Source: New England Journal of Medicine 350 (1), 90-91, 2004. 

BOOK REVIEW

Cholera, Chloroform, and the Science of Medicine: A Life of John Snow

By Peter Vinten-Johansen, Howard Brody, Nigel Paneth, Stephen Rachman, and Michael Rip, with the assistance of David Zuck. 437 pp., illustrated. New York, Oxford University Press, 2003, ISBN: 0-19-513544-X

John Snow has long been revered, most notably by anesthetists and public health workers, for the pioneering medical work he did in the 19th century. But the majority of writings about Snow (who was my husband's great great uncle) have focused on either anesthesia or public health. As a result, he has been regarded perhaps as a somewhat quixotic figure, well known in parallel but unconnected fields. This book, however, provides a synthesis of Snow, a holistic account of a mid-19th-century medical doctor whose primary aim was to use the science of his day to improve the medical understanding of disease and the clinical treatment of ill health.

Portrait of John Snow (1813–1858)

by Thomas Barker, 1847.

The team from Michigan State University that researched the book made the sensible decision to have one writer at the helm. The narrative is consistent and flowing, much of it told through Snow's own words. It follows Snow's life chronologically, from his early years as the eldest son of a working-class family in York, England, to a medical apprenticeship in Newcastle upon Tyne to student days in London. While he was a student at the Hunterian School of Medicine on Great Windmill Street, in the Soho area of London, Snow was taught the very latest techniques of the new "hospital" medicine. At the core of this approach was the integration of the outward lesions of the body and inward pathology; students were trained to examine patients with Laennec's innovative new instrument, the stethoscope. Experimental research making use of chemistry, physiology, and vivisection was encouraged. The authors rightly draw attention to the importance of this period in equipping Snow with both the vision and the skills that were at the core of his future work.

Once he was qualified, Snow set up in general practice in Soho, bucking the usual trend for young doctors to return to their hometowns, where it was easier to make a living. Snow's practice was slow to build, but he used the years fruitfully, becoming an active member of the Westminster Medical Society, which later became the Medical Society of London, and the Royal Medical and Chirurgical Society. It was also during this period that he researched the physiology of respiration, investigating such subjects as asphyxia and carbon monoxide poisoning. The book traces well the trajectory of his intellectual development in these areas. So it was that when news of the discovery of the powers of ether to induce unconsciousness, and thus insensibility to the pain of surgery, reached London in December 1846, Snow was immediately receptive to the potential of this new technique. He became respected and valued within the London medical community, and his contribution to the establishment of the specialty of anesthesia was so great that it is still marked in the 21st century.

In 1848, though, while he was building up his anesthesia practice, cholera returned to London, and by 1849, about 53,000 deaths were registered for England and Wales. Snow put his mind to work on the key questions of the day: What was the cause of cholera, and how was the disease transmitted? His radical theory that water was an important means of transmission won him few followers. When the next cholera epidemic struck London, in 1854, Snow saw it as an opportunity to collect proof and validate his hypothesis. The story of his involvement with the Broad Street pump has become legendary within the history of public health and has frequently been mistold and misrepresented. The real importance of that event was the way that Snow used his medical authority to persuade local officials to take action. His complementary investigation into the supply of water to districts in South London was a visionary experiment. This book's reworking of both these epidemiologic studies is particularly good, dispelling the myths and reconstructing Snow's focused and singular approach to the problem.

Snow's ambition and desire to make a difference in humane terms gave him the courage to take hold of science and use it to the full in his medical practice. This book confirms just how significant his achievement was, and it will be enjoyed by doctors and historians alike.

Stephanie J. Snow, Ph.D.
Manchester University
Manchester M13 9PL, United Kingdom

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