The case books of Dr. John Snow.

John Snow (1813-1858) was a distinguished Victorian physician. He occupies a prominent place in the history of medicine for he achieved an enduring reputation and greatness in an unusual way. Most of his distinguished contemporaries became famous by making lasting contributions to one important aspect of medical science. Snow's special claim is that he made fundamental contributions to not one, but two completely unrelated aspects of medicine. These were his promotion of early anaesthesia, by establishing its scientific and practical foundations, and his discovery of the mode of spread of epidemic cholera. He has been the subject of many biographical notes, and is justly f&ed by anaesthetists for his pioneering work in their specialty, and by epidemiologists for his similar work in theirs. The Library of the Royal College of Physicians of London possesses three of John Snow's manuscript Case Books.' These comprise virtually the whole of Snow's still surviving manuscript material, the rest of which (in this country) is now believed to consist of little more than one brief letter and a testimonial.2 The Case Books cover the period from July 1848 until Snow's death ten years later. They contain nothing directly relevant to his epidemiological work on cholera, but they do record his day-to-day activities as an anaesthetist and, to a lesser extent, as a general practitioner. This complete transcription of their contents gives an insight into Snow's general medical practice, and offers a wealth of largely unused material concerning his pioneering work as a practical anaesthetist during the specialty's earliest years. Anaesthesia began in the United States and was first used by the dentist William Thomas Greene Morton ( 1819-1868) who, on 30 September 1846, administered sulphuric ether for dental extraction in his own practice.3 Two weeks later he gave the first public demonstration of ether for surgery. It was this public demonstration which established anaesthesia for the world. It took place in Boston at the Massachusetts General Hospital on 16 October 1846.4 At first, to gain financial advantage for himself, Morton attempted to conceal the true nature of the ether. Despite the initial enthusiasm generated by his use of anaesthesia, the secrecy with which he surrounded his invention was repugnant to most people. He was vilified for attempting to restrict the use of his humanitarian discovery and to benefit financially from such restriction.5 Morton's reputation was not the only casualty of this unfortunate approach, for his gauche subterfuge was one of the principal factors which led to a more or less muted reaction to the introduction of ether in the USA, the very country