How did the son of a laborer from York end up as a physician in London among the most prominent members of British society, and be asked to administer chloroform on two occasions to Queen Victoria? The answer appears here.

REMARKABLE JOURNEY

Following his working-class start in life, John Snow toiled long and hard to become a physician. Early during his illustrious career he developed a lasting interest in anesthetic agents. Shortly after anesthetic ether was introduced in Great Britain, Snow in 1847 published a short article entitled, On the Inhalation of the Vapor of Ether. He was then 34 years old and only three years beyond his M.D. degree. Thereafter and for many years to come, he produced a series of papers on his clinical experience with anesthesia.

Besides ether as an anesthetic agent, he also focused on chloroform. It was not until shortly after his death in 1858, however, that Snow's major work appeared: On Chloroform and Other Anesthetics, and Their Action and Administration.

BIRTH AND ANESTHESIA

During his career, Snow anesthetized 77 obstetric patients with chloroform. Typically he would delayed initiating the anesthetic until patients approached the second stage of labor. He limited the dose so that his patients would achieve satisfactory analgesia, but not be rendering completely unconscious. Many pushed on command during the delivery. Snow felt that light levels of anesthesia had little effect on labor and had even observed instances in which labor appeared to accelerate after he began anesthetic induction. While Snow believed it possible for the obstetrician to administer the anesthetic, he suggested that it would be safer if anesthesiology was delegated to some other person.

During the middle of his career, Snow began working with three of Queen Victoria's physicians, including Dr. Charles Locock. All had reservations about the use of anesthesia, as did most physicians of the day. Yet in 1848, all three conferred with John Snow, possibly at the urging of Prince Albert (see picture) who expressed interest in obtaining anesthesia for his wife, Queen Victoria.

In keeping with most families of her time, Victoria and Albert had many children, nine in all. Most of her children married into other royal families of Europe:

• Victoria, Princess Royal (born 1840, married Friedrich III, German Emperor);
• Edward VII (born 1841, married Alexandra, daughter of Christian IX of Denmark);
• Alice (born 1843, married Ludwig IV, Grand Duke of Hesse and by Rhine);
• Alfred, Duke of Edinburgh and of Saxe-Coburg and Gotha (born 1844, married Marie of Russia);
• Helena (born 1846, married Christian of Schleswig-Holstein);
• Louise (born 1848, married John Campbell, 9th Duke of Argyll);
• Arthur, Duke of Connaught (born 1850, married Louise Margaret of Prussia);
• Leopold, Duke of Albany (born 1853, married Helen of Waldeck-Pyrmont); and
• Beatrice (born 1857, married Henry of Battenberg).

While the Queen and Prince Albert first showed interest in chloroform in 1848, no anesthetic was administered for her seventh delivery in 1850 of Arthur, the future Duke of Connaught. Such reservations disappeared in 1853 by the time her eighth delivery occurred (Prince Leopold). Dr. John Snow gave her chloroform, but used an open-drop method (see picture to the right) rather than the inhaler he had earlier invented (see picture to the left).

The social elite in London soon followed the Queen's lead, adding further credibility to the use of anesthesia. Four years later, the Queen had Princess Beatrice, her ninth and final child, also with Dr. John Snow providing chloroform. He again used the open-drop approach, likely at her or Dr. Locock's request. Snow's friend and biographer, Sir Benjamin Richardson, wrote more on the impact of Snow's experience with Queen Victoria in the third section of his biographical memory.

JOHN SNOW'S CASE RECORDS

The case records of the Queen Victoria's eighth and ninth births are presented below.

BIRTH OF PRINCE LEOPOLD

April 7, 1853

Dr. Snow was 40 years old.He had recently moved in London to the affluent Sackville Street, off Piccadilly, but still near the Broad Street Pump, the site one year later of his lasting epidemiological fame. He administered chloroform to the Queen on this day to assist with the birth of her son.

CRITICAL REACTION OF THE LANCET

May 14, 1853

The influential medical journal, The Lancet, criticized Dr. Snow (but not by name) and Queen Victoria's physicians for using chloroform during the birth of Prince Leopold.

BIRTH OF PRINCESS BEATRICE

April 14, 1857

Dr. Snow was 44 years old. He administered chloroform to the Queen on this day to assist with the birth of her daughter. Fourteen months later Dr. Snow died at the youthful age of 45 years.

Sources:

Caton, D. Anesthesiology 92m 247-52, 2000.

Ellis, RH. Medical History (Supp 14), 1994.

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