John Snow, the First English Anaesthetist, Part 5 – Anaesthetist to Queen Victoria

Chloroform delivered on a handkerchief

In the 1850s, with John Snow’s contributions to the science behind Anaesthesia, his fame in the London medical circle was growing. He had become a Licentiate of the Royal College of Physicians, the penultimate stage of recognition at the time. The highest would have been to become a Fellow, but his studies at the University of London prevented him from this. Furthermore, it is unclear if he even actively aspired to reach this higher status.

He also became president of 2 other Medical Societies, but all of this did not allow him entrance into fashionable society. As his case books show after 1850, the patients that engaged his services as an anaesthetist came more and more from the upper classes, but not so much as a GP, since he never became their physician as well. In the end, this would have made little difference to him, as he was occupied almost exclusively with anaesthesia at that time.

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John Snow.

Ever since James Young Simpson had introduced chloroform during labour, two of Snow’s main interests were combined. With his long interest in midwifery, which went back to his Newcastle days, this new procedure added a new perspective to it. As he put it in ‘On Chloroform…’:

“With regard to the cases of labour in which the pain is not greater than the patient is willing to bear cheerfully, there is no occasion to the use chloroform; but when the patient is anxious to be spared pain, I can see no valid objection to the use of this agent, even in the most favourable cases…  and the patient may be fairly allowed to have a voice in this, as in other matters of detail which do not involve the chief results of the case.”

Simpson administered chloroform quite liberally and preferred to keep mothers completely unconscious during delivery. Snow on the other hand shared the opinion with a number of other colleagues, that light ether or chloroform should be used for dental procedures, while a heavy dose was reserved for surgery. Therefore, he preferred to use it  in smaller quantity for pain relief to ensure that the contractions were not diminished by the agent. Heavy anaesthesia was not used, unless the delivery necessitated surgical intervention.

1855 Queen Victoria watercolor by Franz Xavier Winterhalter (Royal collection).
Queen Victoria watercolor by Franz Xavier Winterhalter, 1855. London, Royal Collection.

For this reason, Snow preferred to use his inhaler for the delivery of the chloroform, which allowed him to control the procedure and the patient could retain a certain amount of autonomy. Failing  this, he would resort to using a handkerchief. Snow’s use of light chloroform in childbirth soon became a well known fact, especially with the younger wives of the respectable classes. The Queen herself had considered chloroform as early as 1848 for her 6th pregnancy, but was advised against it by the Royal Physician, Sir James Clark. Clark was a big skeptic and refused to use chloroform.

It can be assumed that a general resistance to chloroform was still strong in the Queen’s medical team five years after she first considered its use. There had been a bulletin in the early 1853 that Professor James Young Simpson was expected to travel from Edinburgh to London within the month to attend to the Queen’s delivery. But following on from this it was John Snow eventually who was to administer the chloroform during Prince Leopold’s birth.

John Snow’s note of the events on Thursday, 7 April 1853 are recorded as follows:

“Administered Chloroform to the Queen in her confinement. Slight pains had been experienced since Sunday. Dr. Locock was sent for about nine o’clock this morning, stronger pains having commenced […]. I received a note from Sir James Clark a little after ten asking me to go to the Palace. […]at twenty minutes past twelve by a clock in the Queen’s apartment I commenced to give a little chloroform with each pain, by pouring about 15 minims (0.9ml) by measure on a folded handkerchief. […] The effect of the chloroform was not at any time carried to the extend of quite removing consciousness. Dr. Locock thought that the chloroform prolonged the intervals between the pains, and retarded the labour somewhat. The infant was born at 13 ,inured past one by the clock in the room. […] The Queen appeared very cheerful and well, expressing herself much gratified with the effect of the chloroform.”

Snow’s appointment was most likely initiated by Prince Albert, who was seeking out what was known as ‘Snow’s option for his wife. In the press afterwards, there was no note of the chloroform the Queen had received. In the Court Circular in the Times on 8 April, Snow’s name is mentioned together with the other doctors present. The first time an exhibition of chloroform during the birth is mentioned is in a leading article of the Association Medical Journal later that year. This article was based on a letter to Simpson by Clarke, in which he mentioned the chloroform that was given to the Queen.

The Lancet, not having this information, defended the position that the Queen could not have been exposed to chloroform and treated this as a mere rumour. Clarke, when approached, confirmed that the Queen had not been exposed to chloroform and lost consciousness, the way he had expressed it to Simpson. He therefore was able to keep face until the Medical Gazette  published the fact that Snow had administered the chloroform on a handkerchief. The Times informed its readers 6 years after the event took place after the death of John Snow.

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Queen Victoria and Prince Albert with their children.

It is widely assumed nowadays, that the fact that chloroform was used on Queen Victoria helped popularised its use in general. But this unfortunately is not the case. In fact, the slow uptake of anaesthesia had been caused by the eminent medical councils of the day. Doctors who opposed the use of chloroform continued to do so even after the news of the Queen’s delivery were published.

A repeat of Snow’s efforts followed in early April 1857. He was asked to return to the palace on Tuesday 14 April as the Queen had enter into labour at 2 am in the morning and by the time he arrived, Prince Albert had already administered minute quantities of chloroform on a handkerchief himself. Snow took over from 11 am and the Queen again expressed a ‘great relief from the vapour’ until Princess Beatrice was born.

After these excursions into the highest ranks of society, there was still no change in the nature of John Snow’s patients. He would assist other surgeons and administer chloroform, but he was never to become physician to the upper classes. Instead he got involved in public health and consequently Cholera, at the same time that he was working as an anaesthetist.

To be continued…


Further Reading

Connor, H. and T. 1996. “Did the use of chloroform by Queen Victoria influence its acceptance in obstetric practice?” Anaesthesia 51: 955-957.

Ellis, Richard H. ed. 1994. The Casebooks of Dr. John Snow. London: Wellcome Institute for the History of Medicine.

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

 


To cite this post : Iris Millis, “John Snow, the first English Anaesthetist. Part 5-Anaesthetist to Queen Victoria”, Museum Highlights (blog on oldoperatingtheatre.com), March 14th, 2017. [On line] http://oldoperatingtheatre.com/john-snow-the-first-english-anaesthetist-part-5-anaesthetist-to-Queen-Victoria/


IMG_1033Iris 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.