About Cholera, Chloroform, and the Science of Medicine

In 1986, Peter Vinten–Johansen and Howard Brody served as faculty leaders of a study abroad program in London, England. They devised a unit involving small–group research projects on different facets of John Snow's investigations of the cholera outbreak in Golden Square/Broad Street during the late summer of 1854. After the study abroad program ended, Vinten–Johansen and Brody revised this unit as a short–course option in medical humanities for second–year students in the College of Human Medicine at MSU and began working on a manuscript analyzing all of Snow's cholera studies. Several years later, Nigel Paneth and Mike Rip joined the discussion, adding new energy and disciplinary perspectives. We organized ourselves as a formal research group. Peter Vinten–Johansen became lead author with final revising and editing responsibilities since he is a European intellectual historian and the objective was to produce a comprehensive intellectual biography of Snow. Steve Rachman soon joined the team, adding yet another perspective. Two years on, David Zuck (living in metropolitan London) began making his contributions as on–site researcher and in–house editor via the internet.

Each member of the team functioned as a primary drafter of proposed chapters relevant to his specialty areas. We met regularly, often every week, for several years. We discussed Snow's writings first, then chapter drafts. After criticizing a draft, we decided whether the primary drafter should have another go at it or assign it to another group member. Eventually, every draft was turned over to Vinten–Johansen for a preliminary revision of content. When all chapters were done, he revised the entire manuscript again in order to harmonize style and produce a single voice.

Unifying thesis of the book, taken from the Preface

"Snow's accomplishments in anesthesia and epidemiology are interconnected. His medical training occurred in the 1830s, when a new generation of medical men attempted to refashion medicine as a scientific discipline, with linkages to "the collateral sciences" such as chemistry and comparative anatomy. In this vision of scientific medicine, the ultimate purposes of developing a solid grounding in the collateral sciences of medicine was to enhance one's clinical acumen and to improve the public health. Snow swallowed this intellectual regimen — hook, line, and sinker — and actualized the vision in his medical career.

Early on, [Snow] took a special interest in respiratory cases among the patients he was treating, devised animal experiments, and presented his findings and case reports at medical society meetings and in the medical press. He was already a specialist, so to speak, in respiratory physiology and clinical practice when news of inhalation ether reached London from the United States in 1846. Within two years, he was arguably the most accomplished anesthetist in the British isles — perhaps, even further afield. When the second pandemic of "Asiatic cholera" reached London in the fall of 1848, his understanding of gas law, respiration physiology, and anesthetic agents caused him to question the predominant theories about the nature and transmission of this devastating disease. The following year, he published two essays that outlined his views and offered preliminary substantiation. From then until his death, at the age of forty–five, in June 1858, his working days were spent administering anesthesia, conducting laboratory and auto–experiments on new anesthetic agents, and tracking down information on outbreaks of cholera. Snow was a shoe–leather anesthetist and epidemiologist, par excellence" (v–vi).