Benjamin Ward Richardson on Snow’s final illness
Transcription of xli-xliv from Richardson’s biographical memoir, which precedes John Snow, On Chloroform (1858).
[xli] We approach the end. In the midst of his success, when medicine most needed him and his hand was most powerful, he stood one day in his mental strength, and the next day fell. Death found him at his work, and the stern enemy came on him suddenly, though not without forewarnings.* [*Dr. Murchison, who with Dr. Budd rendered Dr. Snow all that able assistance which the best of medicine can offer, has kindly given several particulars in regard to the fatal illness, which I embody in the text, with many thanks.]
His health had long been indifferent; he had suffered from hæmatemesis several times in the last few years, for which Dr. Budd had attended him, and he had his own forebodings that his life was not of the longest. In the month of December 1857 he was suddenly seized one evening with vertigo and sickness, which compelled him to keep the recumbent position for more than twenty-four hours. At the end of this time he felt better, and went about his usual avocations. He had no convulsions at this time, nor did he lose his consciousness. After this attack, he complained on many different occasions, both to his housekeeper and to several of his medical friends, of numbness in his extremities. Some of these to whom he mentioned this circumstance, do not recollect whether this symptom was greater on one side of the body than on the other; while others distinctly state that it was referred to the left side only. His housekeeper was certain that he never complained of this numbness before the attack in December; and even afterwards, it would appear to have been only an occasional symptom. For six weeks before his final seizure he had made no mention of it. About three weeks before his last attack, he had complained, for some days, of a severe pain in the back of his head, which he himself considered [xli/xlii] neuralgic, and for which he treated himself. This pain quite left him, and for about a fortnight he had been enjoying excellent health.
On the evening of Tuesday, June the 8th, 1858, he attended a meeting of the Royal Medical and Chirurgical Society. On the following evening there was a meeting of a private society for the study of chest diseases, held at Dr. Quain’s. The subject discussed was the cause of the first sound of the heart. On this, the last occasion of the kind at which he was present, he was in unusual spirits, and looked exceedingly well. He entered into the debate with great earnestness, agreed to form one of a committee to inquire into the cause of the first sound by experiment, and left his friends with enthusiastic expression as to the success of the proposed undertaking. We exchanged our last farewells that night.
He went to bed at half-past eleven o’clock on June 9th, and on the following morning he came down stairs at 8 A.M. When he came down, he complained to his housekeeper of slight giddiness, and she thought he did not walk very steadily. He reclined on the sofa, and said that he should be well again in a few minutes, but that he did not think he could eat any breakfast. Soon after, however, he got up, said he felt very hungry, and ate a very hearty breakfast. When this was done, he proceeded to write a portion of the manuscript of the work on anæsthetics now published. He had written to the last printed sentence, when his housekeeper, who had scarcely left him, heard a noise, as if some one had fallen. She ran up again and found her master on the floor, making vain endeavours to regain his chair. He does not appear to have had any convulsions, and his consciousness was unimpaired, for he remarked when his housekeeper came into the room, that though he did not quite understand the nature of his [xlii/xliii] complaint, he was very sure he never had any such symptoms before. His housekeeper observed that he had quite lost all power over his left arm and leg, and that his mouth appeared drawn to the right side. She had him lifted on the sofa; and here he remained for twenty-four hours before any medical assistance was sent for. This was his own wish, as he said he should soon be better, and that he did not wish to trouble any one. During this period he complained much of pain over the lower end of the sternum, which he endeavoured to relieve by frequent inhalations of sulphuric ether, but he neither ate nor slept the whole time. At 6 A.M. on the morning of Friday, June 11th, retching came on, and he vomited a considerable quantity of blood. Upon this his housekeeper sent for Dr. Budd, who, along with Dr. Murchison, continued to attend him to the last. His symptoms, when seen by these gentlemen, were briefly as follows: — Complete paralysis of motion over the whole of the left side of the body, but without loss of sensibility; the left angle of the mouth falling down, and the apex of the tongue deviating to the left; memory and consciousness were unimpaired; there was pain and great tenderness in the epigastrium, with urgent hiccup and hæmatemesis; there were slight indications of albuminuria, but there were no dropsical symptoms.
The hæmatemesis ceased after about twenty-four hours, but the vomiting and hiccup continued. By Monday, the 14th, these symptoms also had subsided, but others of a more alarming nature began to show themselves. The pulse and respiration became accelerated, the countenance and extremities became livid, and there was occasional wandering delirium. These symptoms gradually increased in severity; but he retained his consciousness until 11 A.M. of Wednesday, June 16th, when the breathing became stertorous, and deglutition impossible. [xliii/xliv] Throughout his illness, he had been sanguine of recovery, and expressed his belief frequently that he should soon be at his professional work again. On this, the last morning of his life, the fact of the danger in which he was placed was explained. He met the intelligence with calmness, but felt a wish to see Dr. Todd. Soon he sank into a somnolent state approaching to dissolution, and at 3 P.M. death took him.* [*Dr. Murchison has also given me an outline of the post mortem appearances, which is subjoined. “The post mortem examination revealed slight white softening, only detectable by the microscope, in the right corpus striatum and optic thalamus, and fatty degeneration of the minute cerebral vessels. The heart was slightly fatty, but there was no valvular disease, nor atheromatous disease of aorta. The lungs were congested, and showed marked evidence of old disease at the apices. Both the kidneys were much contracted and granular, with numerous cysts, the right organ being almost entirely converted into cysts; with the uriniferous tubes either denuded, or containing granular disintegrating epithelium. There was distinct cicatrix of an old ulcer in duodenum, and the stomach was much congested, with numerous hæmorrhagic spots.”]
On the Monday following, Dr. Snow was buried at the Brompton Cemetery. It was the wish of many of his medical friends to follow him to his last home. But his relations, recalling his own unostentatious feelings, laid him in the grave in simple ceremony; and there, ingenuous friend, in the sleep that knows no waking, he sleeps on and takes his rest; the rest he has earned. The old changes of the world live after him, women mourning for their children; youths exulting on the marriage day; the inanimate returning to the elements; the animate returning to the infinite. But in the gaping time shall it chance rarely, for another science-man to come and go, who, taking him all in all, may call him “brother”!