John Snow, Thomas Wakley, and The Lancet *

Few doctors gain fame as pioneers in one field; fewer still in two. Our contemporary, Sir James Black, is one of the latter: a Nobel Laureate, he developed two families of drugs – beta-adrenergic blocking agents, and H2 inhibitors. John Snow is another: a pioneer of inhalation anaesthesia, he also proposed [1] then clarified [2] a role for faecally polluted matter in the spread of cholera. This latter discovery is stamped on the medical memory by the alleged termination of a cholera outbreak in an area just east of Regent Street when on 7 and 8 September 1854 Snow persuaded the St James’s parish vestreymen to remove the handle from the water-pump in Broad (now Broadwick) Street. (In fact the outbreak was nearly over before the pump handle was removed! [3].) Nevertheless, the Broad Street pump-handle affair serves as a dramatic coup de théâtre and is seared into medical folk-lore while his definitive work on the Lambeth, and Southwark and Vauxhall, companies’ water supplies lies largely unknown outside the ranks of the epidemiological cognoscenti (and often within their ranks as well!) and was largely ignored selling only 56 of the 300 copies printed leaving poor Snow to lament: I spent more than £200 in hard cash and realised in return scarcely as many shillings [4, p. xxii]. The way of the prophet is hard indeed. This article will consider Snow’s anaesthesia work most particularly as seen through the eyes of The Lancet, then owned and edited by Thomas Wakley and the premier journal-cum-medical newsletter in the English language. Since this meeting of the Association of Anaesthetists of Great Britain and Ireland is in Belfast I will start with a short description of the first operation under ether anaesthesia in Ireland on New Year’s Day 1847.