John Snow Chronology - 1847

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).

"Medical Intelligence. Animal Magnetism Superseded-Discovery of a New Hypnopoietic [productive of sleep]." LMG 38 (1846): 1085-86. [18 December issue; "a highly respectable physician of Boston" has informed the journal of Morton's process for using ether vapor to render dental patients insensible (or intoxicated). Extracted details of a case of molar extraction in "Martin's rooms." LMG urges caution, noting that ether is a strong narcotic that "must be regarded as producing a state of temporary poisoning in which the nervous system is powerfully affected" (1086). [reprinted in its entirety in PharJ 6 (1846-47): 336-37, issue of 1 January 1847.]

"The Sedative Effect of Ether Tested in the Operating Theatre of the North London Hospital." PharJ 6 (1846-47): 337-38. [issue of 1 January 1847. House surgeon sends account of two successful operations by Liston at 2:00 on Friday 18 December, including the amputation of Frederick Churchill's lower leg, at which "the vapour of ether was inhaled by means of a vessel resembling an ordinary inhaler.]

"Performance of Surgical Operations during the State of Narcotism from Ether." LMG 39 (1847): 38-39. [1 January issue; journal asserts its claim to having given first public announcement in England of the ether procedure, then follow with account of Liston's operation at Univ College Hosp on 22 Dec (?) much like that in Lancet of 2 Jan.]

"Surgical Operations Performed during Insensibility." Lancet 1 (1847): 5-9. [2 January issue; Francis Boott's submission, containing (extracts) letters from Bigelow, sr., H. J. Bigelow, and R. Liston sent to Boot, plus his cover letter which states outcome of Robinson's dental operation on Miss Lonsdale on 19 December, and three or four unsuccessful cases perhaps due to "defect in the valve of the mouthpiece" (9). Editorial- sulphuric ether. Lancet 1 (1847): 16-17. [2 January; cautious endorsement. Notes that the apparatus used by Liston was "contrived by Mr. Squires, of Oxford-street" (17).

Editorial-8 January. LMG 39 (1847): 68-69. [notes that use of ether in surgical operations "is now becoming almost universal." Mentions Fairbrother's operation in Bristol, and considers Herepath's apparatus (identical to those long used in experiments with nitrous oxide) best and simplest described to date. Long critique of the "absurd patent" claim.]

Letters to the Editor - inhalation of ether. Lancet 1 (1847): 49-51. [9 January issue. Letters from Boot, "__ __, Q. C.," Clendon (including sketch of an apparatus by Clarke, and Collyer.]

"Operations without Pain." Lancet 1 (1847): 54. [9 January: "An operation was last week performed by Mr. J. G. Lansdown, at the Bristol General Hospital, the patient being previously placed under the influence of sulphuric ether vapour. In this case, the thigh was removed without any manifestation of pain on the part of the patient. The operation appears to have been as perfect and satisfactory a test of Dr. Morton's discovery as that performed by Mr. Liston. The inhalation of ether was performed by means of an apparatus constructed by Mr. Herapath. Wine was given at intervals during the operation, and it was stated, that insensibility may be increased or diminished by administering wine and the etherous vapour alternately."]

"Royal Medical and Chirurgical Society-12 January 1847." Lancet 1 (1847): 98; LMG 39 (1847): 154. ["Mr. Snow said that the difficulty of removing an alkalescent state of the urine, by the administration of the mineral acids, was no proof that these acids did not pass off by the urine; for in nearly all cases of alkaline urine it became alkaline after its secretion from the decomposition of the urea, and such an amount of ammonia was produced in this way as it would be almost impossible to neutralize by any quantity of mineral acid which could be safely administered as a medicine."]

"Pharmaceutical Society--13 January 1847." Lancet 1 (1847): 73. [16 January issue; paper by Mr. Squire describing his apparatus for administering ether. During discussion, Mr. Hooper described his apparatus, improved after suggestions by Dr. Boott and Mr. Robinson.]

"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.]

"Mr. Hooper's Ether Inhaler." Lancet 1 (1847): 77. [illus + description]

Editorial-operations without pain. Lancet 1 (1847): 74-75. [16 January issue; supports the application of ether in surgical operations, but cautious about use in midwifery and recognizes individual variations respecting insensibility; decries applications for a patent.]

"Operations without Pain." Lancet 1 (1847): 77-80. [16 January issue; case descriptions at King's College Hospital, using Hooper's apparatus, devised by Robinson, who superintended case one, perhaps the other six listed as well as those at Guy's, Westminster, and St. Thomas's. Letters from Lansdown and Fairbrother at Bristol; amputation of thigh (not in hospital?); operations on eye (using Hooper's apparatus) and teeth (using Squires' apparatus). James Dorr's counter to Q.C.'s opinion on patenting "The Letheon," which he represents.]

"Westminster Medical Society-16 January 1847." LMG 39 (1847): 156-57; 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.]

"Mode of Employing Ether Vapour in Surgical Operations." LMG 39 (1847): 166-67. [22 January issue; Robinson describes the signs he looks for, and alternating method of breathing ether and air.]

"Apparatus for the Respiration of Ether Vapour." LMG 39 (1847): 167-68. [22 January issue; Tracy at Bart's describes apparatus (sponges in well, with inhaling tube) he's devised, and made by Ferguson.]

"Painless Operations at the London Hospital." LMG 39 (1847): 168. [22 January issue; successful case of amputation of leg on 14 January.]

"The Weather, and the more prevalent diseases of the summer of 1846." Lancet 1 (1847): 85-88. [23 January issue; by William McIntyre, M. D. In section on diarrhea and cholera: "Though these cases were of a sufficiently alarming aspect, and seemed to be verging upon the appalling and hopeless condition which marks the stage of collapse in the Asiatic disease, they can only, I think, be regarded as instances of the ordinary autumnal cholera of this country. . . . Our cholera of 1846, true to the description of Sydenham, was restricted to the months of July and August. The Asiatic disease observed no such limitation; on the contrary, after clearing its native East, it traversed the globe, uncontrolled by clime, season, weather, and every barrier which human foresight or ingenuity could interpose in its route; and this, perhaps, rather than any peculiarity of symptoms, constitutes its best claim to being considered a nova pestis. . . . (88).

"Table of the quantity of vapour of ether." MT 15 (1846-47): 325. [23 January 1847]

Westminster Medical Society-23 January 1847. LMG 39 (1847): 200; Lancet 1 (1847): 120-21. [JS's presentation, "Apparatus for Inhaling the Vapour of Ether." Lancet article has illustration of the apparatus.]

"Operations without Pain." Lancet 1 (1847): 104-07. [23 January issue; at St. George's, Charing Cross, in Liverpool, Bart's (70 cases of extracting teeth, with apparatus supplied by Mr. Ferguson, "instrument-maker to the hospital" (108)), and East-Retford, where John C. Hall noted that he undertook an auto-experiment ("not having a patient to practice upon") as soon as he received Hooper's apparatus (107).

Editorial-"sanatory reform." Lancet 1 (1847): 101. [23 January; connected to health of towns commission, with "the Asiatic cholera creeping . . . towards Europe" adding to the import of doing something soon.]

"Royal Medical & Chirurgical Society-27 January 1847." LMG 39 (1847): 250; Lancet 1 (1847): 153. [JS comments on diseases of the kidney.]

"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. Additional case reports from Cheltenham (apparatus includes a bladder in warm water), Maidstone Ophthalmic (Hooper and Robinson's apparatus), Bristol, private dental practice (apparatus devised by "a medical student now walking one of the London hospitals"), as possible cure of consumption, cautions about "narcotism by ether" becoming a fad, and letters about priority in discovery of ether for medical uses.]

"The Cholera at Kurrachee, Scinde." Lancet 1 (1847): 132. [30 January issue. 86th reg camped to the leeward of K "on account of the cholera." Describes hot weather in spring of 1846; first case on 11 June. Then categorizes cases into four classes.]

"Operations without Pain." Lancet 1 (1847): 132-35. [30 January issue; at Bart's (Caesarian), the Middlesex (apparatus by Jacob Bell), the London, Kent Ophthalmic Institution (Hooper's apparatus).

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

Mr. Squire, "On the Inhalation of the Vapour of Ether, and the Apparatus Used for the Purpose." PharJ 6 (1846-47): 350-59. [issue of 1 February '47, but contains communications and minutes from meeting of Society on 13 January. Mentions the "temporary apparatus . . . put hastily together for Mr. Liston, when he performed the first capital operation in this country [on 18 December]. . ." (350). There is an illustration of the improved apparatus, plus description; clarifies differences in effects of washed and unwashed ether. Discussion follows, with explanation by Hooper of the apparatus he contrived after suggestions from Boot and Robinson; illustrations of differences between his fittings and those of Squire. Clendon exhibited an apparatus, illustrated. Waugh described his mouthpiece, illustrated. Jacob Bell described his apparatus, illustrated. Discussion by others, with illustrations of stop-cock by Stokes, Tracy (of Bart's, who claimed he had seen 70-80 cases already at which ether was administered) described an apparatus made for him by Ferguson of Smithfield (illustrated), and an exhibition by Ferguson himself of three apparatus he had made. Andrew Ure concluded discussion with comment that "ether was a non-respirable gas" and must be mixed with atmospheric air in order for the lungs to absorb it (359); to which the Editor demurred, indicating "subsequent experiments" to the contrary. He called for experiments on "the relative proportion of ethereal vapour and atmospheric air inspired" and "a series of accurate experiments" on the most effective concentration for administration-and suggested readers consult Snow's table of ether vapour densities at different tables printed on p. 361.]

"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. 13 February issue; additional case descriptions from the Middlesex (Bell's apparatus, described in Pharmaceutical Journal), King's (Hooper's), Cheltenham (bladder and tube) and a "modification of Snow's apparatus"), Royal Cornwall Infirmary (apparatus by a local medical man, "made under his direction"), and Essex and Colchester.

"Medical Intelligence: Painless Operations on the Lower Animals." LMG 39 (1847): 260-61. [5 February issue; two operations at Royal Veterinary College, one on horse, other on a sheep, using ether vapor. Both successful, with animals showing no discomfort.]

"Reviews"-Report of French Commission on the Plague and Quarantine. Lancet 1 (1847): 150-52. [6 February issue; in continuation from a prior issue, the reviewer begins with statement that the word, epidemic, is unhelpful in scientific dialogue. "Literally, it is applicable to any disease prevailing amongst the many-the people. Most absurdly it has been used in contradistinction to contagion, whereas it by no means expresses the mode in which the disease is communicated, but simply the fact of its extensive prevalence. This meaning has been given to the word from the idea, that in an epidemic the very diffusion precludes the possibility of individual infection; that it supposes an agency resting on broader foundations-one involving the condition of the air which is breathed by, or the food and water supplied to, the sufferers" (151). Believes it likely that no form of "epidemic plague" is "independent of a special external influence" (151). Concludes that "true history" of epidemic diseases "is yet to be unfolded" (152); certainly, "the idea of a mere migrating atmospheric influence leaves two-thirds of the facts totally unexplained" (152).

"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."

"On the Inhalation of Ether." Lancet 1 (1847): 168-69. [13 February issue; James Robinson's description of his method and review of some cases.]

"Etherization." Lancet 1 (1847): 187-88. [13 February issue; anonymous correspondent uses a case involving amputation of the thigh to review various apparatuses and papers to date (including citation of Snow's note + table from LMG). Concludes that "it is probable that the variation of the symptoms observed in this case may in some degree depend upon the quality and quantity of the ether, rather than on the difference of constitution, or peculiarity of temperament . . . ." (187).]

"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".]

MT 16 (6 March 1847): 43. [fatality after lithotomy, performed at the Suffolk and Colchester Hospital, blamed on ether. In a second fatality, an old gentleman operated on by Mr. Traverse, died within 24 hours of an operation from "the stupor caused by the ether" (43).

"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.

"Treatment of Facial Neuralgia by the Inhalation of Ether, and on a New Inhaler." LMG 39 (1847): 358-64. [26 February issue; Francis Sibson's article, one of early one studies of the medicinal use of ether vapor. Considered successful in facial neuralgia, not in sciatica. Apparatus (illus) includes adaptation of chamber and water bath from Snow's inhaler.]

"Inhalation of the Vapour of Ether." LMG 39 (1847): 364-66. [26 February issue; Fairbrother's case presentation, with preliminary review of literature. Concludes that "the insensibility of ether [proves] to be of a peculiar kind, and to vary considerably in different individuals in the nature and extent of its physiological effects: just as wine, spirits, tobacco, opium, &c. . . . . It is probable that the variations of the symptoms observed in this case may in some degree depend upon the qulaity and quantity of the ether, rather than on the difference of constitution or peculiarity of temperament . . ." 364). Then reviews explanations for variations by Squire, Hooper, Velpeau, and Snow (quotes from minutes of his WMS presentation and Table 1). May be syntax, but Fairbrother suggests that Snow took a cue from Velpeau on temperature of ether. On Snow's table, writes "this demands attention, but the temperature of the room may be easily ascertained, and regulated with a little care" (365).]

"The Effects of Ether." LMG 39 (1847): 366-68. [26 February issue; by Philpot Brookes, at Cheltenham. Series of case reports, all successful in his opinion except an amputation of arm in which "the ether was given with Dr Snow's apparatus" but the patient cried "lustily" throughout the operation. Notes that "the mouth-piece did not fit nicely to the mouth" of that patient.]

Review of James Robinson's Treatise on the Inhalation of the Vapour of Ether. LMG 39 (1847): 379. [26 February issue; "will present no novelty to those who have read the weekly medical journals."

"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.]

"Patents for Surgical Operations." PharJ 6 (1846-47): 397-99. [1 March '47 issue; editorial, critical of Dorr for representing Jackson and Morton. Interesting inclusion of instructions issued by Dorr on 30 January for the "Letheonic Apparatus," advising operators that air passages in any apparatus must be large, and never less than 3/8 inch bore, or there is a danger of strangling the patient.]

"Apparatus for Administering the Vapour of Ether." PharJ 6 (1846-47): 421-23. [1 March '47 issue; by Mr. Owen, of Exeter, describing his invention.]

"Apparatus for Inhaling Ether." PharJ 6 (1846-47): 423-25. [1 March '47 issue; among others, includes an extract from Lancet (30 January 1847): 120-21 of Snow's first inhaler, plus illustration.

Editorial comment: "By a remarkable coincidence we find that an instrument identical in principle with that invented by Dr. Snow, was invented some years ago by Mr. Jeffrey as an inhaler. The circumstance reminds us of the case of the new planet, in which two rival discoveries are in the field." (424) Has an illustration of Jeffrey's inhaler.]

"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).

Westminster Medical Society-6 March 1847. Lancet 1 (1847): 314. [JS notes that the tables on pneumonia produced by the Registrar-General cannot be trusted since "bronchitis was frequently confounded with pneumonia, particularly in children. The deaths were registered as inflammation of the chest, whatever the portion of the lungs affected."] [N.B. how the R-G's tables are based on humoral paradigm, JS's on disease specific nosologies from the hospital clinical paradigm.]

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

Editorial-is enthusiastic acceptance of ether justified? LMG 39 (1847): 460-63. [12 March issue; thinks administration orally may be equally effective and with less risk than through lungs. But is it always desirable that surgical patients be rendered unconscious? Thinks not. Individuals are so variable that it is impossible to determine the desirable dose in advance. Decries the medical profession's unwillingness to be forthright about the dangers, and the deaths that have occurred which cannot be explained away as unrelated to ether. Too often, surgeons turn operations into public spectacles, with newspaper reporters in attendance and prurient spectators when females are given ether.]

Review of James Robinson, A Treatise on the Inhalation of the Vapour of Ether . . . ." Lancet 1 (1847): 284-85. [13 March issue; "Mr. Robinson attributes the want of success in the first few instances to the incompleteness of the apparatus employed. Experience and ingenuity has enabled him to suggest the construction of an instrument which is now employed with almost universal success. Mr. Hooper, of Pall Mall, is the maker, and although Mr. Robinson is the inventor, we believe he refuses to derive any profit from its sale. The same honourable circumstance may also be mentioned as regards Dr. Snow's invention, one peculiarly adapted to country practice, being small, compact, and portable. It differs from Mr. Robinson's in being made of tin, and by immersing it in water heated to certain temperatures, the vapour may be increased, an advantage in cases where the patient has been a hard drinker. We believe that most of the other instruments which have been suggested and brought before the profession are only modifications of the two we have mentioned, and the only thing wanting to make them perfect appears to us to be a good mouth-piece; as yet, we have not seen one universally applicable" (284).]

"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.]

"Medical Trials and Inquests-Alleged Fatal Effects of Ether in Surgical Operations." LMG 39 (1847): 563-67. [26 March issue; the case of Ann Parkinson, Mr. Robbs the administrator. Extracts of inquest, largely from the Times. Editorial response-Robbs was clearly not at fault, but still unclear if ether was at fault.]

"Inhalation of Ether in Obstetric Practice." Lancet 1 (1847): 321-23. [27 March issue; lecture by W. Tyler Smith.]

"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.]

"On the Fatal Effects of Ether Vapour." LMG 39 (1847): 585-90. [2 April issue; Robbs' report on the Ann Parkinson case.]

"Etherization and Asphyxia." Lancet 1 (1847): 355. [3 April issue; from John Scott, of Shelton, including extracts from La Presse. Calls for experiments on administration of ether that compare proportions of ether to oxygen at various temperatures. No mention of JS.]

MT 16 (3 April 1847): 122. [Robinson notes that he now gives pur O2 after ether to assist the resuscitation of the patient without disability.]

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.

Editorial-effects of ether vapor. Lancet 1 (1847): 392-93. [10 April issue; decries silence to date of London Hospital surgeons about all details regarding the administration of ether-seeks a "detailed analytical account of the results" by experienced medical men. Prints a copy of the circular sent out by T. Wakley, jun., to metropolitan and country hospitals.]

Westminster Medical Society-10 April 1847. LMG 39 (1847): 778-79. [JS comments on deformity of chest in children, and refers to paper he read at WMS several years before.]

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

Notice of W. P. Brookes' Practical Remarks on the Inhalation of the Vapour of Sulphuric Ether, &c. LMG 39 (1847): 689. [16 April issue; another contribution to "'ethereal' literature," but mainly a summary of author's experiences.]

"Physiological Effects of the Effects of the Inhalation of Ether." LMG 39 (1847): 669-71, 715-17. [issues of 16 and 23 April; paper by Dr. Buchanan delivered at Philosophical Society of Glasgow.]

On Ether-Vapour, its Medical and Surgical Uses." Lancet 1 (1847): 431-34. [24 April issue; includes printing of paper by C. J. Jackson on preparation of ether, an overview of "alleged fatal cases," and "inferences from my own experiments" about physiological action-quotes JS, "consciousness seems to be lost before sensibility to pain," but then cites contrary experiences.]

"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.]

"On the Effects of Ether on the different Classes of Animals." LMG 39 (1847): 777-78. [30 April issue; paper by Dr. Gull read at South London Medical Society on 15 April.]

"Observations and Experiments on the Direct Action of Ether on the Blood." Lancet 1 (1847): 457-58. [1 May issue; by James H. Pring, M.D. No mention of JS]

"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.]

Medical Intelligence-Health of Towns Bill. LMG 39 (1847): 875. [14 May issue; Lord Morpeth will postpone parts of bill dealing with metropolis at another session.]

"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.]

"New Method of Etherization." LMG 39 (1847): 950-51. [28 May issue; Prof. Pirogof sent notice of experiments on living animals has resulted in a method for administering ether into the bowels. Translated from the French, in St. Petersburg Bulletin.]

"Administration of Ether by the Rectum." LMG 39 (1847): 957. [28 May issue; Dupuy in Gaz. Med., success in experiments on dogs and rabbits.]

"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): led 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."]

"Employment of Ether Vapour Enemata in India." LMG 39 (1847): 1049-50. [11 June issue; notes that Pirogof's methods were already tried, successfully on dogs but unsuccessfully on humans, in India.]

"Selections from Journals-On the Employment of Ethereal Inhalation in Midwifery." LMG 39 (1847): 1052-54. [11 June issue; abstract of Siebold's paper delivered 8 May in Göttingen. Successful experiments on women.]

"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).

"Academy of Sciences. Influence of Ether on Respiration." Lancet 2 (1847): 49. [10 July issue; Ville and Blandin's experiments "on etherization," concluding that "the carbonic acid thrown off during respiration always augments in quantity in proportion as sensibility becomes enfeebled, and, on the contrary, diminishes as sensibility returns and is reėstablished." Then give a table with results. Editorial comment: "Although the ether agitation is still very rife in France, and the inhalation of ether is tried, and, as we would deem, very rashly, in all kinds of diseases, yet we have lately laid but few accounts respecting this topic before our readers . . . ."]

"Original Communications to The Lancet in Abstract. Treatment of Asiatic and English Cholera." Lancet 2 (1847): 75. [17 July issue; Mr. Griffin of Weymouth recommends calomel on grounds that "Asiatic and English cholera are characterized by an absence of the secretion of bile, the restoration of which it must be our first object to effect . . . ." Editorial reply: "The unfortunate use of the same word, 'cholera,' to indicate two diseases essentially distinct in almost every particular, has led Mr. Griffin, as it has done many others, to confound them together as respects their pathology and treatment. The vomiting and purging in Asiatic cholera are not essential symptoms, as in the English disease, and the discharges are altogether different. The Asiatic or spasmodic cholera is allied to fever and the plague in its causes and their action on the system, while the English disease results from a disordered action of the liver, which produces exhaustion only by the excessive discharges it induces from the primę vię. The absence of bile in the evacuations, in the spasmodic disease, is characteristic of the complaint, but only as a sign that the secerning organs are unable to perform their duty. The same thing occurs in the yellow fever which is met with on the African coast . . . ."]

"Correspondence. Letter from Dr. Morton, of Boston, U.S." Lancet 2 (1847): 80-81. [17 July issue; after trying various apparatuses, he has returned to use of a sponge.]

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

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

"On Deformity of the Chest in Children." Lancet 2 (1847): 137. [31 July issue; ltr to the editor, dated "July, 1847," in which Snow defends himself against accusation of plagiarism, in 1841 paper before the WMS on this subject, made by George A. Rees, M.D. Lond., in Lancet 2 (1847): 37-38 (10 July issue).]-N.B., this is a new addition to our bibliography of Snow's writings.

"Experiments on the State of the Blood in Etherization." Lancet 2 (1847): 138. [31 July issue; on rabbits, and concludes that "ether has not any immediate ill effects upon the blood, and that its operation must be upon the nervous system."]

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.

"Medical Intelligence. Alleged Rape Perpetrated on a Female While Under the Influence of Ether." LMG 40 (1847): 259. [6 August issue; extract from Paris journal, Gaz. Med.]

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.

"Sulphuric Ether in the Treatment of Intermittent Fevers." LMG 40 (1847): 391. [27 August issue; in Gannat area, by Dr. Challeton.]

"The Letheon." Lancet 2 (1847): 241. [28 August issue; claim that discovery was by a Dr. Wells, dentist, in the U.S.]

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).

"Medical Intelligence. Ether Vapour Applied by a Bladder and Sponge." LMG 40 (1847): 474. [10 September issue; M. Munaret's apparatus, including a wire mesh over face that holds the bladder.]

"Foreign Department. The Rice-water Evacuations of Cholera." Lancet 2 (1847): 284. [11 September issue; "chemical and microscopical examination" by Andral, presented to Academy of Sciences, shows that the "grumous, solid matter" is "derived from the intestinal mucous membrane."]

"Results of the Inhalation of Ether in One Hundred and Six Cases." LMG 40 (1847): 547-49. [24 September issue; by Wells, from Malta, a strong advocate of its use. Aware of Snow's degrees of etherization and apparatus, although Wells prefers a sponge for its simplicity.]

Editorial-Asiatic cholera coming, but anti-sanitary views predominate." LMG 40 (1847): 592. [1 October issue; reports cholera has reached Poland, and moving northwesterly direction. "With greatly augmented mortality from zymotic diseases, and the unchecked continuance of causes which promote this mortality, it is obvious that the metropolis is but ill prepared to resist the invasion of this formidable malady. . . . Anti-sanitary views are at present triumphant. . . . The Government may appoint Boards of Health, but so long as crowded streets are undrained, unsewered, and unventilated, their efforts to avert the attacks of cholera will be futile. All this was as well known in 1831 as it us at present; yet sixteen years have been suffered to elapse, and the only practical step actually taken, has been the appointment of a committee, within the last few weeks, to inquire into the special means requisite for the sanitary improvement of the metropolis! . . ."]

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.]

Review of Snow, On the Inhalation of the Vapour of Ether in Surgical Operations. Lancet 2 (1847): 410-11. [16 October issue.]

Editorial-treatment of Asiatic cholera." LMG 40 (1847): 677-81. [15 October; "We do not know any subject better adapted for discussion at the medical societies, which are now about to meet in the metropolis, than the present state of our knowledge respecting the treatment of Asiatic Cholera. . . . Did we, or did we not, gain any kind of knowledge by the loss in these islands of 42,000 lives [in 1831-32] . . . ?" Then recommends Copland's Dictionary, part 10, "Pestilence Choleric," for its survey of the treatments that have been described, concluding "that we are entirely at a loss for any certain principle of treatment" since "many of the so-called remedies . . . have left the essence of the disease untouched." Agree with Copland's criticism of the overuse of calomel, a favorite of Indian practitioners, who believe "that the chief source of mischief was the absence of bile; whereas this is probably only a symptom incidental to the general cause of disturbance" (677). The (ingested) saline treatment of Dr. Stevens has usually been a failure, probably because the victim is too weak to absorb the solution when administered-which has led to the injected saline treatment, normally considered effective in the short run but did not halt the diarrhea or touch the essence of the disease. Call for a Professional Congress to scrutinize all prior and new methods of treatment, and then give a full accounting. "We believe it will be found [if such a congress met] that as yet medicine has not only done nothing for the treatment of Asiatic cholera, but that some plans pursued in 1831-2 are so injurious that the patient would have a better chance of escape if left to himself*. (footnote *: The homeopathists have boasted of their success in treating cholera; the secret of this is that they did not interfere so much as regular practitioners, and gave full play to the vis medicatrix naturę!)" (679). Offers statistics of numbers of cholera cases to deaths that suggest "the metropolis, with its numerous charitable institutions, and with the advantages of the best professional skill, was the seat of an amount of mortality only a little inferior to that of other localities, where the disease appears to have run its course unchecked" (680).

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.]

Editorial-Sanitary Legislation." LMG 40 (1847): 761-64. [29 October; cheered that "the prospect of a visitation from the cholera" is strengthening the position of the "Health of Towns' party" in Parliament, and that the "Filth of Towns' party" is unable to block all sanitary legislation (761). Singles out Dr. Hector Gavin's pamphlet on "Unhealthiness of London, and the Necessity of Remedial Measures" and prints extensive extracts from it. Emphasis on higher mortality in towns than country, and thinks deaths in towns are under-reported. Suggests a "rough plan of the metropolitan districts, shaded according to the intensity of the mortality" (763), and also feature Gavin's "graphic description of this disease-mist" that hangs over London (762). Journal clearly aligned with Health of Towns party, and pushing for sanitary legislation as an antidote to cholera mortality.]

Editorial-Sanitary condition of English towns. LMG 40 (1847): 808-11. [5 November; riffs on the recent publication of the Quarterly Return of the Registrar-General on this subject. Cites statistics, which for London shows no improvement in health. Then quotes from the Report (Farr): "All the diseases of the zymotic class-such as small-pox, measles, scarlatina, typhus, influenza, and cholera-have the remarkable property of becoming epidemic. After certain intervals of time, in which they are fatal to a smaller or greater number of persons in different places and seasons, great multitudes are suddenly attached and destroyed in a given locality; the disease in this intense form involves the neighbouring population, spreads around the whole region, and sometimes travels over the tracks of human intercourse through the world. Little is known of the immediate chemical or vital causes of epidemics; but in given circumstances, where many are immersed in an atmosphere of decaying organic matter, some zymotic disease is invariably produced; where there is starvation, it is most frequently typhus; cold, influenza; heat, it is cholera, yellow fever, plague. . . . A city breathing an atmosphere perfectly pure may not be exempt from every epidemic; but observation has shown that such irruptions are infrequent, and fatal to few persons of strength or stamina. Internal sanatory arrangements, and not quarantine or sanatory lines, are the safeguards of nations. A salubrious city in an epidemic . . . is exposed to danger and injury, but not to the same extent as the present cities of Europe . . ." (810).

Review of Snow, On the Inhalation of the Vapour of Ether in Surgical Operations. LMG 40 (1847): 812-14. [5 November issue.]

"British Medical Journals. On the Mode and Effects of the Inhalation of Ether." Lancet 2 (1847): 498. [6 November issue; extracted from LMG's letter from Wells in Malta, including passage where Wells notes that "several cases have convince me that, contrary to the statements of Dr. Snow and others, in many persons a state of insensibility to pain precedes the loss of consciousness,-that the faculty of perception remains after that of tactile sensibility is lost." Also considers the Hooper-Robinson apparatus "particularly defective." While "Dr. Snow seems to have combined all the advantages an apparatus can afford, but still, I think, as a simple, portable, and effective means of rapidly inducing insensibility, the sponge must be preferred by the practical surgeon."]

Editorial. Ineluctable Progress of the Cholera. Lancet 2 (1847): 500-01. [6 November issue; "From the preceding account [of cholera's appearance in various places], based on official documents, the approach of the cholera to this country is rendered morally certain; it follows pretty much the same route as heretofore, it is seen to be unstayed by climate; penetrating, as it does, towards northern Russia; to vary in intensity, and even in character, at different places; to pass over tracts of country; and not to follow, except a general north-westward course, any direction favoured by the physical features of the country, or the direction of the winds" (501). Yet, "we sit still with shut eyes and folded hands."]

"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.]

"Medical Intelligence. Discovery of a Substitute for Ether Vapour by Professor Simpson." LMG 40 (1847): 906. [19 November issue; simply announces "the discovery . . . of a new anęsthetic agent, which is in many respects preferable to the use of ether vapour in surgical operations. . . . Chloroform, or Perchloride of Formyte."]

"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.]

"Hospital Reports. St. Bartholomew's Hospital." Lancet 2 (1847): 571. [27 November issue; notes first use of chloroform on 20 November.]

"On a New Anęsthetic Agent, More Efficient than Sulphuric Ether." Lancet 2 (1847): 549-50. [20 November issue; different in several respects from the one published the following week by LMG.]

"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]

"Physiological Erfects [sic] of the Inhalation of Ether." LMG 40 (1847): 929-33. [26 November issue; article by Andrew Buchanan, M.D., of Glascow. "The narcotic effects produced by ether . . . do not always follow upon inhalation. The operation, as it is at present practised, must be admitted to be uncertain and not devoid of danger. . . . The source of this uncertainty and danger is the difficulty of determining the exact quantity of ethereal vapour which is inhaled, and the proportion of air which is mingled with it" (929). Then proceeds to discuss a new inhaler he's constructed; don't find mention of JS.]

"Discovery of a New Anęsthetic Agent, more efficient than sulphuric ether." LMG 40 (1847): 934-37. [26 November issue; by J. Y. Simpson, who begins: "At the first winter meeting of the Medico-Chirurgical Society of Edinburgh, held on the 10th November last, I had an opportunity of directing the attention of the members to a new agent, which I had been using for some time previously, for the purpose of producing insensibility to pain in surgical and obstetric practice" (934). Advantages over ether-less needed to produce effect; more rapid and complete action; more agreeable to inhale; less expensive; odor is not unpleasant; more portable; no special inhaler required. Then describes its use in surgical operations (4 cases) and obstetric practice (3 cases). Outlines the conditions for successful etherization in surgery, and notes that chloroform is advantageous in each. Recommends administration by handkerchief.]

Editorial-Chloroform. LMG 40 (1847): 938-39. [26 November; begins with the current disinterest of readers in ether administration, "while the machines, with the most complex arrangement of valves, tubes, &c., have by degrees given place to the use of an ordinary sponge. Sic transit gloria" (938). Then refers to letter from Simpson in this issue, and notes that the same letter has already been published elsewhere and chloroform already tried in London (by Liston, among others). Reminds readers that "Chloric Ether" has "for some time" been used as a local application in London. In footnote, cites Liebig on how to prepare the liquid. Cautions about becoming overly enthusiastic again.]

Editorial. Sanitary Reform and the Medical Profession. Lancet 2 (1847): 578-79. [27 November; "With cholera advancing . . . all the medical advocates of sanitary reform should exert themselves with zeal to cement the union between sanitary measures and the profession of medicine, so that the latter may receive an accession of strength and influence from the enactment of sanitary laws" (578). Also prints copy of circular sent by Metropolitan Sanitary Commission to Poor Law Union medical officers, asking "what provisions are made in your district for the prompt removal of filth and refuse, and the due supply of water, and the condition as to cleanliness of the interior of the houses in which you have found sickness to be most prevalent" (579).]

Westminster Medical Society-27 November 1847. LMG 40 (1847): 1031-32; Lancet 2 (1847): 605-06. [discussion on chloroform was resumed after a paper on aneurism of the aorta.]

"Physiological Properties of Chloroform." LMG 40 (1847): 978-79. [3 December issue; by R. M. Glover, Newcastle Med School. Acknowledges Simpson's preeminence in proposing chloroform as substitute for ether, but points out that he had published his findings in 1842 on the agent's physiological properties after a series of experiments on animals (introduced into carotid, jugular, stomach, and peritoneum). Found extensive congestion of lungs in a number of cases, so he cautions against assuming it is safe when inhaled by humans (unless alcohol consumption has protective properties).]

Editorial-Influenza. LMG 40 (1847): 980-81. [3 December; influenza now in London. "We have thus evidence of a similar epidemic disorder attacking almost simultaneously three cities forming a triangle of the map of Europe [Copenhagen, Marseilles, London] . . . . To add to the difficulty of accounting for the origin of these epidemics by medical theories, we may mention a curious fact that may throw some light upon the diffusion of cholera, by shewing that an epidemic and a quasi-contagious character may be observed in one and the same disease" (980-81). Gives example of a steamer that regularly moves between Marseilles and Alexandria. Crew became ill with influenza on board-although unclear if they spread to inhabitants of Alexandria.]

Editorial-Asiatic Cholera Propagated by Human Intercourse." LMG 40 (1847): 981-83. [3 December; editorial follows one on influenza. "Much has been said and written respecting the mode in which this singular disease [cholera] is diffused. That the poison of cholera is spread in some way or other cannot admit of dispute. One class of observers content themselves by saying that cholera is not infectious, adducing cases apparently irreconcileable with this hypothesis. Admitting the validity of these objections, it still remains to be proved that the cholera is a pure epidemic. . . . Let any one examine the recent progress of the cholera northward and westward through the Russian empire, and say whether it is in the nature of an epidemic to creep slowly from place to place, to follow the banks of great rivers, to prevail on one bank and not on the other, to spread along one side of a street in a populous city and not on the other, to set at defiance in its progressive diffusion, the influence of winds, temperature, seasons, and all those atmospheric changes included under the head of climate.* (footnote *: in part of its progress in Russia, "the cholera advanced constantly against the wind. It chiefly manifested itself in villages immediately after the arrival of travellers labouring under it.") Thus, "the laws of its propagation are quite inexplicable upon the common doctrine of epidemic diseases. Its diffusion through the atmosphere is all but disproved, since . . . we should have it radiating equally around from a focus of great intensity, or obeying the course of prevalent winds. But such a mode of diffusion has not been observed . . ." (982). "It has been often remarked that a town or village situated between two others infected with cholera, has escaped. This has been adduced as a triumphant instance of its non-propagation by human intercourse, or of the total absence of infection. The argument is ingenious, but unsound, because it proves too much: it just goes to show that the cholera cannot be communicated or diffused in any conceivable manner! If the disease were really epidemic, and the atmosphere had any influence in its diffusion, it would be utterly impossible that the intermediate town or village should escape the aeiral poison . . ." (982). "there is another hypothesis which has found a few advocates, i.e. that cholera does not travel, but that by a sort of coincidence, and a species of epigenesis, the seeds of the disease arise spontaneously in one town or village so soon as it has ceased to appear in another adjacent to it. . . . [That] it is not of Indian but of local origin. We think, however, the geographical progression of this malady must be taken as fatal to this view. Our own belief . . . [since 1831-32] is, that it is not a pure epidemic, nor a universally infectious malady; but that it can by decidedly propagated by human intercourse" (982-83). Quarantine laws are pointless, however.]

Review of Carlo Matteucci (Pisa), Lectures on the Physical Phenomena of Living Beings. LMG 40 (1847): 985ff. [3 December issue; some of these lectures have appeared in London medical journals. Reviewer notes to contents of twenty chapters, including "Molecular Attraction," "the production of heat, light, and electricity in animals, the physiological action of Gravity, Light, Caloric, and Electricity," and Animal Mechanics.]

"Correspondence. Chloroformization in Dentistry." LMG 40 (1847): 993. [3 December issue; by C. Stokes, a surgeon in London.]

"Correspondence. Method of Preparing Chloroform." LMG 40 (1847): 993. [3 December issue; by S. Thomson, Edinburgh.]

Westminster Medical Society-4 December 1847. Lancet 2 (1847): 655-57. [18 December issue; Lankester comments on current epidemic of influenza, followed by a paper by Ogier Ward on "Treatment of Asiatic Cholera in the Stage of Collapse." Snow is not recorded as commenting on either.]

"Medical Society of London-6 December 1847. History of Chloroform, and its use as an Anęsthetic Agent." LMG 40 (1847): 1079-80. Lancet 2 (1847): 631.[11 December issue; paper read by Dr. Cogswell.]

Editorial. Death of Robert Liston, Esq., F.R.S. Lancet 2 (1847): 633-34. [11 December issue; fulsome praise-cf. to later notice of Snow's death.]

"Medical News. Asiatic Cholera." Lancet 2 (1847): 637. [11 December issue; abstract of first report of the Sanitary Commissioners, which recommends replacement of Metropolitan Commissions of Sewers with one sanitary commission for entire London, except the city corporation.]

"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.]

"Administration of Chloroform in Cases of Difficult Parturition; delivery completed without pain." Lancet 2 (1847): 653-54. [18 December issue; case descriptions by Edward Murphy, UCL.]

Editorial. Ether Vapour of Proven Benefit in Surgical Operations. Lancet 2 (1847): 660. [18 December; does not take a stand on relative merits of ether and chloroform, however.]

"Medical News. Government Precautions against the Cholera." Lancet 2 (1847): 664. [18 December issue; "In the House of Commons, on Friday last, in answer to an hon. member, Lord Morpeth said, that the Act which had been passed in 1832, for the purpose of preventing the spread of cholera, was still in force, and on the first alarm which should arise of the existence of cholera among us, would be put in operation by means of proclamations directing the formation of boards of health. It was at present under consideration whether the form of proclamation which had been used on the former occasion should be modified or not."]

"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.]

"Correspondence. Asphyxia and Convulsions under the Influence of Chloroform." LMG 40 (1847): 1117-18. [24 December issue; by J. Beales, Suffolk. Not all unsuccessful, however.]

"Medical Intelligence. Experiments on the Action of Chloroform Vapour." LMG 40 (1847): 1123. [24 December issue; results of M. Gruby's experiments on dogs and rabbits, comparing effects produced by ether and chloroform.]

"Observations on Dr. Simpson's Anęsthetic Statistics." Lancet 2 (1847): 677-78. [25 December issue; by Robert Barnes, lecturer on midwifery (at a London school). Of the natural-pain school, Barnes concludes: "The question is not to be decided by the warm persuasions of 'zealous missionaries' of the female sex; by wanton abuse of medical practitioners; by inconclusive arguments reared on a few imperfect and doubtful facts, and those facts wrested from their legitimate applications; by false analogy, bad arithmetic, and statistics run wild; however conclusive they may be to the judgment, and agreeable to the taste, of the Edinburgh professor of midwifery" (678).]

Review of Researches into the Pathology and Treatment of the Asiatic or Algide Cholera. Lancet 2 (1847): 678-80. [25 December issue; part 1 of a review of E. A. Parkes' book.]

Editorial--"Cholera and Quarantine." MT 17 (1847-48): 198-99. [25 December 1847; notes that "cholera is a singular disease." While MT acknowledges that "Dr. Copland and some others are firm believers in the doctrine of contagion . . . the majority of writers, by far, both Indian and European, are opposed to the doctrine of infection or contagion" [strict contagionists] (198). On the contrary, "the majority of medical men attribute the production and propagation of this terrible disease to certain conditions of the atmosphere acting upon individuals previously disposed to disease by some peculiar state of the constitution" [rather more Sydenhamian than usually found; no hint of environmental contingency or predisposing social cause]. Quotes Milroy with approval, as well as a surgeon, Mr. Campbell: "That this disease is not infectious, but is caused by the direct application to the surface of a peculiar miasma, existing in particular strata of the atmosphere, has been fully proved by the history of its progress, as well as by the phenomena attending it" (199). Consequently, quarantine does little good. Advocates sanitary reforms.]

"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."]