John Snow
Although William T. G. Morton directed his energy to anesthesia
after 1846, he also pursued patent claims and remuneration more often than administration
of anesthesia.[482]
Most historians therefore suggest
that John Snow ( Fig. 1-21
)
was the first full-time anesthesiologist. He promoted anesthesiology as a subject
of scientific inquiry and through his own example established it as a worthy profession.
John Snow was born in York, England on June 15, 1813, the oldest
child in a farming family. His early years
Figure 1-21
John Snow is considered by many to be the first full-time
anesthesiologist. His scientific and professional career became a model for future
practitioners. (Courtesy of the National Library of Medicine, Bethesda,
MD.)
were spent in attendance at a private school in York and working on the family farm.
At the age of 14, he became an apprentice to William Hardcastle, a surgeon in Newcastle.
Four years later, a cholera epidemic erupted in Newcastle, and while attending those
afflicted with this disease, Snow made several observations that proved to be valuable
in later years. At 23 years of age, he began the formal study of medicine at the
Hunterian School of Medicine in London. This was a short course, and only 1 year
later, he passed his examinations and was entered as a member of the Royal College
of Surgeons of England.
Benjamin Ward Richardson, who was intimate with Dr. Snow and who
wrote a short biography, characterized him as an individual who sought "only the
truth, the naked truth for its own sake without consideration of honor or profit."
Snow's initial attempts to establish a private general practice were thwarted by
his inability to attract paying patients. He would not engage in the common practice
of writing prescriptions for neurotic patients. Consequently, his time was spent
volunteering at the Charing Cross Hospital and in scientific pursuits and reading.
In 1841, at the age of 30, he read his first paper, "Asphyxia and on the Resuscitation
of Newborn Children," before the Medical Society of London. This first paper describes
positive-pressure ventilation for resuscitation of the depressed newborn and indicates
his penchant for matters relating to anesthesia. This interest took firm control
of his life after the news from America arrived in London that operations could be
performed without pain after the inhalation of sulfuric ether.
Snow took up the exclusive practice of ether administration and
within 1 year had written the first of his two landmark books on inhalation anesthesia.
When Dr. James Simpson introduced chloroform in October 1847, Snow enthusiastically
embraced the new agent. His chloroform inhaler was superior to prior devices in
that it used valves to prevent rebreathing. He classified the stages of anesthesia
and studied the effect of ether[355]
and chloroform
on animals and humans to learn the concentrations required for anesthesia at various
stages. The precision and detail with which this work was performed was not to be
accomplished again for nearly 100 years, when the vapor pressures of inhalation anesthetics
necessary for anesthesia were determined. His contemporaries recognized his clinical
skills to be of the highest caliber, and he was recommended to provide anesthesia
for the delivery of two of Queen Victoria's children. Snow delivered chloroform
in 1853 for the birth of Prince Leopold and in 1857 for the birth of Princess Beatrice.
In 1854, a rampant cholera epidemic broke out in the Charing Cross
district, and Snow used his prior experience with the disease to analyze the causative
factors involved in transmission. His advice to remove the handle of the Broadstreet
water pump because of suspected transmission through the water supply was carried
out, and the epidemic subsided. His theories on transmission of cholera were published
at his own expense in the London Medical Gazette.
His last treatise, On Chloroform and Other Anesthetics,
[446]
was in its final stages of completion when
he died of kidney disease complicated by a stroke on June 14, 1858, at the age of
45.
