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John Snow, the First English Anaesthetist. Part 3: A medical living and the arrival of ether

John Snow took his medical qualifications in 1838 and started to look into ways of setting out in his chosen career. The first choice was staying at Westminster Hospital, where he had been walking the wards as a student. Just at the time the position of Hospital Apothecary became vacant, and Snow was one of the strongest candidates that were applying for the position. Although his application looked hopeful almost to the last minute, Snow was eventually rejected by Westminster Hospital.

Possible location of Snow's house in London.

This could have been a blessing in disguise, as the chosen candidate took the hospital to court half a year later for underpay and a large amount of previously undisclosed work that he was expected  to do in addition to the Apothecary duties. Instead, Snow decided to join the large numbers of general practitioners trying to forge a living in the over supply of London.

His interest in research, publication, and his association with the Medical Societies of London must have influenced this decision. He therefore moved to 54 Frith Street, just around the corner from his student lodgings and opened for business. Frith Street was a 600 yard thoroughfare in Soho with about 540 inhabitants, with an average 9 people per building, who were supplied with  at least 4 general practitioners according to the 1831 and 1841 censuses. Generating income was not easy under these circumstances.

Midwifery had been an interest of Snow since his days in Newcastle, and it  was one of the foci of his new practice. Additionally, he signed up with friendship schemes and benevolent societies. These were basically medical insurances for the working poor. Members paid 1 penny a week into the schemes, and the societies would pay an annual lump sum to a practitioner, who was then treating the members and their families in need.

Even though these lump sums were relatively small and would not cover the actual work involve, they provided Snow with a basic income and enough time to pursue his research interests. 

The main procedures for General Practitioners were taking care of all kinds of injuries and accidents. His household was frugal, but he managed for a period of time until he finally found his niche in medicine.

During this time, Snow strengthened his links with the Westminster Medical Society (WMS), although his loyalty was not exclusive. He also published in the Lancet and by 1843, he was elected Fellow to the Royal Medical and Chirurgical Society. He only delivered a few papers to the latter medically conservative group compared to the WMS.

His publications for the WMS were structured like lectures. He identified a clinical or general health problem, which he followed up in the contemporary literature, before laying out his own theories and solutions. His publications were on a wide variety of subjects including chemistry, anatomy, and physiology as well as pathology approaches. He was also in the habit of writing regular letters to the editors about various subjects since his student days.

All this research was laying the basis for what was to come in 1846, when the advent of anaesthesia finally provided him not only with a new field in which he excelled at, but also with a secure income. Furthermore, he was able to go back to all his experience, which he had gathered from previous research, to analyse its possibilities and dangers. Boston, 16 October 1846, was the place and date that changed medicine and surgery forever.

Two illustrations of ether apparatus with text below. 1847. London, Wellcome Library.

News of Morton’s first successful demonstration of ether in surgery had finally arrived in London on 18 December 1846. Dentist James Robinson used it successfully in Dr Booth’s practice for the extraction of a tooth the following day. And only 2 days after that, surgeon Robert Liston used the new substance in surgery on his patient Frederick Churchill, a footman. An inhaler had been devised for him by Peter Squire, Apothecary to the Queen, and was operated by William Squire, Peter’s nephew and medical student, who was also Liston's assistant.

This was an exciting development which meant that the biggest drawbacks to surgery, pain and consciousness of the patient, had finally been conquered. Re-posts and letters in various medical publications, as well as the London Illustrated Gazette, quickly spread the word and a race in surgery started to produce a large variety of options and devices to deliver the vapour.

On the 28 of December, John Snow, attended a dental operation performed by Robinson and he was able to see with his own eyes the potential of ether. But whereas other medical men took the opportunity to get ether as quickly into their practice as possible by adapting new vaporisers, Snow followed a different approach.

Building on his almost 10 years of experience and dedication to medical science, he quickly set up a number of experiments. For these he used a variety of small animals he kept in his lodgings to expose them to different quantities of ether and temperatures in order to determine its effects. 

He had a strong interest in respiration and asphyxia, subjects he had started to research in the previous years on a different background. His results were presented in the weekly meetings of the WMS during the first weeks of 1847.

By the 18 of January 1847, Snow had set out a preliminary table establishing the strength of ether vapour depending on temperature. The following week, he displayed an apparatus he had designed to control temperature of ether vapour and this Apparatus was the one he used during his first administration of ether at St. George’s Hospital 5 days after that.

His dream of leading a medical life and doing clinical research in London had become true. His tireless research made him the first true anaesthetist, even before the term came into practice.


References

Richardson, Benjamin 1858. “The Life of John Snow”. In: J Snow, On Chloroform and other Anaesthetics. London: Churchill.

Vinten-Johansen, Peter, et al. 2003. Cholera, Chloroform, and the Science of Medicine: A Life of John Snow. Oxford: Oxford University Press.

Zuck, D. 2008. “John Snow’s London.” Proceedings of the History of Anaesthesia Society 39: 109-127.


To cite this post : Iris Millis, “John Snow, the first English anaesthetist. Part 3 –A medical living and the arrival of ether”, Museum Highlights (blog on oldoperatingtheatre.com), January 8th, 2017. [On line] http://oldoperatingtheatre.com...


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Iris Millis is currently a museum officer at the Old Operating Theatre Museum and Herb Garret. She has previously worked for the Anaesthesia Museum and Bodyworlds. She is member of the History of Anaesthesia Society and the John Snow Society. Follow her on Twitter, @historical_iris.

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