him, apply another sponge, dipped in vinegar, frequently to the nose, or throw the juice of the root of fenugrek into the nostrils; shortly he awakes.”

I altogether disbelieve that a sponge, prepared as above, would, after being placed in hot water, give off any odour or vapour which would cause insensibility. The active ingredients, as they exist in the various plants, are not sufficiently volatile to be given off at a heat below that of boiling water. Hemlock, indeed, contains a volatile principle, which can be liberated by an alkali; but, even if it were set free by any chance during the preparation of the sponge, it would all be dissipated by the long boiling.

If sleep were really caused in this way, it must have been by some of the moisture from the sponge reaching the mouth or throat, and being swallowed; and it may be remarked that the author speaks of the preparation of a taste or flavour (confectio saporis), rather than an odour, although the sponge is certainly directed to be applied to the nostrils. It must be remarked, also, that if the patient were made so insensible, as not to feel the surgeon’s knife, he would be little affected by vinegar, or the juice of fenugrek, in his nostrils.

Immediately after the prescription quoted above, and in the same paragraph with it, Theodoric gives another recipe from Master Hugo, directing antimony, quicksilver, soap, quick lime, and a little arsenic, to be sublimed together. A portion of the resulting compound, the size of a nut, is directed to be placed over a hernia, or whatever else is to be operated on. Then follows a rather lengthy direction for subliming arsenic, also from Dominus Hugo. The arsenic so sublimed is described as rendering surgical operations extremely pleasant. The words are—“hæc acus fiat mitis et suavis: sicut sudor beatæ virginis quum peperit Christum.”

I have applied arsenic to the skin for twenty-four hours, with no other effect than irritation, and an eruption of pimples, the sensibility of the part being increased; and in my opinion, arsenic would not cause insensibility, unless it were applied so long that the inflammation caused by it should end in gangrene. I consider that the statement of Theodoric, respecting arsenic, strengthens the doubts I have expressed concerning his spongia somnifera. There is another reason for disputing the efficiency of the above mentioned recipes. Theodoric directs the patients about to undergo operations to be tied, or held by strong men. In the operation for hernia, for instance, he directs the patient to be tied to the bench, or table, with three bands, one round the ankles, another round the thighs, and a third across the chest, holding the arms and hands. This circumstance is the more significant, since Theodoric had lived some time with Hugo, and seen his practice, as he states in the dedication to his work.

It is reasonable also to conclude that if any successful plan of preventing the pain of surgical operations had been introduced after the revival of literature, it would not have fallen into disuse and been forgotten.

In an interesting paper by Dr. Silvester,[16] an anecdote is quoted, with an intention to show that anæsthetics were commonly had recourse to in severe operations as late as the end of the seventeenth century. The quotation is from a German work by A. G. Meissner, called _Skizzen_, or Sketches, and published at Carlsruhe in 1782. It is as follows:—

“Augustus, King of Poland and Elector of Saxony, suffered from a wound in his foot, which threatened to mortify. The court medical men were opposed to the operation of amputation; but during sleep, induced by a certain potion surreptitiously administered, his favourite surgeon, Weiss, a pupil of Petit, of Paris, cut off the decaying parts. The royal patient was disturbed by the proceeding, and inquired what was being done, but on receiving a soothing answer he again fell asleep, and did not discover till the following morning, after his usual examination, that the operation of amputation had really been performed.”

It is most probable that the potion surreptitiously administered in this case, was an ordinary sleeping draught, and that only the “decaying parts” were cut off, as in fact is stated. The decaying parts of course would be without feeling.

The mind of surgeons seems now and then to have turned spontaneously towards preventing or alleviating the pain of operations, and certain attempts and suggestions were made with this object during the later part of the last century, in apparent ignorance of what had been done by the ancients in this direction.

Ambroise Tranquille Sassard, principal surgeon of the Hospital la Charité at Paris, recommended the employment of a narcotic previous to serious and painful operations, the dose to be proportioned to the age and strength of the patient.[17] He does not state whether the plan was actually tried.

Mr. James Moore, surgeon,[18] recommended compression of the large nerves, and tried it on a patient in St. George’s Hospital, whose leg Mr. John Hunter amputated below the knee. The crural and sciatic nerves were compressed for nearly an hour by an instrument contrived for the purpose, and Mr. Moore considered that the greater part of the pain was prevented. The patient complained more of the sawing of the bone than of the cutting part of the operation. I am not aware whether this plan was tried in other instances, but it is certain that it did not come into general use.

M. le docteur Liégard (de Caen) has stated,[19] that the peasants in his part of France are in the habit of tying a band very tightly round the arm or leg before operations on the extremities. He had himself removed a toe-nail in two cases, without pain, after a handkerchief had been tied very tightly round the lower part of the leg. By this measure both the nerves and blood vessels are, of course, more or less compressed.

The persons who believe in the existence of a force or power, which they call Mesmerism, or animal magnetism, made many and persevering efforts in recent times to cause insensibility to the surgeon’s knife. In some cases they were imposed on by dishonest and designing patients, who afterwards confessed they had suffered the pain to which they had pretended to be insensible, but in other cases I have no doubt of the operations having really been performed without pain. Absence of consciousness and sensation is a common symptom in many cases of hysteria and catalepsy, and in certain susceptible persons, hysteria and catalepsy, or conditions nearly resembling them, can be induced by acting on the imagination, or by exhausting the attention by means of the fixed stare and monotonous “passes” of the so-called Mesmerisers.

Dr. Esdaile was more successful in putting Hindoos to sleep, and operating on them in the hypnotized[20] state, than any one has been with Europeans: yet it was only in a portion of the cases in which it was tried that the alleged agent took effect. In many instances, efforts continued for two or three months had no effect on the patient; and in many of the operations, which were reported as successful, “there was much convulsive movement of the limbs, corrugation of the brows, and even loud cries and sobs,” although the patients afterwards denied all knowledge of what had passed.[21]

The discovery of the means of preventing pain, which will occupy the greater number of the following pages, did not arise out of any of the attempts either in ancient or modern times above enumerated. It sprung directly from the practice of inhaling chemical and medicinal substances.