Ether & Chloroform Chronology: 1846-48

Gray = Snow's published writings

Light Blue = Snow's presentations at meetings and anesthetic administration

Dark Blue = Snow's recorded comments at meetings

Black = contextual articles, letters, editorials, minutes, etc.,

E = Snow, On the Inhalation of the Vapour of Ether in Surgical Operations (London: Churchill, September/October 1847).

"Letter from Mr. J. Robinson." MT 15 (1847): 273-74. [dated 28 December 1846; mentions that he performed dental surgery that morning with Snow in attendance.]

"Surgical Operations with the Vapour of Ether at St. George's Hospital." LMG 39 (1847): 168. [22 January issue; two of three cases on 14 Jan were abject failures when patients could not be rendered insensible; was JS amongst the "large concourse of spectators"? If so, this would not be a hard act to follow.]

"Westminster Medical Society-16 January 1847." LMG 39 (1847): 157-57; Lancet 1 (1847): 99-100. [After case presentations by Chowne and Hancock involving the inhalation of ether, JS comments on effects of temperature of air during administration of ether. Gives table of cubic inches of ether in 100 ci air at five temperatures (44 to 84). Mentions that Mr. Ferguson of Smithfield is making him an instrument that uses a water bath to control temperature. Later in meeting, JS noted that he had seen the removal of a diseased eye under influence of ether.]

"Operations without Pain." Lancet 1 (1847): 158. [6 February issue; three operations at St. George's on 28 January, in which "the vapour of ether was administered in each case by Dr. Snow, by means of the inhaler described and depicted in our last number"; E, #1, 2, 3.

"Table for calculating the strength of ether vapour." LMG 39 (1847): 219-220 (29 January).

"Table of the Quantity of the Vapour of Ether in One Hundred Cubic Inches of Air." PharJ 6 (1846-47): 361. [1 February 1847; table identical to that published in LMG on 29 January.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 184. [Three operations on 4 February, "in which the vapour of ether was exhibited again by Dr. Snow, in the presence of Sir B. C. Brodie, Mr. Keate, and a numerous assembly of spectators." Apparatus slightly modified during previous week, under JS's direction, by the instrument maker, Mr. Ferguson; E, #4, 5, 6.

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 210. [20 February issue; two operations on 11 February; E, #7, 8. "Dr. Snow, who gave the ether in this and the following operation, placed his apparatus in water at 70; but as soon as the operation of lithotomy was commenced, he partly turned the two-way tap, mentioned in our last, so as to reduce the vapour in the air respired from fifty to about twenty per cent., and the child [of four or five] breathed it thus diluted during the three or four minutes the operation continued. As soon as the stone was extracted, the mouth-piece was withdrawn, and the child instantly opened its eyes, and seemed revived." In the second operation, a mastectomy: "The woman inhaled for four minutes, when it was ascertained by Dr. Snow that the cap which admits air to the ether was not removed, and, consequently, she got no ether, and but little air. This was remedied, and she had the disadvantage of beginning the inhalation of ether rather out of breath. It excited some coughing, and in three or four minutes the face was becoming purple, and the pulse feeble and quick, and the features rather distorted. The inhalation was accordingly discontinued, and the operation commenced. She struggled and moaned during the operation; but at the termination of it, having recovered her faculties, she said that she had felt no pain whatever, and seemed in very high spirits. "Mr. H. C. Johnson said that this patient laboured under bronchitis, and it had been a question whether the ether should be tried. He considered that it had somewhat disagreed with her, and that the bronchitis was the cause."

"Westminster Medical Society-13 February 1847." LMG 39 (1847): 383-85; Lancet 1 (1847): 227-28. [minutes of paper, "Observations on the Vapour of Ether, and its Application to Prevent Pain in Surgical Operations," read by JS. Ether vapor occupies space when mixed with air, but it does not produce insensibility by excluding oxygen from the air- asphyxia since supplying displaced O2 did not counteract the effects of the vapor. Animal experiments, comparing asphyxia caused by a deficiency of O2 with effects of ether, which "allowed the blood to be changed from venous to arterial in the lungs, but probably interfered with the changes which take place in the capillaries of the system. He had ascertained that a little vapour of ether mixed with air would prevent the oxidation of phosphorous placed in it, and considered that it had a similar effect over the oxygen in the blood, and reduced to a minimum the oxidation of nervous and other tissues" (Lancet, 227). Then follows some comments suggestive of JS's concern for welfare of patients, and brief description of how to admin ether using his apparatus.]

Westminster Medical Society-20 February 1847. Lancet 1 (1847): 228. [Dr. Ayres begins by noting that his attempts to administer ether as recommended by JS "produced irritation of the larynx and headache" and instead claimed that oral administration was preferable. JS replies: "since he read his paper at the previous meeting, he had completed some experiments, by which he had ascertained that the vapour of ether was given out again from the lungs unchanged, and that the amount of carbonic acid produced during the inhalation of ether was less than at other times; these circumstances he considered confirmed the explanation of the modus operandi of ether which he had previously given".]

"Medical Intelligence-St. George's Hospital." LMG 39 (1847): 482-83. [12 march issue; reviews three operations on Thursday 25 February "in which the vapour of ether was administered by Dr. Snow with the effect of completely preventing pain" (482); E, #9, 10.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 367-68. [3 April issue; begins with third operation on 25 February, left out of previous report, in which patient eventually died from phlebitis and abscess in lung; E, #11. "It may be remarked here, that all the other patients to whom either has been given in St. George's Hospital, including those in the present report, have either recovered, or are recovering favourably; and that no ill consequences have in any case followed the use of ether. Besides the eighteen cases in which it has been administered by Dr. Snow, it has been given with complete success, by means of the same apparatus, in three operations that did not admit of being delayed till the operating day. . ." (367). Only one operation without ether at this hospital since 28 January.

"Westminster Medical Society-27 February 1847." LMG 39 (1847): 473; Lancet 1 (1847): 259. [JS demonstrated application of ether to a linnet, followed by its recovery.]

"To the Editor of the Pharmaceutical Journal." PharJ 6 (1846-47): 474-75. [1 April '47 issue; Snow clarifies that there is no coincidence between his inhaler and Jeffreys', that he has always indicated that his was an adaptation. Cites LMG and Lancet issues-but the extract came from a Lancet issue which assumed readers already knew this. Editor expresses regret. Snow adds: "The object of the apparatus is to regulate the proportion of vapour in the air by regulating the temperature; and to effect this, I take advantage of the capacity for caloric which there is in two or three pints of water, and of the conducting power of metal of which the instrument is formed. The form I have adopted, is a matter of detail to enlarge the surface of ether exposed to the air" (474). He also clarifies that table published in February number was for unwashed ether, and that he based his table on "the formula for the elastic force of the vapour of ether, by Dr. Ure . . . . having ascertained by experiments, that it could be used with correctness for that purpose" (475).

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 367-68. [3 April issue; gives case descriptions of two operations on 4 March; E, #12, 13. "In these, as in former operations, the vapour, which was given by Dr. Snow with an equal volume of air until insensibility was induced, was continued in a much more diluted state during the operations, and the patients were also allowed to take two or three inspirations of the external air, now and then, by the nostrils" (368).

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 367-68. [3 April issue; two on Thursday 11 March; E, #14, 15.

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 367-68. [3 April issue; three on 18 March; E, #16, 17, 18. One was a "hard drinker. . . . The apparatus was placed in water at 70, and he began to inhale through the wide tubes, three quarters of an inch in diameter, which Dr. Snow has now got to his apparatus, and at the end of four minutes he was quite insensible, lying quite passive, with limbs relaxed" (368).

"On the Inhalation of the Vapour of Ether." LMG 39 (1847): 498-502 (19 March), 539-42 (26 March). [Dr. Ure, whose eudiometer Snow employed, was in the RM & CS-see Lancet 1 (1848): 232.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 499-500. [8 May issue; reviews operations on 1, 8, 15[?] April. "Dr. Snow administered the ether in these cases, and the temperature of the water in which the instrument was placed was about 67 in the cases in which it is not mentioned; and, consequently, the proportions of vapour and of air were about equal up to the time the operations commenced. When the ether was continued during the operation, a more dilute vapour, usually about twenty per cent. to eighty of air, was given, and the patient was also allowed to take a few inspirations of air by the nostrils now and then" (500). On 1 April, E, #19, 20.]

Westminster Medical Society-3 April 1847. LMG 39 (1847): 646-47; Lancet 1 (1847): 388-89. [ JS demonstrated "a small and very neat apparatus for the inhalation of ether" made by Mr. Ferguson.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 499-500. [8 May issue; on 8 April, E, #21, 22, 23.

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 499-500. [8 May issue; on 15 April, E, #24, 25.

"Operations without Pain. St. George's Hospital." Lancet 1 (1847): 546. [22 May issue; amputation on 29 April by Mr. Cutler; E, #26. "An artificial atmosphere, consisting of one part oxygen to three of air, was passed by Dr. Snow over the ether in the inhaler, which was kept at a temperature of about 67, the intention being to supply the amount of oxygen displaced by the vapour. Before she had inhaled a minute, she was excited, and sobbed in an hysterical manner, and began to throw her arms about. The process was discontinued a minute and three-quarters from its commencement, and in a minute or two she was persuaded to open her mouth and begin to inhale again without the oxygen; she became insensible in three minutes, with less excitement than before, and her limb was removed without pain." 6 May: another amputation, this time "Dr. Snow administered the ether, using Mr. Sibson's face-piece, mentioned above [below, actually], which answered very well"; E, #27.]

"Operations without Pain. University College Hospital." Lancet 1 (1847): 546. [22 May issue; 3 May, E, #1, 2 (UCH). "Two operations were performed by Mr. Liston, and the vapour of ether administered by Dr. Snow." In the lithotomy, "the operation was commenced four minutes and a half after he began to inhale, and did not cause the least sign of pain. . . . The patient inhaled during part of the operation the vapour more diluted with air than it had been before; he was rather excited for a minute or two during his recovery after the operation, but was soon quite collected. Fifteen drachms of ether were used in this case, and Dr. Snow had a fresh mouthpiece to his apparatus, which he said was invented by Mr. Sibson, of the Nottingham General Hospital. It was made of metal and covered with silk, in the form of a partial mask, and admitted of respiration both by the mouth and nostrils, the border of it contained pliable sheet lead, which could be moulded to the peculiarities of the features, and retained the form given to it. . . . Mr. Liston said that he had at one time doubts about the utility of the ether, but he had lately performed several operations in private, in which the ether had been given by Dr. Snow with perfect success, and he was inclined to modify his opinion. Dr. Snow managed the ether better than he had previously seen it given."]

Operation at St. George's Hospital. 6 May, E, #28.

"A Lecture on the Inhalation of Vapour of Ether in Surgical Operations." Lancet 1 (1847): 551-54. [29 May issue; delivered at the United Service Institution, 12 May 1847].

"Hospital Reports. St. George's Hospital." Lancet 2 (1847): 35. [10 July issue; operations on 13, 20, 27 May; 3, 10, 17 June. "The vapour of ether was administered in all these cases by Dr. Snow." 13 May, E, #29.]

"Hospital Reports. St. George's Hospital." Lancet 2 (1847): 35. [10 July issue; 20 May, E, #30, 31, 32.]

"Hospital Reports. St. George's Hospital." Lancet 2 (1847): 35. [10 July issue; 27 May, E, #33.]

"Hospital Reports. St. George's Hospital." Lancet 2 (1847): 35. [10 July issue; 3 June, E, #34.]

"Hospital Reports. University College Hospital." Lancet 1 (1847): 639. [19 June issue; 4 June, E, #3 (UCH). Amputation by Liston: "Dr. Snow, who administered the ether, placed his apparatus in the cold water of the operating theater, which was 65, and put into it two ounces of ether which was there, a quantity which generally suffices for an operation. The patient inhaled quietly, and the operation was commenced at the end of five minutes . . . . It was found soon after, that the ether was finished, and some one went to another part of the hospital for more; in the meantime, the incisions and directions preparatory to sawing the bones having been completed, the man began to complain, and Mr. Liston waited till he was rendered again insensible, which was in about a minute after inhalation was resumed . . . ." 5 June, E, #4 (UCH): Mr. Quain amputation. 7 June, E, #5, 6 (UCH): Liston performed lithotomy, followed by a finger amputation. "The ether was given in this, as in the former case by Dr. Snow. This patient found the ether disagreeable, and wished to leave it off when partly under its influence, but with a little trouble she was partly persuaded and partly compelled to persevere, and soon became quite insensible . . . ."]

"Hospital Reports. St. George's Hospital." Lancet 2 (1847): 35. [10 July issue; 10 June, E, # 35, 36. "In the last two operations [amputation of a middle finger on 10 June, a thumb on 17 June] he used a face-piece, which he has altered from that described in the last report, and introduced two swing valves into it, to supersede the spherical valves he had previously used. The expiratory valve is made to be moved gradually at will from the opening it covers, so as to admit external air and supersede the two-way tap."]

"Hospital Reports. St. George's Hospital." Lancet 2 (1847): 35. [10 July issue; 17 June, E, #37. "In the last two operations [amputation of a middle finger on 10 June, a thumb on 17 June] he used a face-piece, which he has altered from that described in the last report, and introduced two swing valves into it, to supersede the spherical valves he had previously used. The expiratory valve is made to be moved gradually at will from the opening it covers, so as to admit external air and supersede the two-way tap."

Operation at University College Hospital. 18 June; E, #7 (UCH).

Operations at St. George's Hospital. 24 June; E, #38, 39, 40.

Operations at University College Hospital. 26 June; E, #8, 9 (UCH).

Operations at St. George's Hospital. 1 July; E, #41, 42.

Operations at University College Hospital. 2 July; E, #10, 11, 12 (UCH).

Operation at St. George's Hospital. 8 July; E, #43.

Operations at University College Hospital. 9 July; E, #13, 14, 15, 16, 17 (UCH).

Operations at St. George's Hospital. 22 July; E, #44, 45.

Operation at University College Hospital. 23 July; E, #18 (UCH).

Operation at University College Hospital. 31 July; E, #19 (UCH).

Operation at University College Hospital. 3 August; E, #20 (UCH).

Operation at St. George's Hospital. 5 August; E, #46.

Operation at University College Hospital. 11 August; E, #21 (UCH).

Operation at St. George's Hospital. 12 August; E, #47.

Operation at St. George's Hospital. 19 August; E, #48.

Operation at St. George's Hospital. 26 August; E, #49.

Operation at University College Hospital. 30 August; E, #22 (UCH).

Operations at St. George's Hospital. 2 September; E, #50, 51, 52.

Operation at University College Hospital. 8 September; E, #23 (UCH).

On the Inhalation of the Vapour of Ether in Surgical Operations: containing a description of the various stages of Etherization, and a statement of the results of nearly eighty operation in which ether has been employed. London: Churchill, September/October 1847. Pp. 88. [Listed as received for review in 8 October issue, LMG 40 (1847): 648.]

Westminster Medical Society-23 October 1847. Lancet 2 (1847): 467. [30 October issue; at second meeting of the session, Dr. F. Bird described case of a woman whose ovaries were extirpated. JS wondered if ether had been employed. "The length of time during which insensibility might be required would form no objection to it use." Goes on to discuss other uses of ether to produce insensibility.]

"Dr. Snow on the effects of ether vapour." LMG 40 (1847): 859. [12 November issue; JS requests a correction of an error in a quotation in review of On the Inhalation, and its implications for the reviewer's opinion; reviewer's reply to JS in 19 November issue, 898-99.]

"Operations without Pain. St. George's Hospital." Lancet 2 (1847): 661. [18 December issue; mastectomy performed on 18 November. "The chloroform was administered by Dr. Snow with his ether apparatus." A lithotomy on 25 November, "Half a drachm of chloroform was sprinkled over a sponge squeezed out of cold water, and the sponge was applied by Dr. Snow over the mouth and nostrils." On the same day, a boy "inhaled the vapour of chloroform from the ether apparatus-the water-bath of the apparatus being at 60." On 2 December, a girl "inhaled from the apparatus with the water-bath at 60, a drachm of chloroform having been put in." After several minutes, "she made a wry face, and cried out a little. The chloroform was found to be all dried up; she had been inhaling only air the latter part of the time . . . ." On 9 December, a male laborer "inhaled chloroform from the apparatus, the water-bath being at 52." Although Snow is not specifically mentioned as having administered in all cases, the report suggests so.]

"Westminster Medical Society--20 November 1847. LMG 40 (1847): 1030-31; Lancet 2 (1847): 575-76. [JS presents the results of auto-experiments on chloroform after learning of Dr. Simpson's use of the agent. Describes earliest administration, tests, how extracted from chloride of calcium given to him by the chemist, Mr. Bullock. Also gives a table on amount of chloroform held by air at various temperatures.]

"Operations without Pain. University College Hospital." Lancet 1 (1848): 25-26. [case discussion of operations in Nov & Dec, 1847, at which "chloroform was administered by Dr. Snow, with his ether apparatus."-first was on 22 November 1847]

"Operations without Pain. University College Hospital." Lancet 1 (1848): 25-26. [case discussion of operations in Nov & Dec, 1847, at which "chloroform was administered by Dr. Snow, with his ether apparatus."-four on 15 December 1847.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1848): 35-36. [Six cases at which JS administered anaesthetic, five of chloroform and one of benzin. On 16 December 1847: "The chloroform was administered by Dr. Snow-a drachm of it being scattered over the interior of a hollow sponge, squeezed out of cold water. The sponge was applied over the mouth and nostrils [of a ten-month infant] . . . ."]

"Operations without Pain. University College Hospital." Lancet 1 (1848): 25-26. [case discussion of operations in Nov & Dec, 1847, at which "chloroform was administered by Dr. Snow, with his ether apparatus."-one on 17 December 1847.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1848): 35-36. [Six cases at which JS administered anaesthetic, five of chloroform and one of benzin. In three cases on 23 December 1847, Snow used a "fresh apparatus" constructed by Misters Matthews and Ferguson (description given) to administer chloroform.]

"Operations without Pain. St. George's Hospital." Lancet 1 (1848): 35-36. [Six cases at which JS administered anaesthetic, five of chloroform and one of benzin. On 30 December 1847, Snow used new apparatus to administer chloroform during an amputation and benzin during a second amputation. "Benzin had been previously used by Dr. Snow in four extractions of teeth in the hospital, and had succeeded perfectly in preventing pain, although it was not carried so far as to paralyze voluntary motion, for the patients sat upright, and held up their heads without support; but the action of it in the above case [the patient had convulsive tremors] was not considered sufficiently favourable to encourage its further use in important operations."]

"Westminster Medical Society-8 January 1848." LMG 41 (1848): 74-76. [Snow read a paper, "Inhalation of Chloroform and Ether."]

"On the Inhalation of Chloroform and Ether, with description of an apparatus." Lancet 1 (1848): 177-80. [12 February issue; read at Westminster Medical Society on 8 January 1848]

"The fatal chloroform case at Newcastle." Lancet 1 (1848): 239. [issue of 26 Feb; Snow believes the case of Hannah Greener "appears to confirm in a melancholy manner the remarks contained in my paper in The Lancet of the 12th instant, respecting the danger arising from the cumulative property of the agent when administered on a handkerchief. The alarming symptoms came on after the cloth with chloroform was removed from the patient's face." Snow disagrees with Simpson's conclusion that attempts to revive the girl caused the fatality, noting "that there is nothing in the reported evidence of the appearances on dissection which might not be caused by the kind of asphyxia liable to be induced when the effects of chloroform are carried too far; and these appearances are quite incompatible with Dr. Simpson's supposition that there was syncope."]

Westminster Medical Society-26 February 1848. Lancet 1 (1848): 312. [Lankester, Murphy, and Snow discuss views of Hannah Greener's death. Snow mentions that he wrote Meggison, and received a reply. "It was evident from this that the fatal event arose from the effect of the vapour accumulating after its exhibition was discontinued . . . ." Suggests use of an apparatus, and mentions attempts at artificial respiration on animals.]

"Remarks on the Fatal Case of Inhalation of Chloroform." LMG 41 (1848): 277-78.

"Royal Medico-Botanical Society-16 March 1848." LMG 41 (1848): 606-07[?? check pages]; MT 17 (1847-48): 462-63; Lancet 1 (1848): 379. [Snow read a paper, "Chloroform and other narcotic Vapours.]

Westminster Medical Society-22 April 1848. Lancet 1 (1848): 476-78. [Mr. I. B. Brown read a paper on "the use of chloroform in midwifery." Snow commented extensively, and "approved entirely of Mr. Brown's practice of putting only about ten or fifteen minims of chloroform on the handkerchief. It was what he had recommended when the handkerchief or sponge was used; and although not the best method of administering chloroform, yet in midwifery, where a small quantity could be applied at a time, there was no serious objection to it. . . . He saw no objection to its moderate and careful administration, even in natural labour, when the patient wished for it, and the pain was very severe. He did not think it would be injurious to the child. . . ." (478).] [Therefore, he's justified in '48 the mode of administration used on QV five years later.]

Westminster Medical Society-29 April 1848. Lancet 1 (1848): 523. [Snow read a paper, "On Narcotism by the Inhalation of Vapours."]

"On Narcotism by the Inhalation of Vapours." LMG 41 (1848): 850-54 (#1), 893-95 (#2), 1074-78 (#3); 42 (1848): 330-35 (#4), 412-16 (#5), 614-19 (#6), 840-44 (#7), 1021-25 (#8). [?? reorder and check exact issue dates]

"Westminster Medical Society-23 December 1848." Lancet 1 (1849): 15. [mention that Snow read a paper, "The Use of Chloroform in Midwifery"; summation of opening remarks, at least, in LMG 43 (1849): 208-10; Lancet 1 (1849): 99-100] "Chloroform in Parturition." LJM 1 (1849): 976. [another view of JS's presentation on 23 December]

"On the Use of Chloroform in Surgical Operations and Midwifery." LJM 1 (1849): 50-55. [dated December 1848, published in January 1849 issue; probably a reprint of the paper delivered on 23 December 1848 at WMS]