John Snow Chronology - 1848

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.,

Review of E. A. Parkes, Researches into the Pathology and Treatment of the Asiatic or Algide Cholera. Lancet 1 (1848): 11-14. [issue of 1 Jan, a conclusion of review begun in (1847) 2: 680. Comprehensive; may be an orientation to range of views before the second epidemic began]

"British Medical Journals." Lancet 1 (1848): 47. [8 January issue; relief of spasmodic asthma by chloroform, from the LMG.]

"Case of Delirium Tremens Treated with Chloroform." Lancet 1 (1848): 70. [15 January issue; by Warwick from Notts.]

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

Editorial on need for purer water for London. Lancet 1 (1848): 103-05. [issue of 22 January; lays out where each water company draws its water and the number of houses it serves, and where, each day. Applauds Lambeth Water Works decision to move its source to Ditton, and urges Parliament to require other companies to do likewise; pre-1852 act]

Bristol General Hospital. Application of Chloroform in Typhus Fever. Lancet 1 (1848): 119. [29 January issue]

"Practical remarks on the employment of chloroform in surgical operations." LMG 41 (1848): 211-13. [ltr from Robinson, dated 2 Feb, in which he mentions that to date he's employed it in 1800 cases. The letter is an argument in favor of admin via apparatus and with trustworthy preparations of chloroform]

"Fatal Application of Chloroform." Lancet 1 (1848): 161-62. [5 February issue; Hannah Greener's death in Winlaton, five miles from Newcastle. Editorial exonerating the surgeon on 158]

"Remarks on the Alleged Case of Death from the Action of Chloroform." Lancet 1 (1848): 175-76. [12 February issue; J. Y. Simpson writes, "The unfortunate patient certainly died when under the influence of chloroform, not, however, as I believe, from its effects, but from the effects of the means used to revive her" (175).. . . . Besides, the dose of chloroform exhibited by Mr. Meggison was so small as to render it exceedingly improbable that it could have been the essential cause of the death of the patient. {New para} . . . while it appears highly improbable that the fatal result in Mr. Meggison's patient could be the consequence of the use of chloroform, and entirely due to it, the conditions in which the patient was placed were such as would almost inevitably have produced death by asphyxia" (176).]

"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]

Westminster Medical Society-no date given. Lancet 1 (1848): 213-14. [issue of 19 February; Dr. Webster characterized the current epidemic of influenza, noting, "The general type of complaint was asthenic, as exhaustion, debility, and depression of the system, were the marked features of this malady throughout all its stages" (213). N. B. the Cullen/Brunonian language still in use.]

Editorial, applauding Lord Morpeth for introducing a sanitary reform bill. Lancet 1 (1848): 216. [19 February; missing several important elements, including "the graveyard nuisance prevention," but a step in needed direction. Then reminds readers of journal's position that "public health is a department of the profession of medicine, and that State Medicine can never be efficiently administered unless a large share of its control be placed in the hands of responsible medical men. . . . And shall we hand over the sanitary control of the sewers, and the water courses, to those who have brought tem into their present infamous condition?"]

"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.] "He said that he considered the introduction of the use of ether vapour for the prevention of pain second only to vaccination in the direct benefits it conferred on mankind, and in the advantages it would confer on medical science second only to the discovery of the circulation of the blood. Chloroform was in some respects an improvement over ether, which, however, was the great discovery" (MT, 462). A bit further on: "He had examined a great number of volatile liquids, and he found that the power of all of them was in an inverse ratio to their solubility in water, and, consequently, in the blood; . . . The physiological strength of the vapours he had ascertained by inhaling small quantities himself, and by placing small animals in closed but capacious glass jars with proportions of vapour determined by weighing-a mode of investigation which he believed would lead to a knowledge of the modus operandi of these vapours" (Ibid.) Mentions use of "Turner's Chemistry" in preparing bichloride of carbon, which "he had given in three cases of tooth-drawing at St. George's Hospital. It produced the same effects as chloroform" but he did not recommend its use (463). Concludes with some explanations for why inhaling diluted chloroform will not bring a patient to the third degree, insensibility.]

Westminster Medical Society-18 March 1848. Lancet 1 (1848): 341-43; LMG 41 (1848): 559-62. [ Dr. Ogier Ward reading paper, "Contagion of Cholera."; he considers the recent report of the Sanitary Commission, in which Southwood Smith & Mr. Owen declared "that the cholera was not contagious, even 'contingently' . . . though when the subject had been discussed before the Westminster Medical Society in 1831, the arguments of the contagionists were so powerful as to compel their opponents to admit that cholera was contagious 'contingently,' if not absolutely" 559-60). Ogier Ward accuses the commissioners of stacking the case for anticontagionism by virtue of the witnesses they chose and the questioning. Then he goes through all the arguments for contagion (by persons, fomites, and infectious via "contagious miasmata . . . thrown off from the body of the diseased person by the secretions and the exhalations of the lungs, skin, &c" (561)), plus its contingency-"all miasmata are volatile, and are suspended in the atmosphere, and follow its movements. In damp, foggy weather . . ." (561). A Mr. Hancock counters with own experiences (sitting in a cholera hospital overnight and dissecting bodies of cholera victims) showing that it's non-contagious; Lankester rejoinder is that just one certain instance of contagion should settle the dispute; others contribute, but no mention of JS]

Westminster Medical Society-25 March, 1 and 8 April. Lancet 1 (1848): 451-52. [continuation of discussion of contagion, and no indication that Snow was present or participated.]

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): 522-23. [Dr. Garrod discussed twenty five cases of dropsy, following scarlet fever. Snow noted "that his experience entirely accorded with that of Dr. Garrod, respecting the nature of this disease. He related a number of cases to the Society about seven years ago, and the cases he had subsequently met with confirmed the views he then expressed. The dropsy was not the only consequence of the renal disorder; for the inflammation of the serous membranes, pericardium, pleura, or peritonæum, often occurred, and were the chief sources of danger in this affection; and in a few rare instances the renal disease caused inflammation of this kind, without occasioning any general dropsy."]

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

"Asiatic cholera in the Metropolis." MT 18 (1848): 25. [ed from 13 May, noting two confirmed cases in London]

"The cholera of 1831-32. Its diffusion by contagion." LMG 41 (1848): 435-37. [?? check issue date; verbatim extract from earlier lecture by Dr. Watson]

Review of Charles Cowdell, A Disquisition on Pestilential Cholera; being an Attempt to explain it Phenomena, Nature, Cause, Prevention, and Treatment, by Reference to an Extrinsic Fungous Origin. Lancet 1 (1848): 666-67. [issue of 17 June]

Review of Boehm's book on Microscopial examination of stomach and bowels in cholera patients. MT 18 (1848): 120-21. [issue of 24 June; a review of the German edition.]

"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).

Review of T. H. Starr, A Discourse on the Asiatic Cholera. Lancet 2 (1848): 69-71. [issue of 15 July; Reviewer chastises author for making animalculæ cause of fungi, similar to argument recently employed by Dr. Cowdell for fungi. Then quotes Liebig's Animal Chemistry at length to show that fungi and infusoria are organic beings, and that the fermentation and putrefaction that follow their death (elimination of "the vital force, which has determined the direction of attraction") is similar to decay in all animal and vegetable organisms after death. Hence, fungi and infusoria cannot be causes of a process that they are subject to. Although these organisms accompany putrefactive process of other organisms, they are not its cause; instead, as sources of pure oxygen, they are "the true enemies and destroyers of all contagions and miasms."]

"Suggestions for the Treatment of Cholera by Anæsthetic Agents." Lancet 2 (1848): 82-83. [15 July issue; anon. reference to discovery of sulphate of carbon as an alternative to chloroform; recs for treatment of cholera since sul of car is an antispasmodic]

"Remarks of a Case of Spasmodic English Cholera." Lancet 2 (1848): 125. [29 July issue; among other treatments, rec. the use of ether as a "stimulant."

"Indications of the Approach of Cholera." MT 18 (1848): 227. [miasmatic and sanitarian editorial of 5 August; predisposing social causes accepted; seems to be humoral in thinking that intemperate diet could push simple "gastric disturbance" into a "severe attack of cholera."]

"Cholera.-Preventive Qualities of Carbonic Acid Gas and Charcoal." Lancet 2 (1848): 165. [5 August issue; rec that water companies filter drinking water through a bed of charcoal "to counteract any predisposition to this scourge."]

"Asiatic cholera successfully treated by chloroform given internally." MT 18 (1848): 237-38. [case presentation by Brady, a surgeon from Harrow; issue of 12 August]

"Chloroform in Cholera." MT 18 (1848): 271. [case presentation by Mr. Stedman, from Isle of Ely; issue of 26 August]

"On the treatment of spasmodic cholera by chloroform." MT 18 (1848): 320-21. [another case by Brady; issue of 16 Sept]

Editorial. Lancet 2 (1848): 383. [30 Sept; condemns a BoH of three members, none of whom are members of the medical profession]

Editorial on parallels between 1831-32 and 1848 cholera. LMG 42 (1848): 582-85. [6 October; shows its contagionist stance with a signature word (progress) in opening sentence: "One of the most remarkable facts connected with the Asiatic Cholera is, that, in its present progress throughout Europe, it should follow so nearly the course which it took in 1830-31." A few paragraphs later: "It is worthy of remark that in 1830-1, as in 1847-8, the cholera has manifested itself chiefly in the great lines of intercourse along frequented roads, and the banks of navigable rivers, attacking chiefly towns and cities where the population was most dense, producing the largest amount of mortality in its first onset, then slowly diminishing in severity, and finally disappearing to reappear in a neighbouring locality" (583). [N.B. that anti-contagionists could interpret this remark as supporting their position, and that the first onset argument is not the usual evidence cited by contagionists] "This comparatively slow progress, together with its advance in the face of prevailing winds, is very unlike the usual mode of diffusion of a purely epidemic disease" (583)-[now back to a typical line of contagionist reasoning]. Suggests origin of the premonitory diarrhea hypothesis-observations by Russian practitioners. "All kinds of treatment have failed to diminish the number of deaths; and the recoveries in this stage [the second, in which "art is powerless"] are probably more to be ascribed to the innate energies of the constitution-to the vis vitæ in combating the poison-than to any of the supposed remedial measures adopted" (585). Offers suggestions for the premonitory stage, but emphasizing that since opium is both "useful and popular" medical men should be consulted-then follow several bedside medicine assumptions (age and other circumstances in determining dosages, role of diet, keep warm, avoid wet or damp).

CBH-instructions . . . respecting the treatment of cholera." LMG 42 (1848): 595-98. [Emphasizes "the important difference that exists between Cholera and Fever [?? influenza], with respect to the mode of propagation of these epidemic diseases. Fever, it is well known, is highly contagious, or easily propagated from one individual to another, while all experience shows that Cholera is rarely, if ever, contagious" (595)- no need to separate sick from well, for healthy to shun the sick, to set up cholera hospitals when most can be treated in own dwellings. A bit later: "Cholera being rarely, if ever, contagious, there is not the risk of infection, as in Fever . . ." (595). Then how to respond to attacks: "In nearly all cases of Cholera, there are two stages of the disease; the first being merely Diarrhea, or simple looseness of the bowels; the second being the stage of Collapse or Blue Cholera, marked by cramps, failure of the circulation, lividity of the skin, cold, clammy perspiration, and all the other well-known symptoms of the disease. In the first stage of the disease, medical treatment is frequently successful: in the second stage too often of no avail" (597). Lists various preservatives, including "Be very careful that the water used as drink is of good quality." But their concluding recommendations leaves out water: "In fine, shun damp places, particularly for sleeping; breathe pure air; observe cleanliness; keep the surface of the body warm; avoid fatigues, and excesses of all kinds; use wholesome plain food; live temperately; preserve, as much as possible, a state of general good health, and you will have adopted the best safeguards against Cholera."

RCP suggestions for measures adopted respecting prevention of Asiatic cholera. LMG 42 (1848): 815-16. [The College's Cholera Committee was unwilling to take a stance on contagion/non-contagion, but noted that "Cholera appears to have been very rarely communicated by personal intercourse" (815). "the disease has almost invariably been most destructive in the dampest and filthiest parts of the towns it has visited." Hence, sanitary measures including improving state of sewers and drains, removals of "decaying vegetable and animal matter," ventilation, etc. Similar preventative measures as suggested by BoH, but cannot agree on a "uniform plan of treatment." Set up Cholera Hospitals to assist the poor (not because of fears of infection) in the event the visitation is serious.]

Editorial. Lancet 2 (1848): 426-27. [14 October. Follow-up on BoH]

"Asiatic Cholera." MT 19 (1848-49): 11-12. [editorial of 14 October 48, indicating that confirmed cases of cholera in London. First cases were in Hull, where sailors died within hours. "Upon a closer investigation of the Hull cases, however, it is evident that the mortal symptoms resulted more from the violation of hygienic rules than the direct attack of an epidemic pestilence. Beer and plums taken in immoderate quantities by individuals exposed to atmospherical vicissitudes, and called to undergo a considerable amount of bodily fatigue, will at any time set up a gastric irritation not easily allayed; and it would be an insult to science to assert that these cases were produced by contagion or infection" (12). Then, "the facts connected with the history of Asiatic cholera . . . prove incontestably that it is not what we commonly understand to be a contagious malady. We have here all the analogies of an epidemic,-originating in the East, extending from one country to another, till people of almost every language have felt its power" (12). In short, the Board of Health is confirmed in "its non-contagiousness" and the recommendations of the Central Board of Health in Dublin are similar (and partly reprinted, including recommended medical actions).]

"Chloroform in Cholera." MT 19 (1848-49): 14. [Letter to ed, dated 9 October, from P. Brady, surgeon in Harrow. Believes he's the first to employ chloroform in the treatment of cholera. Gives recommendations for use in all stages: first, in a draught; second, draught + pill, followed by chloroform in a liniment to be rubbed into body whilst keeping it as warm as possible (contra what JS will soon suggest at the WMS), and in third, chloroform as part of an enema. Three dabs 'll do you!]

Analyses of Works of Cholera. Lancet 2 (1848): 451-53. [21 October issue; brief reviews/extracts from several recent works, including one by "Mr. Greenhow, of Newcastle" who considers that "the influence of cholera, like the carbonic acid of the Grotto del Cane, gravitates to the lowest situations'; states that lesson from 1831-32 is that cholera isn't contagious; danger is from the localities, usually low places-a certain line of altitude "beneath which disease will certainly take place, in degrees proportioned to the predisposition or susceptibility of the inhabitants."]

"Public Health.-Cholera." Lancet 2 (1848): 462-63. [21 October issue; abstract of regulations promulgated by GBoH, under the Nuisances Removal and Diseases Prevention Act (11 & 12 Victoria, chap. 123, sec 1.)]

Medical Society of London-9 October. Cholera. Lancet 2 (1848): 453-54; LMG 682-83. [Lancet issue of 21 October; Dr. Clutterbuck informed of a case of cholera at the London Hosp. Not inclined to consider cholera contagious. Asks for info on treatment used by fellows. Only Dr. Chowne is recorded as saying he considers cholera contagious, "but not very contagious." Mentions incident in Newcastle.]

"Westminster Medical Society-21 October 1848." Lancet 2 (1848): 506-08; LMG 42 (1848) 769-70. [President Webster's inaugural address includes his view that current progress of cholera in London is meager compared to "other epidemic maladies," particularly scarlatina since "the subjects of its attacks are usually children, or young people just entering upon the morning of life; whereas the victims of cholera are generally drunkards and persons of worn-out constitutions, or those who have set every hygienic rule at defiance" (LMG, 768-69). Compare as well the mortality from cholera with "the invasion of the epidemic influenza, which was so fatally prevalent in the metropolis at the early part of last winter, when 1213 persons died from that complaint during six weeks ending on Saturday, the 8th of January last" (769). Mr. Brown then related a case of a woman who aborted in second month. "In consequence of the severe pain experienced in removing the placenta, the patient was placed under the influence of chloroform. It was quite successful, and she is doing well" (769); no discussion reported. Mr. Hird then read a paper on "Pathology and Treatment of Cholera." He gave "an account of the disease," described "the symptoms in a highly graphic manner," and compared symptoms and his treatment with results of twelve post-mortem examinations [clinicopathological aspect of hospital paradigm]. He had best results in second stage from half-hour admin of acetate of lead mixed in a solution of opium and spirits of cinnamon. Other actions along the Kennedy model (as outlined by P. Smith in his pamphlet). "In the stage of reaction, the treatment applicable to typhoid fever was called for" (770), not bloodletting. Concluding remarks: "Mr. Hird objected to the use of large doses of opium in every stage of the disease." Dr. Peregrine was first to comment on basis of three cases he had seen "in the present invasion." "He regarded all the symptoms of the disease as the result of the draining of serum from the system," and therefore it was urgent to control the diarrhea with chalk powder and opium. "In the advanced stages of the disease it was important to keep up the warMTh of the surface of the body by the application of heat." "Dr. Snow objected to the application of warMTh in cases of cholera, and founded his objection to its employment on the fact that in cases of asphyxia such application was injurious. Cholera was not asphyxia, but in some points resembling it, so far as the internal congestion was concerned" (770). [These are JS's second published comments on cholera, although first comments are in the teetotal address of 1836. N.B. no mention of 1831-32 experiences, no response to the pathological notion of causation presented by Peregrine. [??Does his comment about internal congestion require post mortem experience with cholera victims, or an analogy to his researches on chloroform dosages-see/compare "Further Remarks on the Cause and Prevention of Death from Chloroform," the paper itself and the summation of his presentation at MSL on 26 Jan 56.]]

"Lectures on the Asiatic Cholera." MT 19 (1848-49): 34-37 (stages, symptoms, etc.), 106-08 (treatment). [by a George Ross, Esq. Surgeon to the Western City Dispensary. First part is a very vituperative critique of governmental commissions and variety of theories. Reiterates a number of the central arguments of the general epidemic cohort, but without clarity or specificity. In treatment section, uses tables of treatments from Vienna and Paris to conclude that stimulants (including venous injection) are highly dangerous, opiates less so but harmful. Uncertain about emetics except for the saline treatment-use of salts + cold water ("the Greville-street combination" (107)), which he thinks ought to be tried more extensively. Bloodletting better than stimulants, but inferior to saline treatment. Praises the RCP for its recommendations over those of the General Board of Health at Gwydyr House.]

"[?? Title missing. MT 19 (1848-49): 51-52. [has argument for miasmatic spread, noting increase in deaths near river banks, esp at low levels, and "defective sanitary arrangements" as cause at higher elevations or far from banks, during the 1831-32 epidemic.]

Medical Society of London-23 October 1848. LMG 42 (1848): 767-68. [Dr. Clutterbuck's presentation on "Cholera at Peckham.-Use of chloroform."]

"Treatment of the Cholera by Chloroform &c. in Peckham House (Poor) Asylum." Lancet 2 (1848): 514. [4 November issue; copy of J. Hill's letter to ed., in The Times of 30 October]

Medical Society of London-6 November 1848. Lancet 2 (1848): 556. [18 November issue; more discussion of cholera, including use of chloroform.]

"Correspondence. The Cholera-Results of Treatment by Chloroform." LMG 42 (1848): 902-03. [Ltr from James Hill, 13 Nov 1848, on treatments at the Peckham House Asylum]

"Nature and probable causes of cholera maligna." LMG 42 (1848): 929-34. [remarks by J. H. James, surgeon to the Devon and Exeter Hospital. "One of the most important questions to be determined is, whether this pestilence is, or is not, infectious. I shall not dispute about terms: nice verbal distinctions are unworthy of such subjects. Is it communicable? whether by breath, contact, fomites, or otherwise? If it is communicable, this question is answered. In this discussion, however, I shall use the terms infectious or contagious as meaning communicable, the least objectionable one, but less commonly in use" (929). Although his conclusion, based on evidence from the Edinburgh Journal for February 1832 and "Dr. Copland's celebrated Dictionary" (930)-HB, take note-is that "the evidence for its being infectious [is] in many instances remarkably strong," he spends much of his paper countering classic anti-contagionist arguments. Has a contingent contagionist dimension: "Circumstances of situation, temperature, and other conditions of the air, aggravate or lessen its violence, but there is no evidence that they produce it. In these respects it agrees with influenza" (931). Believes that there are two "classes" of "infectious and pestilential diseases": invariably malignant (including plague and yellow fever) and varying intensities, from mild to severe (scarlatina, variola-and perhaps cholera). "If the disease is considered infectious, little difficulty will arise from various phenomena (which however explained or inexplicable) it possesses in common with other epidemics. They slumber for a time, then break out with violence, sweep in a particular direction, ravage a large portion of the earth's surface, and subside again for a while" (932). After an assertion that "the Supreme Being" indulges in multiple creations, including "new forms of disease," James notes that "when the seminum has once been produced on the surface of the earth, we must admit that, under certain conditions, it may be preserved indefinitely, and after long intervals renew its work of destruction" (932); cites "virus of the vaccine or small-pox," scarlatina, and thinks that "the semina [of such diseases] can operate at large distances" (933). "If (to sum up the arguments) it be allowed that the cause of cholera is an infection; that this infection is copiously produced from the bodies of the sick; that it may be disseminated to large distances; that the inhabitants of places attacked are liable to be influenced in great numbers, though in very different degrees; that the severe attacks are commonly the result of some powerful occasional cause [?? such as aerial contingency]; that the mild ones have been improperly omitted as instances of the disease; we may explain nearly all the phenomena which have been observed" about cholera (934). (On the latter point, he prophetically points to the infant at 40 Broad Street.) Closing reference to "the inspissated state of the blood. This has been regarded as a cause of the deficient circulation and of the asphyxia [recall JS's remarks at WMS], and it has been attributed to the large separation of the fluid parts of the blood from the alimentary canal . . ." (934). James thinks it possible for cholera to present without diarrhea, but recommends animal experimentation to resolve this. In the meantime, James asserts: "I believe myself that the changes in the blood of cholera patients either depends upon the operation of the poison, which, as it were, curdles it in the vessels, or on the loss of so much of the vital principle as to allow it to approach a state of semicoagulation before death actually occurs" (934).

"Chloroform as a Remedy for Cholera." MT 19 (1848-49): 286-87. [Jones Lamprey, M.D., London. Finds too many analogies between results from administration of chloroform and cholera to consider the former "a specific" remedy. Looks at patient responses and post mortem examination, esp the transaction of the Acad. de Méd. In short, Lamprey advises against its use in most cases. [??was there by now a dispute that would have made Snow, the acknowledged expert on admin and research in chloroform in London, consider investigating the proposed chloroform-cholera connection?]

"On Chloroform in Cholera." Lancet 2 (1848): 551-52. [ltr. in 18 November issue from James Moffat, M.D. Edinburgh, rec. use of chloroform at first appearance of cholera symptoms.]

Medical Society of London-27 November. LMG 42 (1848): 988. Lancet 2 (1848): 610 [2 December 1848 issue; Clutterbuck offered update on the Peckham Asylum treatments, and discussion followed, including comment by Hird.]

"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]