Part 3

The Medical Society of London, reformed under that name in 1849–50, by amalgamation with the Westminster Medical, was at this time the principal scene of Dr. Snow’s scientific exertions. In 1852, the Society elected him as Orator for the ensuing year; and at the eightieth anniversary of the Society, held on March the 8th, at the Thatched House Tavern, he delivered an admirable oration on “Continuous Molecular Changes, more particularly in their Relation to Epidemic Diseases.” He made no claim to the orator’s gown; but the address was too forcible and first class not to call forth the enthusiasm of the audience. It was admirably received; and few of us who were present on that interesting occasion will forget the simple and genuine earnestness of our beloved associate, as in the twinkling twilight he carried us along with the smooth current of his thoughts. He spent nearly twelve months in the preparation of this oration. It was intended to convey, in the most pleasing manner at his command, a broad view of his observations on the communication of certain spreading diseases. He advanced, on this occasion, the idea that intermittent fever, and perhaps yellow fever, are, like cholera, carried by their poisons direct into the alimentary system.

Two years after this event, having, meantime, passed the office of vice-president, the Society elected him to the highest honour it can confer,—to the presidential chair. He took his place as President, in his unassuming manner, on March 10th, 1855, delivering a short but pleasing address. Throughout the year he carried out the duties of his office with great success. One of his presidential acts was peculiarly graceful. One evening, while presiding, Dr. Clutterbuck (then the father, or oldest member of the Society) came into the meeting. The venerable and distinguished old man, then long past his eightieth year, had lately been a stranger to the assembly, and was known but to few of the members. The President, as Dr. Clutterbuck entered the room, himself rose, and in a way that was irresistible in its simple courtesy resigned his chair to the veteran Esculapian. “It is near fifty years,” said Dr. Clutterbuck with emotion, as he took the proffered seat, “since I last occupied this honourable position.” At the next anniversary meeting, held on March the 8th, 1856, Dr. Clutterbuck came to his last meeting, and to see (so the fates willed it) his friend the President play also his last part in presidential duties. At the anniversary dinner on that same day, the President reviewed, in feeling terms, his own career in the professional strife, and expressed that his success in life had originated in his acquaintance with the Society over which he then governed by the general will.

In addition to the fellowship of the Medical Society, Dr. Snow belonged to the Royal Medical and Chirurgical, Pathological, and Epidemiological societies. He was also a member of the British Medical Association. The Medical Society, from its old associations, was, however, that in which he took the most active part. Next to this, the Epidemiological Society claimed his regard. When Mr. Tucker first contemplated the formation of the Epidemiological Society, Dr. Snow was one of the first with whom he held consultation, and from whom he received that able support which enabled him to found that excellent institution. From the first of the Society, Dr. Snow was an active member. He was on many of its committees; he was a member of council, and a frequent contributor to its Transactions. He used often to meet with opponents to his peculiar opinions at the meetings of this Society, but he always retained friendships.

The position which he took as an epidemiologist was original, and in opposition to the views of many eminent men who had in the matters relating to public health considerable influence, scientific and political. He could not consequently, and did not, expect to go on his way unopposed. But he did sometimes expect a more deliberate and considerate attention to his hard wrought labours than he received or deserved. He used constantly, though no great professor of Shakespearian lore, to deplore the long admitted fact, that nothing so inevitably tends to transform an earnest inquiring and enthusiastic man, into a supercilious, superficial, and cold-hearted egotist, as translation from the stool of self-reliance and independence, into the gilded chair of office and brief authority.

It must be admitted that Dr. Snow’s views on the spread of epidemics were extreme in character; but from the slight which they too hastily received, they were not, I believe, properly understood. It has often been said that he encouraged by his arguments the perpetuation of certain offensive arts and occupations which are injurious to the public health; and in 1855, several journalists commented on him severely for this supposed error. But the fact is, he never presumed that any man could breathe with impunity other gaseous mixture than oxygen and nitrogen in atmospheric proportion. He knew too well the effect of inhaling chemical substances to allow of such supposition to enter his mind. But he contended, in regard to pure epidemic disorders, distinguished by specific symptoms, that these have a specific poison, which is propagated by certain fixed laws, which attains its progression and increase in and through animal bodies; which is communicated from one animal body to another, and which is the same in its essence from first to last. This was his position, and he adhered to it. No mere emanation arising from evolution of foul smelling gas can, per se, according to his views, originate a specific disease, such as small-pox or scarlet-fever; as well expect that the evolution of such gas should plant a plain with oaks or a garden with crocuses. True, small-pox may occur over a cesspool as an oak may spring up from a manure heap; but the small-pox would never appear over the cesspool in the absence of its specific poison; nor the oak rise from the manure heap in the absence of the acorn which seeded it.

In 1855, Dr. Snow gave evidence before the select committee on the “Public Health and Nuisances Removal Bill,” in which evidence he strove to convey the impressions which are condensed above. Feeling that he had not been correctly understood, he afterwards wrote a letter to Sir Benjamin Hall, in which he set forth the whole of his argument very distinctly and sensibly. He indicated in this letter that he was no defender of nuisances, but that whereas a bad smell cannot simply because it is a bad smell give rise to specific disease, so an offensive business conducted in a place where it ought not be should be proceeded against by ordinary law as a nuisance, without using in regard to it the word pestiferous, or otherwise dragging in and distorting the science of medicine. As time rolls on, it will probably be elicited that the groundwork of Dr. Snow’s theory is sound. That if he committed error, it was in adhering too closely to the abstract fact, and in not allowing sufficient importance to the favouring influence of impure conditions in the propagation and distribution of the specific poisons of the specific diseases.

At all events, the view he had maintained originally, he maintained to the end, and throughout conscientiously; and the aspersions that the object of his argument was to support his special theory regarding the communication of cholera, are utterly unfounded. In the present year, 1858, he read at the Epidemiological Society, and published in the Medical Times and Gazette, a repetition of his previous opinions, strengthening them by a statistical record, showing that the mortality of persons working at so-called offensive occupations is at certain ages lower, and at certain ages slightly higher, than in the general population. When the paper was read at the Epidemiological Society, Mr. Edwin Chadwick made a long series of objections to the paper, and complained that the argument was illogical. It was so, doubtless, on Mr. Chadwick’s premises; but on the premises advanced by Dr. Snow, as to the specific propagation of specific diseases by specific poisons, physiological problems on which, from his experimental researches and knowledge, he was far the best authority, his arguments were perfectly logical, and perfectly consistent.

In relation to public health, Dr. Snow contributed many other observations. In the first number of the Sanitary Review, he communicated a valuable paper, previously read at the Epidemiological Society, on the “Comparative Mortality of Town and Rural Districts”; and, previous to his decease, he was busily occupied in investigating the question of adulteration of bread with alum. He made several analyses of different specimens of bread, but his papers merely leave a brief record of the fact, without any comments or results.

We return for a few moments to some further points connected with his researches on inhalation. In addition to his experiments with volatile narcotics, he carried out for a long time a series of inquiries with other medicinal substances, and administered many remedies by inhalation at the Brompton Hospital, during a period of twenty months. In 1851, he recorded the result of this experience at the Medical Society of London, and explained the modes of administering various agents. Some, as morphia and stramonium, were inhaled with the aid of heat; others, as hydrocyanic acid and conia, were inhaled at the ordinary temperature. The particulars of these experiments will be found in a short paper in the London Journal of Medicine for January 1851.

He continued steadily to investigate the effects of various volatile agents for the production of insensibility, and arrived by frequent experiment to such a degree of positive knowledge regarding agents of this class, that the composition and boiling point of any new chemical body having been supplied, he could predict whether or not its vapour would produce narcotism by inhalation. Other than the volatile narcotics referred to in his present essay, he performed a variety of experiments with carbonic acid, carbonic oxide, cyanogen, hydrocyanic acid, Dutch liquid, ammonia, nitrogen, amylovinic ether, puff-ball smoke, allyle, cyanide of ethyle, chloride of amyle, a carbo-hydrogen from Rangoon tar, a carbo-hydrogen coming over with amylene, and various combinations of these. His grand search was for a narcotic vapour which, having the physical properties and practicability of chloroform, should, in its physiological effects, resemble ether in not producing, by any accident of administration, paralysis of the heart. The fact that in almost every fatal case from chloroform the result had occurred from the action of the narcotic on the central organ of the circulation, was never absent from his thoughts. An agent having this effect, however intrinsically valuable, was not to be put in the hands of every person for administration. “There would be a great uproar,” he remarked on one occasion, “if a student were to undertake on the operating table to tie the femoral artery, and were to open the femoral vein. Yet at some of our hospitals, the administration of chloroform has been entrusted to the porter, who would only grin in ignorance, if informed that each time his services were required, he performed the grand act of suspending for a time the oxidation of the whole body, and of inducing a temporary death; and who would tell you, if you asked him the composition of chloroform, that it was smelling stuff.” He spoke this from no selfish feeling, but with that kind of regret which an educated engineer would feel, on referring to the fact of a railway porter who, knowing nothing of steam, how to put it on, when to take it off, or why it propelled, had mounted an engine and driven a host of confiding passengers to their destruction. This is the way in which he expressed himself, and it would be difficult to show that he was not correct.

Intent on the discovery of some new anæsthetic, which might be more safely entrusted to general use, Dr. Snow began, in 1856, to experiment with amylene. As usual, he went to work cautiously and with precision. First he ascertained the boiling point of the specimen supplied to him; then the point of saturation of air with the vapour at different temperatures; then the effects of inhalation of the vapour by inferior animals, and the quantity required to be inspired, with the air breathed, to produce insensibility. These were the usual steps in all his inquiries of this kind. When he had obtained any substance which would produce insensibility favourably on animals, he pushed it, in one or two experiments, to its extreme in animals of different kinds; and having produced death by the inhalation, both by giving rapidly a large dose, and by giving a small dose for a long period, he observed the mode of death, whether it occurred by cessation of the heart, or by cessation of the respiration primarily. If the agent seemed to promise favourably from these inquiries, he commenced to try it on man; and the first man was invariably his own self. His friends, knowing his unflinching courage in the ardour of his inquiries, often expostulated with him in regard to the risks he ran. It was of no avail. He felt the personal trial a duty, and he did it. I do not believe, as some have supposed, that these personal experiments had any effect in producing his early death; but it is certain that he underwent many risks in the performance of his investigations, and that he held his own life of least consideration when the lives or well-being of others were under consideration.

There is yet another trait in his character which I cannot but notice, and which I would respectfully commend to all physiological inquirers. While he held it as a necessity to use inferior animals for the purpose of experiment, he never touched living thing with the physiologist’s finger without having before him some definite object; and never performed experiment on any animal without providing with scrupulous care against the infliction of all unnecessary suffering. The interests of humanity were, according to his rule, best advanced by the practice of a humanity that was universal.

He paid considerable attention to the subject of local anæsthesia, and tried numerous methods for attaining to a knowledge of a perfect local anæsthetic. He performed experiments with freezing mixtures, with chloroform; and for the production of rapid and efficient benumbing by cold, he tried, in 1854, the effects of applying solid carbonic acid to the skin. At one of the meetings of the Medical Society, he reported at length the results he had arrived at; but he was never satisfied with them, and soon relinquished the inquiry, in order to concentrate his energies on the discovery of what he felt sure must be discovered ultimately,—an anæsthetic which might be inhaled with absolute safety, and which would destroy common sensation without destroying consciousness.

To some extent he succeeded in this latter direction, in his discovery of the physiological effects of amylene; and for some time he was sanguine as to the great safety of the new agent. But the deaths which he has so faithfully recorded as occurring in his own hands from amylene, removed his expectations, and he discontinued its use as soon as he learned the risks which might follow its administration.

By his earnest labours Dr. Snow soon acquired a professional reputation, in relation to his knowledge of the action of anæsthetics, which spread far and wide; and the people, through the profession, looked up to him from all ranks, as the guide to whom to entrust themselves in “Lethe’s walk”. On April the 7th, 1853, he administered chloroform to Her Majesty at the birth of the Prince Leopold. A note in his diary records the event. The inhalation lasted fifty-three minutes. The chloroform was given on a handkerchief, in fifteen minim doses; and the Queen expressed herself as greatly relieved by the administration. He had previously been consulted on the occasion of the birth of Prince Arthur, in 1850, but had not been called in to render his services. Previous to the birth of Prince Leopold, he had been honoured with an interview with His Royal Highness the Prince Albert, and returned much overjoyed with the Prince’s kindness and great intelligence on the scientific points which had formed the subject of their conversation. On April 14th, 1857, another note in the diary records the fact of the second administration of chloroform to Her Majesty, at the birth of the Princess Beatrice. The chloroform again exerted its beneficent influence; and Her Majesty once more expressed herself as much satisfied with the result.

Inquisitive folk often overburthened Snow, after these events, with a multitude of questions of an unmeaning kind. He answered them all with goodnatured reserve. “Her Majesty is a model patient,” was his usual reply: a reply which, he once told me, seemed to answer every purpose, and was very true. One lady of an inquiring mind, to whom he was administering chloroform, got very loquacious during the period of excitement, and declared she would inhale no more of the vapour unless she were told what the Queen said, word for word, when she was taking it. Her Majesty, replied the dry doctor, asked no questions until she had breathed very much longer than you have; and if you will only go on in loyal imitation, I will tell you everything. The patient could not but follow the example held out to her. In a few seconds she forget all about Queen, Lords, and Commons; and when the time came for a renewal of hostilities, found that her clever witness had gone home to his dinner, leaving her with the thirst for knowledge still on her tongue.

From the literary and general history of Dr. Snow, let us turn for a few pages to his history personal. I will take the mean of the last eight years of his life,—the period in which I knew him,—as the period from which to draw particulars. He was of middle size, and, some years since, slender; but of late he had become of slightly fuller build. His long life in comparative student loneliness had made him reserved in manner to strangers; but with private friends he was always open, and of sweet companionship. With his increased popularity he became less reserved to strangers; and within the last few years he so far threw off restraint as to visit the opera occasionally. But he moderated every enjoyment, and let nothing personal stand in the way of his scientific pursuits. He was the impersonation of order. He had his time and place for everything; he kept a diary, in which he recorded the particulars of every case in which he administered chloroform or other anæsthetic, with comments on the results of the administration, and hints as to dangers avoided or chanced. He kept a record of all his experiments, and short notes of observations made by his friends. He rose early, and retired early to rest,—at eleven o’clock. He seemed, whenever he was waited on, as though he had nothing in hand, and were always open to an engagement.

Anything and everything of scientific interest arrested his attention, and his kindliness of heart was at all times in the foreground. When I was living at Mortlake, he would run down, on request, after his day’s duties were over, to a post-mortem, to see a poor patient, or to take part in an experiment, returning as cheerily as though he had been to receive the heaviest fee. I name this as but one example of his kindly nature; there are many who could corroborate the example in like personal manner.

He laid no claim to eloquence, nor had he that gift. A peculiar huskiness of voice, indeed, rendered first hearings from him painful; but this was soon felt less on acquaintance, and the ear once accustomed to the peculiarity, the mind was quickly interested in the matter of his discourse, for he always spoke earnestly, clearly, and to the point. In the societies he spoke very often, and gave expression to views, on which he had spent great thought, with a generous freedom which, in so far as the fame of his originality was concerned, had been better held in reserve. It had been better, that is to say, for him to have carefully elaborated some of his views in the closet, and published them fully, than to have sent them forth in the hurry of debate. Had he lived, he would possibly have collected many stray labours thus put forward, and have given to them the matured consideration which they deserved. One of his views, on which he would have bestowed great attention, refers to the origin of various morbid growths, as cancer. He believed that these morbid formations are all of local origin; that they arise in the parts of the body where they are found, from some perversion of nutrition; and that the constitutional effects are secondary to and dependent on the local disorder. He had made many observations on this important subject, notices of which are to be found scattered, here and there, in the proceedings of the Medical Society of London, but no connected record was ever completed.

His private conversation was both instructive and amusing; he was full of humorous anecdotes, which he told in a quiet, and irresistibly droll style; and when he laughed, his goodnatured face laughed in every feature. 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.