Ch l Chl f d hCholera, Chloroform, and the Science of MedicineScience of Medicine

Jean‐François Boivin

18 August 2010

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THE LANCET.THE LANCET.LONDON: SATURDAY, JUNE 23, 1855.

It is the misfortune of Medicine, in its conflict with the prejudices of society that it is continually exposed to the prejudices of society, that it is continually exposed to discomfiture, through the perverse, crotchetty, or treasonable behaviour of certain of its own disciples.p

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Dr. Snow is satisfied that every case of cholera for instance, . S w a d a v y ca c a a c , depends upon a previous case of cholera, and is caused by swallowing the excrementitious matter voided by cholera patients…

…But Dr. Snow claims to have discovered that the law of propagation of cholera is the drinking of sewage-water. Hi h f di l ll h h i O hHis theory, of course, displaces all other theories. Other theories attribute great efficacy in the spread of cholera to bad drainage and atmospheric impurities bad drainage and atmospheric impurities.

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Queen VictoriaQueen Victoria

For much of the English-speaking world in the For much of the English speaking world in the early 1850s, the question was whether chloroform should be given at all in childbirth When Queen should be given at all in childbirth. When Queen Victoria neared the completion of her eighth pregnancy in March 1853, the possibility of her pregnancy in March 1853, the possibility of her receiving pain relief was quietly being floated, and Snow was advised that he might be called in.27Snow was advised that he might be called in.Asked to administer chloroform for a patient in labor residing at 18 James Street, labor residing at 18 James Street,

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Whereas the main point of public controversy was whether obstetric analgesia was consistent with biblical teaching, the issue for some g,medical men was the wisdom of administering to the queen a medicinal agent that had been to the queen a medicinal agent that had been held responsible for a number of anesthetic-

l d d h 34 I M 1853 L related deaths.34 In May 1853 a Lancet editorial expressed “astonishment” at the “rumour” that the Queen had received chloroform.

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A very extraordinary report has obtained general circulation d i h h h f h connected with the recent accouchement of her most

gracious Majesty Queen Victoria. It has always been understood by the profession that the births of the Royal y p ychildren in all instances have been unattended by any peculiar un untoward circumstances. Intense astonishment, therefore, has been excited throughout the profession by the g p yrumour that her Majesty during her last labour was placed under the influence of chloroform, an agent which has unquestionably caused instantaneous death in a q y d dconsiderable number of cases. Doubts on this subject cannot exist. In several of the fatal examples persons in their usual health expired while the process of inhalation their usual health expired while the process of inhalation was proceeding, and the deplorable catastrophes were clearly and indisputably referrible to the poisonous action of chloroform and to that cause aloneof chloroform, and to that cause alone.

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Let it not be supposed that we would d l h i i f hl f undervalue the immense importance of chloroform

in surgical operations. We know that an i l l bl f i d b i incalculable amount of agony is averted by its employment. On thousands of occasions it has b i i h i j b i h i h been given without injury, but inasmuch as it has destroyed life in a considerable number of instances, i i h l i i l i i i its unnecessary inhalation involves, in our opinion, an amount of responsibility which words cannot d l d ibadequately describe.

Lancet 1(1853):453( )

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Planned elective cesarean section: A bl h i f ?reasonable choice for some women?

Mary E. Hannahy

β See related article page 775

CMAJ 2004; 170:813 814CMAJ 2004; 170:813‐814

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Césariennes à la carteKATIA GAGNON

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26312

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Figure 7.5. William Farr (1807 – 1883)

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Farr acknowledged that Snow might be correct, but he thought the requisiteg g g qthreshold of proof was very high and ultimately unattainable: “To measure theeffects of good or bad water supply, it is requisite to find two classes ofinhabitants living at the same level [elevation], moving in equal space,enjoying an equal share of the means of subsistence engaged in the sameenjoying an equal share of the means of subsistence, engaged in the samepursuits, but differing in this respect,—that one drinks water from Battersea,the other from Kew. … But of such experimenta crucis the circumstances ofLondon do not admit. …”12 Farr’s usage of the same Baconian term thatSnow had

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In three cases…the same districts are supplied by two companies.

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Snow understated matters when he wrote that the “inquiry was il d d i h d d l f bl ” (MCC2 77) Hnecessarily attended with a good deal of trouble” (MCC2,77). He

soon discovered that finding out whether the water to a given house was supplied by Lambeth of S&V was not as simple as he had

i i d f “ h f i i hi h I ldanticipated, for “there were very few instances in which I could at once get the information I required. Even when the water-rates are paid by the residents, they can seldom remember the name of the

C ll h h l k d f h I h fWater Company till they have looked for the receipt. In the case of working people who pay the weekly rents, the rates are invariably paid by the landlord or his agent, who often lives at a distance, and the

d k h f h ” ( )residents know nothing of the matter” (MCC2, 77).

But Snow’s ingenuity as a chemist combined with a hefty dose of But Snows ingenuity as a chemist combined with a hefty dose of good luck, provided a solution: the water provided by Lambeth and S&V during his inquiry contained consistently different amounts of saltsalt.

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data (see Vital Statistics, Overview). Farr’s contemporary, John ( , ) p y, JSnow, undertook investigations of cholera epidemics in London and also practiced anesthesia, giving chloroform to Queen Victoria for childbirth [44] Snow’s investigations of cholera in Victoria for childbirth [44]. Snow s investigations of cholera in London, undertaken by the newly founded London Epidemiological Society, let to the determination that cholera

i d i i d d i ki P f f hi was transmitted via contaminated drinking water. Proof of this hypothesis prompted preventive interventions, including the recommendation to remove the handle of the Broad Street pump, a source of contaminated drinking water.

Encyclopedia of epidemiologic methods. Page 379.

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2001; 30:1-1122

2001; 30:1-1122

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We understand that the sisters of the late Dr. Snow are now in a position of d bl d ff l h f l f l hconsiderable pecuniary difficulty; they are, in fact, almost if not entirely without

means. The researches of Dr. Snow are among the most fruitful in modern medicine. He traced the history of cholera. We owe to him chiefly the severe induction by which the influence of the poisoning of water-supplies was proved. No induction by which the influence of the poisoning of water supplies was proved. No greater service could have been rendered to humanity that this; it has enabled us to meet and combat the disease, where alone it is to be vanquished, in its sources or channels of propagation. Dr. Snow’s labours, next to those of Sir J.Y. Simpson,

l i d h f h i li i d i d f i l popularized the use of anaesthetics to relieve pain during and after surgical operations. He had therefore a strong claim on the nation. An application will be made for a civil list pension for his bereaved and unprovided sisters. We cannot conceive a more fitting case for the exercise of the Royal and national bounty. Dr. g y ySnow was a great public benefactor, and the benefits which he conferred must be fresh in the minds of all.

Lancet 2 (1866):363-364

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