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.
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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
 click to return to the Book on Snow site
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